{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:38:00Z","timestamp":1773005880605,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":46,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Endocrinology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Carcinoid syndrome from pulmonary carcinoids without hepatic metastases is rare and diagnostically challenging when biochemical markers are normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A woman in her mid\u201060\u2009s presented with an incidental right adrenal mass during evaluation for dyspnea and elevated D\u2010dimer. She reported a 20\u2010year history of paroxysmal tachycardia and 5 years of episodic flushing, profuse sweating, exertional dyspnea, and fine tremors triggered by minimal physical activity. Imaging revealed a 3.6\u2009cm lipid\u2010rich adrenal adenoma and an 8\u2009\u00d7\u200910\u2009mm left upper lobe pulmonary nodule. Comprehensive biochemical evaluation was normal: 24\u2009h urinary 5\u2010hydroxyindoleacetic acid 6\u2009mg\/d (normal 0\u201315), chromogranin A 50\u2009ng\/mL (normal 0\u2013187), plasma metanephrine 0.12\u2009nmol\/L (normal 0.00\u20130.49), and normetanephrine 0.68\u2009nmol\/L (normal 0.00\u20130.89), excluding pheochromocytoma. Fine needle aspiration of the left pulmonary nodule confirmed a typical carcinoid tumor. Left upper lobe trisegmentectomy revealed low\u2010grade neuroendocrine neoplasm (pT1b pN0) with minimal mitotic activity (&lt;1 per 10\u2009HPF) and no necrosis. Postoperative 68Ga\u2010DOTATATE PET\/CT demonstrated a radiotracer\u2010avid suspicious right lower lobe nodule (SUVmax 2.8) without hepatic metastases. Surgery markedly improved carcinoid syndrome symptoms, with residual episodes responding to long\u2010acting octreotide 20\u201330\u2009mg every 4 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case illustrates that pulmonary carcinoid tumors can present with carcinoid syndrome despite normal biochemical markers and the absence of hepatic metastases. The temporal improvement following resection and response to octreotide established the diagnosis when biochemical testing was uninformative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinicians should maintain high suspicion for pulmonary carcinoids in patients with unexplained paroxysmal symptoms, even with negative biochemical testing and absent metastatic disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crie\/2260680","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:41:29Z","timestamp":1771231289000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonmetastatic Pulmonary Carcinoid Presenting With Carcinoid Syndrome Despite Negative 5\u2010HIAA: A Case 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