Impact of Stress on Serum Gastrin in Zollinger‐Ellison Syndrome

We report an impressive case with Zollinger‐Ellison syndrome (ZES), in which stress‐induced sympathetic discharge influenced serum gastrin. Our patient was a 35‐yr‐old female who complained of frequent and massive vomiting (more than 4000 ml of gastric juice) which was aggravated especially by psychosocial stress. Basal hypergastrinemia (1900 pg/ml) was found after the admission. The most striking finding was that laboratory stress dramatically increased serum gastrin (from 1900 to 5400 pg/ml) and plasma noradrenaline (from 180 to 1130 pg/ml). Mental arithmetic stress further enhanced hypergastrinemia (5800 pg/ml) with a concomitant increase in plasma noradrenaline (1240 pg/ ml). Neostigmine (10 μg/kg im) also increased serum gastrin up to 6100 pg/ml but propranolol (40 μg/kg iv) reduced these elevations (noradrenaline: 990 pg/ml, gastrin: 5000 pg/ml). In this case, the effect of stress on serum gastrin mimicked the effect of catecholamine infusion in ZES. These findings suggest that psychological stress induces serum gastrin secretion via β‐adrenoceptor with exacerbation of symptoms in some cases with ZES.