Endocrine Abstracts

Carcinoid heart disease (CaHD) is a progressively debilitating condition in patients with carcinoid syndrome resulting from chronic exposure to tumour-secreted circulating amines, especially serotonin (with associated valvular plaque deposition and fibrosis), leading to valvular dysfunction and right-sided heart failure. The last decade has witnessed an increase in the incidence of this complex clinical condition, likely due to advancements in imaging techniques and the development of more reliable biomarkers. The natural history of this disease entity remains to be fully elucidated; however, based on results from various clinical trials, different therapeutic options, such as valvular replacement, somatostatin analogues, telotristat, and other molecular-targeted therapies, have emerged. It remains a significant cause of morbidity and mortality in individuals with Carcinoid syndrome. This systematic review examined the evolution and natural history of CaHD, investigated current diagnostic and treatment modalities with a particular focus on morbidity and mortality, and critically appraised the available evidence to recommend further future powered studies. A qualitative review was conducted using Google Scholar and MEDLINE, and the accruing results were illustrated in a narrative format using tables and figures. The diagnosis and management of CaHD remained complex due to systemic malignant disease and cardiac involvement in affected individuals. The last decade, however, has witnessed a remarkable improvement in the overall survival of these patients, largely due to advancements in therapeutics. Nevertheless, the criteria for defining these treatment modalities, particularly with regard to timing, sequence, and priority of use, remain much debated. Early diagnosis and timely surgical intervention are of utmost importance, and the importance of a multidisciplinary approach in the care of these patients cannot be overemphasised. This study critically explores issues surrounding existing controversies in the diagnosis and treatment of CaHD and recommends potential areas for research to improve the overall survival of patients in the near future.