Management of Gastrinoma
Gastrinoma is a functioning neuroendocrine tumor resulting in the oversecretion of gastrin. Patients often present with abdominal pain, diarrhea, and reflux. They are most often sporadic but may be associated with multiple endocrine neoplasia type 1 (MEN1) in a minority of cases. Biochemical testing for hypergastrinemia includes a fasting serum gastrin level. If the results are equivocal, a secretin stimulation test can be performed. After the diagnosis is confirmed, cross-sectional imaging should be performed which will most often localize the tumor to the gastrinoma triangle. Further localization may include somatostatin receptor scintigraphy and endoscopic ultrasound. Medical treatment should be guided toward decreasing the burden of hypersecretion with either proton pump inhibitors or histamine-2 receptor blockers. For isolated, sporadic gastrinomas, treatment includes surgical resection. However, roughly 50% of patients with have metastatic disease at the time of diagnosis. The approach for patients with MEN1 is less clear.
KeywordsZollinger-Ellison syndrome Peptic ulcer disease Multiple endocrine neoplasia 1 Hypergastrinemia Secretin-stimulation test Gastrinoma triangle Octreotide
- 1.Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Chapter 38: Endocrine pancreas. In: Sabiston textbook of surgery. 20th ed. Philadelphia: Elsevier; 2017. p. 941–62.Google Scholar
- 2.Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Chapter 39: Multiple endocrine neoplasia. In: Williams textbook of endocrinology. 13th ed. Philadelphia: Elsevier; 2016. p. 1723–61.Google Scholar
- 3.Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT, Weir GC. Chapter 148: Multiple endocrine neoplasia Type 1. In: Endocrinology: adult and pediatric. 7th ed. Elsevier Saunders: Philadelphia; 2016. p. 2566–93.Google Scholar
- 4.Feldman M, Friedman LS, Brandt LJ. Chapter 33: Neuroendocrine tumors. In: Sleisenger and Fordtran’s gastrointestinal and liver disease. 10th ed. Philadelphia: Elsevier; 2016. p. 501–41.Google Scholar
- 5.McPherson RA, Pincus MR. Chapter 22: Laboratory diagnosis of gastrointestinal and pancreatic disorders. In: Henry’s clinical diagnosis and management by laboratory methods. St. Louis: Elsevier; 2017. p. 306–23.Google Scholar