Zollinger-Ellison syndrome laboratory findings: Difference between revisions

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==Laboratory Findings==
==Laboratory Findings==
*Serum gastrin measurements with calcium and especially with secretin challenge will be 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>
*Serum gastrin measurements with [[calcium]] and especially with [[secretin]] challenge will be 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>
*Patient with acid hypersecretion who has a high serum gastrin level that does higher on secretin infusion should be considered to have the 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>
*Patient with acid hypersecretion who has a high [[serum]] gastrin level that does higher on [[secretin]] infusion should be considered to have the 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>
*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:
Line 20: 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
*An important feature for the diagnosis of neuroendocrine tumors is immunostaining for chromogranin A and synaptophysin. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref>
*An important feature for the diagnosis of [[neuroendocrine tumors]] is immunostaining for [[chromogranin A]] and [[synaptophysin]]. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref>
*Gastrin immunostaining can be used to differentiate from other neuroendocrine tumors. Gastrinomas express a high density of somatostatin receptors, thus making somatostatin scintigraphy an effective localizing tool. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref>
*Gastrin immunostaining can be used to differentiate from other [[Neuroendocrine tumor|neuroendocrine tumors]]. [[Gastrinoma|Gastrinomas]] express a high density of [[somatostatin receptors]], thus making somatostatin [[scintigraphy]] an effective localizing tool. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref>
*Diagnostic accuracy of imaging for localization of gastrinoma: <ref name="pmid24319020">{{cite journal |vauthors=Epelboym I, Mazeh H |title=Zollinger-Ellison syndrome: classical considerations and current controversies |journal=Oncologist |volume=19 |issue=1 |pages=44–50 |year=2014 |pmid=24319020 |pmc=3903066 |doi=10.1634/theoncologist.2013-0369 |url=}}</ref> <ref name="pmid12628075">{{cite journal |vauthors=Hung PD, Schubert ML, Mihas AA |title=Zollinger-Ellison Syndrome |journal=Curr Treat Options Gastroenterol |volume=6 |issue=2 |pages=163–170 |year=2003 |pmid=12628075 |doi= |url=}}</ref>
*Diagnostic accuracy of imaging for localization of [[gastrinoma]]: <ref name="pmid24319020">{{cite journal |vauthors=Epelboym I, Mazeh H |title=Zollinger-Ellison syndrome: classical considerations and current controversies |journal=Oncologist |volume=19 |issue=1 |pages=44–50 |year=2014 |pmid=24319020 |pmc=3903066 |doi=10.1634/theoncologist.2013-0369 |url=}}</ref> <ref name="pmid12628075">{{cite journal |vauthors=Hung PD, Schubert ML, Mihas AA |title=Zollinger-Ellison Syndrome |journal=Curr Treat Options Gastroenterol |volume=6 |issue=2 |pages=163–170 |year=2003 |pmid=12628075 |doi= |url=}}</ref>


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Revision as of 02:16, 16 August 2017

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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 will be the most important method of diagnosis. [1]
  • Patient with acid hypersecretion who has a high serum gastrin level that does higher on secretin infusion should be considered to have the 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 suggest 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:
Diagnostic accuracy of imaging for localization of gastrinoma
Modality Sensitivity Comments
  • CT
  • MRI
  • SRS
  • EUS
  • Angiography / Arterial Stimulation
  • 50%
  • 25-50%
  • 80%
  • 70%
  • 40-60%
  • Tumors enhance on early arterial phase because of high vascularity; sensitivity decreases for tumors <2cm
  • Low T1 and high T2 signal intensity.
  • Additional ability to detect extra abdominal metastatic lesions; enhanced sensitivity when combined with SPECT
  • Much higher sensitivity for pancreatic compared with duodenal lesions; can guide needle biopsy to obtain tissue diagnosis.
  • Contrast administered into GDA and inferior pancreaticoduodenal artery; may be performed intraoperatively

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 6.0 6.1 Cingam S, Karanchi H. PMID 28722872. Missing or empty |title= (help)
  7. ↑ Epelboym I, Mazeh H (2014). "Zollinger-Ellison syndrome: classical considerations and current controversies". Oncologist. 19 (1): 44–50. doi:10.1634/theoncologist.2013-0369. PMC 3903066. PMID 24319020.
  8. ↑ Hung PD, Schubert ML, Mihas AA (2003). "Zollinger-Ellison Syndrome". Curr Treat Options Gastroenterol. 6 (2): 163–170. PMID 12628075.

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