SUN-011 "From GI Origin to Multisystem Metastasis: A Case of Advanced Carcinoid Syndrome"

Abstract Disclosure: B. Agrawal: None. A. abed: None. H. patel: None. S. Prabhakaran: None. S. Narra: None. Introduction: Carcinoids are rare neuroendocrine tumors, typically slow-growing malignancies that arise from various organs, most commonly the gastrointestinal (GI) tract. While often indolent, metastatic carcinoids are associated with a poor prognosis and pose significant diagnostic and therapeutic challenges. Case Presentation: A 63-year-old female with cirrhosis, ESRD on dialysis, HFrEF (40%), CAD with prior PCI, type 2 diabetes with gastroparesis and blindness, and advanced malignancy presented with nausea, vomiting, and diarrhea. Diagnosed with a lung mass in 2023, her malignancy progressed in 2024 to hepatic metastases, gallbladder thickening with a vascularized mass, a duodenal lesion, peritoneal carcinomatosis, and osseous metastases. Biopsy confirmed spindle-cell morphology and low Ki-67 (8.1%), consistent with a bronchial carcinoid. Despite initial treatment with lanreotide and everolimus, adherence was poor due to fear of side effects. On admission, she was hyperkalemic with EKG changes, managed with dialysis, which caused hypotension requiring pressors. She developed sepsis-like symptoms, was treated with antibiotics, and experienced cardiac arrest requiring 1 minute of CPR. Troponin elevation (>3000) suggested ischemia, and imaging revealed osseous metastases with mild orbital mass effect. Echocardiogram showed severe pulmonary hypertension, valvular dysfunction, and reduced RV function. Management included a heparin drip for splenic infarct (later switched to Eliquis), oseltamivir for influenza, and supportive care. Despite interventions, her condition deteriorated, and the family opted for comfort care. She was palliatively extubated. Discussion: The GI tract, particularly the right colon and appendix, is the most common origin of carcinoids. At diagnosis, metastatic disease is present in 47% of cases, significantly worsening prognosis. Elevated levels of chromogranin A (CgA) and 5-HIAA are typically observed, especially in metastatic cases. Diagnostic advances, including MRI and somatostatin receptor imaging (e.g., OCTREOSCAN), have improved staging and monitoring. Somatostatin analogs benefit patients with metastases and positive scans by stabilizing tumor growth and alleviating symptoms. Surgical excision is preferred for localized disease, while pancreatic and proximal colon carcinoids carry poorer outcomes. Conclusion: Carcinoid tumors are rare, slow-growing malignancies with less aggressive biology than noncarcinoid tumors. Treatment aims to cure localized disease or palliate symptoms in advanced cases, with early palliative care integration essential for improving quality of life. Presentation: Sunday, July 13, 2025