NBME 24 Answers : Block 3 : #44 = A 62-year-old man comes to the physician for a ...

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nbme24/Block 3/Question#44

A 62-year-old man comes to the physician for a ...

Serum gastrin

+6 upvote downvote
submitted by neonem(257),

I think the idea here is that if you take someone off a PPI, if there's no neoplasm or any problem with gastrin production then you should see it go down from baseline due to more negative feedback of gastric acidity. If not, you probably have a neoplasm that's just making tons of gastrin, such as in the case of Zollinger-Ellison syndrome.

gonyyong I thought it was that if you are taking a PPI, you will see elevated gastrin regardless of it you have a gastrinoma. Thus to confirm diagnosis, you make them stop taking it, then re-measure gastrin → if it's still high, you have confirmed. If it's normal, it's something else +6

+2 upvote downvote
submitted by welpdedelp(75),

I thought this was just referencing zollinger ellison, which would have elevated gastrin

+1 upvote downvote
submitted by dentist(2),

To me: this seemed more straightforward. You'd want to follow up and check Gastrin levels on a patient who previously had 4x normal.

+0 upvote downvote
submitted by paszw0red(1),

The use of any agent that inhibits gastric secretion of acid (H2-receptor antagonists or PPIs) will result in a rise in serum gastrin as the feedback inhibition of gastrin release is diminished.

If you want to rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial measure of elevated Gastrin was not due to your drug rather than the patients disease.