Insulinoma with Subsequent Association of Zollinger-Ellison Syndrome

Nobumasa Mizuno, Satoru Naruse, Motoji Kitagawa, Hiroshi Ishiguro, Osamu Ito, Shigeru B.H. Ko, Toshiyuki Yoshikawa, Chisato Tanahashi, Masafumi Ito, Tetsuo Hayakawa

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Abstract

We report a patient with insulinoma associated with Zollinger-Ellison syndrome. A 67-year-old woman was first admitted to our hospital for an abdominal mass. Abdominal computed tomography (CT) revealed a large pancreatic tumor, which was then diagnosed as an unresectable pancreatic adenocarcinonia. At the age of 71, she presented symptoms of hypoglycemia. Fasting blood glucose was 21 mg/dl and plasma immunoreactive insulin level was 846 μU/ ml. Plasma gastrin, glucagon, vasoactive intestinal polypeptide and somatostatin levels were all normal. At the age of 73, hypoglycemic attacks occurred more frequently and she was admitted to our hospital. Abdominal CT scan showed multiple liver metastases. Chemotherapy with 5-fluorouracil and doxorubicin was performed. Three months later, she had an emergency laparotomy because of a perforated duodenal ulcer. Plasma gastrin level was 1,960 pg/ml at that time. Gastric hypersecretion was well controlled with a proton pump inhibitor (lansoprazole) but she died of widespread cancer dissemination 8 years after her first admission. On autopsy, histologic examination revealed a mixed acinar-endocrine carcinoma of the pancreas. Immunohistochemical stains were positive for insulin, gastrin, and αI-antitrypsin.

Original languageEnglish
Pages (from-to)386-390
Number of pages5
JournalInternal Medicine
Volume40
Issue number5
DOIs
Publication statusPublished - 2001 May
Externally publishedYes

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Keywords

  • Gastrin
  • Insulin
  • Mixed acinar-endocrine carcinoma
  • Multiple hormone syndrome

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mizuno, N., Naruse, S., Kitagawa, M., Ishiguro, H., Ito, O., Ko, S. B. H., Yoshikawa, T., Tanahashi, C., Ito, M., & Hayakawa, T. (2001). Insulinoma with Subsequent Association of Zollinger-Ellison Syndrome. Internal Medicine, 40(5), 386-390. https://doi.org/10.2169/internalmedicine.40.386