WBR0740
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| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[Prompt::A 45-year-old man with no past medical history presents to the physician's office with complaints of persistent diarrhea and abdominal pain for the past 3 weeks. The patient also reports recent unintentional weight loss. He denies the use of any medication and has no allergies. On endoscopy, the patient is found to have multiple ulcers in the duodenum and the jejunum. Acid output is measured and is abnormally elevated. Which of the following does not correlate with the severity of the disease in this patient?]] |
| Answer A | AnswerA::Secretion of more than one type of hormone |
| Answer A Explanation | AnswerAExp::Polyhormone secretion in gastrinoma, such as co-secretion of gastrin and ACTH, is associated with poorer prognosis. |
| Answer B | AnswerB::Liver metastasis |
| Answer B Explanation | AnswerBExp::Liver metastasis is associated with increased mortality and poor prognosis. |
| Answer C | AnswerC::Very high gastrin levels |
| Answer C Explanation | AnswerCExp::A very high level of gastrin, above 700 pg/mL, is associated with poorer prognosis. |
| Answer D | AnswerD::Overexpression of growth factors |
| Answer D Explanation | AnswerDExp::Overexpression of growth factors is associated with low curability and aggressive disease. |
| Answer E | AnswerE::Duodenal location of primary tumor |
| Answer E Explanation | AnswerEExp::Pancreatic location of primary tumor is shown to be associated with worse outcome and poorer prognosis compared to its its duodenal counterpart. |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::The patient is presenting with signs and symptoms consistent with gastrinoma or Zollinger-Ellison syndrome. The prognosis of gastrinoma is affected by several factors. Prognosis is poorer among patients with gastrin levels beyond 700 pg/mL, metastasis to the liver, co-secretion of other hormones such as ACTH, and overexpression of growth factors. The size of the tumor is more likely to be a prognostic factor than the actual location, as to whether it originates from the pancreas or the duodenum. Nonetheless, pancreatic gastrinoma is associated with poorer prognosis compared to its its duodenal counterpart. Educational Objective: Pancreatic gastrinoma is associated with worse outcome compared to its its duodenal counterpart. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Gastrinoma, WBRKeyword::Zollinger, WBRKeyword::Ellison, WBRKeyword::Syndrome, WBRKeyword::Gastrin, WBRKeyword::Diarrhea, WBRKeyword::Abdominal pain, WBRKeyword::Ulcer, WBRKeyword::Duodenum, WBRKeyword::Mortality, WBRKeyword::Prognosis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |