pancreatic mass, kidney stones, high liver functions, urine oxalates high

[kishme]

can you help me figure out what is going on?  Could it be zollinger ellisons syndrome? My uncle has it and they say its hereditary. I have been getting kidney stones for about 5-6 years recurrently and before that I had bad ulcers. Now they are seeing enlarged pancreas suggestive of a mass, and previously my liver showed up on ct scan as abnormal density and high liver functions.I have also heard plenty of remarks on the multiple cysts on my cervix and ovaries. I have chronic pain in my lower left flank area and same side under my ribs in abdominal area. They say I shouldn't be experiencing pain from the stones except for when they move but I have it most of the time and most often need strong pain medicine in order to function. Its not from my back though because I can feel it squeeze inside like something is going to explode. I am very frustrated and tired of going to the ER. I recently have gone to a nephrologist and they say I have high oxalates in my urine.  Could this be something other than simple kidney stones or could it all be connected? I am a 27 year old female with pulmonary stenosis and a poor health history and 2 children maybe you have some ideas?

[Kevin Pho, MD]

You may want to consider whether multiple endocrine neoplasia type 1 (MEN-1) is a possibility.

This is a familial disorder characterized by predisposition to tumors of the parathyroid glands (which occur in nearly all patients by age 50 years), anterior pituitary, and pancreatic islet cells/GI tumors.

Primary hyperparathyroidism is the most common manifestation of MEN-1, with over 90 percent penetrance by age 40 to 50.  This leads to a high calcium level, which may predispose you to kidney stones.  

Regarding the GI tumors, the most common cause of symptoms is the Zollinger-Ellison (gastrinoma) syndrome. About 40 percent of patients with MEN-1 have either the Zollinger-Ellison syndrome or asymptomatic elevation in serum gastrin concentrations.

I would approach your physician with the possibility of this syndrome and make the appropriate referrals - an endocrinologist would be a good start.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Arnold.  Approach to therapy in multiple endocrine neoplasia type 1.  UptoDate, 2004.

[surgeon]

have you been checked for hyperparathyroidism?