Gastrin Là Gì

     

A gastrinoma is a gastrin-producing tumor usually located in the pancreas or the duodenal wall. Gastric acid hypersecretion & aggressive, refractory peptic ulceration result (Zollinger-Ellison syndrome). Diagnosis is by measuring serum gastrin levels. Treatment is proton pump inhibitors & surgical removal.

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(See also Overview of Pancreatic Endocrine Tumors Overview of Pancreatic Endocrine Tumors Pancreatic endocrine tumors arise from islet và gastrin-producing cells & often produce many hormones. Although these tumors develop most often in the pancreas, they may appear in other organs... read more .)


Gastrinomas are a type of pancreatic endocrine tumor that arises from islet cells but can also arise from the gastrin-producing cells in duodenum and, much less rarely, other sites in the body. Gastrinomas occur in the pancreas or duodenal wall 80 to lớn 90% of the time. The remainder occur in the splenic hilum, mesentery, stomach, lymph node, or ovary. About 1/2 of patients have multiple tumors. Gastrinomas usually are small ( 1 cm in diameter) and grow slowly. About 1/2 are malignant. About 40 to 60% of patients with gastrinoma have multiple endocrine neoplasia Overview of Multiple Endocrine Neoplasias (MEN) The multiple endocrine neoplasia (MEN) syndromes comprise 3 genetically distinct familial diseases involving adenomatous hyperplasia & malignant tumors in several endocrine glands. MEN 1 involves... read more .


Zollinger-Ellison syndrome typically manifests as aggressive peptic ulcer disease Peptic Ulcer Disease A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more

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, with ulcers occurring in atypical locations (up to 25% are located distal lớn the duodenal bulb). However, as many as 25% of patients do not have an ulcer at diagnosis. Typical ulcer symptoms Symptoms and Signs A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more
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& complications Complications A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more
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(eg, perforation, bleeding, obstruction) can occur. Diarrhea is the initial symptom in 25 lớn 40% of patients.


Diagnosis of Gastrinoma


Serum gastrin level


CT, scintigraphy, or positron emission tomography (PET) to localize


Gastrinoma is suspected by history, particularly when symptoms are refractory to lớn standard acid suppressant therapy.

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Serum gastrin level is the most reliable test. All patients have levels > 150 pg/mL (> 72 pmol/L); markedly elevated levels of > 1000 pg/mL (> 480 pmol/L) in a patient with compatible clinical features and gastric acid hypersecretion of > 15 mEq/hour establish the diagnosis. However, moderate hypergastrinemia can occur with hypochlorhydric states (eg, pernicious anemia, chronic gastritis, use of proton pump inhibitors), in renal insufficiency with decreased clearance of gastrins, in massive intestinal resection, & in pheochromocytoma.


A secretin provocative test may be useful in patients with gastrin levels 1000 pg/mL (Helicobacter pylori infection Diagnosis Helicobacter pylori is a common gastric pathogen that causes gastritis, peptic ulcer disease, gastric adenocarcinoma, and low-grade gastric lymphoma. Infection may be asymptomatic or... read more , which commonly results in peptic ulceration and moderate excess gastrin secretion.


Once the diagnosis of gastrinoma has been established, the tumor or tumors must be localized. The first kiểm tra is abdominal CT or somatostatin receptor scintigraphy, which may identify the primary tumor and metastatic disease. PET or selective arteriography with magnification và subtraction is also helpful. If no signs of metastases are present & the location of the primary tumor is uncertain, endoscopic ultrasonography should be done. Selective arterial secretin injection is an alternative.

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Five- và 10-year survival are > 90% when an isolated tumor is removed surgically vs 43% at 5 years and 25% at 10 years with incomplete removal.