Newer studies in the Zollinger-Ellison syndrome

Passaro, Edward; Basso, Nicola; Sanchez, Robbi; Gordon, H. Earl

doi:10.1016/s0002-9610(70)80101-5

Cited by 47 publications

(12 citation statements)

References 5 publications

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“…Literature BAO data are from 129 patients 11,14,35,[39][40][41]67,92,95,96,100,103,117,122,144,146,153,154,170,175,177,185,189,191,192,216,220,228,230,236,254,257,270,284,289,292,331,343,355,[369][370][371][372]378,401,439,443,446,474,491 ; and literature MAO data are from 55 patients 11,…”

Section: Discussionmentioning

confidence: 99%

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

et al. 2004

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In patients with multiple endocrine neoplasia type 1 (MEN1), the most common functional pancreatic endocrine tumor (PET) syndrome is Zollinger-Ellison syndrome (ZES). ZES has been well studied in its sporadic form (that is, without MEN1); however, there are limited data on patients with MEN1 and ZES (MEN1/ZES), and the long-term natural history is largely unknown. To address this issue we report the results of a prospective long-term National Institutes of Health (NIH) study of 107 MEN1/ZES patients and compare our results with those of 1009 MEN1/ZES patients in 278 case reports and small series in the literature. Patients were clinically, radiologically, and biochemically evaluated yearly for all MEN1 manifestations (mean follow-up, 10 yr; range, 0.1-31 yr). Compared with patients from the literature, the NIH MEN1/ZES patients more frequently had pituitary (60%) and adrenal (45%) disease and carcinoid tumors (30%), but had equal frequency of hyperparathyroidism (94%), thyroid disease (6%), or lipomas (5%). Twenty-five percent of both the NIH and the literature patients lacked a family history of MEN1; ZES was the initial clinical manifestation of MEN1 in 40%. ZES onset preceded the diagnosis of hyperparathyroidism in 45%. However, ZES was rarely (8%) the only initial manifestation of MEN1 if careful testing was done. ZES occurred before age 40 years in 50%-60% of the current patients, in contrast to older studies. The diagnosis of ZES is delayed 3-5 years from its onset and is delayed as long as in sporadic ZES cases. Pituitary disease and carcinoid tumors (gastric > bronchial, thymic) are more frequent than generally reported, whereas a second functional PET is uncommon. In patients with MEN1/ZES without a family history of MEN1, the MEN1 manifestations are not as severe. This study shows that MEN1/ZES patients differ in many aspects from those commonly reported in older studies involving few MEN1/ZES patients. In this study we have identified a number of important clinical and laboratory features of MEN1/ZES that were not previously appreciated, which should contribute to earlier diagnosis and improve both short- and long-term management.

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Section: Discussionmentioning

confidence: 99%

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

et al. 2004

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“…The value of these tests has been studied in small series (Berson and Yalow, 1972;Isenberg et al, 1972;Passaro et al, 1972;Thompson et al, 1972b;Becker et al, 1973;Bradley et al, 1973;Korman et al, 1973a, b;Bonfils et al, 1974) and, recently, in relatively larger groups of ZE patients (Creutzfeldt et al, 1975;Thompson et al, 1975). However, comparison of the value of different provocation tests in the same patient has not been recorded previously.…”

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confidence: 99%

Comparative study of the value of the calcium, secretin, and meal stimulated increase in serum gastrin to the diagnosis of the Zollinger-Ellison syndrome.

Lamers¹,

Tongeren²

1977

Gut

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SUMMARY To evaluate the usefulness of provocation tests in the diagnosis of the Zollinger-Ellison (ZE) syndrome stimulation tests with calcium, 15 mg/kg.3 h, and secretin GIH, 1 U/kg.30 s, were performed in 15 patients with histologically proven or suspected ZE syndrome. Nine of these 15 patients were without previous gastric surgery and in them meal stimulated serum gastrin levels were measured as well. These tests were also performed in normal subjects and in patients with duodenal ulcer, antrectomy, total gastrectomy, and achlorhydria. All tests were considered to be positive if a more than a 50 % increase in serum gastrin was found. The results indicate that secretin stimulation is the provocation test of first choice in the diagnosis of this syndrome. This test is most valuable for the following reasons: (1) there were few (two out of 15) false-negative test results in ZE patients; (2) there were no false-positive tests in 69 patients without gastrinoma; (3) it was easy and quick to perform; and (4) there were no adverse reactions. The two ZE patientswithnegativesecretinstimulation tests had negative calcium provocation tests as well, in spite of histologically proven gastrinoma. In 11 patients with suspected or proven ZE syndrome and basal serum gastrin levels of less than 1000 pg/ml a rather good correlation (r = 0-841; p < 0 01) was found between the percental increase in serum gastrin after stimulation by calcium and secretin. Meal stimulated serum gastrin levels are helpful only in patients without previous gastric surgery.

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“…These peptide responses can be regulated by a variety of endogenous and pharmacological agents [1][2][3][4]. Octreotide acetate, a somatostatin analogue, is a potent inhibitor of peptide release as well as an inhibitor of tumour growth and angiogenesis [5-7, 9, 22, 23], The mechanism of octreotide action is direct inhibition of peptide secretion via binding of the somatostatin ana logue to one of five membrane-bound receptor subtypes (sst i_5).…”

Section: Discussionmentioning

confidence: 99%

“…The release of these peptides may be provoked by physiological stimuli such as the ingestion of food or by the administration of a variety of pharmacolog ical stimuli such as calcium, secretin, glucagon or tolbuta mide. The ability of these pharmacological stimuli to pro voke peptide release from functional endocrine tumours forms the basis of clinical provocative testing used to con firm the diagnosis of tumours such as gastrinoma (by cal cium or secretin challenge), insulinoma (by tolbutamide challenge) or VIPomas (by tolbutamide challenge) [1][2][3][4]. Conversely, a patient's response to treatment with cyto toxic agents, surgery or peptide-suppressing agents is K A KG E K ® 1996 s -Karger AG.…”

Section: Introductionmentioning

confidence: 99%

Calcium Reverses Octreotide Inhibition of Insulin and Glucagon Levels in Patients with Insulinoma and Glucagonoma

Thompson

O'Dorisio²,

Woltering³

1996

Digestion

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Excessive secretion of peptides causes the clinical syndromes associated with functional gastro-intestinal tumours. The somatostatin analogue octreotide acetate inhibits peptide release from a variety of tumours. This study investigated the interactions of calcium and somatostatin analogues on peptide release in two patients, one with a glucagonoma (patient A) and one with an insulinoma (patient B). Peptide responses were evaluated before (fasting levels) and after provocative tests (a 4-hour calcium infusion, an intravenous tolbutamide infusion, a secretin bolus and a standard test meal) in the absence and presence of octreotide acetate treatment (100 μg subcutaneously every 8 h). Patients A and B had elevated fasting plasma levels of glucagon and insulin, respectively, which were reduced by octreotide therapy by 73 and 50%, respectively. The peak provoked levels and calculated values for peptide synthesis were lower after octreotide therapy. In both patients, tolbutamide provoked most peptide release, and calcium infusion was the least susceptible to the effects of octreotide therapy. Calcium appears to inhibit octreotide suppression of glucagon and insulin secretion in patients with glucagonoma and insulinoma, respectively. Calcium may stimulate peptide release from endocrine tumours by suppressing the inhibitory effects of endogenous somatostatin. Normalisation of serum calcium, either surgically or pharmacologically, may improve the effectiveness of somatostatin analogue therapy.

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Newer studies in the Zollinger-Ellison syndrome

Cited by 47 publications

References 5 publications

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

Comparative study of the value of the calcium, secretin, and meal stimulated increase in serum gastrin to the diagnosis of the Zollinger-Ellison syndrome.

Calcium Reverses Octreotide Inhibition of Insulin and Glucagon Levels in Patients with Insulinoma and Glucagonoma

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