A new cause of Zollinger-Ellison syndrome: Non-small cell lung cancer

Numerous epidemiologic studies suggest a relationship between lung cancer a nd peptic ulcer disease. Furthermore, various lung cancers synthesize and r elease a number of peptides such as gastrin and gastrin-releasing peptide t hat could cause acid hypersecretion; however, Zollinger-Ellison syndrome (Z ES), because of a lung tumor, has never been described. We report such a pa tient for the first time. A 60-year-old man with a non-small cell lung carc inoma (large cell type) presented with diarrhea, heartburn, abdominal pain, and duodenal ulcers, Evaluation showed ZES was present (fasting hypergastr inemia, hyperchlorhydria) and control of all symptoms by omeprazole. No abd ominal or cardiac tumor, the other known locations of gastrinomas causing Z ES, was found on detailed tumor imaging studies. Resection of the lung tumo r resulted in a decrease in gastrin levels to normal values, Plasma radioim munoassays showed elevated gastrin, chromogranin A and normal levels of gas trin-releasing peptide, and 9 other hormones. The tumor showed similar immu nocytochemical results. The characteristics of this case are compared with 100 cases of sporadic abdominal gastrinomas, and the evidence reviewed sugg ests why ZES should be considered in patients with lung cancer with peptic symptoms.