Sunday, July 17, 2016

GI Hormones: Zollinger Ellison Syndrome

Hi everyone ! So this is the 2nd post in  the series of the hormones of the GIT. 
Last post we discussed about the functions of the hormone Gastric.  This post we look at its applied aspects. And that's majorly looking into the Zollinger Ellison Syndrome. 
Hope you like it. ::)


Etiology: sporadic or Associated with MEN1 SYNDROME (Multiple Endocrine Neoplasia syndrome)

TRIAD : Tumor + Hypergastrinemia + Peptic ulcerations. 

Tumor. = Gastrinoma. 50% gastrinomas are malignant.                                                       ○MC Site is the duodenum
○(☆MC site for PUD in general is also duodenum. So it only makes sense that for the mucosa to ulcerate there must be a local gastrin supply available ).

○2nd MC site for gastrinoma = Pancreas. Originally the tumor was defined as a non Beta cell Pancreatic tumor. 😨. Now its been realised the duodenum was the culprit all along.
○PUD and Hypergastrinemia. = due to increased gastrin secretion by the tumor, gastrin exerts an increase in the acid secretion + its trophic action on gastric mucosa. This causes erosions of gastric mucosa as well as causes hypertrophy of it (paradox). Thus we get a Hypertrophic Gastropathy + PUD.

Abdominal pain is the MC symptom . Can mimic PUD.
○2nd MC symptom is Diarrhea.
May be associated with mucosal damage due to acid leading to villous atrophy (excessive acid of stomach. Pancreatic/intestinal alkalinity may be unable to counteract. Pancreatic secretions may be compromised due to tumor)
GI bleed -- hematemesis, melena. Due to ulcer-hemorrhage. 

○S.gastrin levels - >100. IOC for screening
○May follow up a positive result with gastric acid function tests
○Somatostatin receptor scintigraphy.
○Evaluate for Liver /LN mmets
○S.Calcium -- associated with MEN1.

Rx :
○PPI. Symptomatic treatment achieved with OMEPRAZOLE and friends.
○Can use Octreotide - Somatostatin analogue. It's a generalised inhibitor of pretty much all hormones.
○Surgical Rx of tumor advised to avoid mets

☆☆☆☆☆MEN1 --> Hyper parathyroidism , pituitary tumors ,Pancreatic tumors.
(Mnemonic : All MEN like 3 things - Pus*y, Pus*y, Pus*y. = parathyroid, pituitary, pancreas)
Autosomal Dominant. cause men are dominant, lol. ¤¤ 

The next post is going to be about the only  other member in the Gastrin family -CCK PZ. 
So don't fail it to check it out. ;;) 
Bye till then. :* :D

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