The following condition is associated with low serum gastrin level except: (AIIMS Nov 2010)
|D||All of the above|
a. Virtually all gastrinoma patients will have a gastrin level >150–200 pg/mL.
b. Multiple processes can lead to an elevated fasting gastrin level: gastric hypochlorhydria or achlorhydria (the most frequent), with or without pernicious anemia; retained gastric antrum; G cell hyperplasia; gastric outlet obstruction; renal insufficiency; massive small-bowel obstruction; and conditions such as rheumatoid arthritis, vitiligo, diabetes mellitus, and pheochromocytoma.
c. A decrease in acid production will subsequently lead to failure of the feedback inhibitory pathway, resulting in net hypergastrinemia.
d. H. pylori infection can also cause hypergastrinemia.
e. Although a fasting gastrin >10 times normal is highly suggestive of ZE, two-thirds of patients will have fasting gastrin levels that overlap with levels found in the more common disorders outlined above.