Which of the following pancreatic tumour is most commonly seen in MEN type-I
a. Pancreatic NETs that are nonfunctioning or that secrete pancreatic polypeptide are probably the most frequent NETs that occur in patients with MEN 1.
b. The most common functional NET in patients with MEN 1 is gastrinoma. The presenting signs and symptoms in patients with hypergastrinemia, or the Zollinger-Ellison syndrome (ZES), include epigastric pain, reflux esophagitis, secretory diarrhea, and weight loss. In the current era with highly effective proton pump inhibitors for medical therapy, active peptic ulcer disease is present in less than 20% of patients at the time of diagnosis.
c. Patients may infrequently present with a severe ulcer diathesis as well as stricture or perforation of the esophagus due to severe reflux esophagitis.
d. Gastrinoma is diagnosed by the documentation of gastric acid hypersecretion (>15 mEq/L in patients without operation, or >5 mEq/L in patients with prior ulcer surgery), associated with elevated fasting levels of serum gastrin (>100 pg/mL). The diagnosis can be confirmed by an abnormal secretin test.
e. Gastrinomas that develop in patients with MEN 1 are usually malignant (∼80%), as indicated by the presence of regional lymph node or distant metastases.
f. Gastrinomas were previously thought to be located predominantly in the head of the pancreas within the gastrinoma triangle.
g. More recent data suggest that gastrinomas in patients with MEN 1 occur most frequently within the wall of the duodenum .
h. Endoscopic ultrasound has been utilized successfully to localize gastrinomas within the wall of the duodenum or head of the pancreas.