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: 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 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:
- Immunostaining for chromogranin A and synaptophysin is an important feature for the diagnosis of neuroendocrine tumors is [6]
- In order to differentiate from other neuroendocrine tumors gastrin immunostaining may be gelpful in diferentiation. Gastrinomas express a high density of somatostatin receptors, thus making somatostatin scintigraphy an effective localizing tool. [6]
- Somatostatin scintigraphy is an effective localizing tool in localizing gastrinomas as they express a high density of somatostatin receptors. [6]
- Diagnostic accuracy of imaging for localization of gastrinoma: [7] [8]
| Diagnostic accuracy of imaging for localization of gastrinoma | ||
| Modality | Sensitivity | Comments |
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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.
- ↑ 6.0 6.1 6.2 Cingam S, Karanchi H. PMID 28722872. Missing or empty
|title=(help) - ↑ 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.
- ↑ Hung PD, Schubert ML, Mihas AA (2003). "Zollinger-Ellison Syndrome". Curr Treat Options Gastroenterol. 6 (2): 163–170. PMID 12628075.