RESUMO
Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Gastrinoma/metabolismo , Gastrinas/metabolismo , Imuno-Histoquímica , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Artéria Mesentérica Superior/diagnóstico por imagem , Imagem Multimodal , Neoplasia Endócrina Múltipla Tipo 1/complicações , Pâncreas/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Urolitíase/diagnóstico , Síndrome de Zollinger-Ellison/complicaçõesRESUMO
Los cuadros endocrinos son poco frecuentes pero en ellos un porcentaje importante de casos presenta diarrea. Estas diarreas son crónicas; hipersecretoras y abundantes (volúmenes diarios de heces mayores de 500 ml) y en su mayoría son debidas a neoplasias funcionales benignas o malignas, que estimulan la secreción de agua y electrólitos en las criptas de Liberkuhn y también la motilidad intestinal
Assuntos
Humanos , Diarreia , Doenças do Sistema Endócrino , Tumores Neuroendócrinos , Tumor Carcinoide , Síndrome de Zollinger-Ellison/complicações , VipomaRESUMO
Se precisa el concepto de diarrea y se señalan las clasificaciones de mayor utilidad práctica. Se definen como diarreas endocrinas las que se deben a sustancias circulantes de naturaleza polipeptídica que modifican la actividad secretora y motora del tracto gastrointestinal. La mayoría de estas sustancias son producidas por células argentófilas del sistema APUD. Entre las diarreas endocrinas secretoras se analizan el Síndrome de Zollinger-Ellison, el Síndrome de Verner Morrison y el Síndrome Carcinoideo. El primero es debido a hipergastrinemia de origen ectópico (hiperplasia o tumor de células no beta) y los dos últimos a hipersecreción de péptido intestinal vaso-activo por células PP del sistema APUD y de serotonina respectivamente