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The Gastrinoma Saga Before Zollinger and Ellison: The Strøm Case Revisited. Ann Surg 2019; 270:e19-e21. [PMID: 31188205 DOI: 10.1097/sla.0000000000003261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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DANOWSKI TS, MATEER FM, LONGABAUGH EE. Endocrine Adenomatosis (Polyendocrine Disease) Familial Occurrences. ACTA ACUST UNITED AC 2009; 172:559-66. [PMID: 14025036 DOI: 10.1111/j.0954-6820.1962.tb07193.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gibril F, Schumann M, Pace A, Jensen RT. Multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome: a prospective study of 107 cases and comparison with 1009 cases from the literature. Medicine (Baltimore) 2004; 83:43-83. [PMID: 14747767 DOI: 10.1097/01.md.0000112297.72510.32] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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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Affiliation(s)
- Fathia Gibril
- From Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Roy PK, Venzon DJ, Feigenbaum KM, Koviack PD, Bashir S, Ojeaburu JV, Gibril F, Jensen RT. Gastric secretion in Zollinger-Ellison syndrome. Correlation with clinical expression, tumor extent and role in diagnosis--a prospective NIH study of 235 patients and a review of 984 cases in the literature. Medicine (Baltimore) 2001; 80:189-222. [PMID: 11388095 DOI: 10.1097/00005792-200105000-00005] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We prospectively studied 235 patients with Zollinger-Ellison syndrome (ZES) (205 without and 30 with prior acid-reducing surgery) and compared the results with 984 patients from 182 reports in the literature. The aims of the study were to evaluate the sensitivity of proposed acid secretory criteria for the diagnosis of ZES, propose new criteria, evaluate the variability and methodology of gastric secretory testing, and correlate the symptoms and signs of ZES, tumor extent, and primary tumor size and location with the degree of gastric acid hypersecretion. Multiple endocrine neoplasia-type 1 (MEN1) occurred in 22% of patients. The mean basal acid output (BAO) in patients without and with prior acid-reducing surgery was 41.2 +/- 1.7 mEq/hr (range, 1.6-118.3 mEq/hr) and 27.6 +/- 3.5 mEq/hr (range 5.9-102.9 mEq/hr), respectively. In patients with MEN1, those with female gender, Hispanic, or Asian race had lower BAOs. Diarrhea, esophageal stricture, and pyloric scarring were associated with a higher BAO. Neither other symptoms nor the tumor extent, primary tumor location, or size correlated with the magnitude of acid hypersecretion. ZES diagnosis was delayed a mean of 5.5 +/- 0.4 yr. Patients who were misdiagnosed as having either Crohn or celiac disease had higher BAOs. The sensitivities from our study and the literature review of the proposed BAO criteria for the diagnosis of ZES in patients without previous gastric acid-reducing surgery were 91% and 90% for BAO > or = 15 mEq/hr, 86% and 82% for BAO > or = 18 mEq/hr, 69% and 67% for BAO > 25 mEq/hr, and < 60% for BAO > 31 mEq/hr, respectively. The specificities of all the proposed BAO criteria were high. Both the criterion of BAO > or = 15 mEq/hr and BAO > or = 18 mEq/hr had good specificities and equal sensitivity. With prior acid-reducing surgery, the sensitivities in our study and from the literature review were 100% and 81% for BAO > or = 5 mEq/hr, 73% and 45% for BAO > 14.4 mEq/hr, and 37% and 31% for BAO > 19.2 mEq/hr, respectively. The reported mean specificity for the criterion of BAO > or = 5 mEq/hr was 85%, while it was 100% for the other 2 criteria. The maximal acid output (MAO) criterion of > 70 mEq/hr had sensitivities in the present National Institutes of Health (NIH) study and the literature review of 39% and 31%, respectively, and the criterion of MAO > 100 mEq/hr had a sensitivity of < 15% in patients with no prior acid-reducing surgery. The proposed criterion of BAO/MAO ratio > 0.6 had a low sensitivity. The proposed criterion of the ratio of basal and maximal acid H+ concentration (BAC/MAC ratio) > or = 0.6 had an excellent sensitivity-- > or = 89% in patients with or without previous acid-reducing surgery. The reported specificity for both the BAO/MAO criterion and the BAC/MAC criterion were similar, but BAC/MAC had a better sensitivity. Combination criteria of BAO generally did not improve sensitivity. The criterion of pH < or = 1 was met by only 27% of patients, and pH < or = 0.96 by 21% of patients with previous acid-reducing surgery. For patients with MEN1 with no prior acid-reducing surgery, the sensitivities were lower compared with patients with the sporadic form of ZES. The mean gastric volume in patients without prior acid-reducing surgery was 314 +/- 10 mL/hr and 247 +/- 25 mL/hr in patients with prior acid-reducing surgery. A basal volume criteria of > 160 mL/hr in patients without prior acid-reducing surgery occurred in > 86% of patients, and > 140 mL/hr in 87% of patients with prior acid-reducing surgery; these, thus, are neglected findings that have good sensitivities. Our analysis shows criteria based on MAO, pH, and BAO/MAO ratio do not have high sensitivities and thus are not useful. In patients without prior acid-reducing surgery, the criteria of BAO > or = 15 mEq/hr, BAC/MAC ratio > or = 0.6, and basal gastric volume > 160 mL/hr are useful for the diagnosis of ZES and have good specificities. In patients with prior acid-reducing surgery, the criteria of BAO > or = 5 mEq/hr, BAC/MAC ratio > or = 0.6, and basal gastric volume > 140 mL/hr have high sensitivities. In patients with sporadic ZES without acid-reducing surgery, the criterion of BAO > or = 18 mEq/hr is recommended as it has a similar sensitivity but higher specificity than the criterion of BAO > or = 15 mEq/hr. Only 1 patient in either data set (NIH or the literature) with or without previous acid-reducing surgery had a basal gastric pH > 2, therefore this finding essentially excludes the diagnosis of ZES. Gastric secretory measurements for 30 minutes, but not 15 minutes, give results comparable to those for a full hour. On the basis of these results, a number of gastric secretory criteria are proposed, including some for the first time, and alterations in methodology are proposed that should prove useful in the diagnosis of ZES.
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Affiliation(s)
- P K Roy
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 10, Rm. 9C-103, 10 Center Drive, MSC 1804, Bethesda, MD 20892-1804, USA
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Roy PK, Venzon DJ, Shojamanesh H, Abou-Saif A, Peghini P, Doppman JL, Gibril F, Jensen RT. Zollinger-Ellison syndrome. Clinical presentation in 261 patients. Medicine (Baltimore) 2000; 79:379-411. [PMID: 11144036 DOI: 10.1097/00005792-200011000-00004] [Citation(s) in RCA: 271] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We prospectively evaluated the initial presenting symptoms in 261 patients with Zollinger-Ellison syndrome (ZES) over a 25-year period. Twenty-two percent of the patients had multiple endocrine neoplasia-type 1 (MEN-1) with ZES. Mean age at onset was 41.1 +/- 0.7 years, with MEN-1 patients presenting at a younger age than those with sporadic ZES (p < 0.0001). Three percent of the patients had onset of the disease < age 20 years, and 7% > 60 years. A mean delay to diagnosis of 5.2 +/- 0.4 years occurred in all patients. A shorter duration of symptoms was noted in female patients and in patients with liver metastases. Abdominal pain and diarrhea were the most common symptoms, present in 75% and 73% of patients, respectively. Heartburn and weight loss, which were uncommonly reported in early series, were present in 44% and 17% of patients, respectively. Gastrointestinal bleeding was the initial presentation in a quarter of the patients. Patients rarely presented with only 1 symptom (11%); pain and diarrhea was the most frequent combination, occurring in 55% of patients. An important presenting sign that should suggest ZES is prominent gastric body folds, which were noted on endoscopy in 94% of patients; however, esophageal stricture and duodenal or pyloric scarring, reported in numerous case reports, were noted in only 4%-10%. Patients with MEN-1 presented less frequently with pain and bleeding and more frequently with nephrolithiasis. Comparing the clinical presentation before the introduction of histamine H2-receptor antagonists (pre-1980, n = 36), after the introduction of histamine H2-receptor antagonists (1981-1989, n = 118), and after the introduction of proton pump inhibitors (PPIs) (> 1990, n = 106) demonstrates no change in age of onset; delay in diagnosis; frequency of pain, diarrhea, weight loss; or frequency of complications of severe peptic disease (bleeding, perforations, esophageal strictures, pyloric scarring). Since the introduction of histamine H2-receptor antagonists, fewer patients had a previous history of gastric acid-reducing surgery or total gastrectomy. Only 1 patient evaluated after 1980 had a total gastrectomy, and this was done in 1977. The location of the primary tumor in general had a minimal effect on the clinical presentation, causing no effect on the age at presentation, delay in diagnosis, frequency of nephrolithiasis, or severity of disease (strictures, perforations, peptic ulcers, pyloric scarring). Disease extent had a minimal effect on symptoms, with only bleeding being more frequent in patients with localized disease. Patients with advanced disease presented at a later age and with a shorter disease history (p = 0.001), were less likely to have MEN-1 (p = 0.0087), and tended to have diarrhea more frequently (p = 0.079). A correct diagnosis of ZES was made by the referring physician initially in only 3% of the patients. The most common misdiagnosis made were idiopathic peptic ulcer disease (71%), idiopathic gastroesophageal reflux disease (GERD) (7%), and chronic idiopathic diarrhea (7%). Other less common misdiagnosis were Crohn disease (2%) and various diarrhea diseases (celiac sprue [3%], irritable bowel syndrome [3%], infectious diarrhea [2%], and lactose intolerance [1%]). Other medical disorders were present in 55% of all patients; patients with sporadic disease had fewer other medical disorders than patients with MEN-1 (45% versus 90%, p < 0.00001). Hyperparathyroidism and a previous history of kidney stones were significantly more frequent in patients with MEN-1 than in those with sporadic ZES. Pulmonary disorders and other malignancies were also more common in patients with MEN-1. These results demonstrate that abdominal pain, diarrhea, and heartburn are the most common presenting symptoms in ZES and that heartburn and diarrhea are more common than previously reported. The presence of weight loss especially with abdominal pain, diarrhea, or heartburn is an important clue suggesting the presence of gastrinoma. The presence of prominent gastric body folds, a clinical sign that has not been appreciated, is another important clue to the diagnosis of ZES. Patients with MEN-1 presented at an earlier age; however, in general, the initial symptoms were similar to patients without MEN-1. Gastrinoma extent and location have minimal effects on the clinical presentation. Overall, neither the introduction of successful antisecretory therapy nor widespread publication about ZES, attempting to increase awareness, has shortened the delay in diagnosis or reduced the incidence of patients presenting with peptic complications. The introduction of successful antisecretory therapy, however, has dramatically decreased the rate of surgery in controlling the acid secretion and likely led to patients presenting with less severe symptoms and fewer complications. (ABSTRACT TRUNCATED)
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Affiliation(s)
- P K Roy
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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OSBORNE MP, BROWN ME, LECOMPTE PM. Ulcerogenic non-beta cell pancreatic islet carcinoma. Studies on the extraction and assay of a possible gastric secretagogue. Am J Surg 1998; 100:48-53. [PMID: 14429196 DOI: 10.1016/0002-9610(60)90537-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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WILLIAMS ED, CELESTIN LR. The association of bronchial carcinoid and pluriglandular adenomatosis. Thorax 1998; 17:120-7. [PMID: 14007148 PMCID: PMC1018681 DOI: 10.1136/thx.17.2.120] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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PARKINS RA. Severe watery diarrhoea and potassium depletion associated with an islet-cell tumour of pancreas. BRITISH MEDICAL JOURNAL 1998; 2:356-7. [PMID: 13732873 PMCID: PMC1969266 DOI: 10.1136/bmj.2.5248.356] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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DELEU J, TYTGAT H, VANGOIDSENHOVEN GE. DIARRHEA ASSOCIATED WITH PANCREATIC ISLET-CELL TUMORS. ACTA ACUST UNITED AC 1996; 9:97-108. [PMID: 14116905 DOI: 10.1007/bf02243513] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dollinger HC, Raptis S, Rommel K, Pfeiffer EF. Synthetic human gastrin I and gastrin-like pentapeptide in studies of intestinal absorption in man. Role of gastrin in human intestinal absorption. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1982; 180:223-8. [PMID: 7123008 DOI: 10.1007/bf01852294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The effects of synthetic human gastric I (SHG I) and gastrin-like pentapeptide (PG) on jejunal water, electrolyte, and glucose absorption were studied in 11 normal subjects. The i.v. administration of graded doses of SHG I increased plasma gastrin levels similar to those after food intake and in the Zollinger-Ellison syndrome. SHG I and PG caused no significant changes in the net movement of water and solute. The findings indicate that gastrin has no direct effect on intestinal absorption in normal man, and does not account for the mechanism of diarrhea in the Zollinger-Ellison syndrome.
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Grimelius L, Hultquist GT, Stenkvist B. Cytological differentiation of asymptomatic pancreatic islet cell tumours in autopsy material. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1975; 365:275-88. [PMID: 46649 DOI: 10.1007/bf00471177] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In eleven cases thirteen pancreatic islet cell adenomas were found in autopsy material from 1366 adult cases. Ten of the adenomas were solitary, while 3 small adenomas were observed in a single case. Another four possible solitary adenomas were observed, but their identity was uncertain owing to marked fibrosis. All the adenomas contained A-2 (A)-1 cells but no B (B)-1 cells. Nine of them also contained A-1 (D)-1 cells. The majority of cells in the adenomas were A-2 cells or cells which did not stain with any of the techniques used. The 4 possible adenomas contained islet cells (A-1, A-2, B) in different proportions. With one exception the patients with adenomas and possible adenomas were 65 years of age or older, and in some of these cases adenomas or hyperplasias were also found in other endocrine organs. The frequency of gastroduodenal ulcers or scars in the cases with adenoma or possible adenoma did not differ notably from that found in the cases without pancreatic adenomas. Among the cases with pancreatic adenoma and possible adenoma there were 3 patients with maturity onset diabetes mellitus, but otherwise no clinical symptoms of endocrine disturbances were noted.
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Doolas A. Steps in the diagnosis of three functioning endocrine tumors. Surg Clin North Am 1971; 51:195-210. [PMID: 4325108 DOI: 10.1016/s0039-6109(16)39341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Schulte WJ, Hensley G, Garancis JC, Wilson SD, Ellison EH. Zollinger-Ellison syndrome. Clinical and histopathologic manifestations. Am J Surg 1969; 117:866-75. [PMID: 4307522 DOI: 10.1016/0002-9610(69)90076-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
Because of the important part played by the intestine in maintaining the constancy of the internal environment, any disturbance in the orderly sequence of secretion and reabsorption of water and electrolytes can quickly lead to severe fluid depletion. Malabsorption of water and electrolytes may occur in diseases of the intestinal mucosa or following massive resection of bowel or as a result of disordered intestinal motility. The handling of fluids by the bowel may be altered by the action of hormones or of bacterial toxins, or in the presence of neoplasms. Electrolyte disorders may result from the introduction of abnormal solutions into the intestinal lumen.Management of the clinical problems requires a clear understanding of the abnormal mechanisms and urgent attention to the re-institution of water and salt balance, restoration of acid-base status and replacement of lost potassium.
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Cook HB, French AB. Physiologic responses to gastric acid hypersecretion in Zollinger-Ellison syndrome. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1968; 13:191-203. [PMID: 5644088 DOI: 10.1007/bf02236593] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Jesseph JE, Moore FT, Endahl G, Passi RB. Peptic ulceration and enteritis. A differential diagnosis. Am J Surg 1967; 113:188-93. [PMID: 6016717 DOI: 10.1016/0002-9610(67)90220-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Gardner JD, Peskin GW, Cerda JJ, Brooks FP. Alterations of in vitro fluid and electrolyte absorption by gastrointestinal hormones. Am J Surg 1967; 113:57-64. [PMID: 6016708 DOI: 10.1016/0002-9610(67)90257-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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OGLESBY JW, MULL JD, HUMPHRIES AL, BRACKNEY EL. Zollinger-Ellison syndrome in a nine year old boy. Am J Surg 1964; 108:412-5. [PMID: 14215126 DOI: 10.1016/0002-9610(64)90362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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DEJODE LR, HOWARD JM, YAMULLA S, KOIWAI EK. RECURRENT PEPTIC ULCERATION AND GASTRIC HYPERSECRETION ASSOCIATED WITH ISLET-CELL HYPERPLASIA OF THE PANCREAS. Br J Surg 1963; 50:790-2. [PMID: 14068622 DOI: 10.1002/bjs.18005022604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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ROSENSTEIN BJ, ENGELMAN K. DIARRHEA IN A CHILD WITH A CATECHOLAMINE-SECRETING GANGLIONEUROMA. CASE REPORT AND REVIEW OF THE LITERATUTE. J Pediatr 1963; 63:217-26. [PMID: 14043063 DOI: 10.1016/s0022-3476(63)80332-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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KLUG TJ, ZOLLINGER RM, ELLENSOHN J. A long-term evaluation of two conservative surgical procedures for duodenal ulcer. Am J Surg 1963; 105:370-4. [PMID: 14033684 DOI: 10.1016/0002-9610(63)90350-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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SHAY H, CHEY WY, KOIDE SM, BURNETT WE. Mechanism of the disordered physiology involved in the Zollinger-Ellison syndrome. ACTA ACUST UNITED AC 1962; 7:401-19. [PMID: 13911482 DOI: 10.1007/bf02232360] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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MORRISON AB, RAWSON AJ, FITTS WT. The syndrome of refractory watery diarrhea and hypokalemia in patients with a non-insulin-secreting islet cell tumor. A further case study and review of the literature. Am J Med 1962; 32:119-27. [PMID: 14476287 DOI: 10.1016/0002-9343(62)90188-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This paper reports the association between severe, prolonged, watery diarrhoea and islet cell tumours of the pancreas. There appear to be significant differences between patients with these symptoms and those with the classical Zollinger-Ellison syndrome.
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Jeckeln E. Die Pathologie der Verdauung und Resorption. HANDBUCH DER ALLGEMEINEN PATHOLOGIE 1961. [DOI: 10.1007/978-3-642-94824-4_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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RAWSON AB, ENGLAND MT, GILLAM GG, FRENCH JM, STAMMERS FA. Zollinger-Ellison syndrome with diarrhoea and malabsorption. Observations on a patient before and after pancreatic islet-cell tumour removal with-out resort. Lancet 1960; 2:131-4. [PMID: 14436604 DOI: 10.1016/s0140-6736(60)91271-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The case history of a 40-year-old woman with a fatal haemorrhage from a duodenal ulcer, jejunitis, renal lithiasis, hypertrophy of the adrenal glands, multiple adenomas of the pancreas, and three adenomas of both the parathyroid and pituitary glands is reported. Though there was histological evidence, in the bones, of hyperparathyroidism, the serum levels of calcium, phosphorus, and phosphatase and the urinary excretion of calcium were normal. The significance of low calcium and high phosphorus excretion in the urine as an indication of parathyroid disorder is discussed."Multiple endocrine adenoma syndrome" is suggested as the appropriate designation for the clinical disorders in which adenomas of one or more endocrine glands are associated with disorders of the alimentary tract when patients present with recurrent peptic ulceration, pancreatic dysfunction, or watery diarrhoea.
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KNIGHT W. Pancreatic component of peptic ulcer disease. Dig Dis Sci 1959; 4:910-20. [PMID: 14410131 DOI: 10.1007/bf02235686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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WADDELL WR, LEONSINS AJ, ZUIDEMA GD. Gastric secretory and other laboratory studies on two patients with Zollinger-Ellison syndrome. N Engl J Med 1959; 260:56-62. [PMID: 13613502 DOI: 10.1056/nejm195901082600202] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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