A Hyperthyroidism, B Hypercalcemia, C Zollinger-Ellison syndrome, D Peutz-Jeghers syndrome. Marked hypersecretion, gastric hyperacidity, and persistent ulcers are associated with which condition?

• A. Hyperthyroidism
• B. Hypercalcemia
• C. Zollinger-Ellison syndrome
• D. Peutz-Jeghers syndrome

Answer: (C)

This pattern points to Zollinger-Ellison syndrome, caused by a gastrin-secreting tumor that drives very high gastric acid production. The excess gastrin stimulates parietal cells to secrete large amounts of acid, leading to gastric hyperacidity and multiple peptic ulcers that are often persistent and refractory to standard therapy. Ulcers may occur beyond the usual stomach area and can be accompanied by diarrhea from the acid load.

Hyperthyroidism doesn’t cause a specific rise in gastric acid or persistent ulcers, though it affects metabolism and many systemic signs. Hypercalcemia can cause a wide range of symptoms but not the characteristic marked acid secretion and refractory ulcers seen in Zollinger-Ellison. Peutz-Jeghers involves mucocutaneous pigmentation and hamartomatous GI polyps rather than hypersecretion of gastric acid or the ulcer pattern described.