Fig. 1

Patient timeline. Patient timeline showing initial presentation in 1986 and subsequent multiple endocrine neoplasia type 1 (MEN-1) and Zollinger-Ellison syndrome (ZES) diagnosis in 1993. Progression of disease detailed throughout the 2000s with accompanying surgical procedures. Patient continues to be asymptomatic at the present date with no disease progression seen on repeat imaging and endoscopy with current gastrin level 114 pg/mL in 2018