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Topic: Gastrinoma

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	eMedicine - Gastrinoma : Article Excerpt by: Senthil Nachimuthu, MD
		Nearly 90% of gastrinomas arise within the triangle surrounded by the porta hepatis, the neck of the pancreas, and the third portion of the duodenum.
		The triad of nonbeta islet cell tumors of the pancreas (gastrinomas), hypergastrinemia, and severe ulcer disease was described by Zollinger and Ellison in 1955, hence the eponym Zollinger-Ellison syndrome (ZES).
		The primary determinants of survival for patients with gastrinomas are the size of the primary tumor and the occurrence of tumor metastasis.
	www.emedicine.com /med/byname/gastrinoma.htm (406 words)

	Endotext.com - Diffuse Hormonal Systems and Endocrine Tumor Syndromes, Gastrinomas
		Sporadic gastrinomas occur primarily in the gastrinoma triangle, defined as the confluence of the cystic and common bile duct superiorly, the second and third portions of the duodenum inferiorly, and the neck and body of the pancreas medially.
		Passaro and colleagues suggest that sporadic gastrinomas originating in the gastrinoma triangle, including those in the duodenal wall and lymph nodes, are of ventral pancreatic bud stem cell origin (1).
		In a study of 151 patients by Norton and colleagues, in patients with sporadic gastrinoma the 10 year disease free survival was 34%, and the disease specific survival was 95% (9).
	www.endotext.org /guthormones/guthormone3/guthormone3.htm (2886 words)

	Gastrinoma \| Blueprint for Health (Site not responding. Last check: 2007-09-07)
		Sometimes, gastrinomas are found only in the lymph nodes, and it is uncertain whether these malignancies have originated in the lymph nodes or have metastasized from a tumor not visible in the pancreas or duodenum.
		Gastrinomas are usually diagnosed by a blood test that measures the level of gastrin in the blood.
		In fact, the life expectancy of patients with gastrinomas that have spread to the lymph nodes is no different from that of patients with gastrinomas that cannot even be found at surgery for about 90%, five years after diagnosis.
	blueprint.bluecrossmn.com /topic/gastrinoma (1487 words)

	Cancer Control Journal:Gastrinoma: State of the Art (Site not responding. Last check: 2007-09-07)
		Gastrinoma was first recognized as a disease entity, the Zollinger-Ellison syndrome (ZES), in 1955.[1] Initial management of this syndrome was historically directed at the end organ (the stomach) and necessitated total gastrectomy.
		In essence, a gastrinoma should be suspected if a patient presents with unusual symptoms, such as a peptic ulcer and diarrhea, familial ulcer disease, recurrent ulcer, ulcers of the distal duodenum or jejunum, ulcer disease in conjunction with hypercalcemia, or an ulcer that fails to heal on conventional doses of an H
		Gastrinomas in patients with MEN 1 are thought to be multiple occurring throughout the pancreas.
	www.moffitt.usf.edu /pubs/ccj/v4n1/article4.html (2487 words)

	JHBMC: Gastrinoma (Site not responding. Last check: 2007-09-07)
		Gastrinoma is a tumor found usually in the pancreas or the small intestine and often occurs with ulcers.
		Current treatments for gastrinoma are not very effective, leaving the patient with a poor prognosis.
		Results of this study suggest octreotide should be the treatment of choice for patients with malignant gastrinoma.
	www.jhbmc.jhu.edu /healthcarenews02/02020503.html (262 words)

	Archives of Pathology & Laboratory Medicine: Primary nodal gastrinomas: An immunohistochemical study in support of ... (Site not responding. Last check: 2007-09-07)
		The term gastrinoma triangle was coined to identify the area; in addition, it was postulated that lymph nodes located in the gastrinoma triangle normally contained neuroendocrine cells capable of secreting gastrin and other neuropeptides.
		Gastrinomas result in the medically challenging management of gastric and duodenal ulcers, the socalled Zollinger-Ellison syndrome.1-3 Many of these tumors have severe clinical implications before they reach a size detectable by conventional ultrasound.
		Gastrinoma triangles were retrieved and lymph nodes were obtained by careful manual dissection of the triangle within 8 hours of autopsy.
	www.findarticles.com /p/articles/mi_qa3725/is_200006/ai_n8897166 (1124 words)

	Gastrinoma
		Although rare, gastrinoma is usually considered as the second most common of the pancreatic islet cell tumours, but recently some investigators have suggested that it may be more common than insulinoma.
		Gastrinomas have most often been reported as originating in the pancreas but there is increasing evidence that they also arise commonly in the wall of the duodenum.
		Gastrinomas vary widely in size, but are usually small, ranging from 0.120 cm in diameter.
	www.amershamhealth.com /medcyclopaedia/medical/Volume%2520IV%25201/GASTRINOMA.ASP (527 words)

	ZOLLINGER-ELLISON SYNDROME
		In Zollinger-Ellison syndrome there is usually more than one gastrinoma, and typically it is located in the pancreas, but can also be found in the first part of the small intestine called the duodenum.
		Gastrinomas are small in size and difficult to localize without exploratory surgery.
		Zollinger-Ellison gastrinomas are often malignant, with a tendency to spread to the surrounding lymph nodes and to the liver.
	www.apma-nc.com /PatientEducation/zollinger.htm (645 words)

	Gastrinoma
		Gastrinomas are rare endocrine tumors and commonly present with severe recurrent peptic ulcer disease.
		More than 60% of gastrinomas are cancerous and the tumor eventually spreads to the liver and other parts of the body.
		A diagnosis of a gastrinoma should be considered in a patient with peptic ulcers that recur frequently and are resistant to treatment.
	www.surgery.usc.edu /divisions/tumor/PancreasDiseases/web%20pages/Endocrine%20tumors/pancreatic%20tumors/gastrinoma.html (527 words)

	p132 : Gastrinoma without peptic Ulcer in MEN-1 with ECL Cell Tumor (Site not responding. Last check: 2007-09-07)
		Gastrinoma occurs sporadically or as a feature of multiple endocrine neoplasia Type 1 (MEN-1).
		Case 1 is a 43 year old women with hyperparathyroidism, ectopic GHRH production in the pancreas, and a duodenal gastrinoma with hepatic metastases.
		In summary, we describe 2 cases of gastrinomas with no evidence of peptic ulcer disease despite excessively high gastrin levels.
	www.thieme.de /abstracts/eced/abstracts2002/daten/p132.html (282 words)

	Gastrinoma Staging Appears Effective: Presented at ACS (Site not responding. Last check: 2007-09-07)
		Gastrinoma tumors secrete large quantities of gastrin, a hormone that triggers gastric acid production which leads to ulcer formation.
		Ellison and colleagues studied 50 years of retrospective gastrinoma data at their institution in response to current controversies about staging and the long-term results of surgical removal of the tumors in patients with either non-familial (sporadic) and multiple endocrine neoplasia type 1 (MEN-1).
		Gastrinoma tumor stage was highly predictive of R-2 resection, meaning patients with higher grade disease were more likely to have macroscopic evidence of residual tumor after surgery.
	www.pslgroup.com /dg/254002.htm (499 words)

	Primary extrapancreatic gastrinoma. Pai PR, Shahani RB, Shah HK, Dalvi AN, Samsi AB, Vora IM J Postgrad Med
		The gastrinoma or Zollinger-Ellison syndrome is one of the fulminant clinical presentations of peptic ulcer disease caused by gastric hyperacidity and gastrin producing islet cell tumour.
		A gastrinoma is typically suspected in a young with symptoms of fulminant complications of peptic ulcer disease or those with poor response to therapy.
		Incidence of gastrinoma is reported to by anywhere between 1 in 200 to 1 in 1000 cases of duodenal ulcer disease [1].
	www.jpgmonline.com /article.asp?issn=0022-3859;year=1992;volume=38;issue=4;spage=210;epage=1,207;aulast=Pai (1007 words)

	SecreFlo(TM): Indications: Gastrinoma
		A Gastrinoma is a tumor that is typically found in the pancreas and duodenum and is the hallmark of a relatively rare gastrointestinal disorder known as Zollinger-Ellison Syndrome (ZES).
		The definitive diagnosis of a gastrinoma is sometimes difficult due to the similarities in symptoms with peptic ulcer disease including burning pain in the abdomen, diarrhea, nausea, vomiting, fatigue, weakness and weight loss.
		Gastrinoma is strongly suspected in patients who show an increase in serum gastrin concentration of more than 110 pg per ml over basal gastrin levels on any post injection samples.
	www.secreflo.com /indications/gastrinoma.html (335 words)

	An unusual cause of watery diarrhoea -- 76 (898): 515 -- Postgraduate Medical Journal
		Gastrinoma should be confirmed by measurement of the fasting gastrin concentration.
		with a gastric pH of <2.5 is diagnostic of gastrinoma.
		Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy.
	pmj.bmjjournals.com /cgi/content/full/76/898/515b (1000 words)

	Gastrin, Serum
		If gastrinoma is likely but fasting gastrin level is not diagnostic, the secretin test is the provocative test of choice.
		Gastrinoma are malignant in 62% of cases, and 44% of patients have metastases.
		Gastrinomas are usually found in the pancreas but they may be primary in the duodenum.
	www.labcorp.com /datasets/labcorp/html/chapter/mono/sr002100.htm (1018 words)

	Endocrine Surgeon
		Gastrin, produced by G cells in the antrum of the stomach, stimulates the parietal cells in the corpus of the stomach to produce acid.
		The cells of the gastrinoma no longer respond to this negative feedback and a huge excess of acid is produced due to the production of large amounts of gastrin.
		This is bound by the junction between the cystic duct and the common bile duct, the junction between the second and third parts of the duodenum and the junction between the head and neck of pancreas.
	www.endocrinesurgeon.co.uk /pancreas/pancreas5.html (231 words)

	MUSC Digestive Disease Center - Case Studies
		DP is a 49-year-old female referred to MUSC for evaluation and treatment of a presumed gastrinoma.
		Gastrinoma is a neuroendocrine tumor that secretes gastrin, resulting in hypergastrinemia and gastric acid hypersecretion.
		Although lymph node metastases are present in approximately 50% of patients, a recent series from the NIH confirms that surgical exploration is associated with biochemical cure in 60% of patients, and is associated with a statistically significant decrease in the rate of development of hepatic metastases (Norton et al., 1999).
	www.ddc.musc.edu /ddc_pro/pro_development/case_studies/case028.htm (471 words)

	GASTRINOMA
		It is usually located in the pancreas but is also found at other sites, as in the antrum of the stomach, hilus of the spleen, and regional lymph nodes.
		The presence of gastrinoma is one of three requirements to be met for identification of Zollinger-Ellison syndrome, which sometimes occurs in families with multiple endocrine neoplasia type 1 (MEN-1).
		Gastrinomas in patients with MEN-1 are usually diffuse in nature.
	www.websters-online-dictionary.org /Ga/Gastrinoma.html (412 words)

	Diagnosis of a gastrinoma in patients on proton pump inhibitor therapy
		Gastrinomas are a rare cause of dyspepsia diagnosed on the basis of a raised fasting gastrin measurement.
		In patients in whom a gastrinoma is confirmed the risks of gastrointestinal perforation when stopping antisecretory medication in order to measure fasting gastrin levels is high.
		Patients with a gastrinoma on PPI therapy had a significantly higher fasting plasma gastrin concentration (mean plus/minus SEM, 298 plus/minus 35pmol/l) than patients without a gastrinoma on PPI therapy but there was an overlap between these two groups.
	www.endocrine-abstracts.org /ea/0008/ea0008p45.htm (331 words)

	Gastrinoma - PetPlace.com (Site not responding. Last check: 2007-09-07)
		Gastrinoma is a malignant tumor of the pancreas that secretes a hormone called gastrin that stimulates acid secretion in the stomach and in turn causes gastrointestinal ulceration.
		In human medicine gastrinomas are referred to as the Zollinger-Ellison syndrome.
		Treatment of gastrinoma patients should be directed at surgical excision of the tumor and control of excess gastric acid secretion.
	petplace.netscape.com /articles/artShow.asp?artID=4686 (483 words)

	Gastrinoma in vitro: morphological and physiological studies of primary cell cultures.
		Gastrinoma in vitro: morphological and physiological studies of primary cell cultures.
		Gastrinoma in vitro: morphological and physiological studies of primary cell cultures.Cultures exhibited limited growth but viability remained high for 2-3 wk.
		Primary cultures of gastrin-containing tumor cells free from stromal contamination offer unique advantages for studies of factors that regulate the synthesis and secretion of gastrin and may prove of potential value for studies on cell differentiation and growth.
	www.pdg.cnb.uam.es /UniPub/iHOP/gp/6569337.html (260 words)

	Clinical Trial: Interferon and Octreotide to Treat Zollinger-Ellison Syndrome and Advanced Non-B Islet Cell Cancer
		Gastrinoma is a tumor produced by the pancreas that secretes the hormone gastrin, which in turn stimulates production of gastric juices that cause ulcers.
		In studies of patients with tumors similar to gastrinoma, the drugs octreotide and interferon-a, alone or in combination, showed some effect in stopping tumor growth and were better tolerated than chemotherapy.
		Patients with metastatic gastrinoma that is not surgically resectable and that has increased in size over a 4-6 month period prior to the study will be treated with interferon-alpha, either alone or with the long-acting somatostatin analogue, octreotide.
	clinicaltrials.gov /ct/show/NCT00001228?order=1 (832 words)

	UpToDate Clinical manifestations and diagnosis of Zollinger-Ellison syndrome (gastrinoma)
		Furthermore, the diagnosis is often established before development of the complications of peptic ulcer disease or spread of a malignant gastrinoma, and therapy that alters the course of the disease is almost always possible [2].
		Gastrinomas can be either sporadic or associated with multiple endocrine neoplasia type 1.
		Approximately 80 percent of patients have the sporadic form [5], although somatic (acquired) mutations in the MEN1 gene are observed in occasional sporadic gastrinomas (show table 1) [6].
	patients.uptodate.com /topic.asp?file=gi_dis/4746 (539 words)

	Dr. Koop - Zollinger-Ellison Syndrome (Site not responding. Last check: 2007-09-07)
		Zollinger-Ellison syndrome is caused by tumors usually found in the head of the pancreas and the upper small bowel.
		Gastrinomas occur as single tumors or as small, multiple tumors.
		About one-half to two-thirds of single gastrinomas are malignant tumors that commonly spread to the liver and nearby lymph nodes.
	www.drkoop.com /ency/article/000325.htm (340 words)

	Genesis Health System - Detailed Disease Info - Gastrinoma (Site not responding. Last check: 2007-09-07)
		Patients with gastrinomas often have gastrin levels more than 200 pg/mL, which is 4–10 times higher than normal.
		A study by the National Institutes of Health (NIH) found this test to be superior to other imaging methods, such as computed tomography scan (CT) or magnetic resonance imaging (MRI), in pinpointing the location of tumors and guiding physicians in treatment.
		Survival five years after diagnosis is 20–30%, however patients with gastrinomas found only in the lymph nodes have been known to live as long as 25 years after diagnosis, without evidence of further tumor spread.
	www.genesishealth.com /micromedex/detaileddisease/00049110.aspx (1335 words)

	News - Proton Pump Inhibitors Mask Diagnosis Of Gastrinoma
		As a result, patients with gastrinoma - thought to account for 0.1-1.0 percent of peptic ulcers - will not be diagnosed until their disease is more advanced.
		The numbers of referrals and new patients with gastrinoma diagnosed before the widespread use of proton pump inhibitors (1986-1992) were compared with the numbers since (1993-1998).
		Analysis also disclosed a 2.6-fold increase in the post-proton pump inhibitor period in the percentage of referrals with a false diagnosis of gastrinoma as the cause of hypergastrinaemia.
	www.docguide.com /news/content.nsf/news/8525697700573E1885256B22004CF9EA (560 words)

	Identical Clonality of Sporadic Gastrinomas at Multiple Sites -- Goebel et al. 60 (1): 60 -- Cancer Research
		Forty-four to 93% of sporadic gastrinomas have LOH
		gastrinoma, in one lymph node gastrinoma (patient 7), and in
		Gastrinomas occur sporadically (75%) and as a manifestation
	cancerres.aacrjournals.org /cgi/content/full/60/1/60 (2869 words)

	Pancreatic Tumors That Are Noncancerous: Tumors of the Digestive System: Merck Manual Home Edition
		A gastrinoma is a tumor usually in the pancreas or duodenum (the first segment of the small intestine) that produces excessive levels of the hormone gastrin, which stimulates the stomach to secrete acid and enzymes, causing peptic ulcers.
		Sometimes a gastrinoma occurs as part of multiple endocrine neoplasia, a hereditary disorder in which tumors arise from the cells of various endocrine glands, such as the insulinSome Trade Names
		A doctor suspects a gastrinoma when a person has frequent peptic ulcers or several peptic ulcers that do not respond to the usual ulcer treatments.
	www.merck.com /mmhe/sec09/ch131/ch131l.html (972 words)

	Zollinger Ellison Syndrome
		In most cases, gastrinomas arise within the wall of the duodenum or within the pancreas.
		Approximately half to two-thirds of the gastrinomas associated with ZES may be malignant.
		Evidence suggests that complete and curative removal of gastrinoma is possible in approximately 20 to 30 percent of individuals with ZES.
	hw.healthdialog.com /kbase/nord/nord360.htm (2262 words)

	BioMed Central \| Abstract \| Gastrinoma (Site not responding. Last check: 2007-09-07)
		Gastrinoma treatment has evolved considerably in the last 20 years.
		There is, however, some controversy as to the surgical approach for gastrinoma found in the setting of multiple endocrine neoplasia, type 1.
		Because of the usual multiplicity and particular indolence of these tumors, two primary strategies have emerged: aggressive approaches have been advocated in an effort to eradicate all present and potential tumor; and less aggressive, or nonoperative, approaches have been suggested because it is unclear whether intervention offers survival or disease-free benefit in this population.
	www.biomedcentral.com /1527-2729/2/337/abstract (301 words)

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