title: [A woman with shock as first sign of Zollinger-Ellison syndrome].
abstract: A 49-year-old woman presented at the emergency ward in shock with upper gastrointestinal bleeding. Extensive ulceration confirmed by gastroduodenoscopy was suggestive of Zollinger-Ellison syndrome. Further evaluation by fasting gastrin assessment, CT, endosonography with cytological biopsy and somatostatin-receptor scintigraphy confirmed the diagnosis ofgastrinoma. Three enlarged lymph nodes near the pancreatic head were surgically removed; each was found to contain neuroendocrine tumour cells. The patient recovered rapidly after surgery and the gastrin level normalised. Zollinger-Ellison syndrome is uncommon but should be considered as a possible cause of upper gastrointestinal bleeding. Shock is very rarely the first sign ofZollinger-Ellison syndrome. In this case, the use of a proton-pump inhibitor may have masked the disease for years.
authors: Academisch Medisch Centrum/Universiteit van Amsterdam, Amsterdam. svansanten@alysis.nl
authors: S
authors: S
authors: van Santen
authors: E J
authors: EJ
authors: van Soest
authors: O R C
authors: OR
authors: Busch
authors: S
authors: S
authors: van Eeden
authors: P
authors: P
authors: Fockens
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D015408:Gastrinoma / Q000175:diagnosis* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012771:Shock, Hemorrhagic / Q000209:etiology*; D016896:Treatment Outcome; D015043:Zollinger-Ellison Syndrome / Q000175:diagnosis* / Q000601:surgery