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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 45 year old male patient, previously healthy, presents to the physician's office complaining of persistent diarrhea and abdominal pain. The patient also reports recent unintentional weight loss. He denies the use of any medication and has no allergies. Appropriate work-up is initiated. 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?
|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?
|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; it is poorer when gastrin levels are elevated beyond 700 pg/mL, metastasis to the liver occurs, co-secretion of other hormones such as ACTH, and growth factors are overexpressed. 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 than its duodenal counterpart.
|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 than its duodenal counterpart.
 
Reference:
Ellison EC, Johnson JA. The Zollinger-Ellison syndrome: a comprehensive review of historical, scientific, and clinical considerations. Curr Probl Surg. 2009; 46(1):13-106.
|AnswerA=Secretion of more than one type of hormone
|AnswerA=Secretion of more than one type of hormone
|AnswerAExp=Polyhormone secretion, such as co-secretion of ACTH, in gastrinomas is associated with poorer prognosis.
|AnswerAExp=Polyhormone secretion in gastrinoma, such as co-secretion of gastrin and ACTH, is associated with poorer prognosis.
|AnswerB=Liver metastasis
|AnswerB=Liver metastasis
|AnswerBExp=Liver metastasis is associated with increased mortality and poor prognosis.
|AnswerBExp=Liver metastasis is associated with increased mortality and poor prognosis.
|AnswerC=Very high gastrin levels
|AnswerC=Very high gastrin levels
|AnswerCExp=Very high levels of gastrin, above 700 pg/mL is associated with poorer prognosis.
|AnswerCExp=A very high level of gastrin, above 700 pg/mL, is associated with poorer prognosis.
|AnswerD=Overexpression of growth factors
|AnswerD=Overexpression of growth factors
|AnswerDExp=Overexpression of growth factors is associated with low curability and aggressive disease.
|AnswerDExp=Overexpression of growth factors is associated with low curability and aggressive disease.
|AnswerE=Duodenal location of primary tumor
|AnswerE=Duodenal location of primary tumor
|AnswerEExp=Pancreatic location of primary tumor is shown to be of worse outcome and poorer prognosis than its duodenal counterpart.
|AnswerEExp=Pancreatic location of primary tumor is shown to be associated with worse outcome and poorer prognosis compared to its its duodenal counterpart.
|EducationalObjectives=Pancreatic gastrinoma is associated with worse outcome compared to its its duodenal counterpart.
|References=Ellison EC, Johnson JA. The Zollinger-Ellison syndrome: a comprehensive review of historical, scientific, and clinical considerations. Curr Probl Surg. 2009;46(1):13-106.<br>
First Aid 2014 page 329
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=gastrinoma, zollinger, ellison, syndrome, gastrin, acid, output, diarrhea, abdominal, pain, ulcer, duodenum, jejunum, location, prognosis, poor, outcome, poorer, worse, survival, mortality
|WBRKeyword=Gastrinoma, Zollinger, Ellison, Syndrome, Gastrin, Diarrhea, Abdominal pain, Ulcer, Duodenum, Mortality, Prognosis
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:32, 28 October 2020
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.
References: Ellison EC, Johnson JA. The Zollinger-Ellison syndrome: a comprehensive review of historical, scientific, and clinical considerations. Curr Probl Surg. 2009;46(1):13-106.
First Aid 2014 page 329]]

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
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