Zollinger-Ellison syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

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 consistent with the diagnosis of Zollinger-Ellison syndrome include:^[1]^[2]^[3]^[4]

Increased levels of serum calcium may suggest multiple endocrine neoplasia type 1 (MEN1)


Modality	Sensitivity	Comments
Diagnostic accuracy of imaging for localization of gastrinoma
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

↑ 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.
↑ 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.