We report a patient with insulinoma associated with Zollinger-Ellison syndr
ome. A 67-year-old woman was first admitted to our hospital for an abdomina
l mass, Abdominal computed tomography (CT) revealed a large pancreatic tumo
r, which was then diagnosed as an unresectable pancreatic adenocarcinoma, A
t the age of 71, she presented symptoms of hypoglycemia, Pasting blood gluc
ose was 21 mg/dl and plasma immunoreactive insulin level was 846 muU/ mi, P
lasma gastrin, glucagon, vasoactive intestinal polypeptide and somatostatin
levels were all normal, At the age of 73, hypoglycemic attacks occurred mo
re frequently and she was admitted to our hospital. Abdominal CT scan showe
d multiple liver metastases, Chemotherapy with 5-fluorouracil and doxorubic
in was performed. Three months later, she had an emergency laparotomy becau
se of a perforated duodenal ulcer Plasma gastrin level was 1,960 pg/ml at t
hat time. Gastric hypersecretion was well controlled with a proton pump inh
ibitor (lansoprazole) but she died of widespread cancer dissemination 8 yea
rs after her first admission, On autopsy, histologic examination revealed a
mixed acinar-endocrine carcinoma of the pancreas. Immunohistochemical stai
ns were positive for insulin, gastrin, and a,antitrypsin,