Case Study: The Role of Gastrin in Hypercortisolism-Associated Gastric Changes
Patient Background: Mr. Smith, a 45-year-old male, presents to the gastroenterology clinic with a history of uncontrolled hypertension, central obesity, and progressive muscle weakness over the past year. He reports excessive weight gain, particularly in the abdominal area, along with easy bruising and thinning of the skin. Clinical examination reveals facial plethora, proximal muscle weakness, and abdominal striae. Laboratory investigations confirm elevated serum cortisol levels and suppressed adrenocorticotropic hormone (ACTH) levels, consistent with a diagnosis of Cushing’s syndrome.
Clinical Presentation: In addition to the typical manifestations of Cushing’s syndrome, Mr. Smith complains of recurrent epigastric pain, bloating, and acid reflux symptoms. He describes frequent episodes of heartburn and regurgitation, despite adherence to proton pump inhibitor therapy. Upper gastrointestinal endoscopy reveals multiple gastric erosions and superficial ulcers scattered throughout the gastric mucosa, indicative of chronic gastritis.
Investigations: Further investigation into the gastric changes associated with Cushing’s syndrome leads to serum gastrin level assessment, which reveals elevated levels compared to age-matched controls. Imaging studies, including abdominal computed tomography (CT) scans, demonstrate diffuse gastric wall thickening and increased gastric acid secretion, consistent with gastrin-mediated effects.
Diagnosis and Treatment: The constellation of clinical findings, biochemical abnormalities, and imaging results confirms a diagnosis of Cushing’s syndrome with concomitant gastrin-mediated gastric changes. Treatment is initiated with a multidisciplinary approach, including medical management to control cortisol excess and targeted therapy to address gastric complications.
Therapeutic Approach:
- Cortisol Control: Mr. Smith is started on medication to suppress cortisol production, aiming to normalize cortisol levels and alleviate systemic manifestations of Cushing’s syndrome.
- Gastrin Suppression: Given the elevated serum gastrin levels and gastric mucosal changes observed, targeted therapy to suppress gastrin secretion is initiated. This involves the use of gastrin receptor antagonists or inhibitors to mitigate excessive gastric acid secretion and promote mucosal healing.
- Gastric Protection: Concurrently, proton pump inhibitor therapy is optimized to provide symptomatic relief and protect the gastric mucosa from further damage, facilitating ulcer healing and symptom resolution.
- Long-term Management: Regular monitoring of cortisol and gastrin levels, along with clinical assessment of gastric symptoms and endoscopic evaluation, is essential to gauge treatment response and adjust therapy as needed. Lifestyle modifications, including dietary changes and stress reduction techniques, are encouraged to optimize gastrointestinal health and overall well-being.
Outcome: With comprehensive management addressing both cortisol excess and gastrin-mediated gastric changes, Mr. Smith experiences significant improvement in his symptoms and overall health. Serial follow-up evaluations demonstrate normalization of serum cortisol and gastrin levels, resolution of gastric erosions, and alleviation of gastrointestinal symptoms. Long-term management focuses on maintaining cortisol and gastrin control, preventing disease recurrence, and promoting patient education and adherence to therapy.
Conclusion: This case highlights the intricate interplay between cortisol and gastrin in the pathogenesis of gastric changes associated with Cushing’s syndrome. By recognizing the role of gastrin dysregulation in mediating gastric complications, tailored therapeutic interventions can effectively target both systemic and gastrointestinal manifestations of Cushing’s syndrome, leading to improved patient outcomes and quality of life. Through a multidisciplinary approach integrating endocrinology, gastroenterology, and nutrition, patients like Mr. Smith can achieve optimal management of their condition and regain control of their health.