SUMMARY In a woman with diarrhoea and the Zollinger-Ellison pattern of gastric secretion, the secretion of fluid and bicarbonate into the duodenum in response to secretin was found to be significantly greater than in controls. No pancreatic tumour was found at operation. The pancreas was, however, larger than normal.The patient did not show symptoms of peptic ulcer disease until vagotomy and pyloroplasty had been performed. A capacity to secrete large amounts of bicarbonate was believed to be the explanation of why she was able to tolerate great amounts of acid.Little attention has been paid to the exocrine pancreatic function in the Zollinger-Ellison syndrome. Decreased enzymatic activity in unstimulated duodenal aspirates has been found by some authors (Maynard and Point, 1958;Summerskill, 1959) and normal by others (Rawson, England, Gillam, French, and Stammers, 1960;Donaldson, Vom Eigen, and Dwight, 1957). After stimulation with secretin and pancreozymin both normal (Shay, Chey, Koide, and Burnett, 1962) and decreased responses (Summerskill, 1959) have been reported. A recent report dealing with the response to a test meal in two patients with the Zollinger-Ellison syndrome (Cook and French, 1968) demonstrates that the amount of alkalinity and activity of trypsin in the upper small intestine may show great variations.
CASE REPORTA 37-year-old married woman had diarrhoea for the first time in 1964. She had never had dyspepsia before or other complaints indicating any disorder, including endocrine disease. The diarrhoea progressed and in 1966 when we saw her for the first time, she was passing five to 10 loose stools daily which often were bulky and greyish in colour, suspicious of steatorrhoea. She had no dyspepsia or weight loss and her appetite was good. During the next two years the diarrhoea progressed moderately but the patient had no other complaints. A temporary improvement was achieved during treatment with an anticholinergic drug, oxyphencyclimine HCl.1 'Daricon, Pfizer.
796LABORATORY FINDINGS The physical examination of the patient was unremarkable. Her body weight was 65 kg and her height 167 cm. Blood examination showed normal values for concentrations of haemoglobin, protein, iron, cholesterol, urea, and creatinine. The sedimentation rate was 1 mm/hr and the red and white blood cell counts were within normal limits. Glucose tolerance tests performed in 1967 and 1968 were normal and normal values were obtained for the blood concentrations of alkaline phosphatase, glutamic oxalic transaminase, total bilirubin and prothrombin, and for bromsulphalein by the retention test. The serum concentrations of electrolytes, including potassium, were normal.Absorption studies Stool fat excretion was raised on a standard ward diet containing approximately 100 g fat daily. The absorption of vitamin A was decreased, being 582 IU/100 ml in 1968, a slight improvement over the values for earlier reports. Two ofthree D-xylose tests were abnormal. In 1967 the result for D-xylose tests was 3.7 g in five-hour urine and i...