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Old 05-20-2011
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Question Pituitary Mass + Peptic Ulcer + High Gastrin!

27 year old male with a chronic headache that increased over last few months. CT of the head show pituitary mass, he also has peptic ulcer disease, study of helicobacter pylori were negative, PPI fail to control peptic ulcers, endoscopy show multiple ulcers, gastrin in serum 1000 pg/ml (high)

What is next step :

A- switch to other antacid.

B- secretin stimulation test

C- reassurance

D- echo of stomach, duodenum, pancreas

Last edited by kemoo; 05-20-2011 at 03:19 AM.
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Old 05-20-2011
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this case is MEN1
pituitary adenoma , pancreas islet cell tumor (gastrinoma), parathyroid hyperplasia
since we have to confirm gastrinoma (multiple ulcer and high gastrin level despite injecting secretin ) then we should look for metastasis by us, ct , MRI of abdomen

according to uw fasting serum gastrin level above 1000 is dx to ZES so no need to confirm dx by secretin stimulation test
if this gastrin level given in q is fasting
so we have to look for metastasis
the choice of D is echo does he mean us to detect metastatic ?????

Last edited by USMLE-Syndrome; 05-20-2011 at 05:02 AM.
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Old 05-20-2011
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As miss patho said, in that case, it's clear that the pt has gastrinoma because the gastrin level in serum is 1000 pg/ml. There is no need to confirm this by doing secretin stimulation test.
So we have to look for the gastrinoma itself or the metastasis of it by echo and locate the tumor in order to do surgical removement. (As in answer D)

Additional information:
*Under phsiological conditions, secretin inhibits G cells from releasing Gastrin but stimulates the GASTRINOMA (If it exists.) to release gastrin.
*So if we inject secretin to pt, we should see the gastrin levels (as well as the acid levels in gaster) decrease.
*But if there is a gastrinoma, we'd see the gastrin levels increase.

Last edited by Proxery; 05-21-2011 at 03:07 AM.
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Old 05-20-2011
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Thanks guys for posting and excellent explanation.

The options are pretty obvious I suppose. May I ask the source this question?
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Old 05-20-2011
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Thanks ...... good explanation

source of question from UW as miss patho wrote above
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Endocrinology-, Gastroenterology-, Internal-Medicine-, Neurology-, Step-2-Questions

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