Gastrinoma is a functionally active tumor, more often localized in the pancreas or duodenum, in excess quantities secreting gastrin. Gastrinoma is clinically manifested by Zollinger-Addison syndrome; recurrent peptic ulcers, diarrhea and steatorrhea. For the diagnosis of gastrinoma, the concentration of gastrin in the blood serum is determined, provocative tests, transhepatic selective angiography with determination of gastrin content in the blood from the pancreatic veins, FGDS, ultrasound of the pancreas, etc. Radical treatment of gastrinoma consists in complete removal of the tumor; when the operation is impossible, drug-induced antiproliferative and symptomatic therapy is performed.
Causes of gastrinoma
In the development of gastrinoma, the role of unfavorable heredity is assumed, which is expressed by the propensity to multiple endocrine neoplasia (MEN) of type I the formation of benign or malignant tumors in several glands of internal secretion. Components of multiple endocrine adenomatosis type I include pituitary tumors, pancreatic islet cell tumors (gastrinoma, insulinoma ) and parathyroid gland hyperplasia. In the structure of multiple endocrine neoplasia, gastrinoma occurs in 25% of cases.
Symptoms of gastrinoma
In 90% of cases with Zollinger-Ellison syndrome caused by gastrinoma, a severe peptic ulcer develops, refractory to treatment. Multiple gastroduodenal ulcers occur very persistently, often recur, poorly susceptible to antiulcer therapy. Ulcers can be found in the stomach, bulb of the duodenum, they often have an atypical postbulbar localization (in the jejunum); If the ulcer is perforated, there may be gastrointestinal bleeding, which poses a threat to life.
Treatment of gastrinoma
A radical method of treatment of gastrinoma is surgical removal of the tumor, but this possibility appears only in a quarter of patients. In abdominal surgery, various types of operations are used (taking into account the localization and spread of the tumor process); enucleation of gastrinoma, pancreatoduodenal resection, distal pancreas resection, subtotal resection of the pancreas, etc. In some cases, resort to selective embolization of gastrinoma.