Carcinoid Heart Disease

Robiolio, Paul A.; Rigolin, VH; Wilson, John S.; Harrison, J. Kevin; Sanders, Linda; Bashore, Thomas M.; Feldman, Jerome M.

doi:10.1161/01.cir.92.4.790

Cited by 309 publications

(88 citation statements)

References 23 publications

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“…In metastatic NET with production of hormones the development of CHD is reported in 20 -70% of the patients (Tornebrandt et al, 1986;Robiolio et al, 1995;Westberg et al, 2001;Zuetenhorst et al, 2003) and in many patients attributed to the cause of death (Ross and Roberts, 1985). In the present series of 32 patients, the incidence of CHD is 28%, which is rather low compared to the results reported in literature.…”

Section: Discussioncontrasting

confidence: 39%

“…Carcinoid heart disease (CHD) is a well-known complication of long-lasting exposure to high levels of serotonin (Tornebrandt et al, 1986;Lundin et al, 1988;Robiolio et al, 1995;Westberg et al, 2001;Zuetenhorst et al, 2003). Many carcinoid patients die from cardiac causes (Ross and Roberts, 1985) and the detection of CHD in an early stage is important to adjust therapy and hence improve prognosis.…”

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confidence: 99%

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Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

et al. 2004

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Carcinoid heart disease (CHD) occurs in 20 -70% of the patients with metastatic well-differentiated neuroendocrine tumours (NET). We evaluated whether natriuretic peptides (ANP or NT-proBNP) are useful in early detection of CHD. Blood samples from 32 patients with NET were compared with cardiac ultrasound follow-up. CHD was defined as thickening of the tricuspid valve in the presence of grade III -IV/IV tricuspid valve regurgitation. CHD was found in nine out of 32 patients (28%), all with symptoms of the carcinoid syndrome compared to 65% in the 23 patients without CHD (P ¼ 0.04). Median levels of NT-proBNP and 5-HIAA were significantly higher in patients with CHD (894 ng l À1 and 815 mmol 24 h À1 ) compared to those without (89 and 206 ng l À1 , Po0.001 and P ¼ 0.007). No significant differences were detected in ANP levels (P ¼ 0.11). Dilatation of the right atrium and ventricle as well as thickening of the tricuspid valve and degree of regurgitation were statistically significant correlated with NT-proBNP levels. The accuracy of NT-proBNP in the diagnosis of CHD was higher than that of ANP. A significantly better survival was observed in case of normal NT-proBNP values. In conclusion, NT-proBNP is helpful as a simple marker in the diagnosis of CHD. Survival is better in patients with normal levels of NT-proBNP.

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Section: Discussioncontrasting

confidence: 39%

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confidence: 99%

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

et al. 2004

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“…Carcinoid heart disease (CHD) is a late complication and occurs in 20%-70% of patients with metastatic carcinoid tumors [23,24]. In many patients, the cause of death is attributed directly to cardiac disease [25].…”

Section: Clinical Presentation and Complicationsmentioning

confidence: 99%

“…In several studies, urinary 5-HIAA excretion, which is indicative for the amount of serotonin production, was significantly higher in patients with CHD than in those without CHD [23,24,27]. Not only a high serotonin level, but also the duration of exposure to serotonin, is important in the development of CHD [27].…”

Section: Clinical Presentation and Complicationsmentioning

confidence: 99%

Metastatic Carcinoid Tumors: A Clinical Review

2005

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Carcinoid tumors are neuroendocrine tumors derived from enterochromaffin cells, which are widely distributed in the body. They can originate from any location in the body, but they are traditionally described as originating from the foregut, midgut, and hindgut. Although the overall incidence of carcinoid tumors appears to have increased in the past decades, the prognosis for patients with metastatic carcinoid tumors has improved during the last decade. Due to longer survival times, complications, such as carcinoid heart disease, and new metastatic patterns, like skin and bone metastases, may become more important features of carcinoid disease. Therapy focused on these complications should be part of the management. Combining new diagnostic and treatment modalities in metastatic carcinoid patients may result in better quality of life and longer survival times. The increasing number of therapeutic options and diagnostic procedures requires a multidisciplinary approach, with decisions made in multidisciplinary meetings focused on "tailor-made" therapy based on patients' specific conditions. Because carcinoid tumors are uncommon, effort should be made to treat these patients in specialized centers and for these centers to join together in multicenter studies. The Oncologist 2005;10:123-131The Oncologist 2005;10:123-131 www.TheOncologist.com

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“…Elevations in circulating 5HT have been linked to the incidence of heart valve damage 10 and valvular 5HT receptor mechanisms are also postulated to be relevant. 11 However, the impact of phentermine on fenfluramine-induced 5HT release is unclear.…”

Section: Introductionmentioning

confidence: 99%

Additive effects on rat brain 5HT release of combining phentermine with dexfenfluramine

et al. 2001

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OBJECTIVE AND DESIGN:This study examined the effects of the anti-obesity agents, phentermine and dexfenfluramine given alone or in combination, on in vitro and in vivo 5HT release from rat brain tissue. RESULTS: In vitro, phentermine was without effect on basal [ 3 H]5HT efflux from hypothalamic slices whereas dexfenfluramine (10 mM) evoked a 131% increase in [ 3 H]5HT release. In combination, the two drugs did not alter [ 3 H]5HT release beyond that caused by dexfenfluramine alone. At pharmacologically equivalent doses, phentermine (5.7 mg=kg, i.p.) caused a rapid, modest elevation, and dexfenfluramine (3 mg=kg, i.p.) a larger but equally rapid elevation of extracellular 5HT in the microdialysates from the rat anterior hypothalamus. In combination, the increase in extracellular 5HT evoked by these drugs was not significantly greater than the sum of their individual effects. CONCLUSIONS: This study provides evidence that phentermine's actions are not restricted to catecholamine systems and indicates that combining phentermine with dexfenfluramine results in an additive increase in neuronal 5HT release.

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Carcinoid Heart Disease

Abstract: These data suggest that serotonin plays a major role in the pathogenesis of the cardiac plaque formation observed in carcinoid patients.

Cited by 309 publications

References 23 publications

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

Metastatic Carcinoid Tumors: A Clinical Review

Additive effects on rat brain 5HT release of combining phentermine with dexfenfluramine

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