It is often located in the duodenum (most often) or pancreas.
May be associated with MEN I syndrome. Gastrinoma is the most common enteropancreatic tumor in the MEN I syndrome.
The most common symptom is abdominal pain.
Conditions suggestive of gastrinoma in patients with peptic ulcer and gastrin levels should be measured;
• Unexplained diarrhea or steatorrhea (inactivation of pancreatic enzymes due to acidity)
• Multiple ulcers or rare localizations (eg, jejunal ulcer)
• Refractory to treatment, complicated or frequent recurrence
• Post-surgical recurrence
• Association with severe esophagitis
• Thickening of gastric folds
• Endocrinological pathology, hypercalcemia or kidney stone (MEN I)
• Fasting hypergastrinemia
Diagnosis
• Fasting gastrin level is used as a screening test, it is the most sensitive test in diagnosis. A serum gastrin level > 1000 pg/ml is highly significant for diagnosis.
• The basal acid release/stimulated acid release (BAO/MAO) ratio increases (normally < 0.4 versus > 0.6 in gastrinoma).
• Secretin stimulation test
It can be used to differentiate gastrinoma from other causes of hypergastrinemia (pernicious anemia, pyloric obstruction, atrophic gastritis, PPI use, etc.).
secretin; It decreases gastrin secretion in cases of secondary hypergastrinemia, and increases it in gastrinoma.
It is the most valuable and most specific test in diagnosis.
• EUS is the most valuable method for demonstrating the tumor radiologically.
• PET-CT and somatostatin (pentreotide) scintigraphy are very useful in detecting distant metastases.
• High dose PPI is given for symptoms and ulcer healing.
• Surgery is performed in cases where the tumor can be localized.
• Somatostatin or chemotherapy is given in metastatic cases