In Zollinger Ellison syndrome what is raised?
Correct Answer: Gastrin
Description: Ans. is 'c' i.e., Gastrin Zollinger Ellison syndrome ? Severe peptic ulcer disease secondary to gastric acid hypersecretion due to unregulated gastrin release from a non 13 cell endocrine tumour (gastrinoma), defines the components of Zollinger Ellison syndrome. Pathophysiology of Zollinger Ellison syndrome The driving force responsible for clinical manifestations of Zollinger Ellison syndrome is hypergastrinemia originating from Gastrinoma (autonomus neoplasm, non [3 cell neoplasm) Gastrinoma Hyper gastrinemia Hyper acidemia Peptic ulcer, erosive esophagitis and diarrhoea Other impoant characteristic of Gastrinoma o Over 80% of these tumours are seen in Gastrinoma triangledeg (triangle formed between duodenum and pancreas) most of them are seen in the head of pancreas. o About 2/3'of these tumours are malignantdeg. o About one half of these tumours are multipledeg. o About one fouh of the patients have multiple endocrine neoplasia (MEN I) syndrome with tumours of parathyroid, pituitary and pancreatic islets being present. Remember : Most common site of gastrinoma's is - Duodenum (50-70%), (Pancreas 20-40%) Most common hormone to be secreted - ACTH besides gastrin is Most common site of peptic ulcers produced is - ls' pa of Duodenum. Most valuable provocative test in - The Secretin injection tests. identifying patients with ZES is Basal acid output is greater than 60% of out pu - BAO> MAO induced by maximal stimulation The term pancreatic endocrine tumour is misnomer because these tumours can occur either almost exclusively in the pancreas or at both pancreatic and extrapancreatic sites
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