Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer

Venu Julapalli, Mehnaz Shafi, Jim Schwartz, Richard Goodgame

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Although our patient had a rare tumor, the differential diagnosis illustrates the interesting biologic spectrum of neuroendocrine tumors of the pancreas. These tumors can occur sporadically in patients without a family history. However, one tumor can produce multiple hormones. In this situation, the tumors may mimic the MEN syndromes, prompting a search for second or third tumors. The presence of MEN-1 syndrome should be investigated in all patients with concomitant Zollinger-Ellison syndrome and Cushing's syndrome. Only a full hormonal and anatomic evaluation can clarify the clinical alternatives: one tumor producing multiple hormones vs multiple endocrine tumors. Gastrinomas that produce ACTH are much more biologically aggressive than simple gastrinomas. Therapy is not based on prospective randomized clinical trials but on appreciating the unique combination of hormone production and tumor spread. Treatment decisions first involve symptom control, then a multidisciplinary approach that may include surgical debulking, somatostatin analog therapy, and chemotherapy.

Original languageEnglish (US)
Title of host publicationMedGenMed Medscape General Medicine
Volume6
Edition2
StatePublished - 2004
Externally publishedYes

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Teaching Rounds
Gastroenterology
Duodenal Ulcer
Medicine
Hemorrhage
Neoplasms
Gastrinoma
Hormones
Zollinger-Ellison Syndrome
Multiple Endocrine Neoplasia Type 1
Neuroendocrine Tumors
Cushing Syndrome
Somatostatin
Adrenocorticotropic Hormone
Pancreas
Differential Diagnosis
Therapeutics
Randomized Controlled Trials
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Julapalli, V., Shafi, M., Schwartz, J., & Goodgame, R. (2004). Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer. In MedGenMed Medscape General Medicine (2 ed., Vol. 6)

Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer. / Julapalli, Venu; Shafi, Mehnaz; Schwartz, Jim; Goodgame, Richard.

MedGenMed Medscape General Medicine. Vol. 6 2. ed. 2004.

Research output: Chapter in Book/Report/Conference proceedingChapter

Julapalli, V, Shafi, M, Schwartz, J & Goodgame, R 2004, Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer. in MedGenMed Medscape General Medicine. 2 edn, vol. 6.
Julapalli V, Shafi M, Schwartz J, Goodgame R. Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer. In MedGenMed Medscape General Medicine. 2 ed. Vol. 6. 2004
Julapalli, Venu ; Shafi, Mehnaz ; Schwartz, Jim ; Goodgame, Richard. / Grand rounds in gastroenterology from Baylor College of Medicine - A 42-year-old Cushingoid man with a bleeding duodenal ulcer. MedGenMed Medscape General Medicine. Vol. 6 2. ed. 2004.
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