Endocrine tumors

Endocrine tumors are being recognised with increased frequency and one or two questions can be expected in most exams

 Neuroendorcrine tumors are uncommon tumors around pancreas that can be symptomatic or asymptomatic. The symptoms are related to excess production of hormones
Q1. Which of the following is least common site for gastrinoma?
   a) 1st part of duodenum.
  b)  2nd part of duodenum
  c) 3rd part of duodenum
  d) 4th part of duodenum
Q2. Which of the following investigations has the highest sensitivity to diagnose  gastrinoma?
a ) CT scan Abdomen
b) Portal Venous Sampling
c) Arteriography
  d) Somatostatin receptor scintigraphy
Q3. Symptoms of diarrhea, hypokalemia and Achlorhydria are associated with
a) Somatostatinoma
b) VIPoma
c) Glucagonoma
d) Gastrinoma
  Q4. Which of the following serum gastrin values is not indicative of  gastrinoma
a) 5000pg/ml
c) 500pg/ml
d) 100 pg/ml
Q5. Which of the following has least incidence of malignancy?
a. Insulinoma
b Gastrinoma
c VIPoma
d. Glucagonoma

  Answers to Questions on Endocrine tumors

1) d
Gastrinomas were originally assumed to arise in the pancreas, (Only premium members can read further explanations and answers) but most subsequent series have shown that at least half originate in the duodenum.
Sixty to 90% are found in the so-called gastrinoma triangle. FIG.
The duodenum is the site of gastrinomas in 45% to 60% of patients, and there is a pronounced proximal-to-distal gradient within the duodenum (i.e., most are in the first part, none in the fourth)
Sabiston text book of surgery 18th edition page 987
 2) d
Because more than 90% of gastrinomas have receptors for somatostatin, SRS is particularly sensitive in imaging both primary and metastatic gastrinoma tissue.
Attempts to localize gastrinomas by means of ultrasonography, arteriography, and enhanced CT and MRI have been only partly successful
Sabiston text book of surgery 18th edition page 989
3) b
VIPomas are endocrine tumors usually arising from pancreatic islets that secrete VIP and cause a syndrome of profound watery diarrhea, hypokalemia, and achlorhydria. The diarrhea persists despite fasting (which qualifies it as a secretory diarrhea) and despite nasogastric aspiration (which differentiates it from the diarrhea of ZES).
Verner-Morrison syndrome is highly variable. Constant features are diarrhea, hypovolemia, hypokalemia, and acidosis;
variable features are achlorhydria or hypochlorhydria, hypercalcemia, hyperglycemia, and flushing with rash.
A glucagonoma causes a syndrome of a characteristic skin rash, diabetes mellitus, anemia, weight loss, and elevated circulating levels of glucagon
Glucagonoma was found to be associated with a low level of amino acids, and parenteral administration of amino acid was found to bring about the disappearance of the skin lesions
Somatostatinoma steatorrhea, diabetes mellitus, hypochlorhydria, and gallstones
Ref. sabiston 18th edition page 990-992
4) d
The diagnosis of gastrinoma depends on the presence of hypergastrinemia in the face of increased secretion of gastric acid. Most laboratories have an upper limit of normal of 100 pg/mL for fasting levels of gastrin. Levels of 100 to 1000 pg/mL are occasionally seen in non-ZES patients, and levels higher than 1000 are nearly diagnostic for ZES,
5)  a
Causes of fever in the post op period in gastro surgical cases
1. Release of pyrogens
2. Intraabdominal collections or abscess
3. Blood and platelet infusions
4. Drug fever (e.g., antibiotics, methyldopa, procainamide, phenytoin)
5. Pulmonary complicatons like pneumonia and empyema