Arteriographic manifestations of the Zollinger-Ellison syndrome
Ralph J. Alfidi, M.D.
Department of Hospital Radiology
Penn G. Skillern, M.D.
Department of Endocrinology
George Crile, M.D.
Department of General Surgery
THE roentgenographic manifestations of the Zollinger-Ellison syndrome1 have been described by various authors.2–4 In addition, three cases were reported in which arteriography demonstrated the presence of non-beta islet cell adenomas and carcinomas of the pancreas.5–7 Our report concerns a case in which the sites of multiple pancreatic adenomas in the body and tail of the pancreas were demonstrated on arteriograms. A remarkable degree of gastric and intestinal venous opacification was seen during the arterial phase of the study. It is possible that this previously undescribed phenomenon is a physiologic change produced by large quantities of circulating gastrin generated by the adenomas.
Report of a case
A 29-year-old Caucasian woman was admitted to the Cleveland Clinic Hospital on December 21, 1967, because of persistent vomiting and for suspected Zollinger-Ellison syndrome. She had a seven-year history of preprandial epigastric pain. She had been amenorrhic since the age of 16 years, and, although married, had never been pregnant. Six years previously she had undergone operation for a perforated duodenal ulcer. One year later, renal and ureteral calculi were discovered. In 1966, serum calcium values on several occasions were reported to be abnormally high. In March 1967, a parathyroid adenoma was removed; however, serum calcium values remained persistently elevated. She had no history of diarrhea.
Physical examination revealed the pulse rate to be 110 and the blood pressure 140/110 mm Hg. There was a well-healed surgical scar on the anterior surface of the neck. Laboratory examinations demonstrated a blood hemoglobin content of 15.2 g . . .