Zollinger-Ellison syndrome laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Zollinger-Ellison syndrome}} | {{Zollinger-Ellison syndrome}} | ||
{{CMG}}{{AE}} {{MJK}} | {{CMG}}{{AE}} {{ARK}}; {{MJK}} | ||
==Overview== | ==Overview== | ||
An elevated concentration of fasting serum [[gastrin]] level and [[secretin]] stimulation test may be helpful in the diagnosis of Zollinger-Ellison syndrome. | An elevated concentration of fasting serum [[gastrin]] level and [[secretin]] stimulation test may be helpful in the diagnosis of Zollinger-Ellison syndrome. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of Zollinger-Ellison syndrome include:<ref name="pmid17108779">{{cite journal| author=Berna MJ, Hoffmann KM, Long SH, Serrano J, Gibril F, Jensen RT| title=Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 6 | pages= 331-64 | pmid=17108779 | doi=10.1097/MD.0b013e31802b518c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17108779 }} </ref><ref name="pmid11388095">{{cite journal| author=Roy PK, Venzon DJ, Feigenbaum KM, Koviack PD, Bashir S, Ojeaburu JV et al.| title=Gastric secretion in Zollinger-Ellison syndrome. Correlation with clinical expression, tumor extent and role in diagnosis--a prospective NIH study of 235 patients and a review of 984 cases in the literature. | journal=Medicine (Baltimore) | year= 2001 | volume= 80 | issue= 3 | pages= 189-222 | pmid=11388095 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11388095 }} </ref><ref name="pmid6847280">{{cite journal| author=Romanus ME, Neal JA, Dilley WG, Leight GS, Linehan WM, Santen RJ et al.| title=Comparison of four provocative tests for the diagnosis of gastrinoma. | journal=Ann Surg | year= 1983 | volume= 197 | issue= 5 | pages= 608-17 | pmid=6847280 | doi= | pmc=PMC1353045 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6847280 }} </ref><ref name="pmid16222731">{{cite journal| author=Tomassetti P, Campana D, Piscitelli L, Mazzotta E, Brocchi E, Pezzilli R et al.| title=Treatment of Zollinger-Ellison syndrome. | journal=World J Gastroenterol | year= 2005 | volume= 11 | issue= 35 | pages= 5423-32 | pmid=16222731 | doi= | pmc=PMC4320348 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16222731 }} </ref> | *Serum [[gastrin]] measurements with [[calcium]] and especially with [[secretin]] challenge is the most important method of diagnosis. <ref name="pmid1145407">{{cite journal |vauthors=Thompson JC, Reeder DD, Villar HV, Fender HR |title=Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome |journal=Surg Gynecol Obstet |volume=140 |issue=5 |pages=721–39 |year=1975 |pmid=1145407 |doi= |url=}}</ref> | ||
*Patients, with acid hypersecretion, who have high [[serum]] gastrin levels that remain high or further elevate on [[secretin]] infusion, should be suspected to have Zollinger-Ellison syndrome. <ref name="pmid1145407">{{cite journal |vauthors=Thompson JC, Reeder DD, Villar HV, Fender HR |title=Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome |journal=Surg Gynecol Obstet |volume=140 |issue=5 |pages=721–39 |year=1975 |pmid=1145407 |doi= |url=}}</ref> | |||
*Laboratory findings consistent with the diagnosis of Zollinger-Ellison syndrome include:<ref name="pmid17108779">{{cite journal| author=Berna MJ, Hoffmann KM, Long SH, Serrano J, Gibril F, Jensen RT| title=Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 6 | pages= 331-64 | pmid=17108779 | doi=10.1097/MD.0b013e31802b518c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17108779 }} </ref><ref name="pmid11388095">{{cite journal| author=Roy PK, Venzon DJ, Feigenbaum KM, Koviack PD, Bashir S, Ojeaburu JV et al.| title=Gastric secretion in Zollinger-Ellison syndrome. Correlation with clinical expression, tumor extent and role in diagnosis--a prospective NIH study of 235 patients and a review of 984 cases in the literature. | journal=Medicine (Baltimore) | year= 2001 | volume= 80 | issue= 3 | pages= 189-222 | pmid=11388095 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11388095 }} </ref><ref name="pmid6847280">{{cite journal| author=Romanus ME, Neal JA, Dilley WG, Leight GS, Linehan WM, Santen RJ et al.| title=Comparison of four provocative tests for the diagnosis of gastrinoma. | journal=Ann Surg | year= 1983 | volume= 197 | issue= 5 | pages= 608-17 | pmid=6847280 | doi= | pmc=PMC1353045 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6847280 }} </ref><ref name="pmid16222731">{{cite journal| author=Tomassetti P, Campana D, Piscitelli L, Mazzotta E, Brocchi E, Pezzilli R et al.| title=Treatment of Zollinger-Ellison syndrome. | journal=World J Gastroenterol | year= 2005 | volume= 11 | issue= 35 | pages= 5423-32 | pmid=16222731 | doi= | pmc=PMC4320348 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16222731 }} </ref> | |||
*Fasting serum [[gastrin]] level: | *Fasting serum [[gastrin]] level: | ||
:*[[Gastrin]] level ≥ 120 pg/mL | :*[[Gastrin]] level ≥ 120 pg/mL | ||
:*For accurate results, gastric antisecretory medications should be stopped | :*For accurate results, gastric antisecretory medications should be stopped | ||
*Serum calcium: | *Serum calcium: | ||
:*Increased levels of serum calcium may | :*Increased levels of serum calcium may be suggestive of [[multiple endocrine neoplasia type 1]] ([[MEN1]]) | ||
*Gastric acid secretion tests: | *Gastric acid secretion tests: | ||
:*Basal acid output | :*Basal acid output | ||
| Line 18: | Line 20: | ||
*Provocative tests: | *Provocative tests: | ||
:*[[Secretin]] stimulation test (test of choice) | :*[[Secretin]] stimulation test (test of choice) | ||
:*Calcium stimulation test | :*[[Calcium]] stimulation test | ||
:*[[Secretin]] plus calcium stimulation tests | :*[[Secretin]] plus calcium stimulation tests | ||
==References== | ==References== | ||
Latest revision as of 16:30, 19 September 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]; Mohamad Alkateb, MBBCh [3]
Overview
An elevated concentration of fasting serum gastrin level and secretin stimulation test may be helpful in the diagnosis of Zollinger-Ellison syndrome.
Laboratory Findings
- Serum gastrin measurements with calcium and especially with secretin challenge is the most important method of diagnosis. [1]
- Patients, with acid hypersecretion, who have high serum gastrin levels that remain high or further elevate on secretin infusion, should be suspected to have Zollinger-Ellison syndrome. [1]
- Laboratory findings consistent with the diagnosis of Zollinger-Ellison syndrome include:[2][3][4][5]
- Fasting serum gastrin level:
- Gastrin level ≥ 120 pg/mL
- For accurate results, gastric antisecretory medications should be stopped
- Serum calcium:
- Increased levels of serum calcium may be suggestive of multiple endocrine neoplasia type 1 (MEN1)
- Gastric acid secretion tests:
- Basal acid output
- Basal gastric secretory volume
- Gastric pH ≤ 2 is highly suggestive of Zollinger-Ellison syndrome
- Provocative tests:
References
- ↑ 1.0 1.1 Thompson JC, Reeder DD, Villar HV, Fender HR (1975). "Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome". Surg Gynecol Obstet. 140 (5): 721–39. PMID 1145407.
- ↑ Berna MJ, Hoffmann KM, Long SH, Serrano J, Gibril F, Jensen RT (2006). "Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features". Medicine (Baltimore). 85 (6): 331–64. doi:10.1097/MD.0b013e31802b518c. PMID 17108779.
- ↑ Roy PK, Venzon DJ, Feigenbaum KM, Koviack PD, Bashir S, Ojeaburu JV; et al. (2001). "Gastric secretion in Zollinger-Ellison syndrome. Correlation with clinical expression, tumor extent and role in diagnosis--a prospective NIH study of 235 patients and a review of 984 cases in the literature". Medicine (Baltimore). 80 (3): 189–222. PMID 11388095.
- ↑ Romanus ME, Neal JA, Dilley WG, Leight GS, Linehan WM, Santen RJ; et al. (1983). "Comparison of four provocative tests for the diagnosis of gastrinoma". Ann Surg. 197 (5): 608–17. PMC 1353045. PMID 6847280.
- ↑ Tomassetti P, Campana D, Piscitelli L, Mazzotta E, Brocchi E, Pezzilli R; et al. (2005). "Treatment of Zollinger-Ellison syndrome". World J Gastroenterol. 11 (35): 5423–32. PMC 4320348. PMID 16222731.