Gastrinoma: Symptoms, Diagnosis, Treatment, and Complications
Gastrinoma is an active, neuroendocrine neoplasm that occurs once in 1 million cases and, unlike other types of neuroendocrine neoplasms, is malignant.Often leads to the development of ulcers due to the synthesis of gastrin - a hormone that stimulates the production of hydrochloric acid in excess.Table of Contents: General Information Causes Symptoms of gastrinoma Diagnosis Treatment Forecast
Gastrinoma, or Zollinger-Elisson syndrome( named after scientists who described the pathology in 1955 for the first time), most often develops inPancreas or duodenum.At the time of diagnosis, as a rule, reaches 2 cm in diameter and more.By this time, the patient experiences the negative effects of increased gastrin secretion on himself, suffering from recurrent ulcers of the skinny and duodenal ulcer.
Please note! Men are at risk, as in 60% of cases gastrinoma is detected in them.90% of all diagnoses are accompanied by the detection of metastases.
Rarely, the tumor can be found in the biliary system, spleen, peritoneum, in lymph nodes, omentum, ovaries.
A typical tumor is a solitary knot or multiple neoplasms without a clear capsule of a yellowish or gray color.
Due to the fact that gastrinoma often occurs due to the development of the syndrome of multiple endocrine neoplasias, one of the main reasons for its development, doctors call the heredity of .It appears in people prone to the formation of various tumors in the glands of internal secretion.
Symptoms of gastrinoma
Your doctor may suspect that you have gastrinoma if a patient has a severe ulcer disease that is difficult to treat.In this case, numerous ulcers constantly recur and are detected not only in the stomach or duodenum, but also in the jejunum.The situation is aggravated by the possibility of perforation of the ulcer, which increases the risk of developing gastrointestinal bleeding, sometimes resulting in a fatal outcome.
For the presence of ulcers indicate:
- stomach pain resembling "hungry", which occurs due to a long break in eating, and then disappears after it enters the body;
- nausea, vomiting;
- burping acid, heartburn.
Important! Often the disease is accompanied by the appearance of esophagitis - an ailment characterized by inflammation of the mucosa of the esophagus.In rare cases, as a result of this, narrowing of the esophagus is possible.
Other symptoms of gastrinoma:
- Diarrhea - begins due to the ingestion of a large amount of hydrochloric acid in the intestines and irritation of its walls.This strengthens his motor skills and worsens the processes of absorption of nutrients from food.The stool with diarrhea is watery, plentiful with a high fat content.
- Rapid weight loss.It occurs not only as a result of severe diarrhea, but also because of metastases to the liver or other organs that are observed with gastrinoma.
- Increase in the size of the pancreas, which is felt by probing the area of its localization.
- Sometimes, stenosis is a pathological condition in which the narrowing of blood vessels is diagnosed.
First of all, the doctor collects an anamnesis.It can be cautious of numerous recurrent ulcers, which are not amenable to antiulcer therapy.In combination with abundant diarrhea, they indicate the presence of gastrinoma.
You can confirm the assumption by:
- General examination of the skin, palpation of the abdomen.
- Carrying out a radiography of the stomach and esophagogastroduodenoscopy, or EGDS.The latter is one of the methods of sensing, in which the doctor examines the esophagus with the help of a microcamera.In the case of gastrinoma, he will certainly detect lesions with giant sizing( more than 2 cm), which are too low, and hypertrophy of the mucosal folds.
- The administration of calcium or secretin intravenously, carrying out functional tests, with meat broth, for example.They allow to exclude the development of peptic ulcer, gastritis.
- Perform a fasting blood test to determine the level of gastrin in it.In the presence of a malignant tumor, it rises with & lt;60 pg / ml to 300 pg / ml and more.
- Study of gastric juice obtained by probing.In the case of the appearance of gastrinoma, an increased content of hydrochloric acid is found in it.
- ultrasound of the pancreas, abdominal cavity, as well as computed tomography and MRI.These methods of investigation allow to reveal the place of localization of the neoplasm focus.
- Carrying out abdominal angiography, which helps not only to see gastrinoma, but also to take blood for analysis from pancreatic veins.If the diagnosis is confirmed, it will show an increased content of gastrin.
- Performing a blood test for hormones - of interest are prolactin, cortisol, insulin.
- Computer tomography and MRI of the brain, radiography of the Turkish saddle.The last two measures allow to exclude or confirm the presence of the first type of MEN( multiple endocrine neoplasia).
The main task of diagnostics is to differentiate gastrinoma with ulcer, celiac disease, neoplasms in the small intestine, thyroid cancer, in which severe diarrhea is also observed.
Treatment of gastrinoma is carried out in several stages :
- measures are taken to reduce the production of hydrochloric acid;
- the tumor is removed;
- in the presence of metastases is carried out chemotherapy.
But about everything in order.
To inhibit the secretion of hydrochloric acid, the patient is prescribed proton pump inhibitors.Also can prescribe antiproliferative drugs, H2-blockers.
The absence of metastases is an occasion for surgical intervention.In this case, a duodenotomy or ultrasonography is performed in order to identify the exact location of the tumor, and then perform its resection.
Important! The event assumes complete cure of the patient only in 20% of cases.
Approximately half of patients use streptozocin in combination with doxorubicin to reduce the size of the tumor, reduce the level of gastrin in the blood. Treatment is performed in specialized departments, meanwhile, in the presence of metastases, complete cure can not be achieved. The metastases themselves are surgically removed along with part of the tissues of the organs in which they are localized.
Complete recovery of patients with gastrinoma can not be achieved in more than 30% of cases.The fatal outcome occurs within 5 years after diagnosis in approximately 40% of patients. High mortality is due not to the development of gastrinoma, but to complications caused by ulcers.
Gastrinoma is a rare but insidious disease, the symptoms of which can easily be confused with the symptoms of peptic ulcer or gastritis, so the patient loses time and the opportunity for a full recovery.Therefore, if the first signs of gastrinoma are found, you should immediately contact a doctor - an endocrinologist or gastroenterologist.
Chumachenko Olga, medical reviewer