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Multiple Endocrine Neoplasm, Type 1Gastrinomas, Pancreatic Neoplasms, Microcarcinoids, the Zollinger-Ellison Syndrome, Lymph Nodes, and Hepatic Metastases
Joseph J. Shepherd, MD;
David R. Challis, FRCPA;
Peter F. Davies, FRACR;
John P. McArdle, FRCPA;
Bin T. Teh, MBBS;
Steven Wilkinson, FRACS
Arch Surg. 1993;128(10):1133-1142.
Abstract
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Objective
We reviewed the age of presentation, malignant potential, and outcome of gastrinomas and pancreatic tumors in patients with multiple endocrine neoplasm, type 1.
Design
Screening of one very large and one smaller, possibly related family on an island, including serum gastrin estimations and, when indicated, pancreatic ultrasound.
Setting and Patients
Over 2000 family members and their family physicians were advised on screening procedures.
Intervention
Data were collected and reviewed retrospectively and prospectively for all medical records, investigations, surgical procedures, and available tissue samples.
Outcome Measurements
Criteria for diagnosis were established for radiological, biochemical, and histological studies.
Results
Sixty-two patients had evidence of gastrinoma or pancreatic neoplasm. In 19 patients the diagnosis was based on demonstration of a tumor. In 21 patients the diagnosis was based on elevated serum gastrin concentration in the absence of demonstrable tumor. None of these patients required gastric surgery if they first underwent parathyroidectomy. In 18 patients the diagnosis was based on the combination of demonstrated pancreatic tumor plus elevated glucagon (two patients), gastrin (11 patients), or insulin (five patients) concentration. Peptic ulcer was difficult to control in seven of the 11 patients with elevated gastrin concentrations plus demonstrated tumor. Four patients had liver metastases that appeared to be secondary to the pancreatic gastrinoma. In patients with insulinomas, the first symptoms occurred before age 20 years. Elevated serum gastrin concentrations were not seen before age 24 years and were observed to occur for the first time in two patients after age 50 years.
(Arch Surg. 1993;128:1133-1142)
Author Affiliations
From the Department of Surgery, University of Tasmania, Hobart (Drs Shepherd, Teh, and Wilkinson), and the Departments of Pathology (Drs Challis and McArdle) and Radiology (Dr Davies), Royal Hobart Hospital, Tasmania, Australia.
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