A 34-year-old man comes to the physician because of palpitations, shortness of breath, diarrhea, and abdominal cramps for 2 months. Physical examination shows cutaneous flushing of the face. Auscultation of the chest shows bilateral wheezing. A 24-hour urine collection shows increased 5-hydroxyindoleacetic acid (5-HIA A) concentration. A contrast-enhanced CT scan of the abdomen shows an intestinal tumor with extensive metastasis to the liver. A diagnosis of an inoperable disease is made and the patient is started on treatment with octreotide. Six weeks later, the patient's symptoms have improved except for his abdominal pain and frequent loose stools. The physician suggests enrolling the patient in a trial to test additional treatment with a new drug that has been shown to improve symptoms in other patients with the same condition. The expected beneficial effect of this new drug is most likely caused by inhibition of which of the following?

Question

Quizplus · Accepted Answer

Eductional Objective: Tryptophan hydroxylase is an enzyme that converts tryptophan to serotonin. The hallmark of carcinoid tumors is the excess production of serotonin, which is primarily responsible for the gastrointestinal symptoms (e.g., diarrhea) in carcinoid syndrome. Telotristat, an inhibitor of tryptophan hydroxylase, has recently been approved as adjunctive therapy for patients with carcinoid tumors whose diarrhea is not controlled with somatostatin analogs (e.g., octreotide).

A 34-Year-Old Man Comes to the Physician Because of Palpitations