Hyperparathyroidism--a reversible cause of cimetidine-resistant gastric hypersecretion.

McCarthy, Denis M.; Peikin, Steven R.; Lopatin, Richard N.; Long, Bill W.; Spiegel, Allen M.; Marx, Stephen J.; Brennan, Murray F.

doi:10.1136/bmj.1.6180.1765

Cited by 33 publications

(13 citation statements)

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“…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%

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%

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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“…Hyperparathyroidism with the resultant hypercalcaemia both increases gastrin secretion from the gastrinoma [7,28,43] and also decreases the sensitivity of the acid secretory process to antisecretory agents by an unknown mechanism [7,[28][29][30]39]. These effects are shown in Fig.…”

Section: The Effect Of Hypercalcaemia On Expression Of the Zes Acid mentioning

confidence: 92%

“…As shown in Fig. 1 (right panel), the potency of gastric antisecretory drugs increased after successful parathyroidectomy such that a given dose of antisecretory drug causes greater acid inhibition and therefore antisecretory drug dosage can be reduced [28,29]. Even though this change in sensitivity is much more important with histamine H 2 -inhibitors, even with H ϩ -K ϩ ATPase inhibitors this increased resistance requires awareness in treating patients prior to parathyroidectomy with ZES and MEN with hypercalcaemia.…”

Section: The Effect Of Hypercalcaemia On Expression Of the Zes Acid mentioning

confidence: 99%

“…At presentation the ZES in patients with MEN-1 is not different from that in patients with sporadic disease in terms of fasting gastrin level, degree of increase in serum gastrin with secretin, basal or maximal acid output, or previous history of peptic ulcer disease (Table 1). A previous parathyroidectomy can have a marked effect on the expression of the ZES [28][29][30], making the diagnosis more difficult and will be dealt with in the section on parathyroidectomy and acid secretion below.…”

Section: Generalmentioning

confidence: 99%

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Management of the Zollinger–Ellison syndrome in patients with multiple endocrine neoplasia type 1

Jensen¹

1998

Journal of Internal Medicine

175

169

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Zollinger-Ellison syndrome (ZES) is the most common symptomatic pancreatic endocrine tumour in patients with MEN-1. Besides the treatment of the usual endocrinopathies seen in patients with MEN-1, the treatment of the ZES requires attention be paid to controlling the gastric acid hypersecretion, to dealing with the gastrinomas per se which are malignant in 18-60% of cases, and to the diagnosis and treatment of gastric carcinoid tumours, that are increasingly seen in these patients. In this article the current management of each of the areas is reviewed and what is known or uncertain discussed, based on our studies at the NIH and data from others. Data from 231 patients including 45 with MEN-1 and 186 without MEN-1 is contrasted in this report. Gastric acid hypersecretion has been controlled in all patients medically with MEN-1 and ZES at the NIH for up to 22 years. The current drugs of choice are H ϩ -K ϩ ATPase inhibitors and twice a day dosing is recommended. Periods of parenteral drug therapy (surgery, etc.) and pregnancy require important modifications. The appropriate surgical therapy of the gastrinoma is controversial. Eighty per cent of patients have a duodenal gastrinoma and 20-30% have a pancreatic tumour. Recent studies suggest gastrinoma enucleation combined with duodenotomy rarely results in cure. Aggressive surgery (Whipple resection) can result in cure of gastrinoma but effect on survival is unclear.There are important differences in gastrinoma location, extent, and percentage with aggressive disease in patients with or without MEN-1, which are discussed. Confusion has occurred because of lack of information on the natural history of the gastrinoma compared to the other pancreatic endocrine tumours that occur in MEN-1 and survival data from patients with and without MEN-1 is contrasted. The occurrence of gastric carcinoids in patients with and without MEN-1 with ZES is contrasted and the areas of certainty and disagreement reviewed.

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“…To date, only a single case has been reported of a patient with hyperparathyroid ism associated with cimctidine-resistant du odenal ulcer [26],…”

Section: Diagnostic Approachmentioning

confidence: 99%

‘Difficult’ Duodenal Ulcer Patients: Clinical and Therapeutic Problems

Porro¹,

Parente²

1991

Dig Dis

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Hyperparathyroidism--a reversible cause of cimetidine-resistant gastric hypersecretion.

Cited by 33 publications

References 1 publication

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

Management of the Zollinger–Ellison syndrome in patients with multiple endocrine neoplasia type 1

‘Difficult’ Duodenal Ulcer Patients: Clinical and Therapeutic Problems

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