History: A 31-year-old morbidly obese woman presented with fatigue. Complete blood count results reŽvealed severe anemia with a hemoglobin level of 3.8 mmol/L (normal range, 7.1-9.9 mmol/L) and hematocrit level of 0.22 (normal range, 0.34-0.48). Results of an iron study performed at an outside institution revealed iron-deficiency anemia; the patient denied experiencing heavy menstrual periods. Colonoscopy results were negative, but upper endoscopy performed the same day showed multiple 10-50-mm pedunŽculated and sessile gastric polyps (Fig 1). No site of active or recent bleeding was identified. A biopsy was performed, and histologic analysis of the specimen revealed carcinoid tumor cells. The patient reported no abdominal pain and had no symptoms to suggest Zollinger-Ellison syndrome or multiple endocrine neoplasia type 1 (MEN-1). She was referred to a tertiary care center for furŽther evaluation.