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Scientific paper| Volume 106, ISSUE 1, P70-81, July 1963

Endocrine associated peptic ulcer

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      Abstract

      Four cases have been presented which have in common a profound ulcer diathesis occurring in association with a neoplastic endocrine lesion.
      In two subjects the adrenal gland was the site of endocrine involvement; one had hyperplasia, the other adenoma, neither showing evidence of Cushing's syndrome.
      A postulation has been made that a cause-and-effect relation exists between the adrenal lesions and the ulcers.
      Two subjects with ulcers and islet cell neoplasm corresponding to the Zollinger-Ellison syndrome are described and the reported evidence for making this a distinct syndrome discussed.
      Efforts to demonstrate a secretagogue in the plasma of subject (Case IV) and his unusual response to Norethandrolone are described and the need for further work in this area noted.
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      References

        • Zollinger R.M.
        • Ellison E.H.
        Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas.
        Ann. Surg. 1955; 142: 709
      1. Syndromes of islet-cell tumors of the pancreas.
        Brit. M. J. 1959; 1 (Editorial): 1231
        • Donaldson Jr., R.M.
        • vom Eigen P.R.
        • Dwight R.S.
        Gastric hypersecretion, peptic ulceration and islet-cell tumor of the pancreas (Zollinger-Ellison syndrome); report of case and review of literature.
        New England J. Med. 1957; 257: 965
        • Summerskill W.J.
        • Oxon D.M.
        Malabsorption and jejunal ulceration due to gastric hypersecretion with pancreatic islet cell hyperplasia.
        Lancet. 1959; 1: 120
        • Thistlethwaite J.R.
        • Horwitz A.
        Ulcerogenic tumors of the pancreas.
        Postgrad. Med. 1958; 24: 599
        • Waddell W.R.
        • Leonsins A.J.
        • Zuidema G.D.
        Gastric secretory and other laboratory studies on two patients with Zollinger-Ellison syndrome.
        New England J. Med. 1959; 260: 56
        • Chears W.C.
        • Thompson J.E.
        • Hutcheson J.B.
        • Patterson C.O.
        Pancreatic islet tumors with severe diarrhea.
        Am. J. Med. 1960; 29: 529
        • Rawson A.B.
        • England M.T.
        • Gillam G.G.
        • French J.M.
        • Stammers F.R.
        Zollinger-Ellison syndrome with diarrhea and malabsorption.
        Lancet. 1960; 2: 131
        • Ellison E.H.
        The ulcerogenic tumor of the pancreas.
        Surgery. 1956; 40: 147
        • Crohn B.B.
        • Janowitz H.D.
        Hyperinsulinism and duodenal ulcer: a rare clinical combination.
        Gastroenterology. 1951; 17: 578
        • Frantz V.K.
        Tumors of islet cells with hyperinsulinism: benign, malignant and questionable.
        Ann. Surg. 1940; 112: 161
        • Freidell H.V.
        • Dickson D.R.
        • Rydell J.R.
        Ulcerogenic tumor of the pancreas.
        Am. J. Gastroenterol. 1959; 31: 58
        • ReMine W.H.
        • Scholz D.A.
        • Priestley J.T.
        Hyperinsulinism.
        Am. J. Surg. 1960; 99: 413
        • Poth E.J.
        • Fromm S.M.
        The relation of pancreatic secretion to peptic ulcer formation: the influence of the hyperglycemic-glycogenolytic factor.
        Gastroenterology. 1950; 16: 490
        • Poth E.J.
        • Fromm S.M.
        • DeYoung R.
        • Aldridge M.
        Pancreatic secretion to peptic ulcer: effect of hypoglycemia with and without pancreatectomy.
        in: Proc. Soc. Exper. Biol. & Med.74. 1950: 514
        • Strom R.
        A case of peptic ulcer and insulinoma.
        Acta chir. scandinav. 1952; 104: 252
        • Lopez-Kruger R.
        • Dockerty M.B.
        Tumors of islets of Langerhans.
        Surg. Gynec. & Obst. 1947; 85: 495
        • Sanchez G.C.
        • Sommers S.C.
        Peptic ulcer diathesis with a mixed adenocarcinoma of the pancreas.
        Gastroenterology. 1960; 38: 467
        • Gregory R.A.
        • Tracy H.
        • French J.M.
        • Sircus W.
        Extraction of a gastrin-like substance from a pancreatic tumor in a case of Zollinger-Ellison syndrome.
        Lancet. 1960; 1: 1045
        • Biggart J.H.
        • Willis J.
        Peptic ulceration and endocrine disease in necropsy material.
        Lancet. 1959; 2: 938
        • Ellison E.H.
        • Abrams J.S.
        • Smith D.J.
        A postmortem analysis of 812 gastroduodenal ulcers found in 20,000 consecutive autopsies, with emphasis on associated endocrine disease.
        Am. J. Surg. 1959; 97: 17
        • Osborne M.P.
        • Brown M.E.
        • LeCompte P.M.
        Ulcerogenic non-beta cell pancreatic islet carcinoma.
        Am. J. Surg. 1960; 100: 48
        • Billington B.P.
        Gastric secretion and the Zollinger-Ellison syndrome.
        Lancet. 1959; 1: 886
        • Oberhelman H.A.
        • Nelson T.S.
        • Dragstedt L.R.
        Peptic ulcer associated with tumors of pancreas.
        Arch. Surg. 1958; 77: 402
        • Fisher E.R.
        • Flandreau R.H.
        Multiple endocrine tumors and peptic ulcer.
        Gastroenterology. 1957; 32: 1075
        • Eiseman B.
        • Maynard R.M.
        Non-insulin producing islet cell adenoma associated with progressive peptic ulceration. (Zollinger-Ellison syndrome).
        Gastroenterology. 1956; 31: 296
        • Ford Jr., T.J.
        • Jordan G.L.
        • Erickson E.E.
        • Freeman R.G.
        Recurrent gastrojejunal ulceration and islet cell carcinoma of the pancreas.
        Arch. Surg. 1957; 75: 272
        • Maynard E.P.
        • Point W.W.
        Steatorrhea associated with ulcerogenic tumors of the pancreas.
        Am. J. Med. 1958; 25: 456
        • Jow E.
        • Webster D.R.
        • Skoryna S.C.
        Effects of glucagon and insulin on gastric section in rats.
        Gastroenterology. 1960; 38: 732
        • Robinson R.M.
        • Harris K.
        • Hlad C.J.
        • Eiseman B.
        Effect of glucagon on gastric secretion.
        in: Proc. Soc. Exp. Biol. & Med.96. 1957: 518
        • Stunkard A.J.
        • VanItallie T.B.
        • Reiss B.B.
        Mechanism of satiety: effect of glucagon on gastric hunger contractions in man.
        in: Proc. Soc. Exp. Biol. & Med.89. 1955: 258
        • VanItallie T.B.
        Medical progress; glucagon, physiologic and clinical considerations.
        New England J. Med. 1956; 254: 795
        • Poth E.J.
        Rational surgical treatment of duodenal ulcer.
        Surg. Gynec. & Obst. 1955; 101: 489
        • Moldawer M.P.
        • Nardi G.L.
        • Raker J.W.
        Concomitance of multiple adenomas of the parathyroids and pancreatic islets with tumor of the pituitary: syndrome with familial incidence.
        Am. J. M. Sc. 1954; 228: 190
        • Underdahl L.O.
        • Woolner L.B.
        • Black B.M.
        Multiple endocrine adenomas: report of 8 cases in which the parathyroids, pituitary and pancreatic islets were involved.
        J. Clin. Endocrinol. 1953; 13: 20
        • Wermer P.
        Genetic aspects of adenomatosis of endocrine glands.
        Am. J. Med. 1954; 16: 363
        • Weber J.M.
        • Lewis S.
        • Heasley K.H.
        Observations on the small bowel pattern associated with the Zollinger-Ellison syndrome.
        Am. J. Roentgenol. 1959; 82: 973
        • Fajan S.F.
        • Conn J.W.
        An intravenous tolbutamide test as an adjunct in the diagnosis of functioning pancreatic islet cell adenoma.
        J. Lab. & Clin. Med. 1959; 54: 811
        • Conn J.W.
        • Seltzer H.S.
        Spontaneous hypoglycemia.
        Am. J. Med. 1955; 19: 460
        • Brown C.H.
        • Nevelle W.E.
        • Hazard J.B.
        Islet-cell adenoma, without hypoglycemia, causing duodenal obstruction.
        Surgery. 1950; 27: 616
        • Busteed F.F.
        • Speir E.B.
        Case of islet-cell carcinoma of the pancreas associated with peptic ulceration of the jejunum.
        Arch. Surg. 1957; 74: 703
        • Cunningham L.
        • Hawe P.
        • Evans R.W.
        Islet cell tumour of the pancreas with unusual clinicopathological features.
        Brit. J. Surg. 1952; 39: 319
        • Farrer T.
        • McBurney R.P.
        • Sanders R.L.
        Recurrent stomal ulcer, refractive to repeated operative procedures.
        Am. J. Gastroenterol. 1959; 31: 641
        • Fisher R.E.
        • Hicks J.
        Further pathologic observation on the syndrome of peptic ulcer and multiple endocrine tumors.
        Gastroenterology. 1960; 38: 458
        • Forty F.
        • Barrett C.M.
        Peptic ulceration of the third part of duodenum associated with islet cell tumors of pancreas.
        Brit. J. Surg. 1952; 40: 60
        • Gordon B.S.
        • Olivetti R.G.
        Carcinoma of the islets of Langerhans.
        Gastroenterology. 1947; 9: 409
        • Hendrick J.W.
        • Davis J.S.
        • Shamblin J.L.
        Ulcerogenic tumors of the pancreas.
        Am. J. Surg. 1959; 97: 92
        • MacKenzie W.C.
        • Norvell S.T.
        • Mathews B.L.
        • Shnitka T.K.
        Islet cell tumors and peptic ulcers.
        Canad. J. Surg. 1958; 2: 6
        • Pender B.
        Islet-cell tumor of pancreas associated with peptic ulceration.
        Lancet. 1959; 1: 123
        • Priest W.M.
        • Alexander M.K.
        Islet cell tumor of the pancreas with peptic ulceration, diarrhea, and hypokalemia.
        Lancet. 1957; 2: 1145
        • Verner J.V.
        • Morrison A.B.
        Islet cell tumor and a syndrome of refractory watery diarrhea and hypokalemia.
        Am. J. Med. 1958; 25: 374
        • Zollinger R.M.
        • McPherson R.C.
        Ulcerogenic tumors of the pancreas.
        Am. J. Surg. 1958; 95: 359
        • Hardy J.D.
        • McPhail J.L.
        Management of functioning tumors of the adrenal cortex.
        Am. J. Surg. 1960; 99: 433
        • Plotz C.M.
        • Knowlton A.I.
        • Ragan C.
        The natural history of Cushing's syndrome.
        Am. J. Med. 1952; 13: 597
        • Classen K.L.
        • Wiederanders R.E.
        Corticoid associated ulcer.
        Nebraska M. J. 1961; 46: 595
        • Beck I.T.
        • Fletcher H.W.
        • McKenna R.D.
        • Griff H.
        Effect of small and massive doses of prednisone on gastric secretory activity.
        Gastroenterology. 1960; 38: 740
        • Wiederanders R.E.
        • Classen K.L.
        • Gobble Jr., W.G.
        The effect of cortisone and diet on the acid secretion of the Heidenhain pouch.
        in: S. Forum. 9. 1958: 434
        • Wiederanders R.E.
        • Classen K.L.
        • Gobble Jr., W.G.
        • Doyle H.H.
        The effect of cortisone acetate on gastric secretion.
        Ann. Surg. 1960; 152: 119
        • Russi S.
        • Blumenthal H.T.
        • Gray S.H.
        Small adenomas of the adrenal cortex in hypertension and diabetes.
        Arch. Int. Med. 1945; 76: 284
        • Brooks R.V.
        The influence of the administration of 17 alpha-ethyl-19-nortestosterone on the excretion of steroids in the human male.
        J. Endocrinol. 1956; 13: 34
        • Brooks R.V.
        • Prunty F.G.
        The suppression of adrenocortical secretion with 17-alpha-ethyl-19-nortestosterone.
        J. Endocrinol. 1957; 15: 385
        • Prunty F.G.
        • Brooks R.V.
        • Clayton B.E.
        • McSwiney R.R.
        Some effects of 17 alphaethyl- 19-nortestosterone in man.
        in: Proc. Roy. Soc. Med.51. 1958: 557
        • Peden J.C.
        • Phin A.
        • Williams P.T.
        The influence of an anabolic agent on the nitrogen balance of patient with major extremity fractures.
        Arch. Surg. 1960; 80: 1036
        • Carter A.C.
        • Weisenfeld S.
        • Goldner M.G.
        Failure of 17 A-ethyl-19-norestosterone to effect plasma 17-hydroxycorticosteroids and ACTH responsiveness in man.
        in: Proc. Soc. Exp. Biol. & Med.98. 1958: 593
        • Castren O.
        • Kalliomake L.
        • Peddarinen A.
        • Soiva K.
        • Viikari S.
        Effect of norethandrolone on the urinary excretion of 17-ketosteroids, total 17-hydroxycorticosteroids and uropepsin and on the gastric secretory activity.
        Acta endocrinol. 1960; 35: 426
        • Clark W.
        • Legros E.
        • Beattie J.
        • Riddouch G.
        • Dott N.M.
        The Hypothalmus: Morphological, Functional, Clinical and Surgical Aspects.
        in: Scott, Edinburgh1938: 173
        • Russfield A.B.
        • Reiner L.
        • Klaus H.
        Endocrine significance of hypophyseal tumors in man.
        Am. J. Path. 1956; 32: 1055
        • Zollinger R.M.
        • Craig T.V.
        Ulcerogenic tumors of the pancreas.
        Am. J. Surg. 1960; 99: 424