I.V. Tereshchenko
MC «Concilium», Perm
Tereshchenko I.V. ― D. Sc. (Medicine), Professor, endocrinologist consultant of the MC «Concilium»
16 Hassan Heroes Str., Perm, Russian Federation, 614010, tel.: (342) 241-24-24, +7-964-192-11-20, e-mail: i_v_t@bk.ru
Abstract. Recently it has been noted that gastrinoma is not always manifested by Zollinger ― Ellison syndrome. This can lead to untimely diagnosis of the gastrinoma, which means a risk of malignancy. The purpose is to evaluate the occurrence of gastrinom, to analyze the differential diagnosis and the features of the clinical manifestations of this tumor, to illustrate with specific examples from clinical practice. An enzyme immunoassay was used to check the level of gastrin in the blood (norm 13-115 pg/ml) in 100 patients who went to the clinic. When hypergastrinemia was detected, patients underwent an in-depth examination, a topical diagnosis of gastrinoma. Increased gastrin in the blood > 115 pg/ml were detected in 33% of cases, of which gastrinoma was first diagnosed in 5 cases. The gastrin level in gastrinomas was stably high: 440-877 pg/ml. Zollinger ― Ellison syndrome was established in two patients, in one ― with the main diagnosis of diabetes mellitus, there was a malignant gastrinoma in the terminal stage, and in 3 cases gastrinomas proceeded atypically.
Conclusion. The observations made suggest that gastrinoma is not a rare pathology, may not be manifested by Zollinger ― Ellison syndrome, have an atypical or even erased clinical picture and are not recognized in a timely manner only after the detection of hypergastrinemia.
Key words: neuroendocrine tumors of the gastrointestinal tract, gastrinoma, differential diagnosis of gastrinoma, malignant gastrinoma, gastrin.