Factors Associated with Progression of Carcinoid Heart Disease

Møller, Jacob Eifer; Connolly, Heidi M.; Rubin, Joseph; Seward, James B.; Modesto, Karen; Pellikka, Patricia A.

doi:10.1056/nejmoa021451

Cited by 270 publications

(247 citation statements)

References 26 publications

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“…Moreover, Colao et al documented that moderate tricuspid regurgitation was significantly more prevalent in treated subjects than in de novo patients and in patients receiving a cumulative dose of cabergoline above the mean (72%) than in those receiving a lower dose (36%, PZ0.036) (15). These observations are in agreement with potential effects of cabergoline on the valvular serotonin receptor, like in the manifestations of the classical right-sided carcinoid heart syndrome (16,17). Four other studies, published in abstract form only, did not find clinically relevant valve disease, in line with the above-mentioned six publications (18)(19)(20)(21).…”

Section: Introductionsupporting

confidence: 86%

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Kars

Pereira²,

Bax³

et al. 2008

European Journal of Endocrinology

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The increased risk of cardiac valve disease in patients treated for Parkinson's disease with cabergoline has raised concerns about the safety of treatment with ergot-derived dopamine agonists in patients with endocrine diseases, especially prolactinoma. Six cross-sectional studies have been published recently, of which five studies do not show an association between the treatment of prolactinoma with cabergoline during 45-79 months and clinically relevant valvular regurgitation in a total of 413 patients. Nonetheless, concern is raised because the use of cabergoline was associated in one study with an increased prevalence of moderate tricuspid regurgitation, and in two other studies with mild tricuspid regurgitation. Furthermore, the use of cabergoline was associated with increased frequencies of valvular thickening, calcifications and increased mitral tenting area. At present, the clinical relevance of these findings is still uncertain, but concern is raised with respect to the safety of the use of cabergoline in the long-term treatment of prolactinomas. Echocardiographic evaluation should be considered in patients, who require long-term treatment with cabergoline, especially in high doses. There is a need for larger, preferably prospective, studies with careful echocardiographic assessment and with longer durations of follow-up than the currently available studies.

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Section: Introductionsupporting

confidence: 86%

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Kars

Pereira²,

Bax³

et al. 2008

European Journal of Endocrinology

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“…14 While it is still debated as to whether serotonin, or another co-secreted hormone or by-product, is causative in the pathogenesis of fibrosis, evidence is mounting in favour of serotonin itself as the causative agent. [14][15][16][17][18] The vast majority of serotonin (90%) originates from the gastrointestinal tract, predominantly from the intestinal enterochromaffin cells (95%), while only 10% is produced in the brain. 17 Indirect evidence of the role of serotonin in the pathogenesis of valvular damage is that patients with cardiac involvement tend to have higher levels of urinary 5-HIAA than those without cardiac involvement.…”

Section: Pathogenesismentioning

confidence: 99%

“…3,26,27 The presence of cardiac involvement indicates a particularly poor prognosis, with survival rates diminishing to approximately 30% at five years. 10,16 Symptoms of cardiac failure, particularly right heart failure, eventually develop in up to 50% of patients with carcinoid syndrome, whereas heart failure is present in up to 20% of patients at the time carcinoid syndrome is diagnosed.…”

Section: Natural Historymentioning

confidence: 99%

Carcinoid heart disease: two clinical cases and a review

Weinreich

Ross

Kotze

et al. 2011

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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We present two cases of metastatic carcinoid tumours, complicated by carcinoid syndrome and by cardiac valve involvement, a well-known, but infrequent, complication. Carcinoid tumours are generally more indolent than other cancers and may have a long asymptomatic phase. The symptoms of carcinoid syndrome generally manifest only once metastases to the liver have occurred. Cardiac involvement occurs in up to 50% of patients, and heralds a poor prognosis. However, a multidisciplinary team approach has improved the prognosis and quality of life for patients with carcinoid heart disease. Therapy includes somatostatin analogues and treatment for heart failure, removal of primary or metastatic tumour deposits, valve replacement in the presence of valvular involvement, and radioisotopes therapy.

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“…. Resection of mesenterial fibrosis and heart valve replacement in patients with carcinoid syndrome and carcinoid heart disease (Ahlman 1996, Westberg et al 2001, Quaedvlieg et al 2002, Moller et al 2003.…”

Section: Correction Of Tumour-related Deficiencies or Disordersmentioning

confidence: 99%

“…In close collaboration with cardiologists and thoracic surgeons, protocols have been developed that include extensive cardiologic monitoring of patients with the carcinoid syndrome, in whom surgical and/or medical therapy has reduced the effects of hormonal hypersecretion. This will eventually lead to a careful selection of patients and correct timing of valve replacement before end-stage heart failure develops (Connolly et al 1995, Westberg et al 2001, Quaedvlieg et al 2002, Moller et al 2003.…”

Section: Correction Of Tumour-related Deficiencies or Disordersmentioning

confidence: 99%

Considerations concerning a tailored, individualized therapeutic management of patients with (neuro)endocrine tumours of the gastrointestinal tract and pancreas.

Herder

Krenning²,

Eijck³

et al. 2004

Endocr Relat Cancer

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Endocrine tumours of the gastrointestinal tract and pancreas may present at different disease stages with either hormonal or hormone-related symptoms/syndromes, or without hormonal symptoms. They may occur either sporadically or as part of hereditary syndromes. In the therapeutic approach to a patient with these tumours, excessive hormonal secretion and/or its effects should always be controlled first. Tumour-related deficiencies or disorders should also be corrected. Subsequently, control should be aimed at the tumour growth. Surgery is generally considered as first-line therapy for patients with localized disease, as it can be curative. However, in patients with metastatic disease the role of first-line surgery is not clearly established and other therapies should be considered, such as non-surgical cytoreductive therapies, biotherapy (with somatostatin analogues or interferon-a), embolization and chemoembolization of liver metastases, chemotherapy (with single or multiple dose regimens) and peptide receptor-targeted radiotherapy. The delicate balance of the use of the different therapeutical options in patients with endocrine tumours of the gastrointestinal tract and pancreas emphasizes the importance of team approach and team expertise.

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Factors Associated with Progression of Carcinoid Heart Disease

Abstract: Serotonin is related to the progression of carcinoid heart disease, and the risk of progressive heart disease is higher in patients who receive chemotherapy than in those who do not.

Cited by 270 publications

References 26 publications

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Carcinoid heart disease: two clinical cases and a review

Considerations concerning a tailored, individualized therapeutic management of patients with (neuro)endocrine tumours of the gastrointestinal tract and pancreas.

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