The patient is a 48-year old male with chief complaint of chronic diarrhea and epigastic pain for the past year. He states that the diarrhea is watery and without blood, pus or mucus. He has a history of duodenal ulcer for which he takes cimetidine. He has been treated for H. Pylori without improvement of his symptoms. He reports a 25-pound weight loss over the past 6 months. He denies use of laxatives.
PMH: None
Vitals: T 98, P 88, BP 114/55, R 28, wt 200
Physical exam:
Gen: no acute distress
EENT: PERRLA, EOMI (extra ocular muscles intact)
Respiratory: Clear to auscultation
Cardiac: RRR (rate rhythm regular)
Abdomen: bowel sounds present, abdomen soft, no organomegaly
Extremities: No cyanosis, clubbing, or edema
Neurologic: Alert and oriented, 5/5 strength, sensation intact
Rectal: guiac negative, normal sphincter tone
Labs: Na 137 mmol/L, K 3.3 mmol/L, Cl 96 mmol/L, Bicarb 27 mmol/L, Bun 18 mg/dL, Creat 0.8 mg/dL, Glucose 167 mg/dL
Additional studies reveal:
Gastrin: 1482 pg/mL (reference 0-100 pg/mL)
Colonoscopy with biopsies: normal
Stool fat: negative
O&P: negative
Stool culture for pathogenic bacteria: negative
Based the high gastrin levels an octreotide scan was ordered which showed intense octreotide activity arising from the distal second part of the duodenum.
What is your diagnosis?
What is the recommended treatment?
This patient is at increased risk of having what syndrome?