Gastric Secretion and Hormonal Interactions in Multiple Endocrine Neoplasia Type I

Gogel, Howard K.

doi:10.1001/archinte.1985.00360050111019

Cited by 16 publications

(6 citation statements)

References 38 publications

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“…Therefore, the timing of the initial PTX as well as its place in the natural history of the MEN1 may differ substantially from patients without ZES. Fourth, the occurrence of the ZES may have an effect on the timing of the PTX in an MEN1 patient, because previous studies in small numbers of patients show, in some studies 23, 42-45 , but not others 44,[46][47][48][49] , the PTX with correction of the hypercalcemia, may have an ameliorating effect on the acid secretion, responsiveness to anti-secretetory drugs, fasting gastrin levels and secretin provocative testing . The current study includes a large number of MEN1/HPT/ZES patients (n=84) who were prospectively studied.…”

Section: Discussionmentioning

confidence: 99%

“…The effect of PTX on the behavior of the gastrinoma in patients with MEN1/HPT/ZES including fasting gastrin levels, basal acid ouput and secretin provocative testing is controversial in the literature 44 . Whereas some previous studies on small numbers of cases 23, [42][43][44][45][46][47][57][58][59][60] report that PTX in MEN1/HPT/ZES patients can markedly decrease the fasting gastrin levels, basal acid output and/or secretin-stimulated gastrin response, a number of other studies report either no effect or a minimal effect on these measures of gastrinoma function 46-49, 59, 61 .…”

Section: Discussionmentioning

confidence: 99%

“…Whereas some previous studies on small numbers of cases 23, [42][43][44][45][46][47][57][58][59][60] report that PTX in MEN1/HPT/ZES patients can markedly decrease the fasting gastrin levels, basal acid output and/or secretin-stimulated gastrin response, a number of other studies report either no effect or a minimal effect on these measures of gastrinoma function 46-49, 59, 61 . Our study convincingly demonstrates the marked ameliorating effect of a successful PTX on these parameters, because we were able to study a larger number of patients and correlate the changes in gastrinoma function with the outcome of the PTX.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Study of Surgery for Primary Hyperparathyroidism (HPT) in Multiple Endocrine Neoplasia-Type 1 and Zollinger-Ellison Syndrome

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prospective Study of Surgery for Primary Hyperparathyroidism (HPT) in Multiple Endocrine Neoplasia-Type 1 and Zollinger-Ellison Syndrome

et al. 2008

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“…In patients with MEN-I, hyperparathyroidism exacerbates the symptoms of gastric acid hypersecretion from ZES. Most studies, but not all, show that a successful parathyroidectomy can ameliorate the manifestations of ZES [93][94][95][96]. In a study of 10 patients with MEN-I who had hyperparathyroidism and ZES, fasting serum concentrations of gastrin, serum gastrin response to secretin provocation, basal and maximal gastric acid outputs, and drug requirements before and after parathyroidectomy were measured [93].…”

Section: Parathyroidectomy In Patients With Men-imentioning

confidence: 99%

Control of gastric acid hypersecretion in the management of patients with Zollinger‐Ellison syndrome

et al. 1993

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During the last 5 years important advances have occurred in the control of gastric acid hypersecretion in Zollinger-Ellison syndrome (ZES). The increased availability of potent gastric acid antisecretory agents such as histamine H2-receptor antagonists and more recently the H+K(+)-ATPase inhibitors such as omeprazole and lansoprazole have made it possible to medically control acid secretion in all patients. Increased understanding of the variation in antisecretory drug dosage between individual patients has led to identification of criteria to ensure effective antisecretory control and to the recognition of subgroups of patients who require special monitoring. Effective regimens for parenteral antisecretory control during surgery have been established. The importance of parathyroidectomy in patients with multiple endocrine neoplasia type I with ZES and the possible usefulness of highly selective vagotomy have been investigated. We review here the new data that led to increased understanding in each of these areas from our studies and studies by others.

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“…The role of surgery has been debated, however, due to the histologic heterogeneity and multiplicity of the lesions, and due to high rates of recurrence, particularly in patients with gastrin excess [8,9]. The incidence of malignancy generally seems to be lower than in the corresponding pancreatic tumors of non-familial origin, although pancreatic neoplasms constitute a principal cause of death in the MEN-1 syndrome [5,[10][11][12].…”

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confidence: 99%

Pancreatic tumors in multiple endocrine neoplasia type 1: Clinical presentation and surgical treatment

et al. 1992

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Among 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (MEN-1), 19 (58%) patients had hypergastrinemia, 7 (21%) patients had hyperinsulinism, and 7 (21%) patients had clinically non-functioning lesions. At least one gross tumor was found in all patients undergoing pancreatic surgery, including those with negative localization studies prior to operation. The patients also had additional macroscopic tumors as well as numerous microadenomas, and the lesions frequently were positive for immunostaining with multiple hormones, mainly pancreatic polypeptide, insulin, glucagon, and somatostatin. Duodenal endocrine lesions were found in 4 of 5 investigated patients and stained with gastrin and somatostatin antibodies. Distal, mainly subtotal pancreatic resection, was performed in 18 patients, eventually combined with caput tumor enucleation or duodenotomy, while a few patients underwent only tumor enucleation or a Whipple procedure. The long-term outcome of operation was most favorable in patients with hyperinsulinism; only 1 patient had clinical recurrence. Patients with hypergastrinemia experienced only transitory lowering of serum gastrin values after pancreatic surgery and 47% of them had or developed metastases. Such tumor spread was seen in 57% of the patients with non-functioning lesions. Nine patients died from progressive tumor disease during follow-up. Consistent with previous studies, we found that surgery is indicated in MEN-1 patients with hyperinsulinism even if a lesion is not visualized by radiology. In addition, these indications should be extended to also include patients with only biochemical markers of disease, including elevations of gastrin, as these indicate the presence of gross tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

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Gastric Secretion and Hormonal Interactions in Multiple Endocrine Neoplasia Type I

Cited by 16 publications

References 38 publications

Prospective Study of Surgery for Primary Hyperparathyroidism (HPT) in Multiple Endocrine Neoplasia-Type 1 and Zollinger-Ellison Syndrome

Prospective Study of Surgery for Primary Hyperparathyroidism (HPT) in Multiple Endocrine Neoplasia-Type 1 and Zollinger-Ellison Syndrome

Control of gastric acid hypersecretion in the management of patients with Zollinger‐Ellison syndrome

Pancreatic tumors in multiple endocrine neoplasia type 1: Clinical presentation and surgical treatment

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