Manifestation of Zollinger-Ellison-Syndrome with hypovolemic shock

A 63-year-old male patient presented to a secondary hospital suffering from severe epigastric pain, vomiting and mild diarrhea for the last few hours. Since many months he experienced increasing fatigue and loss of appetite. Furthermore, recurring mild epigastric pain persisted since many years. A gastroscopy in the ambulatory setting has been unremarkable. These gastrointestinal symptoms had improved under proton-pump-inhibitor (PPI) therapy but recurred after discontinuation. Medical history revealed a diagnosis of arterial hypertension treated with lisinopril 20mg and hydrochlorothiazide 25mg, each once daily.