Gastrinoma Flashcards
What is the mean age of onset for Zollinger-Ellison Syndrome?
50 years
What is the most common functioning malignant pancreatic endocrine tumor?
Gastrinoma
What are the two forms of Zollinger-Ellison Syndrome?
- Sporadic (75%)
- MEN-1 association (25%)
Where are gastrinomas most commonly located?
- Duodenum (50-70%)
- Pancreas (20-40%)
What is the primary site for gastrin secretion in Zollinger-Ellison Syndrome?
Duodenum
What are the boundaries of Passaro’s Triangle?
Junction of 2nd & 3rd part of duodenum, junction of neck & body of pancreas
What are the main presenting symptoms of Zollinger-Ellison Syndrome?
- Abdominal pain (70-100%)
- Diarrhea (50-70%)
- GERD (30-35%)
What causes diarrhea in Zollinger-Ellison Syndrome?
- Inability of the intestinal tract to absorb large volumes of fluid
- Acid-induced injury to the mucosa
- Precipitation of bile salts
- Inactivation of pancreatic lipase by low pH
What is the most common cause of death in Zollinger-Ellison Syndrome?
Liver metastasis
What must be excluded in patients with intractable peptic ulcers?
Zollinger-Ellison Syndrome
What unique characteristic is associated with acid-induced diarrhea in gastrinoma?
Halted by nasogastric aspiration of gastric secretions
What fasting serum gastrin level is indicative of Zollinger-Ellison Syndrome?
> 100 pg/mL
What is the best provocative test for Zollinger-Ellison Syndrome?
Secretin provocation test
What is almost diagnostic of Zollinger-Ellison Syndrome?
Elevated serum gastrin level with a pH 2 in the gastric aspirate
What is the basal acid output level in most patients with Zollinger-Ellison Syndrome?
> 15 mEq/hr
What is the diagnostic level for serum gastrin?
> 1000 pg/mL
What increase in gastrin value after administration of secretin is diagnostic?
> 200 pg/mL
