Síndrome de zolinger - Elison / Syndrome of Zolinger - Elison

Resumen:El síndrome de Zollinger - Ellison es una endocrinopatía que fue descrita en 1955 por los doctores Robert Zollinger y Edwin Ellison, quienes propusieron la triada diagnóstica que incluye hipersecreción gástrica ácida, úlcera péptica y gastrinoma. Esta enfermedad predomina en mujeres entre los 50 y 60 años de edad. Según su etiología, este síndrome se clasifica en una forma esporádica o asociada a neoplasia endocrina múltiple tipo 1 (NEM - 1).Más de la mitad de los gastrinomas se localizan en la pared duodenal, el páncreas es la segunda ubicación en frecuencia. Existen localizaciones ectópicas en ovario, mesenterio, hígado y ducto biliar. A nivel histopatológico se encuentran células tumorales redondas, con núcleos pequeños y nucléolos prominentes. La hipersecreción ácida gástrica está asociada a un defecto en la inhibición del retrocontrol negativo de la somatostatina sobre las células G antrales productoras de gastrina. Clínicamente, los pacientes manifiestan dolor abdominal, diarrea, pirosis, náuseas y vómitos; relacionados principalmente a la formación de úlceras pépticas. El diagnóstico debe incluir una medición en los niveles séricos de gastrina y valores de pH gástrico. El tratamiento de primera línea es la terapia antisecretora, principalmente con inhibidores de la bomba de protones. Los estudios de imágenes son deutilidad para detectar metástasis y evaluar la enfermedad quirúrgicamente resecable. Se debe hacer diagnóstico diferencial con otros tumores neuroendocrinos y causas de hipergastrinemia.

Abstract:Zollinger - Ellison syndrome is an endocrinopathy that was first described in 1955 by doctors Robert Zollinger and Edwin Ellison, who proposed the diagnostic triad that includes gastric acid hypersecretion, peptic ulcer and gastrinoma. This disease predominates in women between 50 and 60 years old. Based on the etiology, the syndrome is classified in sporadic or associated with multiple endocrine neoplasia type 1 (NEM - 1). Over half of gastrinomas are located in the duodenal wall, the pancreas is the second frequency location. There are ectopic locations, such as ovary, mesentery, liver and bile duct. Round cells, small nuclei and prominent nucleoli, are the main hispathologycal characteristics. Gastric acid hypersecretion is associated with a defect in the negative feedback inhibition of somatostatin on G antral gastrin-producing cells. Clinically, patients present abdominal pain, diarrhea, heartburn, nausea and vomiting; primarily related to the development of peptic ulcers. Diagnosis includes a measurement in serum gastrin levels and gastric pH values. The first line treatment is the antisecretory therapy, primarily proton-pump inhibitor. Imaging studies are useful to detect metastases and evaluate the surgically resectable disease. Neuroendocrine tumors and hypergastrinemia causes are the main differential diagnoses, the clinician should consider.

An immunohistochemical study of the gastrointestinal endocrine cells in the ddY mice

The distributions and frequencies of some endocrine cells in the gastrointestinal (GI) tract of ddY mice were studied with immunohistochemical method using 7 types of antisera against bovine chromogranin (BCG), serotonin, gastrin, cholecystokinin (CCK)-8, somatostatin, glucagon and human pancreatic polypeptide (HPP). All of 7 types of immunoreactive (IR) cells were identified. Most of IR cells in the intestinal portion were generally spherical or spindle in shape (open typed cell) while cells showing round in shape (close typed cell) were found in the intestinal gland and stomach regions occasionally. Their relative frequencies were varied according to each portion of GI tract. BCG-IR cells were demonstrated throughout whole GI tract except for the cecum and they were most predominant in the fundus and pylorus. Serotonin-IR cells were detected throughout whole GI tract and they were most predominant cell types in this species of mice. Gastrin-IR cells were restricted to the pylorus and CCK-8-IR cells were demonstrated in the pylorus, duodenum and jejunum with numerous frequencies in the pylorus. Somatostatin-IR cells were detected throughout whole GI tract except for the cecum and rectum and they showed more numerous frequencies in the stomach regions. In addition, glucagon-IR cells were restricted to the fundus, duodenum and jejunum with rare frequencies, and HPP-IR cells were restricted to the rectum only with rare frequency. In conclusion, some strain-dependent unique distributional patterns of gastrointestinal endocrine cells were found in GI tract of ddY mice.

Sustentacular cells of phaeochromocytoma express positivity for gastrin and bombesin

To assess the presence of certain growth factors in phaeochromocytoma. Materials and Serial sections at 5[micro] thickness were made from paraffin embedded blocks of surgical specimens of ten cases of human phaeochromocytoma. Antibodies to gastrin, bombesin or its C-terminal precursor, as well as antibodies to S-100 protein were applied utilizing avidin-biotin peroxidase complex method. Sustentacular cells as identified by S-100 protein stained positively with antibodies to Gastrin and Bombesin. Gastrin and Bombesin, which are growth factors, were demonstrated in sustentacular cells of phaeochromocytoma. This finding is in agreement with recent studies which showed that folliculo-stellate cells of the pituitary are capable of producing active growth factors that can stimulate tumor growth

Changes in Gastrin-17 level associated with helicobacter pylori colonization in dyspeptic patients with and without ulcer formation

Ninety patients with dyspeptic symptoms in the form of heart-burn, epigastric pain, nausea, vomiting and feeling of fullness were classified into: Group 1, 30 patients with cirrhotic liver, portal hypertension and esophageal varices, Group 2, 30 patients with gastric or duodenal ulcers, Group 3, 30 patients with normal endoscopic gastric mucosa [non-ulcer dyspepsia]. Upper gastroscopy and 3 biopsies from the antrum were taken from all cases. CLO test for detection of H. pylori infection and histopathology of the biopsies were done

Síndrome de Zollinger-Ellison: controle da gastrinemia no pré e pós-operatório / Zollinger-Ellison syndrome gastrinemy control in preoperative and postoperative period

A síndrome de Zollinger-Ellison é uma doença que se manifesta por úlcera cloridropéptica recidivante, além de hipersecreçäo e hiperacidez gástrica. É causada por um tumor que se origina no sistema neuroendócrino, especialmente nas células näo-beta das ilhotas pancreáticas, produtoras do hormônio gastrina. Estudamos dois pacientes com gastrinoma e discutimos o tratamento usado, ou seja, a gastrectomia total, sob controle da dosagem de gastrina.

Hipergastrinemia del habitante de las grandes alturas del Perú estudio comparativo con sujetos del nivel del mar / Hypergastrinemia in high altitude, natives comparative study with sea level natives

Se determinó la gastrinemia basal con técnicas de radioinmunoensayo en dos grupos homólogos de 20 varones jóvenes aparentemente sanos, uno natural y residente en Cerro de Pasco, a 4,400 m.s.n.m. y otro de Lima a 150 m.s.n.m. En el grupo de la altura se encontró una media de 113.8 +/- 55.9 pg/ml y a nivel del mar 50.2 +/- 12.3 pg/ml., con una diferencia estadísdtica altamente significativa. se plantea como posible explicación la hiperfunción secundaria o primaria de las células "G" productoras de la hormona o bién una hiperplasia de las mismas. se considera la hipergastrinemia como una peculiaridad fisiológica en el poblador de las grandes alturas y que junto con una mayor acción vagal, contribuyen a explicar por lo menos a dos factores: una mayor secreción ácida basdal y una hiporespuesta relativa a nuevos estímulos, descritos anteriormente

role of gastrin in infantile hypertrophic pyloric stenosis

The serum gastrin level was estimated in eighteen children with infantile hypertrophic pyloric stenosis at the time of pyloromyotomy. We also estimated the gastrin level in a control group. It was found that there was no significant difference of gastrin level between the two group. It was also found that serum gastrin in the neonatal period is higher than serum gastrin of normal adultsThe widespread use of maternal ultrasonography has resulted in an increasing number of newborns diagnosed with obstructive uropathy [O.U]. Over the past 4 years, 39 neonates had been referred for evaluation of their prenatally detected O.U. thirty-four were males. Mean time of prenatal ultrasound examination was 32 +/- 2 weeks of gestation. Postnatal evaluation consisted of ultrasonography, voiding cystourethrography, excretory urography and radionuclide renal scan to assess the differental function and document the severity of obstruction. One infant died at 2 days of age. In the remaining 38 patients, surgery was needed in 34 of them. The excellent postoperative clinical and radiological status of these patients further advocates early intervention when feasible

Aspectos endoscópicos, histológicos e níveis sericos de gastrina em pacientes portadores de Campylobacter pylori / Endoscopic and histologic aspects and serum levels of gastrin in patients with Campylobacter pylori

Os autores apresentam uma comparaçäo entre os achados endoscópicos, histológicos e níveis séricos de gastrina em 59 pacientes que foram submetidos a endoscopia digestiva alta para elucidaçäo de sintomas dispépticos e nos quais foi encontrado o Campylobacter pylori. Os autores näo verificaram diferenças significantes entre a presença do bacilo em relaçäo ao achado endoscópico e nem em relaçäo aos nvieis de gastrina, estando a presença do bacilo associada ao achado de alteraçöes inflamatórias da mucosa n histologia (p = 0,000048). Chama a atençäo dos autores o achado do C. pylori em 20% dos pacientes que apresentavam quadro histopatológico normal

A mucosa gastroduodenal em doentes com hipertensäo portal: correlaçäo com a gastrinemia / The gastroduodenal mucosa in patients with portal hypertension: correlation with gastrinemia

Tem sido registrada elevada incidência de alteraçöes da mucosa gastroduodenal em hepatopatas crônicos, inclusive causando hemorragias digestivas. Com o objetivo de verificar esta associaçäo com a gastrinemia, foram estudados 24 doentes portadores de hipertensäo portal, sendo 12 de etiologia esquistossomótica (HE) e 12 näo esquistossomótica (HNE). Foram realizados dosagem de gastrinemia de jejum, endoscopia digestiva com bópsias de estômago e duodeno, além de exames laboratoriais que avaliam a funçäo hepática. Os doentes com HNE apresentavam achados endoscópicos, assim como processo inflamatório crônico da mucosa gastroduodenal, bem mais significativos que os doentes HE. As dosagens de gastrinemia encontradas estiveram dentro da normalidade nos dois grupos, a exceçäo de dois doentes no grupo de HNE. Assim, conclem os autores que os HNE, principalmente pelo risco mais elevado de hemorragia digestiva, devem ser mantidos sob vigilância, orientaçäo alimentar adequada e eaté mesmo uso continuado de medicamentos, se for o caso. Além disso, outras pesquisas devem ser feitas para elucidar a etiologia destas alteraçöes da mucosa nestes doentes