Zollinger-Ellison syndrome in a patient with normal screening gastrin level.

A 59-year-old female presented with multifocal peptic ulcer disease and diarrhea. A fasting serum gastrin level obtained while the patient was receiving no antacid therapy was normal. A secretin stimulation test was positive. A small gastrinoma was found in the anterior duodenal wall at exploratory laparotomy. Normal fasting gastrin levels do occur in patients with overt Zollinger-Ellison syndrome and should not deter further investigation if clinical suspicion of this syndrome is high.

Fulminant hepatic failure.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs Homer A. Boushey, Professor of Medicine, and David G. Warnock, Associate Professor of Medicine, under the direction of Dr Lloyd H. Smith, Jr, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.

Isoproterenol induces activity fronts in fed dogs through somatostatin release.

We confirmed previous studies by others that intravenous somatostatin infusions (1.4 and 2.5 micrograms/kg X h) induced jejunal activity fronts in fed dogs. This finding, coupled with earlier demonstrations that somatostatin is released from the stomach and pancreas in vitro by isoproterenol, led us to investigate the possible role of somatostatin in mediating isoproterenol-induced activity fronts. Plasma somatostatin and motilin concentrations were determined after a meat-base meal, before and after isoproterenol infusions (0.5 micrograms/kg X min). Jejunal activity fronts were initiated in 15 of 17 experiments an average of 25 min after the start of the isoproterenol infusion. The concentration of motilin did not change, but somatostatin concentrations increased progressively beginning 15 min after starting the isoproterenol infusion. Thus, isoproterenol released somatostatin in vivo and this release was associated with jejunal activity fronts. The rise in plasma somatostatin concentration was similar to that obtained after somatostatin infusions, although in the latter experiments the activity fronts began soon after initiation of the somatostatin infusion. The results suggest that isoproterenol-induced activity fronts are mediated by somatostatin. We speculate that beta-adrenergic nerves may induce activity fronts through somatostatin release, possibly in situations such as extreme stress.