A 50-year-old woman presents to the clinic with a 6-month history of episodic flushing, diarrhea, and unintentional weight loss. She also reports a sensation of "pounding" in her chest and neck, especially during these episodes. Her medical history includes well-controlled hypertension and type 2 diabetes. She takes lisinopril and metformin. Her temperature is 37.5°C (99.5°F), blood pressure is 130/80 mm Hg, pulse is 100/min, and respirations are 18/min. On physical examination, cardiac auscultation reveals a systolic murmur best heard at the lower left sternal border that increases with inspiration.
Laboratory results show the following:
Which of the following is the most appropriate initial treatment for this patient’s condition?
The correct answer is:
C) Octreotide
The patient's presentation of episodic flushing, diarrhea, weight loss, and elevated 24-hour urinary 5-HIAA is consistent with carcinoid syndrome. Octreotide, a somatostatin analog, is the treatment of choice for symptomatic relief and control of carcinoid syndrome by inhibiting the release of serotonin and other vasoactive substances from the tumor.
Answer choice A: Azathioprine, is incorrect. Azathioprine is an immunosuppressant used for inflammatory bowel disease and other inflammatory conditions, not for carcinoid syndrome.
Answer choice B: Infliximab, is incorrect. Infliximab is a tumor necrosis factor (TNF) inhibitor used for inflammatory conditions like Crohn disease and rheumatoid arthritis, not for carcinoid syndrome.
Answer choice D: Prednisone, is incorrect. Prednisone is a corticosteroid used for various inflammatory and autoimmune conditions but is not a recommended treatment for carcinoid syndrome.
Answer choice E: Surgical resection, is incorrect. Surgical resection may be indicated for localized carcinoid tumors, but octreotide is the initial treatment for symptomatic control in metastatic or unresectable disease.
Key Learning Point
In patients with carcinoid syndrome, characterized by episodic flushing, diarrhea, weight loss, and elevated 24-hour urinary 5-HIAA, the most appropriate initial treatment is octreotide, a somatostatin analog that controls symptoms by inhibiting the release of serotonin and other vasoactive substances.
