A case of Zollinger-Ellison syndrome produced by gastrinoma in the duodenum accompanied with multiple endocrine neoplasia type 1

A case of Zollinger-Ellison syndrome produced by gastrinoma in the duodenum accompanied by multiple endocrine neoplasia type-1 (MEN-1) is reported. A 46 year-old female underwent distal gastrectomy due to gastric ulcer 5 year s ago. As ulceration of the residual stomach recurred, further examination was performed. Hyperprolactinemia, hypergastrinemia, primary hyperparathyro idism, pancreatic tumor, and duodenal carcinoid were evident, and the diagn oses of Zollinger-Ellison syndrome and MEN-1 were established. The origin o f the gastrin secretion was suspected to be from the pancreatic tumor, so s ampling of the portal blood was performed. As lesion on the gastrinoma in t he pancreas could not be identified, total parathyroidectomy was performed for primary hyperparathyroidism. The level of the gastrin secretion, howeve r, remained high. Partial resection of the duodenum for the duodenal carcin oid and a distal pancreatectomy were carried out concurrently. Immunohistoc hemical study of the anti-gastrin antibody revealed duodenal tumor cells. I nitially, the gastrinoma was thought to be in the pancreas, however, the le sion accompanied with MEN-1 and the Zollinger-Ellison syndrome had occurred in the duodenum.