Hopethe Hubbard, MD; Richard Goodgame, MD


February 13, 2007

Case Presentation

A 53-year-old black woman was admitted to the emergency department with an acute exacerbation of chronic diarrhea.

The patient had peptic ulcers diagnosed by endoscopy 6 years ago. Neither records nor details regarding the location and size of the ulcers were available. Eighteen months ago she began having 4-5 loose watery stools per day without melena or bright red blood per rectum. One day prior to admission the diarrhea became worse, with 10 loose watery stools in 24 hours. She also had 3 episodes of vomiting. She was brought to the hospital because of extreme weakness and lightheadedness.

Prior medical history was positive only for the peptic ulcer disease, and negative for serious illnesses, hospitalizations, or operations. She was taking no medications. Her family history was negative for peptic ulcers or any diseases suggestive of multiple endocrine neoplasia. Social history was negative for smoking and alcohol use. Review of systems was negative, except as noted in the history of the present illness.

On exam, the patient was found to have hypotension and tachycardia. There were signs of dehydration. Laboratory evaluation showed increased creatinine and blood urea nitrogen levels. She was treated with intravenous fluids. Vital signs and renal function tests returned to normal. After fluid resuscitation, routine laboratory tests including hemoglobin, red blood cell indices, white blood count, platelets, serum electrolytes, glucose, and liver chemistries were all normal.

Because of the history of peptic ulcer disease and diarrhea, the diagnosis of Zollinger-Ellison syndrome (ZES; gastrin-secreting tumor) was considered. Fasting serum gastrin was 5508 pg/mL (normal, 0-90 pg/mL). Repeat testing showed a gastrin level of 934 pg/mL.




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