WBR0740

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[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?]]
Answer A	AnswerA::Secretion of more than one type of hormone
Answer A Explanation	AnswerAExp::Polyhormone secretion, such as co-secretion of ACTH, in gastrinomas 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::Very high levels 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::Primary location of tumor
Answer E Explanation	AnswerEExp::Tumor location, as to whether it originates from the duodenum or the pancreas, is not very important in gastrinomas and is not a predictor of outcome.
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; 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. Educational Objective: Location of gastrinoma is not associated with its prognosis. 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. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::gastrinoma, WBRKeyword::zollinger, WBRKeyword::ellison, WBRKeyword::syndrome, WBRKeyword::gastrin, WBRKeyword::acid, WBRKeyword::output, WBRKeyword::diarrhea, WBRKeyword::abdominal, WBRKeyword::pain, WBRKeyword::ulcer, WBRKeyword::duodenum, WBRKeyword::jejunum, WBRKeyword::location, WBRKeyword::prognosis, WBRKeyword::poor, WBRKeyword::outcome, WBRKeyword::poorer, WBRKeyword::worse, WBRKeyword::survival, WBRKeyword::mortality
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