title: Increased chromogranin a and carcinoid syndrome-like symptoms in a patient treated with duloxetine.
abstract: OBJECTIVE
  We report the case of a 50-year-old female patient who presented with symptoms suggestive of a serotonin-secreting neuroendocrine neoplasm. In addition, her serum chromogranin A (CA) level was elevated by more than 8-fold.
  
  
  METHODS
  We present a case report with review of the relevant literature.
  
  
  RESULTS
  No abnormalities could be detected in a complete conventional and functional morphological diagnostic work-up including a gallium-68-DOTA-d-Phe1-Tyr3-octreotide (Ga-68-DOTATOC) positron emission tomography-computed tomography (PET-CT) scan. These negative results prompted us to consider possible drug-related effects as the cause for these findings. The patient had started to take duloxetine, a second-generation antidepressant (SGA) and selective serotonin-norepinephrine reuptake inhibitor (SNRI), at a dose of 60 mg/day 2 months prior to her first visit at our department for pain relief. After withdrawal of duloxetine, her symptoms promptly ceased, and her CA levels fell to normal values within 7 weeks.
  
  
  CONCLUSIONS
  We conclude that selective serotonin-norepinephrine reuptake inhibitors (SNRIs) can cause symptoms suggestive of serotonin-secreting neuroendocrine neoplasms, as well as elevated CA levels leading to unnecessary and expensive diagnostic workups. To our knowledge, the association between SNRI treatment and increased CA levels has not been described in the literature and needs to be further evaluated in well-controlled prospective studies.
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig.
authors.forename: Stefan
authors.initials: S
authors.lastname: Karger
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wiesner
authors.affiliation: Clinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig.
authors.forename: Anette
authors.initials: A
authors.lastname: Kersting
authors.affiliation: Clinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig.
authors.forename: Miriam
authors.initials: M
authors.lastname: Braun
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig IFB Adiposity Diseases, University of Leipzig.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ebert
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig IFB Adiposity Diseases, University of Leipzig.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wurst
authors.affiliation: Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig.
authors.forename: Juergen
authors.initials: J
authors.lastname: Kratzsch
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig.
authors.forename: Michael
authors.initials: M
authors.lastname: Stumvoll
authors.affiliation: Department of Endocrinology and Nephrology, University of Leipzig IFB Adiposity Diseases, University of Leipzig.
authors.forename: Mathias
authors.initials: M
authors.lastname: Fasshauer
mesh_terms: D053379:Chromogranin A / Q000097:blood*; D000068736:Duloxetine Hydrochloride; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D008875:Middle Aged; D015282:Octreotide; D000072078:Positron Emission Tomography Computed Tomography; D011446:Prospective Studies
chemical_list: D053379:Chromogranin A; D005710:Gallium Radioisotopes; D000068736:Duloxetine Hydrochloride; C000615430:Gallium-68; D015282:Octreotide