{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:59:05Z","timestamp":1785128345550,"version":"3.55.0"},"reference-count":10,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Carcinoid syndrome is an uncommon manifestation of metastatic neuroendocrine tumor (NET) and may present without classic flushing or bronchospasm. We describe a woman in her 50s with hypertension treated with hydrochlorothiazide who presented with confusion, severe hyponatremia with a serum sodium concentration of 114\u2005mmol\/L (reference range, 135-145\u2005mmol\/L), chronic watery diarrhea, bilateral leg edema, and 40-lb weight loss. Computed tomography (CT) revealed a calcified mesenteric mass and multiple hepatic lesions. Serum chromogranin A was 1434\u2005ng\/mL (SI: 1434\u2005\u00b5g\/L) (reference range, &amp;lt;100\u2005ng\/mL [SI: &amp;lt;100\u2005\u00b5g\/L]), and 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) was 108\u2005mg\/24\u2005hours (SI: 565\u2005\u00b5mol\/24\u2005hours) (reference range, &amp;lt;6\u2005mg\/24\u2005hours [SI: &amp;lt;31\u2005\u00b5mol\/24\u2005hours])\u2014well above the threshold associated with carcinoid heart disease (CHD). Transthoracic echocardiography demonstrated severe tricuspid regurgitation with retracted leaflets, consistent with CHD. Liver biopsy confirmed a well-differentiated grade 2 NET. Urine sodium &amp;lt;20\u2005mmol\/L and urine osmolality 188 mOsm\/kg indicated volume depletion from gastrointestinal losses, aggravated by hydrochlorothiazide. Hydrochlorothiazide was discontinued; isotonic saline, octreotide, and furosemide improved hyponatremia, diarrhea, and edema. Chronic diarrhea with isolated right-sided valvulopathy should prompt evaluation for carcinoid syndrome even when electrolyte derangement dominates.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag191","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:03:58Z","timestamp":1785125038000},"source":"Crossref","is-referenced-by-count":0,"title":["Carcinoid syndrome revealed by chronic diarrhea and isolated severe tricuspid regurgitation"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2192-6734","authenticated-orcid":false,"given":"Darpan","family":"Kothia","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6961-8517","authenticated-orcid":false,"given":"Otto","family":"Valdes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4883-6389","authenticated-orcid":false,"given":"Asaad","family":"Mouselli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Carmona","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ascension Sacred Heart Hospital, Florida State University College of Medicine , Pensacola, FL 32504 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"issue":"4","key":"2026072700035085100_luag191-B1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1002\/cncr.11105","article-title":"A 5-decade analysis of 13,715 carcinoid tumors","volume":"97","author":"Modlin","year":"2003","journal-title":"Cancer"},{"issue":"4","key":"2026072700035085100_luag191-B2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/S1470-2045(17)30110-9","article-title":"Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis","volume":"18","author":"Halperin","year":"2017","journal-title":"Lancet Oncol"},{"issue":"1","key":"2026072700035085100_luag191-B3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1159\/000507847","article-title":"Carcinoid heart disease: pathophysiology, pathology, clinical manifestations, and management","volume":"146","author":"Jin","year":"2021","journal-title":"Cardiology"},{"issue":"11","key":"2026072700035085100_luag191-B4","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1056\/NEJMoa021451","article-title":"Factors associated with progression of carcinoid heart disease","volume":"348","author":"M\u00f8ller","year":"2003","journal-title":"N Engl J 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Oncol"},{"issue":"2","key":"2026072700035085100_luag191-B9","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1056\/NEJMoa1607427","article-title":"Phase 3 trial of 177Lu-DOTATATE for midgut neuroendocrine tumors","volume":"376","author":"Strosberg","year":"2017","journal-title":"N Engl J Med"},{"issue":"7","key":"2026072700035085100_luag191-B10","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.annonc.2020.03.304","article-title":"Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Pavel","year":"2020","journal-title":"Ann Oncol"}],"container-title":["JCEM Case 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