Clinical Note

Gastrinoma

Non-beta-cell tumors of the pancreas or duodenum sometimes produce gastrin and continually release it into the blood. Patients with this disease, called gastrinoma or Zollinger-Ellison syndrome, usually develop duodenal ulcers, diarrhea, stea-torrhea, and sometimes hypokalemia. Gastrin is released from these tumors at a high spontaneous rate not affected by feeding or acidification of the luminal contents. The hypergastrinemia causes hypersecretion of gastric acid through two mechanisms: (1) The trophic action of gastrin causes an increased parietal cell mass and acid secretory capacity, and (2) increased serum gastrin levels constantly stimulate secretion from the hyperplastic mucosa. The symptoms of this disease are due to the presence of large amounts of acid in the small bowel. The acid overwhelms the neutralizing bicarbonate secretions of the pancreas, liver, and duodenal mucosa and erodes the mucosa, producing an ulcer.

Steatorrhea and diarrhea are caused primarily by the inactivation of pancreatic lipase and the precipitation of bile salts at low luminal pH. Increased volumes of gastric and pancreatic secretions also add to the fluid in the intestine. There is evidence that pharmacologically high levels of serum gastrin may also inhibit the absorption of fluid and electrolytes by the small intestine and increase the transit of intestinal contents. Both of these would add to the severity of diarrhea. Because the tumors are difficult to resect and slow growing, the surgical treatment for this condition is total gastric resection— removal of the target organ involved. Some of the newer, potent drugs that inhibit acid secretion have been used successfully to treat the symptoms of gastrinoma as well.

10 11 12 13 14 15 16 17 18 Ile — Lys — Asn — Leu — Gin — Ser — Leu — Asp — Pro

19 20 21 22 23 24 25 26 Ser — His — Arg — Ile — Ser — Asp — Arg — Asp —

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