Endocrine Abstracts

Carcinoid heart disease and ureteric obstruction secondary to retroperitoneal fibrosis are rare but serious complications of neuroendocrine tumours (NETs). We report the case of a 52-year-old woman with a four-year history of diarrhoea of unknown cause, malignant hypertension, dizziness, and intermittent flushing, which were initially misattributed to menopausal symptoms. She presented to hospital with lethargy, worsening abdominal pain and an acute kidney injury from ureteric obstruction. On examination a pansystolic murmur was auscultated, and transthoracic echocardiography revealed right heart dilation, severe torrential tricuspid regurgitation, moderate-to-severe pulmonary regurgitation, moderate mitral regurgitation, probable pulmonary hypertension and bilateral atrial dilation. The left ventricular systolic function was moderately impaired (45-50%). A ventilation-perfusion scan ruled out any pulmonary embolism to explain the severe tricuspid regurgitation. Contrast-enhanced CT identified a primary carcinoid tumour in the ileocecal region with multiple hepatic metastases, a distal paraesophageal lesion, and retroperitoneal fibrosis resulting in medially deviated ureters and moderate bilateral hydronephrosis. Elevated biochemical markers, including Chromogranin A, B, and 24-hour urinary 5-HIAA, supported the diagnosis. Octreotide scintigraphy showed uptake in the ileal mass but no significant uptake in the liver, lymph nodes, or heart. These findings confirmed Stage IV small bowel NET with multi-organ involvement. Despite initial bilateral double J stenting, nephrostomies were later required due to stent failure. Symptomatic management included Lanreotide therapy, with Octreotide infusions administered prior and during procedures to prevent carcinoid crisis. Ongoing follow-up with Cardiology will determine the need for valvular replacement and if Lanreotide has improved valvular functions. This case underscores the necessity of a multidisciplinary team approach in managing complex NET presentations.