<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1409-0015</journal-id>
<journal-title><![CDATA[Medicina Legal de Costa Rica]]></journal-title>
<abbrev-journal-title><![CDATA[Med. leg. Costa Rica]]></abbrev-journal-title>
<issn>1409-0015</issn>
<publisher>
<publisher-name><![CDATA[Asociación Costarricense de Medicina Forense]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1409-00152016000100275</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Síndrome de zolinger - Elison]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferrandino Carballo]]></surname>
<given-names><![CDATA[Fiorella]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Umaña Brenes]]></surname>
<given-names><![CDATA[Alberto Alonso]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Costa Rica  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Costa Rica</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Costa Rica  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Costa Rica</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2016</year>
</pub-date>
<volume>33</volume>
<numero>1</numero>
<fpage>275</fpage>
<lpage>281</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S1409-00152016000100275&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S1409-00152016000100275&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S1409-00152016000100275&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: El síndrome de Zollinger - Ellison es una endocrinopatía que fue descrita en 1955 por los doctores Robert Zollinger y Edwin Ellison, quienes propusieron la triada diagnóstica que incluye hipersecreción gástrica ácida, úlcera péptica y gastrinoma. Esta enfermedad predomina en mujeres entre los 50 y 60 años de edad. Según su etiología, este síndrome se clasifica en una forma esporádica o asociada a neoplasia endocrina múltiple tipo 1 (NEM - 1). Más de la mitad de los gastrinomas se localizan en la pared duodenal, el páncreas es la segunda ubicación en frecuencia. Existen localizaciones ectópicas en ovario, mesenterio, hígado y ducto biliar. A nivel histopatológico se encuentran células tumorales redondas, con núcleos pequeños y nucléolos prominentes. La hipersecreción ácida gástrica está asociada a un defecto en la inhibición del retrocontrol negativo de la somatostatina sobre las células G antrales productoras de gastrina. Clínicamente, los pacientes manifiestan dolor abdominal, diarrea, pirosis, náuseas y vómitos; relacionados principalmente a la formación de úlceras pépticas. El diagnóstico debe incluir una medición en los niveles séricos de gastrina y valores de pH gástrico. El tratamiento de primera línea es la terapia antisecretora, principalmente con inhibidores de la bomba de protones. Los estudios de imágenes son de utilidad para detectar metástasis y evaluar la enfermedad quirúrgicamente resecable. Se debe hacer diagnóstico diferencial con otros tumores neuroendocrinos y causas de hipergastrinemia.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Zollinger - Ellison syndrome is an endocrinopathy that was first described in 1955 by doctors Robert Zollinger and Edwin Ellison, who proposed the diagnostic triad that includes gastric acid hypersecretion, peptic ulcer and gastrinoma. This disease predominates in women between 50 and 60 years old. Based on the etiology, the syndrome is classified in sporadic or associated with multiple endocrine neoplasia type 1 (NEM - 1). Over half of gastrinomas are located in the duodenal wall, the pancreas is the second frequency location. There are ectopic locations, such as ovary, mesentery, liver and bile duct. Round cells, small nuclei and prominent nucleoli, are the main hispathologycal characteristics. Gastric acid hypersecretion is associated with a defect in the negative feedback inhibition of somatostatin on G antral gastrin-producing cells. Clinically, patients present abdominal pain, diarrhea, heartburn, nausea and vomiting; primarily related to the development of peptic ulcers. Diagnosis includes a measurement in serum gastrin levels and gastric pH values. The first line treatment is the antisecretory therapy, primarily proton-pump inhibitor. Imaging studies are useful to detect metastases and evaluate the surgically resectable disease. Neuroendocrine tumors and hypergastrinemia causes are the main differential diagnoses, the clinician should consider.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Síndrome de Zollinger]]></kwd>
<kwd lng="es"><![CDATA[Ellison]]></kwd>
<kwd lng="es"><![CDATA[gastrinas]]></kwd>
<kwd lng="es"><![CDATA[gastrónoma]]></kwd>
<kwd lng="es"><![CDATA[neoplasia endocrina múltiple tipo 1]]></kwd>
<kwd lng="es"><![CDATA[hipergastrinemia]]></kwd>
<kwd lng="es"><![CDATA[ácido gástrico]]></kwd>
<kwd lng="es"><![CDATA[tumores neuroendocrinos]]></kwd>
<kwd lng="en"><![CDATA[Zollinger]]></kwd>
<kwd lng="en"><![CDATA[Ellison Syndrome]]></kwd>
<kwd lng="en"><![CDATA[gastrins]]></kwd>
<kwd lng="en"><![CDATA[gastrinoma]]></kwd>
<kwd lng="en"><![CDATA[multiple endocrine neoplasia type 1]]></kwd>
<kwd lng="en"><![CDATA[hypergastrinemia]]></kwd>
<kwd lng="en"><![CDATA[gastric Acid]]></kwd>
<kwd lng="en"><![CDATA[neuroendocrine tumo]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ellison]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Zollinger-Ellison Syndrome: A Comprehensive Review of Historical, Scientific and Clinical Considerations]]></article-title>
<source><![CDATA[Curr Probl Surg]]></source>
<year>2009</year>
<volume>46</volume>
<page-range>13-106</page-range></nlm-citation>
</ref>
<ref id="B2">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Epelboym]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Mazeh]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Zollinger-Ellison Syndrome: Classical Considerations and Current Controversies]]></article-title>
<source><![CDATA[The Oncologist]]></source>
<year>2014</year>
<volume>19</volume>
<page-range>44-50</page-range></nlm-citation>
</ref>
<ref id="B3">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pritchard]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Zollinger-Ellison Syndrome: Still a Diagnostic Challenge in the 21st Century?]]></article-title>
<source><![CDATA[Gastroenterology]]></source>
<year>2011</year>
<volume>140</volume>
<page-range>1380-98</page-range></nlm-citation>
</ref>
<ref id="B4">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Feldman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Friedman]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Brandt]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<source><![CDATA[Sleisenger and Fordtran´s Gastrointestinal and Liver Disease]]></source>
<year>2015</year>
<edition>10</edition>
<publisher-loc><![CDATA[Estados Unidos ]]></publisher-loc>
<publisher-name><![CDATA[Saunders Elseviers]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Krampitz]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Norton]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Current Management of the Zollinger-Ellison Syndrome]]></article-title>
<source><![CDATA[Advances in Surgery]]></source>
<year>2013</year>
<volume>47</volume>
<page-range>49-59</page-range></nlm-citation>
</ref>
<ref id="B6">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Burgos]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Burgos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tumores neuroendocrinos del páncreas]]></article-title>
<source><![CDATA[Rev Med Chile]]></source>
<year>2004</year>
<volume>132</volume>
<page-range>627-34</page-range></nlm-citation>
</ref>
<ref id="B7">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ito]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Igarashi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Jensen]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pancreatic neuroendocrine tumors: Clinical features, diagnosis and medical treatment: Advances]]></article-title>
<source><![CDATA[Best Practice &amp; Research Clinical Gastroenterology]]></source>
<year>2012</year>
<volume>26</volume>
<page-range>737-53</page-range></nlm-citation>
</ref>
<ref id="B8">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hauser]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<source><![CDATA[Mayo Clinic Gastroenterology and Hepatology Board Review]]></source>
<year>2015</year>
<edition>5</edition>
<publisher-loc><![CDATA[Estados Unidos ]]></publisher-loc>
<publisher-name><![CDATA[Oxford University Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tomassetti]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Campana]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Pisciteli]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Mazzotta]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Brocchi]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pezzilli]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Treatment of Zollinger - Ellison Syndrome]]></article-title>
<source><![CDATA[World Journal of Gastroenterology]]></source>
<year>2005</year>
<volume>11</volume>
<numero>35</numero>
<issue>35</issue>
<page-range>5423-32</page-range></nlm-citation>
</ref>
<ref id="B10">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Metz]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis of the Zollinger - Ellison Syndrome]]></article-title>
<source><![CDATA[Clinical Gastroenterology and Hepatology]]></source>
<year>2012</year>
<volume>10</volume>
<page-range>126-30</page-range></nlm-citation>
</ref>
<ref id="B11">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rebollo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zamorano]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La gammagrafía de receptores de somatostatina en los tumores neuroendocrinos]]></article-title>
<source><![CDATA[Endocrinol Nutr]]></source>
<year>2002</year>
<volume>49</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>48-55</page-range></nlm-citation>
</ref>
<ref id="B12">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vinic]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Raymond]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pancreatic Neuroendocrine Tumors: Approach to Treatment with Focus on Sunitinib]]></article-title>
<source><![CDATA[Therapeutic Advances in Gastroenterology]]></source>
<year>2013</year>
<volume>6</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>396-411</page-range></nlm-citation>
</ref>
<ref id="B13">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tiensuu]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Sorbye]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Welin]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Federspiel]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Grønbæk]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Hellman]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nordic Guidelines (2014). for Diagnosis and Treatment of Gastroenteropancreatic Neuroendocrine Neoplasms]]></article-title>
<source><![CDATA[Acta Oncológica]]></source>
<year>2014</year>
<volume>53</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1284-97</page-range></nlm-citation>
</ref>
<ref id="B14">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fendrich]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical Treatment of Zollinger - Ellison Syndrome]]></article-title>
<source><![CDATA[Pancreatic Disorders &amp; Therapy]]></source>
<year>2012</year>
<volume>2</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-2</page-range></nlm-citation>
</ref>
<ref id="B15">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Valdez]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tumores Neuroendocrinos]]></article-title>
<source><![CDATA[Rev. Esc. Med. Dr. J. Sierra]]></source>
<year>2012</year>
<volume>26</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>31-6</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
