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Tests and diagnosis
By Mayo Clinic staffYour doctor may review or recommend the following:
- Medical history. Your doctor will ask about your signs and symptoms and review your medical history. If you have a blood relative with MEN I, it's more likely that you have Zollinger-Ellison syndrome.
- Blood tests. A sample of your blood is analyzed in a laboratory to see whether you have elevated gastrin levels. While elevated gastrin may indicate tumors in your pancreas or duodenum, it can also be caused by other conditions. You'll have to fast before this test and may need to stop taking any acid-reducing medications to get the most accurate measure of your gastrin levels. Because gastrin levels can fluctuate, this test may be repeated a few times.
- Measure gastrin levels. Since elevated gastrin levels can be caused by conditions other than Zollinger-Ellison, your doctor may test the acidity of the stomach to clarify which condition is elevating your gastrin levels. If your stomach is making acid, your doctor may perform a secretin stimulation test. For this test, your doctor measures your gastrin levels, gives you an injection of the hormone secretin and measures gastrin levels again. If you have Zollinger-Ellison, your gastrin levels will increase even more.
- Upper gastrointestinal endoscopy. After you've been sedated, your doctor inserts a thin, flexible instrument with a light and video camera (endoscope) down your throat and into your stomach and duodenum to look for ulcers. Through the endoscope, your doctor may remove a tissue sample (biopsy) from your duodenum for examination in the laboratory to help detect the presence of gastrin-producing tumors. To prepare for the test, your doctor will ask you not to eat anything after midnight the night before the test.
- Imaging studies. Your doctor may use imaging techniques such as a nuclear scan — which uses radioactive tracers to help locate tumors — computerized tomography (CT), ultrasound imaging or magnetic resonance imaging (MRI).
- Endoscopic ultrasound. In this procedure, your doctor examines your stomach and duodenum with an endoscope fitted with an ultrasound probe. The probe allows closer imaging of the digestive tract, making it easier to spot tumors. It's also possible to remove a tissue sample through the endoscope. You'll need to fast after midnight the night before this test, and you'll be sedated during the test.
References
- Zollinger-Ellison syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/zollinger. Accessed May 5, 2010.
- How is cancer of the pancreas diagnosed? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_pancreatic_cancer_diagnosed_34.asp?sitearea=. Accessed May 5, 2010.
- Goldfinger SE. Clinical manifestations and diagnosis of Zollinger-Ellison syndrome (gastrinoma). http://www.uptodate.com/home/index.html. Accessed May 8, 2010.
- Goldfinger SE. Management and prognosis of Zollinger-Ellison syndrome (gastrinoma). http://www.uptodate.com/home/index.html. Accessed May 8, 2010.
- Morrow EH, et al. Surgical management of Zollinger-Ellison syndrome; State of the art. Surgical Clinics of North America. 2009;89:1091.
- Wilcox CM, et al. Treatment strategies for Zollinger-Ellison syndrome. Expert Opinion on Pharmacotherapy. 2009;10:1145.
- FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm. Accessed May 26, 2010.
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