does not occur in a patient with gastrinoma

Discussion in 'AIIMS Nov 2013' started by Guest, May 8, 2005.

  1. Guest

    Guest Guest

    Which of the following does not occur in a patient with gastrinoma?

    1. Epigastric pain.
    2. Diarrhoea.
    3. Basal acid output (BAO) Less than 15 mEq/litre.
    4. Serum gastrin levels > 200 pg/ml.
  2. patient with gastrinoma

    Which of the following does not occur in a patient with gastrinoma?
    3. Basal acid output (BAO) Less than 15 mEq/litre.


    Please do read thru the following sites:
    The Proof:
    http://www.moffitt.usf.edu/pubs/ccj/v4n1/article4.html
    http://content.nejm.org/cgi/content/full/333/10/634

    Diagnosis
    The Zollinger–Ellison syndrome manifests itself in 90 to 95 percent of cases as severe peptic ulcer disease.1 About half the time, the ulcer disease is associated with diarrhea, and in approximately 10 percent of patients, diarrhea is the only clinical manifestation.2,3 Basal serum gastrin concentrations are usually elevated in patients with this syndrome.4 Normal basal serum gastrin values with abnormal results of secretin tests have been reported, however, in a few patients.5,6,7
    While most individuals experience some degree of intermittent hyperacidity requiring symptomatic treatment (eg, antacids), only a small percentage of these people will have a gastrinoma. In essence, a gastrinoma should be suspected if a patient presents with unusual symptoms, such as a peptic ulcer and diarrhea, familial ulcer disease, recurrent ulcer, ulcers of the distal duodenum or jejunum, ulcer disease in conjunction with hypercalcemia, or an ulcer that fails to heal on conventional doses of an H2-blocker or omeprazole (Fig 1). In addition, a patient being considered for an "ulcer" operation should have at least a baseline fasting serum gastrin level measured in order to exclude gastrinoma as a possible cause. This is also the first step in establishing a diagnosis of gastrinoma.

    If symptoms suggest a gastrinoma, both fasting serum hypergastrinemia of more than 100 pg/mL and an elevated basal acid output (BAO) of more than 15 mEq/h must be present to establish the diagnosis of ZES. If either of these tests is inconclusive, a secretin stimulation test should be performed to confirm the diagnosis. This test involves administering intravenously a secretin bolus of 2 U/kg and monitoring subsequent serum levels of serum gastrin over 30 minutes. An increase in the serum gastrin level of 200 pg/mL or greater at 10 minutes is indicative of the presence of gastrinoma. It is rare for a patient with ZES to have a normal fasting serum gastrin level (false negative).

    Several disorders, however, can cause hypergastrinemia (false positive). Hypergastrinemia in association with low BAO can be seen in patients on therapy with H2-blockers or omeprazole (which should be discontinued prior to measurement of the gastrin level), vagotomy, renal failure, or achlorhydria associated with pernicious anemia or atrophic gastritis. Hypergastrinemia and elevated BAO are seen in patients with gastric outlet obstruction, in those with antral G-cell hyperplasia, in patients with the retained antrum syndrome, or in those who have had a recent massive small bowel resection. Hypergastrinemia has been recently reported to be associated with hyperchlorhydria in patients with Helicobacter pylori infections.[2] Eradication of the H pylori led to a decrease in serum gastrin levels. All of these conditions can be distinguished from gastrinoma by a negative secretin provocative test.

    Another important consideration in the diagnosis of gastrinoma is the presence of other endocrine abnormalities, particularly multiple endocrine neoplasia syndrome type 1 (MEN 1). The natural history and treatment of patients with gastrinoma and MEN 1 differ from those of patients with sporadic gastrinoma. Since approximately 20% to 60% of patients with gastrinoma have the MEN 1 syndrome, it is important to make this diagnosis.[3-6] The initial presenting symptom is usually hypercalcemia, although one third of patients may present with the ZES as their initial manifestation of MEN 1.[7]
  3. Guest

    Guest Guest

    Answer

    3. Basal acid output (BAO) Less than 15 mEq/litre.

    I agree with you aiims cracker
  4. Thanks

    Thank you Manasi.
  5. Guest

    Guest Guest

    Just for reference Harrison 16th page 2227 ..

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