Use of perioperative telotristat in a patient with carcinoid heart disease.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Maria Flynn, Christopher Noss, Robert Miller, Corey Adams, Dean Ruether, Denise Chan, Janice Pasieka, Kirstie Lithgow
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引用次数: 0

Abstract

Summary: Carcinoid heart disease is a rare complication of carcinoid syndrome, resulting in right-sided valvular heart disease and subsequent heart failure due to long-term exposure to vasoactive substances. The management of this condition is complex, often requiring surgical intervention. Current perioperative regimens entail the use of prophylactic somatostatin analogs to prevent carcinoid crisis; however, regimens vary widely among practitioners and evidence supporting their efficacy in this clinical setting is mixed. This case report describes the perioperative management of a 65-year-old man with carcinoid heart disease requiring tricuspid and pulmonary valve replacement surgery. As an adjunct to somatostatin analog therapy, the novel tyrosine hydroxylase inhibitor, telotristat, was initiated preoperatively. This combination resulted in normalization of preoperative urinary 5-HIAA levels. The patient successfully underwent tricuspid and pulmonic valve replacement without evidence of carcinoid crisis. This clinical case is the first published documenting the use of telotristat in the perioperative period in a patient with carcinoid syndrome and carcinoid heart disease and was associated with a good long-term outcome despite the high-risk nature of the case.

Learning points: Carcinoid crisis is a life-threatening complication of carcinoid syndrome, resulting in hemodynamic instability, bronchospasm, and arrhythmia. Cardiac surgical patients with carcinoid syndrome present a unique challenge as they are subject to physiologic conditions and medications which can potentiate intraoperative carcinoid crisis. Perioperative management of patients with carcinoid syndrome currently entails the use of prophylactic somatostatin analogs; however, these agents do not prevent carcinoid crisis in all cases. Telotristat, a tryptophan hydroxylase inhibitor, shows promise as an adjunctive therapy to somatostatin analogs to reduce the risk of intraoperative carcinoid crisis.

在一名类癌性心脏病患者围手术期使用特罗替司他。
摘要:类癌性心脏病是类癌综合征的一种罕见并发症,由于长期暴露于血管活性物质,会导致右侧瓣膜性心脏病和随后的心力衰竭。这种疾病的治疗非常复杂,通常需要手术干预。目前的围手术期治疗方案需要使用预防性的体生长抑素类似物来预防类癌危象;然而,不同医生的治疗方案差异很大,支持其在这种临床环境中疗效的证据也不尽相同。本病例报告描述了一名 65 岁男性类癌性心脏病患者的围手术期管理,该患者需要进行三尖瓣和肺动脉瓣置换手术。术前开始使用新型酪氨酸羟化酶抑制剂 telotristat 作为体生长抑素类似物治疗的辅助药物。联合用药后,术前尿液中的 5-HIAA 水平恢复正常。患者成功接受了三尖瓣和肺动脉瓣置换术,且未出现类癌危象。该临床病例是首次发表的在类癌综合征和类癌性心脏病患者围手术期使用替罗曲司他的文献,尽管该病例具有高风险性,但长期疗效良好:类癌危象是类癌综合征的一种危及生命的并发症,可导致血液动力学不稳定、支气管痉挛和心律失常。患有类癌综合征的心脏外科患者面临着独特的挑战,因为他们所处的生理条件和服用的药物会加重术中类癌危象。目前,类癌综合征患者的围手术期管理需要使用预防性的体生长抑素类似物;但是,这些药物并不能在所有病例中预防类癌危象。色氨酸羟化酶抑制剂特洛替司他有望作为体生长激素类似物的辅助疗法,降低术中类癌危机的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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