Octreotide Case 6 Answers

1) Name the patient's current syndrome and underlying diagnosis

Zollinger-Ellison syndrome due to gastrinoma. The patient had an irresectable but benign gastrinoma diagnosed some 20 years ago and was one of the first patients to be treated with ranitidine in clinical trials. He has been managed on intense acid blocking therapy (>100mg omeprazole a day)

Gastrinoma is the most common of the gastroenteropancreatic neuroendocrine tumours. This leads leads to Zollinger-Ellison syndrome. First described in 1955, elevated serum gastrin levels cause hypersecretion of gastric acid leading to severe or intractable peptic ulceration. Diarrhoea and malabsorption occur in up 40%. About 80% of those with Multiple Endocrine Neoplasia type 1 have a pancreatic tumour, the most common form of which is a gastrinoma, seen in 40-50% of cases. Gastrinomas may only be 1-2mm but 2/3rds are malignant. Even so, they are indolent tumours. If gastrinomas are limited to the lymph nodes, they can survive 20yrs but metastatic disease to the liver has a 5yr survival rate of only 20%.

Somatostatin receptor scintigraphy is superior to other imaging methods due to its high sensitivity (95-100%) for the detection and localization of primary and metastatic gastrinomas.

2) What is labelled A above?

Transverse colon. Some bowel excretion of tracer is normal and patients are given large amounts of laxatives before and after the test.

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