Internal Medicine

0521779407-23 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:24

Zinc Deficiency Zollinger-Ellison Syndrome 1559

differential diagnosis

n/a

management

General Measures

■Treat underlying cause

specific therapy

■Oral zinc

follow-up

n/a

complications and prognosis

■None

■Completely reversible

ZOLLINGER-ELLISON SYNDROME

SHAI FRIEDLAND, MD and ROY SOETIKNO, MD

history & physical

■less than 1% of patients with gastroduodenal ulcers have ZE syn-

drome

■consider ZE with multiple ulcers, ulcers distal to duodenal bulb, or

ulcers that do not respond to treatment

■more than 30% have diarrhea (due to excessive acid secretion)

■90% of gastrinomas are malignant; liver metastases common

■85% are found in gastrinoma triangle (most in pancreas or duodenal

wall)

■consider multiple endocrine neoplasia (MEN) type I with hyper-

parathyroidism, pituitary adenomas, or family history of ZE

tests

■Serum gastrin (fasting)

➣greater than 1000 pg/ml with gastric pH <3 is diagnostic

➣150–1000 pg/ml is nonspecific; can be caused by gastric atrophy,

antisecretory drugs, H pylori

➣secretin stimulation test: increase by 200 pg/ml is diagnostic

■Localization

➣contrast CT with pancreatic protocol: sensitive for pancreatic-

gastrinomas larger than 1.5 cm and for metastases

➣endoscopic ultrasound sensitive for smaller pancreatic lesions