Lenhart Adrienne, Hassan Mona, Meighani Alireza, Sadiq Omar, Siddiqui Yousuf
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI 48202, USA.
Case Rep Gastrointest Med. 2017;2017:7636952. doi: 10.1155/2017/7636952. Epub 2017 Feb 21.
Zollinger-Ellison syndrome (ZES) is a rare clinical disorder, characterized by hypersecretion of gastric acid and multiple ulcers distal to the duodenal bulb. This occurs via the release of gastrin by neuroendocrine tumors known as gastrinomas. Patients with ZES present with nonspecific GI symptoms, which often leads to a delay in diagnosis. Our patient is a 55-year-old female with chronic abdominal pain, nausea, and diarrhea. She underwent EGD, EUS, MRCP, CT scans, and cholecystectomy, which did not reveal the cause of her symptoms. Repeat EGD showed a cratered ulcer in the second portion of the duodenum, suspicious for ZES. Serum gastrin was initially only moderately elevated while on PPI therapy, but chromogranin A was also elevated. Repeat gastrin level after stopping PPI therapy was 1639 pg/mL. Somatostatin receptor scintigraphy was obtained, which showed two small lesions in the gastrinoma triangle. She subsequently underwent a Whipple pancreaticoduodenectomy and pathology was positive for four microscopic foci of a neuroendocrine tumor. She reported improvement in her symptoms after surgery. This case highlights the need for increased awareness of ZES in patients with unexplained GI complaints and emphasizes the use of multiple modalities in the diagnosis of ZES.
佐林格 - 埃利森综合征（ZES）是一种罕见的临床疾病，其特征为胃酸分泌过多以及十二指肠球部远端出现多发溃疡。这是通过被称为胃泌素瘤的神经内分泌肿瘤释放胃泌素而发生的。ZES患者表现出非特异性胃肠道症状，这常常导致诊断延迟。我们的患者是一名55岁女性，有慢性腹痛、恶心和腹泻症状。她接受了上消化道内镜检查（EGD）、内镜超声检查（EUS）、磁共振胰胆管造影（MRCP）、CT扫描以及胆囊切除术，但这些检查均未揭示其症状的病因。重复进行的EGD显示十二指肠第二部有一个火山口样溃疡，怀疑为ZES。在接受质子泵抑制剂（PPI）治疗时，血清胃泌素最初仅中度升高，但嗜铬粒蛋白A也升高。停用PPI治疗后的重复胃泌素水平为1639 pg/mL。进行了生长抑素受体闪烁显像，结果显示在胃泌素瘤三角区有两个小病灶。她随后接受了惠普尔胰十二指肠切除术，病理检查显示神经内分泌肿瘤有四个微小病灶呈阳性。她报告术后症状有所改善。该病例强调了对于有不明原因胃肠道症状的患者提高对ZES认识的必要性，并强调了在ZES诊断中使用多种检查方法的重要性。
