To the Editor.
—We read with interest the case report by Kessler1 in the August 1983 Archives of a patient with carcinoid heart disease.Kessler stated that "hindgut carcinoids, comprising the descending colon and rectum, frequently metastasized but demonstrated no evidence of endocrine activity."1(p1615)Exceptions exist on that rule. In rectal carcinoid tumors intracytoplasmatic secretory granules have been described.2 In rare patients with rectal carcinoid tumor, elevated levels of 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) have been found3; however, only two patients with a rectal carcinoid and a carcinoid syndrome have been described until now. Neither of them was seen with carcinoid heart disease.4,5
Report of a Case.
—We observed, in 1966, a 28-year-old patient with a rectal carcinoid associated with carcinoid syndrome and pulmonic stenosis. Flushing, abdominal cramps, diarrhea and tenesmus had begun two years earlier. When the patient was hospitalized, late in the evolution