INTRODUCTION A 56 year old woman was referred with persistent facial flushing symptoms.

1. DISCUSSION Carcinoidtumours are of neuroendocrine cell origin and are slowly progressive tumours that produce serotonin and tachykinins that can occur in the gastrointestinal tract, ovaries, testis and bronchi. A Case of Carcinoid Syndrome in a post-menopausal womanA Yulia¹, I W Seetho²1. Department of Obstetrics and Gynaecology, North Cumbria Hospitals NHS Trust, UK.2. Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK. • INVESTIGATIONS • Her 24-hour urine 5 Hydroxyindoleacetic acid (5-HIAA) level was significantly raised at 2196 mmol/L. • 24-hour urine catecholamines were normal. • A Computed Tomography abdomen and pelvis revealed evidence of a colonic tumour with liver metastases. • Her liver biopsy histology was consistent with a carcinoid tumour primary. • Her chest radiograph showed cardiomegaly and an echocardiogram revealed significant tricuspid incompetence and pulmonary stenosis with evidence of heart failure. Fig 3: Vasoactive substance release from lung, ovarian, bowel carcinoid and subsequent metabolism INTRODUCTION A 56 year old woman was referred with persistent facial flushing symptoms. Her symptoms had been attributed to post-menopausal symptoms for the past 5 years and she had been treated with hormone replacement therapy. On closer questioning, in addition to her facial flushing, she described symptoms of diarrhoea, abdominal pain, breathlessness, leg swelling and fainting symptoms. CARCINOID SYNDROME The carcinoid syndrome occurs when these vasoactive substances are released, with features of flushing, diarrhoea, bronchospasm and right heart valve disease. Typically carcinoid syndrome develops when hepatic metastases has occurred and consequently many cases of carcinoid tumours can present at a late stage. This woman had been troubled with long-standing flushing symptoms but was not investigated for a carcinoidtumour and she did not improve despite the treatment she had been receiving prior to the diagnosis. CONCLUSIONS A high index of suspicion is paramount when a patient presents with unexplained flushing symptoms, especially if other investigations have not provided an explanation as to the cause. Although often presenting late, carcinoid tumours can be resected and the prognosis is more favourable when diagnosed early. References: 1) Kaltsas GA, Michael Besser G, Grossman AB. The Diagnosis and Medical Management of Advanced NeuroendocrineTumors. Endocrine Reviews 2004; 25(3):458-511. 2) Ramage JK, Davies AHG, Ardill J, Bax N, et al, on behalf of the UKNetwork for neuroendocrine tumours. Guidelines for the management of gastroenteropancreaticneuroendocrine (including carcinoid) tumours. Gut 2005;54(Suppl IV): iv1-iv16. doi:10.1136/gut.2004.053314. Fig 1: Carcinoid histology Fig 2: Carcinoid Liver metastases CLINICAL MANAGEMENT A diagnosis of primary colonic carcinoid disease with liver metastases was made. Curative resection was not possible due to her extensive hepatic metastatic disease. She was treated with octreotide (somatostatin analogue) which improved her symptoms.