Zollinger-Ellison Syndrome

2008-03-13T19:44:00.000-07:00

Zollinger-Ellison syndrome
From Wikipedia, the free encyclopedia

Endoscopy image of multiple small ulcers in the distal duodenum in a patient with Zollinger-Ellison syndrome

Classification & external resources
ICD-10
E 16.4
ICD-9
251.5
MedlinePlus
000325
eMedicine
med/2437 ped/2472
MeSH
D015043

Zollinger-Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the Stomach to produce excess hydrochloric acid. Often the cause is a tumor (gastrinoma) of the duodenum or The Pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to Peptic Ulcer (in almost 95% of patients)
Gastrin works on stomach parietal cells causing them to secrete more hydrogen ions into the stomach lumen. In addition, gastrin acts as a trophic factor for parietal cells, causing parietal cell hyperplasia. Thus there is an increase in the number of acid-secreting cells, and each of these cells produces acid at a higher rate. The increase in acidity contributes to the development of Peptic Ulcers in the stomach and duodenum. High acid levels lead to multiple ulcers in the stomach and small bowel.

Patients with Zollinger-Ellison syndrome may experience abdominal pain and diarrhea. The diagnosis is also suspected in patients without symptoms who have severe ulceration of the stomach and small bowel, especially if they fail to respond to treatment.
Gastrinomas may occur as single tumors or as multiple, small tumors. About one-half to two-thirds of single gastrinomas are malignant tumors that most commonly spread to the Liver and lymph nodes near the pancreas and small bowel. Nearly 25 percent of patients with gastrinomas have multiple tumors as part of a condition called multiple endocrine neoplasia type I (MEN I). MEN I patients have tumors in their pituitary gland and parathyroid glands in addition to tumors of the pancreas.

Symptoms

epigastric pain (stomachache)
vomiting blood (hematemesis) (occasional)
difficulty in eating
diarrhea
steatorrhea

Diagnosis
The diagnosis of Zollinger-Ellison syndrome is made by several laboratory tests and imaging studies.

Laboratory tests:

secretin stimulation test, which measures gastrin levels in response to secretin
fasting gastrin levels
antral acidity

Therapy
Proton pump inhibitors (such as omeprazole and lansoprazole) and histamine H2-receptor antagonists (such as famotidine and ranitidine) are used to slow down acid secretion. If possible the tumours should be surgically removed, or treated with chemotherapy.

Octreotide can be used to slow down acid secretion.

History
This syndrome was first described in 1955 by R Zollinger and E Ellison.[1]

Footnotes
^ Zollinger RM, Ellison EH (1955). "Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas". Ann. Surg. 142 (4): 709–23; discussion, 724–8. PMID 13259432.
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v • d • e Endocrine pathology: endocrine diseases (E00-35, 240-259)
Thyroid
Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema) - Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome
Pancreas
Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome
Parathyroid
Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary)
Pituitary
Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease/Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome
Adrenal
Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (due to 21-hydroxylase deficiency) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism
Gonads
ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - testicular dysfunction (5-alpha-reductase deficiency) - testosterone biosynthesis (17-beta-hydroxysteroid dehydrogenase deficiency) - general (Hypogonadism, Delayed puberty, Precocious puberty)
Other
Autoimmune polyendocrine syndrome - Carcinoid syndrome - Short stature (Laron syndrome, Psychogenic dwarfism) - Gigantism - Androgen insensitivity syndrome - Progeria - Multiple endocrine neoplasia (1, 2)
Retrieved from "http://en.wikipedia.org/wiki/Zollinger-Ellison_syndrome"
Categories: Digestive diseases Endocrinology Syndromes Eponyms
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