We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Localization and Resection of Insulinomas and Gastrinomas

Douglas L. Fraker, MD; Jeffrey A. Norton, MD
JAMA. 1988;259(24):3601-3605. doi:10.1001/jama.1988.03720240063036.
Text Size: A A A
Published online


Case 1  A 45-YEAR-OLD woman with a threeyear history of epigastric pain was treated initially with cimetidine and then with ranitidine hydrochloride and antacids, with only mild relief. Her fasting serum gastrin level was elevated at 496 ng/L (496 pg/mL) (normal, <100 ng/L [<100 pg/mL]). Her basal acid output was 32 mEq/h (normal, <15 mEq/h). The results of her secretin stimulation test were abnormal, with a rise in the serum gastrin level from 239 ng/L (239 pg/mL) at baseline to 825 ng/L (825 pg/mL) (abnormal increment, >200 ng/L [>200 pg/mL]). Ultrasound, computed tomographic (CT) scan, and selective angiogram all failed to demonstrate a gastrinoma. Selective venous sampling was performed and a marked step-up in gastrin levels was found in the superior pancreaticoduodenal vein (Fig 1). The patient underwent an exploratory laparotomy, and intraoperative ultrasound demonstrated a lesion in the posterior head of the pancreas (Fig 2). After enucleation,


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.