History and exam

Key diagnostic factors

common

presence of risk factors

Multiple endocrine neoplasia (MEN) type 1 syndrome is a key risk factor.

refractory or recurrent peptic ulcer disease

Large amounts of the hormone gastrin are produced by the tumour/s; this causes the stomach to produce too much acid, which may lead to peptic ulcers.

diarrhoea

Occurs in 37% to 73% of patients.[1][2]

Other diagnostic factors

common

epigastric abdominal pain

Occurs in 70% to 100% of patients. This abdominal pain or burning, which may be localised or diffuse and is frequently relieved by food or antacids, is due to peptic ulcer disease.[1]

gastro-oesophageal reflux disease

Occurs in 44% of patients.[1]

uncommon

steatorrhoea

Due to malabsorption of lipids as a result of pancreatic enzyme deactivation.

gastrointestinal bleed

May be associated with refractory or recurrent peptic ulcer disease.

bone pain

Patients with bone metastases may complain of low back ache in particular.

Risk factors

strong

multiple endocrine neoplasia type 1 (MEN1)

About 20% of gastrinomas are associated with MEN1. It is an autosomal dominantly inherited syndrome characterised by tumours in multiple endocrine organs, especially the parathyroid, pituitary, and pancreas. The presence of nephrocalcinosis should raise suspicion for MEN1.[13][14]

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