Carcinoid syndrome is a rare cause of pellagra. Carcinoid is a syndrome of excessive secretion of serotonin. Tryptophan is the precursor for serotonin as well as niacin, and in this syndrome all tryptophan is shunted to make serotonin at the expense of tryptophan. This results in decreased production of niacin and, potentially, the clinical symptoms of pellagra.
Treatment: Pellagra rapidly responds to supplementation with niacin. Niacin is given orally every 6 hours until the patient responds. If a patient does not respond, a coexisting vitamin deficiency should be sought. If possible, a nutritionist should be consulted to advise the patient on proper dietary intake. Alcoholics, who can be deficient in many B vitamins, are often treated with multiple B vitamins. Patients with carcinoid syndrome need to take supplemental niacin to avoid pellagra symptoms, but the goal of therapy is to treat the underlying tumor.
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