The Intricate Interplay of Gastrin in Mary’s Hormonal Imbalance

January 10, 2024by Dr. S. F. Czar0

Case Study:

Patient: Mary, a 42-year-old woman with a history of chronic heartburn and intermittent episodes of severe abdominal pain.

Presenting Symptoms:

  • Heartburn and acid reflux for over 10 years, worsening recently despite medication.
  • Recurrent episodes of severe abdominal pain lasting for hours, often accompanied by nausea and vomiting.
  • Unexplained weight loss over the past year.
  • Fatigue and difficulty sleeping.

Medical History:

  • No prior surgeries or major illnesses.
  • Family history of diabetes and obesity.
  • Takes over-the-counter antacids for heartburn relief.

Initial Investigations:

  • Upper endoscopy reveals multiple gastric ulcers and inflammation in the duodenum.
  • Biopsy confirms the presence of gastritis (inflammation of the stomach lining).
  • Blood tests show elevated gastrin levels and abnormal insulin sensitivity.
  • Bone density scan indicates early signs of osteoporosis.

Differential Diagnosis:

  • Zollinger-Ellison syndrome (ZES)
  • Gastroesophageal reflux disease (GERD) with complications
  • Peptic ulcer disease with complications
  • Early-stage type 2 diabetes
  • Gastric neuroendocrine tumor

Further Investigations:

  • Gastrin stimulation test to confirm or rule out ZES.
  • Imaging tests (CT or MRI) to rule out pancreatic tumors associated with ZES.
  • Comprehensive metabolic panel to assess diabetes markers and insulin resistance.
  • Bone mineral density analysis for further evaluation of osteoporosis.


Based on the combined clinical picture, elevated gastrin levels, and positive gastrin stimulation test, Mary is diagnosed with ZES. Further investigations do not reveal evidence of a pancreatic neuroendocrine tumor, indicating primary ZES arising from the stomach or duodenum.

Treatment Plan:

  • Proton pump inhibitor (PPI) medication to suppress gastric acid secretion and promote ulcer healing.
  • Surgical consultation to evaluate options for gastrin-producing tumor removal if localized in the stomach or duodenum.
  • Nutritional counseling to manage weight and optimize blood sugar control.
  • Calcium and vitamin D supplementation to address early signs of osteoporosis.
  • Ongoing monitoring of gastrin levels, ulcer healing, and metabolic parameters.

Potential Impact of Gastrin’s Duality:

  • In Mary’s case, gastrin acts as a “foe,” driving excessive acid production and contributing to ZES-related complications like ulcers and abdominal pain.
  • However, her elevated gastrin levels might also have a protective effect, stimulating bone cell growth and potentially contributing to her early-stage osteoporosis.
  • Understanding the complex interplay of gastrin in her specific case helps tailor treatment strategies that address both the immediate complications and potential long-term health concerns.

When Silence Overtakes the Melody

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