Abstract
To describe a patient with a potential harbinger of Zollinger-Ellison syndrome. We present a case of a 29-year-old woman with persistent galactorrhea and gastric distress, who was a member of an extensive multiple endocrine neoplasia (MEN) I kindred. Both clinical and laboratory findings are reviewed. Laboratory studies were notable for persistent hypercalcemia and increased levels of parathyroid hormone and fasting pancreatic polypeptide. Because of nonspecific upper gastrointestinal distress, which was sometimes responsive to antacids, the patient underwent further diagnostic evaluation. Baseline gastrin levels were normal. A secretin challenge test yielded normal results. At upper endoscopy, visual findings in the stomach and duodenum were unremarkable. A raised nodule (4 by 2 by 2 mm) was removed from an otherwise normal-appearing duodenum as a routine biopsy procedure. The acinar architecture, the inconspicuous nucleoli, and the granular, eosinophilic cytoplasm of the cells were diagnostic of a neuroendocrine tumor. Histologic immunohistochemical staining was positive for gastrin but negative for pancreatic polypeptide. RNA studies were not technically possible. Subsequently, serum pancreatic polypeptide levels normalized....Continue Reading
References
Nov 1, 1992·Gastrointestinal Endoscopy·H D Mai, R A Sanowski
Nov 1, 1992·Gastrointestinal Endoscopy·E StrausR T Jensen
Jan 1, 1989·Acta Oncologica·B ErikssonB Skogseid
Jan 1, 1989·Acta Oncologica·B ErikssonE Wilander
Jan 1, 1989·Acta Oncologica·K ObergB Eriksson
Jun 1, 1989·Radiology·H FruchtR T Jensen
May 15, 1986·The New England Journal of Medicine·M L BrandiS J Marx
Apr 1, 1988·Pathology, Research and Practice·G Klöppel, P U Heitz
Nov 1, 1986·Gastroenterology·J C BartonR T Jensen
Nov 1, 1982·The Journal of Clinical Endocrinology and Metabolism·C B LamersJ J Peetoom
Jan 1, 1983·Annals of Internal Medicine·R T JensenM J Collen
Jan 1, 1984·American Journal of Surgery·B E StabileE Passaro
Jun 1, 1995·Surgery·P RuszniewskiP Bernades
Aug 1, 1993·Annals of Surgery·S L SuggR T Jensen
Jul 1, 1996·Annals of Internal Medicine·F GibrilR T Jensen
Sep 1, 1964·Annals of Surgery·E H ELLISON, S D WILSON