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Zollinger-Ellison syndrome

Z-E syndrome; Gastrinoma

 

Zollinger-Ellison syndrome is a condition in which the body produces too much of the hormone gastrin. Most of the time, a small tumor (gastrinoma) in the pancreas or small intestine is the source of the extra gastrin in the blood.

Causes

 

Zollinger-Ellison syndrome is caused by tumors. These growths are most often found in the head of the pancreas and the upper small intestine. The tumors are called gastrinomas. High levels of gastrin cause production of too much stomach acid.

Gastrinomas occur as single tumors or several tumors. One-half to two-thirds of single gastrinomas are cancerous (malignant) tumors. These tumors often spread to the liver and nearby lymph nodes.

Many people with gastrinomas have several tumors as part of a condition called multiple endocrine neoplasia type I (MEN I). Tumors may develop in the pituitary gland (brain) and parathyroid gland (neck) as well as in the pancreas.

 

Symptoms

 

Symptoms may include:

  • Abdominal pain
  • Diarrhea
  • Vomiting blood (sometimes)

 

Exams and Tests

 

Signs include ulcers in the stomach and small intestine.

Tests include:

  • Abdominal CT scan
  • Calcium infusion test
  • Endoscopic ultrasound
  • Exploratory surgery
  • Gastrin blood level
  • Octreotide scan
  • Secretin stimulation test

 

Treatment

 

Drugs called proton pump inhibitors (omeprazole, lansoprazole, and others) used for treating this problem. These drugs reduce acid production by the stomach. This helps the ulcers in the stomach and small intestine heal. These medicines also relieve abdominal pain and diarrhea.

Surgery to remove a single gastrinoma may be done if the tumors have not spread to other organs. Surgery on the stomach (gastrectomy) to control acid production is rarely needed.

 

Outlook (Prognosis)

 

The cure rate is low even when it is found early and the tumor removed. However, gastrinomas grow slowly. People with this condition may live for many years after the tumor is found. Acid-suppressing medicines work well to control the symptoms.

 

Possible Complications

 

Complications may include:

  • Failure to locate the tumor during surgery
  • Intestinal bleeding or hole (perforation) from ulcers in the stomach or duodenum
  • Severe diarrhea and weight loss
  • Spread of the tumor to other organs

 

When to Contact a Medical Professional

 

Call your health care provider if you have severe abdominal pain that does not go away, especially if it occurs with diarrhea.

 

 

References

Jensen RT, Norton JA. Endocrine tumors of the pancreas and gastrointestinal tract. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 32.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Zollinger-Ellison syndrome

           

             

            Review Date: 11/20/2014

            Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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