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Carcinoid Syndrome — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineCarcinoid SyndromeRACP Adult Medicine

A 50-year-old man presents with recurrent episodes of facial flushing, diarrhoea, and wheezing. His urinary 5-HIAA is markedly elevated. CT shows a 3 cm mass in the terminal ileum with liver metastases. What is the most important investigation to assess cardiac involvement?

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Correct answer: B — Transthoracic echocardiography

Carcinoid heart disease (Hedinger syndrome) occurs in up to 50% of patients with carcinoid syndrome and liver metastases. Serotonin causes fibrotic thickening of right-sided heart valves (tricuspid regurgitation and pulmonary stenosis). All patients with carcinoid syndrome should undergo echocardiography to screen for this complication, which significantly impacts prognosis and management.

Reference: eTG – 2025 – Gastroenterology; ENETS – 2022 – NET Guidelines