How should I approach the management of a patient with carcinoid syndrome, particularly regarding symptom control?

Management of carcinoid syndrome focuses primarily on symptom control through pharmacological and supportive measures. The cornerstone of symptom control is the use of somatostatin analogues, such as octreotide or lanreotide, which inhibit the release of serotonin and other vasoactive substances responsible for flushing, diarrhoea, and bronchospasm ¹. These agents effectively reduce the frequency and severity of symptoms and are considered first-line therapy ¹.

In addition to somatostatin analogues, symptom control may require adjunctive treatments. For diarrhoea refractory to somatostatin analogues, antidiarrhoeal agents like loperamide can be used cautiously ¹. Nutritional management is also critical, as patients with carcinoid syndrome often experience malnutrition due to chronic diarrhoea and malabsorption; tailored nutritional support should be provided to maintain adequate caloric and micronutrient intake (Del Olmo-García et al., 2025).

For patients with severe or refractory symptoms, telotristat ethyl, a tryptophan hydroxylase inhibitor that reduces serotonin production, can be considered to further control diarrhoea and flushing ¹. Additionally, management of carcinoid heart disease, a common complication, requires regular cardiac monitoring and may necessitate cardiology referral ¹.

Overall, an integrated approach combining somatostatin analogues, symptom-targeted therapies, and nutritional support optimises symptom control in carcinoid syndrome. This approach aligns with UK clinical guidelines and is supported by recent literature emphasizing the importance of nutritional management in functioning gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) (Del Olmo-García et al., 2025).