Introduction: Carcinoid syndrome is a hormonal complication accompanying neuroendocrine tumors (NETs) and is defined by chronic diarrhea and/or flushing in the presence of systemically elevated levels of serotonin or its metabolite 5-hydroxyindolacetic acid. The condition is often diagnosed late because of nonspecific symptoms, and many patients present with metastatic disease. This was a retrospective review of patients with carcinoid syndrome who were followed up at the Endocrine Clinic, Putrajaya Hospital, up to date. Case: Three women aged between 30 and 40 years were diagnosed with carcinoid syndrome secondary to metastatic NETs. Two cases were diagnosed before and during their pregnancies, resulting in one successful pregnancy while another required termination of pregnancy. All patients presented with symptomatic disease, predominantly flushing and chronic diarrhea and abdominal distension, leading to the diagnosis within the same year to as long as a decade after symptomatology. All were found to have extensive liver and nodal metastases at diagnosis. Liver biopsy showed tumor grade 1 in two of the cases, while the case with tumor grade 2 exhibited an aggressive disease course with carcinoid heart disease and bone metastases. None were amenable to surgery. Somatostatin analogues (SSAs) were the mainstay of treatment, administered every 2–4 weeks and titrated according to clinical response. Cytotoxic chemotherapy and bone-targeted agent were given for the case with rapid disease progression and skeletal-related event. Somatostatin analogue radiolabeled peptide therapy (PRRT) was reserved for symptom control in progressive disease refractory to first-line SSAs, after assessment with PET-Ga68 DOTATATE imaging. Conclusion This case series highlights delayed diagnosis and advanced presentation due to its nonspecific symptoms. The occurrence in young women, including during pregnancy, underscores the complexity of management and the need for individualized multidisciplinary care, with somatostatin analogues, systemic therapy, and PRRT playing key roles in symptoms control and disease progression.