Mechanism of the disordered physiology involved in the Zollinger-Ellison syndrome
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A detailed study of the altered gastrointestinal physiology and findings at autopsy in a patient with Zollinger-Ellison syndrome is presented. The results warrant certain considerations with regard to mechanisms involved in the altered physiology.
The importance of the discovery by Gregoryet al. of a gastrinlike substance in the pancreatic tumor of such a patient is obvious in relation to the excessive gastric secretion which was first emphasized in this syndrome. Our results indicate that undue vagal activity may also play a role, in some cases at least.
Data are presented which indicate that the parietal cell mass in some of these patients may be maximally or nearly maximally stimulated at all times.
A rather remarkable effect of adequate anticholinergic and ulcer therapy on the control of the gastric secretion, diarrhea, and ulcer healing is recorded.
It is our belief that the characteristic features of this disease, the fulminant peptic ulcer diathesis, the watery diarrhea with or without excessive potassium loss, and steatorrhea can all be related to the inordinate increase of gastric secretion; that the non-B cell tumor or islet hyperplasia must be very important in the gastric hypersecretion; and that vagal activity can also exert an important influence on this secretion (demonstrated in the case reported above).
Finally, the nonfunctioning parathyroid adenoma found microscopically was of no importance in the patients clinical picture.
KeywordsAdenoma Gastric Secretion Parathyroid Adenoma Ulcer Healing Watery Diarrhea
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- 2.Sun, David, C. H., andShay, H. Optimal effective dose of anticholinergic drug in peptic ulcer therapy.A.M.A. Arch. Int. Med. 97:442, 1956.Google Scholar
- 3.Marks, I. N., andShay, H. Augmented histamine test, Ewald test meal and Diagnex test.Am. J. Dig. Dis. (New Series) 5:1, 1960.Google Scholar
- 4.Shay, H., andSun, David C. H. Stress and Gastric secretion in man. I. A study of the mechanism involved in insulin hypoglycemia.Am. J. Med. Sci. 228:6, 1954.Google Scholar
- 6.Shay, H., Sun, David C. H., Chey, W. Y., andO'Leary, D. K. Practical pancreatic function profile for the diagnosis of chronic pancreatic disease.Am. J. Dig. Dis. (New Series) 6:142, 1961.Google Scholar
- 8.Maximov, A. A., andBloom, W.A Textbook of Histology (ed. 5), p. 449, Philadelphia, Saunders, 1948.Google Scholar
- 9.Gregory, R. A., Tracy, H. J., French, I. M., andSircus, W. Extraction of a gastrin-like substance from a pancreatic tumor in a case of Zollinger-Ellison syndrome.Lancet 1:644, 1956.Google Scholar
- 10.Gregory, R. A., andTracy, H. J. The preparation and properties of gastrin.J. Physiol. 149:70, 1959.Google Scholar
- 11.Hallenbeck, G. A., Code, C. F., andKennedy, J. C. “Gastrin” of Pancreatic Origin. Sixty-second Annual Meeting of the American Gastroenterological Association. Chicago, May 27, 1961.Google Scholar
- 14.Elman, R., andHartmann, A. F. Spontaneous peptic ulcers of duodenum after continued loss of total pancreatic juice.A. M. A. Arch. Surg. 23: 1030, 1930.Google Scholar
- 15.Dragstedt, L. R., Clark, D. F., andVermeulen, C. Significance of lipocaic in surgery.Ann. Surg. 110:907, 1939.Google Scholar
- 16.Cox, A. J., andBarnes, V. R. Experimental hyperplasia of the stomach mucosa.Proc. Soc. Exp. Biol. & Med. 60:118, 1945.Google Scholar
- 17.Meyers, W. C. A study of gastric mucosa in various diseases affecting the upper part of the gastro-intestinal tract.Gastroenterology 10:923, 1948.Google Scholar
- 25.Shay, H. Etiology of peptic ulcer.Am. J. Dig. Dis. (New Series 6:29, 1961.Google Scholar
- 26.Shay, H. The pathologic physiology of gastric and duodenal ulcer.Bull. N. Y. Acad. Med. 20: 264, 1944 (2nd Series).Google Scholar
- 27.Brown, C. H., Neville, W. E., andHazard, J. B. Islet-cell adenoma, without hypoglycemia, causing duodenal obstruction.Surgery 27:616, 1950.Google Scholar
- 29.Borgström, B., Dahlqvist, G. L., andSjövall, J. Studies of intestinal digestion and absorption in the huma.J. Clin. Invest. 6:1521, 1957.Google Scholar
- 30.Isselbacher, Kurt J. Discussion Panel—Newer Concepts of gastrointestinal absorption. Fats. Sixty-second Annual Meeting American Gastrointestinal Association. May 26, 1961, Chicago, Illinois.Google Scholar
- 31.Chey, W. Y., Shay, H., andO'Luary, D. K. Role of pancreas in the intestinal absorption of fat in man. To be reported.Google Scholar
- 32.Rawson, A. B., England, M. T., Gillam, G. G., French, J. M., andStammers, F. A. R. Zollinger-Ellison Syndrome with diarrhea and malabsorption.Lancet 1:131, 1960.Google Scholar
- 34.Warren, S., andJoslin, F. P. Pathology of Diabetes Mellitus. p. 25. Philadelphia, Lea and Febigar, 1938.Google Scholar
- 35.Bensley, R. R. Structure and relationships of the Islets of Langerhans.Harvey Lect. 10:250, 1914–15.Google Scholar
- 36.Barbosa, J. J., Dockerty, M. B., andWaugh, J. M. Pancreatic heterotopia.Surg. Gynec. & Obstet. 82:527, 1946.Google Scholar