Metastatic carcinoid tumour presenting as hepatic encephalopathy

Background: Hepatic encephalopathy is rarely encountered with carcinoid syndrome, but massive hepatic replacement by carcinoid tumour can cause neuropsychiatric alterations. Case outline: A man of 42 years presented with carcinoid syndrome accompanied by features of hepatic encephalopathy. Following extended right hepatectomy his mental status returned to normal in line with markers of hepatic failure. Conclusion: Extensive replacement of liver parenchyma by carcinoid tumours can lead to hepatic dysfunction as circulating levels of unmetabolised ammonia rise secondary to porto systemic shunting.