Texas Tech University Health Sciences Center Amarillo, Texas
Sameer Prakash, DO, Nooraldin Merza, MD, Tarek Mansi, MD, Hina Yousuf, MD, Kerolos Abdelmalek, MD; Texas Tech University Health Sciences Center, Amarillo, TX
Introduction: Zollinger-Ellison syndrome is a rare endocrine disorder occurring in approximately 0.1-3 persons per million. It is characterized by a neuroendocrine tumor secreting gastrin, appearing as solitary or multiple, located generally in the duodenum and pancreas, and subsequently promotes acid hypersecretion. A 51-year-old male presented to the gastroenterology clinic with a 4-year history of chronic watery diarrhea and was found to have Zollinger-Ellison syndrome. He had sought medical management several times in his presentation and failed medical management.
Methods: A 51-year-old male with a past medical history of GERD presented to his gastroenterologist with a 4-year history of chronically unformed stools often explosive and watery in nature. The chronic diarrhea was episodic and was associated with burning abdominal discomfort, nausea, and 20 lb. weight loss. CT abdomen pelvis was unremarkable and EGD showed multiple duodenal ulcerations and hypertrophic gastropathy. At that time, a probable diagnosis of gastrinoma was made. Serum chromogranin A was elevated at 51 nmol/L (ref. range 0-5 nmol/L and gastrin at 2186pg/ml (ref. range 0-115 pg/mL). He was referred to a tertiary referral center and upper endoscopic ultrasound (EUS) showed no identifiable gastrinoma. Octreotide-CT fusion scan showed a proximal duodenal 1.1 cm gastrinoma with no metastatic disease and underwent local resection. Pathology showed a low mitotic index neuroendocrine tumor that was strongly positive for chromogranin A. He did well postoperatively with normalization of gastrin levels, resolution of symptoms, and was able to withdraw from proton pump inhibitor therapy. Serial levels of chromogranin A and gastrin remained normal and he is under long-term medical follow-up. Discussion: Zollinger-Ellison syndrome is a complicated medical diagnosis and patients often seek multiple providers for management before diagnosis is ultimately made. Therapy is surgical in patients who are surgical candidates and remains the definitive treatment. Postoperative surveillance with serum gastrin and chromogranin testing at regular follow-up is necessary for monitoring recurrence. The patient continues to undergo postoperative surveillance and was able to completely be taken off acid suppression therapy.
Disclosures: Sameer Prakash indicated no relevant financial relationships. Nooraldin Merza indicated no relevant financial relationships. Tarek Mansi indicated no relevant financial relationships. Hina Yousuf indicated no relevant financial relationships. Kerolos Abdelmalek indicated no relevant financial relationships.