Pancreatic Islet Cell Tumors

Pancreatic or duodenal neuroendocrine tumors in MEN type I occur most frequently in the fourth or fifth decade. Greater than 95% of those who develop enteropancreatic neuroendocrine tumors already have hyperparathyroidism.13 However, Zollinger-Ellison syndrome may be the first manifestation in a small population of patients.14 The clinical presentation usually depends on the increased hormone levels; therefore, patients may present early when tumors are small, for example, with duodenal gastrinomas that are unde-tectable on preoperative imaging but that cause significant ulcer disease, esophageal reflux symptoms, and diarrhea (Figure 16-3). Symptoms of local enlargement or infiltration including back pain and abdominal mass, left-sided portal hypertension, jaundice, or metastatic disease (cachexia, hepatosplenomegaly) may rarely be present at presentation, but more frequently in older patients with nonfunctional tumors. Nonfunctional neuroendocrine tumors, of which three-

Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

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