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Progrediente Dyspnoe bei Karzinoidsyndrom

Progressive dyspnoea in two patients with carcinoid syndrome

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Zusammenfassung

Beim Karzinoidsyndrom ist auch an eine Herzbeteiligung zu denken. Wir berichten über 2 Patientinnen mit progredienter Dyspnoe bei hepatisch und ossär metastasierten neuroendokrinen Karzinomen des Ileums. Als Ursache fand sich ein Rechts-Links-Shunt auf Vorhofebene, in Fall 1 über ein persistierendes Foramen ovale, in Fall 2 über einen Vorhofseptumdefekt vom Sekundumtyp. In beiden Fällen konnte die Dyspnoesymptomatik durch einen interventionellen Verschluss des Vorhofseptumdefekts gelindert werden. Ermöglicht wurde der Rechts-Links-Shunt in beiden Fällen durch die häufig mit einem Karzinoidsyndrom assoziierte Rechtsherzendokardfibrose mit der Konsequenz einer Trikuspidalinsuffizienz, welche zu einer Druckerhöhung im rechten Vorhof geführt hatte.

Abstract

In patients with carcinoid syndrome, there has always to be considered cardiac impairment. We report about two patients with hepatic and bone metastases of a neuroendocrine tumor of the midgut, who suffered from progressive dyspnea. This was caused in both cases by a right-to-left atrial shunt, in case 1 based on a patent foramen ovale (PFO), in case 2 based on a secundum atrial septal defect. Symptoms were significantly reduced by percutaneous closure of PFO and ASD, respectively. Right-to-left atrial shunt was facilitated by right-sided carcinoid induced endocardial fibrosis with the consequence of severe tricuspid regurgitation, leading to an increase of right atrial pressure.

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Authors and Affiliations

  1. Medizinische Klinik II, Campus Großhadern, Klinikum der Ludwig-Maximilians-Universität München, Interdisziplinäres Zentrum für Neuroendokrine Tumoren des GastroEnteroPankratischen Systems (GEPNET-KUM), Marchioninistraße 15, 81377, München, Deutschland

    S. Nölting, M. Nicolaus, M. Lehrke, B. Göke, J. Schirra &  C.J. Auernhammer

  2. Medizinische Klinik I, Campus Großhadern, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    J. Behr, R. Baumgartner, H. Methe & P. Boekstegers

  3. Institut für Klinische Radiologie, Campus Großhadern, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    K. Herrmann & D. Theisen

Authors
  1. S. Nölting
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  2. M. Nicolaus
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  3. J. Behr
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  4. R. Baumgartner
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  5. H. Methe
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  6. P. Boekstegers
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  7. K. Herrmann
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  8. D. Theisen
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  9. M. Lehrke
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  10. B. Göke
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  11. J. Schirra
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  12. C.J. Auernhammer
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Corresponding author

Correspondence to C.J. Auernhammer.

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Nölting, S., Nicolaus, M., Behr, J. et al. Progrediente Dyspnoe bei Karzinoidsyndrom. Internist 51, 1439–1445 (2010). https://doi.org/10.1007/s00108-010-2649-7

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  • DOI: https://doi.org/10.1007/s00108-010-2649-7

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