ENDOCRINE CELL REPLACEMENT OF OXYNTIC GLANDS IN ZOLLINGER-ELLISON SYNDROME - A ROLE FOR FEMALE SEX-HORMONES

A 48-year-old woman with Zollinger-Ellison syndrome (ZES), but no evidence of multiple endocrine neoplasia (MEN)-1 syndrome, developed an unusually florid evolution of enterochromaffin-like (ECL) cell hyperplasia, which led to extensive replacement of oxyntic glands by endocrine tissue and resulted in the disappearance of the patient's gastric acid hypersecretion with antisecretory treatment no longer required. The patient's previous history included breast cancer, treated with surgery and 5 years of antiestrogen therapy, and bilateral granulosa-thecal cell tumor of the ovary. In addition, increased circulating levels of 17 beta-estradiol (17 beta E) and progesterone, possibly depending on concomitant development of liver cirrhosis, were also found. On the basis of these associations, it is suggested that abnormalities in the domain of female sex hormones, with a potential synergistic role of liver dysfunction, may be involved in the florid evolution of hypergastrinemia-driven proliferation of ECL cells observed in the present case.