요석증이 초기 증상으로 발현된 제1형 다발성 내분비 선종이 동반된졸링거 엘리슨 증후군

• Published in: The Korean journal of gastroenterology Vol. 61; no. 6; pp. 333 - 337
• Main Authors: 이나은, Na Eun Lee, 이영재, Young Jae Lee, 윤소희, So Hee Yun, 이재운, Jae Un Lee, 박문식, Moon Sik Park, 김중근, Joong Keun Kim, 김지웅, Ji Woong Kim, 조진웅, Jin Woong Cho
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.06.2013
• Subjects: Gastrinoma; Multiple endocrine neoplasia type 1; Urolithiasis; Zollinger-Ellison syndrome
• ISSN: 1598-9992

Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.