Occult Pancreatic Neuroendocrine Tumor Presenting as Carcinoid Syndrome

We present a case of a 50-year-old male who initially presented to the clinic with complaints of palpitations, shortness of breath, dizziness, night sweats, headaches with associated intermittent episodes of diarrhea, episodes of flushing, and rash on the upper body. Laboratory testing revealed elevated chromogranin A levels. Initial imaging with computed tomography (CT) of the abdomen and pelvis with contrast was negative for any lesions. However, due to his clinical presentation and high suspicion of a neuroendocrine tumor (NET), a positron emission tomography-CT (PET-CT) scan with Gallium 68-DOTATATE was obtained, confirming and localizing his NET in the neck of the pancreas and the liver. Following confirmation and localization of his tumor, he was referred for surgical evaluation and treatment. Pancreatic neuroendocrine tumors are rare and difficult to diagnose, highlighted by unsuccessful initial efforts to localize and confirm the tumor. This case underscores the importance of clinical suspicion and acumen in diagnosing neuroendocrine tumors. Upcoming imaging modalities of PET-CT scans provide promising avenues to uncover neuroendocrine tumors.