SHM Converge Scientific Abstract ePoster Gallery-I Gut a Feeling That Tonight's Gonna Be a Runny Night by Carcinoid's Dire Rear

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This case describes a 55-year-old woman with metastatic renal cell carcinoma and generalized anxiety disorder who developed severe chronic diarrhea, with more than 10 large-volume watery stools daily, abdominal cramping, dehydration, and profound electrolyte abnormalities. Her symptoms persisted despite loperamide, steroids, and multiple antibiotic courses for presumed C. difficile infection.<br /><br />Over several hospitalizations, an extensive workup for chronic diarrhea was unrevealing, including autoimmune, celiac, infectious, stool, and imaging studies. Endoscopic biopsies showed only mild chronic gastritis and mild duodenal villous changes, without a clear cause. Her diarrhea remained refractory, leading to recurrent admissions and significant morbidity.<br /><br />Given ongoing unexplained secretory diarrhea, carcinoid syndrome was eventually considered. Supporting laboratory findings included elevated 24-hour urine 5-hydroxyindoleacetic acid, chromogranin A, and gastrin levels, suggesting a neuroendocrine tumor source. She was discharged with plans for octreotide scintigraphy, though she was later lost to follow-up.<br /><br />The case emphasizes that chronic diarrhea has a broad differential and can be diagnostically challenging, even in patients with known malignancy. Carcinoid syndrome should remain in the differential for persistent, unexplained diarrhea, especially when routine testing is negative. Early recognition is important because it may reduce symptoms, prevent repeated hospitalizations, and lower healthcare costs associated with prolonged diagnostic evaluations.

Asset Subtitle

Arman Bahmani

Meta Tag

Author List Arman Bahmani, Brian E. Yang, Lisa N. Le, Sarah N. Matthews

Category Clinical Vignettes

Concept Carcinoid Syndrome

Concept Chronic Diarrhea

Concept Neuroendocrine Tumor

Concept 24-hour Urine 5-HIAA

Concept Chromogranin A

Distinguished Non-Finalist

Presenter Organization Loma Linda University Medical Center - Murrieta

Presenting Author Arman Bahmani

Track Adult

Keywords

metastatic renal cell carcinoma

chronic diarrhea

carcinoid syndrome

secretory diarrhea

octreotide

5-HIAA

chromogranin A

neuroendocrine tumor

electrolyte abnormalities

gastrointestinal workup

Carcinoid Syndrome

Chronic Diarrhea

Neuroendocrine Tumor

24-hour Urine 5-HIAA

Chromogranin A