Carcinoid syndrome — SCE Endocrinology MCQ

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HardNET/MENCarcinoid syndromeSCE Endocrinology

A patient with metastatic ileal neuroendocrine tumour and carcinoid syndrome has rising 5-HIAA, exertional dyspnoea and a new systolic murmur. What complication should be assessed urgently?

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Correct answer: C — NT-proBNP and echocardiography for carcinoid heart disease

The best answer is “NT-proBNP and echocardiography for carcinoid heart disease”. Sustained serotonin exposure can cause plaque-like right-sided valvular fibrosis; symptoms, murmur and biochemical activity should prompt biomarker and echocardiographic assessment. “Calcific aortic stenosis inferred without imaging” is less appropriate because a common valve lesion remains possible but the syndrome-specific high-risk complication must be actively sought “Acute coronary syndrome caused directly by 5-HIAA” is less appropriate because 5-HIAA does not by itself establish coronary plaque rupture “High-output failure from occult thyrotoxicosis as the presumed mechanism” is less appropriate because thyroid disease does not unify the known serotonin-secreting tumour and new valve signs “Amyloid cardiomyopathy as the defining serotonin complication” is less appropriate because amyloid can affect the heart but is not the characteristic 5-HIAA-mediated lesion

Reference: ENETS guidance paper for carcinoid syndrome. https://pmc.ncbi.nlm.nih.gov/articles/PMC9539661/