gastrins and Hypercalcemia

Today, calcitonin assay is used for the diagnosis of thyroid medullary cancer in the context of nodular thyroid disease. Calcitonin is an excellent marker of thyroid medullary cancer but some hypercalcitoninemia can also be related to other diseases, such as renal failure, endocrine tumors other than thyroid medullary cancer and sometimes to C cell hyperplasia, which is a not well-defined situation. Recent studies contributed to define calcitoninemia thresholds, which guide decision and avoid excessive invasive treatment.. After a brief reminder of physiological role of calcitonin and assays, the difficulties encountered in interpreting hypercalcitoninemia and its potential causes other than thyroid medullary cancer are addressed. Recent studies, on large series, now allow a better knowledge of specificity and sensitivity of calcitonin measurement in patients with nodular thyroid disease and a well-argued management.. In the future, calcitonin dosage will be ordered even more frequently, as some authors recommend it for the diagnosis of thyroid nodule. It is up to us to know how to use this remarkable marker, by considering all possible situations of benign hypercalcitoninemia and reserving aggressive treatments for patients who really need them.

Topics: Adult; Biomarkers; Calcitonin; Carcinoma, Medullary; Diagnosis, Differential; Endocrine Gland Neoplasms; Gastrins; Humans; Hypercalcemia; Hyperplasia; Kidney Failure, Chronic; Sensitivity and Specificity; Sepsis; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

From 1 to 5% of patients can be expected to develop recurrent ulceration following current surgical therapy for peptic ulcer disease. The development of recurrent ulcer frequently reflects an inadequacy of the initial procedure. The nature of the inadequacy is often difficult to delineate because of alterations in anatomy and physiology and the lack of accurate diagnostic procedures. Incomplete vagotomy and inadequate gastric resection account for the vast majority of surgical deficiencies. Gastrinoma, retained gastric antrum, and hyperparathyroidism are the most frequently encountered endocrine causes. A thorough evaluation must include gastrointestinal X-rays, fiberoptic endoscopy, multiple serum calcium and gastrin determinations, and provocative testing. Medical management of recurrent ulcer fails in the vast majority of cases. Reoperation is successful in about 70% of cases and has a mortality rate of 4%. Recurrent ulcer after simple gastroenterostomy is best treated by gastric resection or vagotomy and resection. After initial adequate gastric resection, vagotomy alone usually suffices. Antrectomy and, if necessary, re-vagotomy should be done for recurrent ulcer after vagotomy and drainage. Re-vagotomy alone is usually effective therapy for recurrent ulcer after initial vagotomy and resection. Non-acid reducing operations should not be done, as they result in high mortality and high second recurrence rates.

Topics: Calcium; Female; Gastrins; Gastroenterostomy; Humans; Hypercalcemia; Male; Pepsinogens; Peptic Ulcer; Recurrence; Vagotomy

Topics: Adrenocorticotropic Hormone; Calcitonin; Calcium; Feedback; Gastrins; Gastrointestinal Hormones; Hypercalcemia; Hypocalcemia; Melanocyte-Stimulating Hormones; Pancreatic Neoplasms; Thyroid Gland; Zollinger-Ellison Syndrome

Topics: Acetylcholine; Bicarbonates; Calcium; Cyclic AMP; Gastric Juice; Gastric Mucosa; Gastrins; Histamine; Humans; Hypercalcemia; Hyperparathyroidism; Pancreatitis; Pepsin A; Peptic Ulcer; Stimulation, Chemical; Vagus Nerve

Topics: Achlorhydria; Acute Kidney Injury; Adenoma, Islet Cell; Adult; Cholecystokinin; Dehydration; Diarrhea; Gastrins; Gastrointestinal Hormones; Glucagon; Humans; Hypercalcemia; Hypokalemia; Kidney Diseases; Male; Pancreatic Neoplasms; Protein Precursors; Secretin; Syndrome; Zollinger-Ellison Syndrome

Topics: Calcium; Gastric Mucosa; Gastrins; Humans; Hydrogen-Ion Concentration; Hypercalcemia; Hyperparathyroidism; Hypocalcemia; Injections, Intravenous; Peptic Ulcer

Topics: 5-Hydroxytryptophan; Adrenocorticotropic Hormone; Chorionic Gonadotropin; Gastrins; Hormones, Ectopic; Humans; Hypercalcemia; Hypoglycemia; Neoplasms; Parathyroid Hormone; Precancerous Conditions; Thyrotropin; Vasopressins

Topics: Animals; Calcitonin; Calcium; Dog Diseases; Dogs; Gastrins; Hormones; Hypercalcemia; Hypocalcemia; Mammals; Parathyroid Glands; Perfusion; Phosphates; Rats; Rodent Diseases; Species Specificity; Stimulation, Chemical; Swine; Swine Diseases; Thyroid Gland

Topics: Gastric Juice; Gastrins; Gastrointestinal Motility; Glucagon; Histamine Release; Humans; Hypercalcemia; Infusions, Parenteral

Topics: Acetylcholine; Animals; Atropine; Calcium; Dogs; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; In Vitro Techniques; Pepsin A; Vagotomy

Topics: Clinical Trials as Topic; Gastric Mucosa; Gastrins; Glucagon; Humans; Hypercalcemia

This report presents a case of pancreatic neuroendocrine cell carcinoma with multiple liver metastases secreting gastrin and parathyroid hormone-related protein (PTHrP) related to lumbar bone fracture and hypercalcemia. A 58-year-old woman visited an affiliated hospital with a chief complaint of lumbago without any evidence of trauma. She was diagnosed with hepatic dysfunction and hypercalcemia as well as multiple lumbar compression fractures without osteolytic lesions. Abdominal computed tomography (CT) showed a hypervascular mass in the pancreatic tail and multiple liver tumors. Duodenal ulcers were found with gastrointestinal endoscopy. There was a marked increase in the serum gastrin level. She was diagnosed as gastrinoma with multiple liver metastases and was admitted to the hospital. She had an increase in serum PTHrP level without the elevation of intact parathyroid hormone at the time of admission. She underwent an extended right hepatectomy in addition to a distal pancreatectomy with a regional lymphadenectomy and splenectomy. The postoperative course was uneventful, and serum gastrin and PTHrP activities reduced to normal levels. She remained symptom-free, and serum calcium, gastrin, and PTHrP levels remain within the normal ranges 19 months after surgery without adjuvant therapy.

Topics: Endoscopy, Gastrointestinal; Female; Gastrins; Hepatectomy; Humans; Hypercalcemia; Liver Neoplasms; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Parathyroid Hormone-Related Protein; Spinal Fractures; Tomography, X-Ray Computed

We describe a patient with multiple endocrine neoplasia type 1 characterized by the simultaneous occurrence of parathyroid cancer, parathyroid adenomas, and pancreatic gastrinoma, who presented with an episode of acute hypercalcemia. The rapid parathyroid hormone assay provided a basis for the diagnosis of parathyroid hyperfunction. Mediastinal metastasis of the parathyroid carcinoma was found at autopsy. However, the staining of pancreatic and gastric tissue for parathyroid hormone-related protein does not make it possible to exclude completely the contribution of this peptide in mediating the hypercalcemia. To our knowledge, this is the first reported case of parathyroid carcinoma as part of the multiple endocrine neoplasia type 1 syndrome.

Topics: Acute Disease; Adenoma; Adult; Carcinoma; Fatal Outcome; Gastrinoma; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia Type 1; Pancreatic Neoplasms; Parathyroid Hormone; Parathyroid Neoplasms

Topics: Abdominal Pain; Adrenal Gland Neoplasms; Diabetes Mellitus, Type 1; Esophageal Stenosis; Gastrins; Humans; Hypercalcemia; Male; Middle Aged; Zollinger-Ellison Syndrome

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Aged; Carcinoma; Carcinoma, Papillary; Female; Gastrins; Humans; Hypercalcemia; Hypothyroidism; Multiple Endocrine Neoplasia; Pituitary Neoplasms; Thyroid Neoplasms

An increased serum pepsinogen I (PG I) concentration has been reported to be a marker of inherited peptic ulcer disease. Since both the Zollinger-Ellison syndrome and hyperparathyroidism, components of the familial multiple endocrine neoplasia type I syndrome (MEN I), are often associated with peptic ulcer, we have studied serum PG I concentrations in members of six well-defined families with MEN I. Serum PG I concentrations in 20 family members with hyperparathyroidism ranged from 35 to 864 ng/ml compared to 21-92 ng/ml in 16 nonaffected MEN I members. However, serum PG I levels were significantly higher (P less than 0.01) in the hyperparathyroid patients with hypergastrinemia (PGI median 192, range 75-864 ng/ml) than in those with normogastrinemia (PGI median 75, range 35-139 ng/ml). In fact, five of seven patients with hyperparathyroidism and hypergastrinemia compared to only one of 13 hyperparathyroid patients without hypergastrinemia had increased serum PG I levels above 130 ng/ml. We conclude that in the MEN I syndrome, increased serum PG I levels are found in patients with Zollinger-Ellison syndrome but not in hyperparathyroid patients with normogastrinemia and not in nonaffected MEN I members. The results indicate that in familial MEN I, hyperpepsinogenemia I is not inherited as a genetic trait but suggest that the elevated serum PG I levels are secondary to chronic hypergastrinemia.

Topics: Female; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia; Pedigree; Pepsinogens; Zollinger-Ellison Syndrome

In patients with hypercalcemia with abdominal symptoms, gastrin concentration is often measured to exclude the Zollinger-Ellison syndrome. We found that interpretation of such measurements is clouded by a contradictory literature. We therefore measured serum gastrin concentrations in 78 patients with primary hyperparathyroidism, 36 with nonparathyroid hypercalcemia, 13 with hypocalcemia, and 33 normocalcemic controls. Gastrin values above normal occurred in 22% of those with primary hyperparathyroidism and 28% of those with nonparathyroid hypercalcemia. Values above 250 pg/mL occurred only in those with hypochlorhydria or multiple endocrine neoplasia, type 1 (MEN 1). After parathyroidectomy, gastrin levels fell significantly, but elevated values tended to recur in those with MEN 1 if hypercalcemia recurred. Thus, chronic hypercalcemia of either parathyroid or nonparathyroid origin may elevate serum gastrin concentrations, but marked elevations suggest either achlorhydria or MEN 1.

Topics: Adult; Aged; Calcium; Chronic Disease; Creatinine; Diagnosis, Differential; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Middle Aged; Multiple Endocrine Neoplasia; Parathyroid Hormone; Radioimmunoassay

Hypercalcemia produced in healthy volunteers by intravenous infusions of calciumgluconolactobionate increased outputs of gastric acid, pepsin, and pancreatic enzymes. Hypercalcemia did not affect gallbladder emptying and serum gastrin values. Further, intravenous somatostatin (SRIF, 5 micrograms/kg.h) markedly inhibited secretion of gastric acid (p less than 0.01), pepsin (p less than 0.05), and pancreatic enzymes (p less than 0.02) stimulated by hypercalcemia. SRIF-inhibited outputs were below basal values. These results indicate that the inhibitory effect of SRIF on exocrine cells of the human gastrointestinal tract can not be reversed by extracellular hypercalcemia.

Topics: Adolescent; Adult; Calcium; Female; Gastric Acid; Gastric Juice; Gastrins; Humans; Hypercalcemia; Lipase; Male; Pancreas; Pepsin A; Somatostatin; Trypsin

Hyperplasia of the parathyroid glands is a central feature of familial multiple endocrine neoplasia type 1. We used cultured bovine parathyroid cells to test for mitogenic activity in plasma from patients with this disorder. Normal plasma stimulated [3H]thymidine incorporation, on the average, to the same extent as it was stimulated in a plasma-free control culture. This contrasted with the results of the tests with plasma from patients with familial multiple endocrine neoplasia type 1, in which parathyroid mitogenic activity increased 2400 percent over the control value (P less than 0.001). Plasma from these patients also stimulated the proliferation of bovine parathyroid cells in culture, whereas plasma from normal subjects inhibited it. Parathyroid mitogenic activity in plasma from the patients with familial multiple endocrine neoplasia type 1 was greater than that in plasma from patients with various other disorders, including sporadic primary hyperparathyroidism (with adenoma, hyperplasia, or cancer of the parathyroid), sporadic primary hypergastrinemia, sporadic pituitary tumor, familial hypocalciuric hypercalcemia, and multiple endocrine neoplasia type 2 (P less than 0.05). Parathyroid mitogenic activity in the plasma of patients with familial multiple endocrine neoplasia type 1 persisted for up to four years after total parathyroidectomy. The plasma also had far more mitogenic activity in cultures of parathyroid cells than did optimal concentrations of known growth factors or of any parathyroid secretagogue. This mitogenic activity had an apparent molecular weight of 50,000 to 55,000. We conclude that primary hyperparathyroidism in familial multiple endocrine neoplasia type 1 may have a humoral cause.

Topics: Adenoma; Adult; Animals; Cattle; Cells, Cultured; Gastrins; Growth Substances; Humans; Hypercalcemia; Hyperparathyroidism; Hyperpituitarism; Hyperplasia; Multiple Endocrine Neoplasia; Parathyroid Glands; Parathyroid Neoplasms; Thymidine; Tritium

Topics: Chronic Disease; Gastrins; Humans; Hypercalcemia

To investigate the effects of acute hypercalcemia on exocrine pancreatic secretion, anesthetized cats were given calcium intravenously. Increasing hypercalcemia (3.7-6.3 mmol/L) evoked a dose-dependent increase in enzyme output that was 12 times greater than in normocalcemic controls (p less than 0.001) and was 60% of subsequent maximal stimulation with intravenous cholecystokinin (CCK). The effect of hypercalcemia on enzyme secretion was abolished when CCK was administered 60 min before calcium and at a dose to cause maximal enzyme output. Atropine did not prevent the calcium-induced increase in enzyme secretion. Pancreatic fluid and bicarbonate outputs were not influenced by hypercalcemia during intravenous administration of small amounts of secretin, but were increased by addition of CCK to the secretin infusion. Hypercalcemia did not induce macroscopic or light-microscopic changes in pancreatic morphology. Plasma levels of both CCK and gastrin were increased (p less than 0.01) during hypercalcemia, with and without precalcium administration of CCK; atropine significantly inhibited (p less than 0.05), but did not abolish the calcium-induced releases of both peptides. These data suggest that in the anesthetized cat, acute hypercalcemia induced by intravenous calcium infusion stimulates pancreatic secretion of enzymes, but not fluid and bicarbonate. Acute hypercalcemia also causes release of CCK and, as shown previously, gastrin. The findings suggest that the stimulatory effect of hypercalcemia on pancreatic enzyme secretion is not dependent on intact cholinergic pathways and is probably not exclusively mediated by release of CCK or gastrin.

Topics: Acute Disease; Amylases; Animals; Atropine; Calcium; Cats; Cholecystokinin; Chymotrypsin; Dose-Response Relationship, Drug; Gastrins; Hypercalcemia; Pancreas; Time Factors

The largest-known family tree of a kindred with multiple endocrine neoplasia type I, dating back to 1840, has been constructed in Tasmania. There are over 600 descendants of one English migrant and his spouse living today. Preliminary data suggests that overall, one-quarter of all family members, and one-half of those above the age of 40 manifest one or more endocrine tumours. In the majority of cases, the diagnosis was not suspected until the general practitioner was informed of the family history, as the symptoms are vague, sometimes bizarre, and overlap with those of common disorders.

Topics: Adult; Aged; Child; Female; Gastrins; Humans; Hypercalcemia; Hypertension; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Neoplasms; Parathyroid Neoplasms; Prolactin

Nineteen rats were parathyroidectomized by electrocauterization, resulting in pronounced hypocalcaemia. Seven of these rats were then given vitamin D3 in a dose causing hypercalcaemia, while 7 received a dose which normalized serum calcium and 5 received no vitamin D. Ten further animals were sham-operated and were not given any extra vitamin D. The experimental period was 16 weeks. No significant differences in serum gastrin values were found between the different groups. Quantitative studies of the antral gastrin cells showed no difference in the number of gastrin cells per unit volume or unit segment between the different groups of vitamin-D-treated animals and sham-operated animals. However, the number of gastrin cells per unit segment was significantly higher in the hypocalcaemic animals than in the sham-operated animals, as a result of an increase in mucosal thickness. The amount of antral mucosal gastrin did not differ between the different groups. Thus the results of this study indicate that experimentally induced hypercalcaemia in parathyroidectomized rats does not influence the serum gastrin, the number of gastrin cells or antral gastrin.

Topics: Animals; Cell Count; Cholecalciferol; Gastrins; Hypercalcemia; Male; Parathyroid Glands; Pyloric Antrum; Rats; Rats, Inbred Strains

Parathyroid glands from inbred rats were transplanted to rats of the same strain. The transplantation resulted in hyperparathyroidism and persistent hypercalcaemia. These hypercalcaemic animals were compared with the hypocalcaemic donors and with untreated controls. No significant differences in serum gastrin values were found between the different groups. In all three groups, one series of animals was killed 6 weeks after the transplantation (6w series) and another after 14 weeks (14w series). Quantitative studies of the antral gastrin cells showed an increase in the number of these cells per unit volume in the 6w series in the hyperparathyroid recipient animals. The number of gastrin cells per unit segment was also higher in the recipient animals than in the parathyroidectomized and untreated groups in both the 6w and 14w series. The amount of gastrin extracted from antral mucosa did not differ between the different groups. The findings show that an experimentally induced hyperparathyroidism in the rat gives a transient increase in the number of antral gastrin cells but no changes in the antral gastrin or serum gastrin levels.

Topics: Animals; Cell Count; Gastrins; Hypercalcemia; Hyperparathyroidism; Male; Pyloric Antrum; Rats; Rats, Inbred BN; Rats, Inbred Lew

Topics: Aged; Female; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Peptic Ulcer

To determine the frequency of gastrointestinal symptoms in primary hyperparathyroidism, we retrospectively analyzed 100 consecutive patients seen at Emory University Hospital from Jan 1, 1977 through March 1, 1979. At the time of diagnosis, 28 patients complained of nausea, 19 of vomiting, 29 of abdominal pain, and 33 of constipation. One patient presented with acute pancreatitis and 14 had ulcer disease (two gastric and 12 duodenal ulcers). Hypercalcemia increases gastric acid secretion and may account for associated ulcer disease and the ulcer-like pain in primary hyperparathyroidism. The mechanisms causing the other gastrointestinal symptoms in hypercalcemia remain to be elucidated. These symptoms abate on correction of hyperparathyroidism.

Topics: Constipation; Female; Gastrins; Gastrointestinal Diseases; Humans; Hypercalcemia; Hyperparathyroidism; Male; Pancreatitis; Peptic Ulcer

A family with Multiple Endocrine Adenomatosis Type 1 (MEA 1) is described. Of the 59 members, 15 were affected. Zollinger-Ellison syndrome was present in six individuals of whom the five available for study had hyperparathyroidism. The youngest of these patients with Zollinger-Ellison Syndrome was 25 years old. Hyperparathyroidism alone was present in nine individuals of whom the eldest was 30 years old. Three other members had raised serum gastrin levels but lacked symptoms suggestive of Zollinger-Ellison syndrome and in these individuals, the serum calcium levels were normal. A review of the literature confirms the finding that, in MEA 1, Zollinger-Ellison syndrome has not been shown to occur in the absence of hypercalcaemia. Screening of affected members of such families can therefore be restricted to the measurements of serum calcium levels.

Topics: Adolescent; Adult; Calcium; Child; Female; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pedigree; Zollinger-Ellison Syndrome

Topics: Adult; Calcium Chloride; Female; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Kidney Failure, Chronic; Male; Middle Aged

In order to investigate the frequency of fasting hypergastrinaemia in primary hyperparathyroidism (A) and in chronic hypercalcaemia (B), in 40 and 16 patients respectively gastrin, parathyroid hormone (PTH) and serum calcium levels were measured and compared with those of a control group (40 subjects) with similar distribution of sex and age. Moreover, possible linear relationships between these parameters were investigated. Notwithstanding significant differences in calcium and PTH levels between the three groups (A: high PTH, high Ca++; B: low PTH, high Ca++; C: normal PTH and Ca++ levels), no significant difference in gastrin levels were found. However, in the first group, a marked increase of gastrin was observed in one patient, very probably affected by a gastrin-secreting tumor (positive secretin test). While no linear relationship between PTH and gastrin values was present in all the three groups, a significant correlation between serum calcium and fasting gastrin was detectable in the group A, ruling-out the above mentioned patient. Present data suggest that PTH does not modify gastrin levels and that chronic moderate hypercalcaemia does not raise serum fasting gastrin, at least in clinical conditions. Moreover, the frequency of hypergastrinaemia in hyperparathyroidism is very low and it seems to be present only in patients with gastrin-secreting tumors.

Topics: Adult; Aged; Calcium; Chronic Disease; Fasting; Female; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone; Radioimmunoassay

Topics: Animals; Gastrins; Hypercalcemia; Iodine; Rats; Rats, Inbred Strains

In order to evaluate the effect of acute moderate hypercalcemia on both smooth and skeletal muscle function of the human esophagus, 12 subjects were given intravenous calcium chloride in normal saline. Serum calcium increased from a basal value of 9.6 +/- 0.1 mg per dl (mean +/- 1 SEM) to 11.4 +/- 0.2 mg per dl at 90 min after initiation of calcium infusion (P less than 0.01). Both amplitude and Dp/Dt of esophageal contractions decreased significantly in the skeletal muscle segment; however, amplitude and Dp/Dt increased significantly in the smooth muscle segment. Lower esophageal sphincter pressure remained unchanged. Duration of contractions and peristaltic wave speed were unaltered. Possible explanations for the divergent effect of hypercalcemia on the two types of esophageal muscle are discussed.

Topics: Acute Disease; Adult; Aged; Calcitonin; Calcium; Esophagogastric Junction; Esophagus; Gastrins; Glucagon; Humans; Hypercalcemia; Magnesium; Male; Manometry; Middle Aged; Muscle Contraction; Muscle, Smooth; Muscles; Peristalsis

Topics: Adult; Calcium; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Hypercalcemia; Middle Aged

Topics: Brain Neoplasms; Calcitonin; Cholesterol; Diarrhea; Endocrine Glands; Gastrins; Gastrointestinal Hormones; Histamine Release; Humans; Hypercalcemia; Neoplasms; Nutrition Disorders; Pellagra; Peptides; Serum Albumin; Thyroid Hormones; Vasoactive Intestinal Peptide; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Aged; Dehydration; Diarrhea; Female; Gastrins; Humans; Hypercalcemia; Hypokalemia; Indomethacin; Prostaglandins E; Prostaglandins F; Syndrome

The number of distribution and the numbers of G cells in the antropyloric region of the rabbit stomach were mapped employing immunoperoxidase localization and morphometric quantitation and compared to similar analyses in hypercalcemic rabbits bearing the VX2 carcinoma. In normal animals, G cells were confined to the lower third of the antropyloric mucosa, where they were randomyly distributed within the mucosal glands. In contrast, tumor-bearing animals showed an extension of these cells into the middle third of the antropyloric mucosa. The absolute counts of G cells in control rabbits were 5.3 +/- 0.78 (mean +/- SE) per unit area, while those in hypercalcemic tumor-bearing rabbits were 11.9 +/- 0.46, a statistically significant increase. It is concluded that rabbits bearing VX2 carcinoma have G-cell hyperplasia.

Topics: Animals; Carcinoma; Cell Count; Female; Gastric Mucosa; Gastrins; Hypercalcemia; Hyperplasia; Immunoenzyme Techniques; Neoplasms, Experimental; Pyloric Antrum; Rabbits

In this study the effect of calcium infusion over 3 h without gastric aspiration on serum gastrin was determined in fifteen normal subjects, ten patients with duodenal ulcer, nine with stomal ulcer, five with total gastrectomy, six with achlorhydria and sixteen with proved or presumed Zollinger-Ellison (ZE) syndrome. Serum gastrin only rose significantly in the patients with ZE-syndrome or achlorhydria. An increase of above or below 50% of basal value seems to be a valuable criterion by which to differentiate between patients with and without ZE-syndrome. Serum gastrin levels in forty-four patients with chronic hypercalcaemia (72+/-24 pg/ml, mean+/-SD) were not significantly different from the levels in 100 normal subjects (66+/-18 pg/ml; P greater than 0.10). However, in one patient with ZE-syndrome and in two patients with achlorhydria serum gastrin values were markedly higher during chronic hypercalcaemia than during normocalcaemia. It is concluded that acute or chronic hypercalcaemia without gastric aspiration does not lead to hypergastrinaemia in the absence of ZE-syndrome or achlorhydria.

Topics: Acute Disease; Calcium; Chronic Disease; Gastrins; Humans; Hypercalcemia; Zollinger-Ellison Syndrome

The relatives of 25 index patients with primary parathyroid hyperplasia were tested for hypercalcemia. At least 13 of these patients had one or more first degree relatives with hypercalcemia. Two familial syndromes each with autosomal dominant transmission were recognized. Two index patients were part of large kindreds categorized as having familial hypocalciuric hypercalcemia (FHH). Manifestations of multiple endocrine neoplasia type I were present in the kindreds of at least four other index patients (FMEN I). In seven other kindreds there were too few affected members to allow definitive classification. Differences between manifestations of FHH and FMEN I were described. Among offspring of affected persons in kindreds with FHH, as distinct from FMEN I, the prevalence of hypercalcemia approached the theoretic maximum of 50 per cent during the first two decades. In FHH, nephrolithiasis and peptic disease were unusual; moderate hypercalcemia occurred without hypercalciuria; and subtotal parathyroidectomy did not abolish hypercalcemia. Concentrations of peptide hormones other than parathyroid hormone (PTH) were normal in those with FHH; in FMEN I high concentrations of glucagon in plasma were found in five of six patients tested, and high concentrations of gastrin were found in three of 12 patients. Hypergastrinemia generally accompanied obvious peptic disease. Distinction of the two conditions is important since patients with FHH may not benefit from subtotal parathyroidectomy, but they generally have a better clinical prognosis than do patients with FMEN I.

Topics: Adolescent; Adult; Aged; Calcium; Child; Female; Gastrins; Glucagon; Humans; Hypercalcemia; Hyperplasia; Male; Middle Aged; Neoplasms, Multiple Primary; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Pedigree; Prolactin

Topics: Adult; Diagnosis, Differential; Diarrhea; Female; Gastrectomy; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Liver Neoplasms; Multiple Endocrine Neoplasia; Neoplasm Metastasis; Zollinger-Ellison Syndrome

A patient with metastatic islet cell carcinoma of the pancreas, recurrent peptic ulcer disease, and hypergastrinemia (Zollinger-Ellison syndrome) developed symptomatic hypercalcemia and renal insufficiency; she was treated with streptozotocin after parathyroidectomy failed to control her hypercalcemia. Shortly after somewhat less than the usual recommended dose of streptozotocin was administered, the serum calcium concentration fell to near normal with complete resolution of symptoms. Seven months after therapy, mild hypocalcemia, consistent with her degree of renal impairment was noted. However, mild hypercalcemia recurred 13 months after therapy. Shortly after streptozotocin therapy, the mean serum gastrin concentration fell to near normal with radiographic disappearance of the anastomotic ulcer. At 7 and 13 months after therapy, serum gastrin levels were normal. Streptozotocin therapy was accomplished without major complications; specifically, without a detrimental effect on the creatinine clearance. Thus, although hypercalcemia in patients with pancreatic islet cell tumors is often due to associated primary hyperparathyroidism, in some patients it may be due to secretion of a hypercalcemic substance from the tumor and may respond to streptozotocin. Similarly, hypergastrinemia in patients with islet cell tumors may also respond to streptozotocin.

Topics: Calcium; Female; Gastrins; Humans; Hypercalcemia; Middle Aged; Streptozocin; Zollinger-Ellison Syndrome

Twenty-one chronic hemodialysis patients were investigated. While only two had radiologic evidence of peptic ulceration, three had markedly elevated basal acid outputs, thirteen had significantly elevated maximal acid outputs and seven had fasting duodenogastric reflux. Elevated fasting serum gastrin levels and prolonged gastrin circulation following stimulated endogenous release were also demonstrated. The abnormalities in gastric function may be explained by fasting and stimulated hypergastrinemia.

Topics: Adult; Female; Gastric Juice; Gastrins; Gastrointestinal Hemorrhage; Humans; Hypercalcemia; Kidney Transplantation; Male; Middle Aged; Peptic Ulcer; Renal Dialysis; Uremia

Topics: Adenoma; Adult; Aged; Cushing Syndrome; Gastric Juice; Gastrins; Glucagon; Humans; Hypercalcemia; Hyperinsulinism; Islets of Langerhans; Middle Aged; Pancreatic Neoplasms; Peptic Ulcer; Zollinger-Ellison Syndrome

Hypercalcemia produced in normal volunteers by intravenous infusions of CaCl2 increased outputs of pancreatic enzyme and gastric acid. Further, hypercalcemia enhanced cholecystokinin (CCK)-stimulated pancreatic enzyme secretion and gallbladder contraction. Our results suggest that hypercalcemia affects pancreatic, gallbladder, and gastric functions as well as their responses to exogenous CCK.

Topics: Adult; Bilirubin; Cholecystokinin; Gallbladder; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Male; Pancreas; Pancreatic Juice; Stomach

To determine the effect of intraduodenal calcium on pancreatic, gallbladder, and gastric functions in healthy man, a validated perfusion method was employed to quantify total pancreatic, biliary, and gastric outputs during duodenal perfusion of either 6 mM, 12 mM,or 25 mM of elemental calcium (as isotonic calcium chloride solutions). Intraluminal calcium stimulated pancreatic enzyme secretion and gallbladder contraction in a dose-related fashion, achieving comparable responses to those produced by intravenous cholecystokinin-pancreozymin (CCK-z). Responses to calcium were reproducible when repeated in the same individual. Gastric acid outputs and serum gastrin levels increased significantly only with higher calcium perfusions (25 mM). Although duodenal calcium perfusion (25 mM) slightly increased serum calcium concentrations, induced hypercalcemia (by intravenous calcium infusion) of similar magnitude had no effect on pancreatic or gallbladder function. It is suggested that intraduodenal calcium may induce release of CCK-PZ (and/or other neurohormonal factors) from the gut, causing stimulation of these digestive organs.

Topics: Adult; Calcium; Cholecystokinin; Duodenum; Gallbladder; Gastric Juice; Gastrins; Humans; Hypercalcemia; Infusions, Parenteral; Male; Pancreas; Perfusion; Stomach; Trypsin

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Child; Diarrhea; Female; Gastric Juice; Gastrins; Glucose; Humans; Hypercalcemia; Male; Middle Aged; Pancreatic Neoplasms; Zollinger-Ellison Syndrome

Topics: Alkalosis; Antacids; Calcium Carbonate; Carbonates; Drug Interactions; Gastric Juice; Gastrins; Humans; Hypercalcemia; Magnesium Oxide; Parasympatholytics; Pepsin A; Peptic Ulcer; Sodium; Stomach Diseases

In 36 patients with ulcer without Zollinger-Ellison-syndrome (25 patients with recurrent duodenal ulcer, 11 with an ulcus pepticum jejuni after B II-resection of the stomach) and 2 patients suffering from ulcus pepticum jejuni with an ascertained gastrinoma the secretion of acid was compared after stimulation of pentagstrin (6 mug/kg) and calcium (4 mg Ca++/kg/h). The secretion of hydrochloric acid was statistically significantly stimulated in all patients suffering from ulcer by the hypercalcaemia (increase of the serum calcium concentration from 5.0 +/- 0.3 mval/1 to 6.2 +/- 0.8 mval/1). But in patients suffering from ulcer with gastrinoma the stimulatory effect was larger than in such patients without autonomous source of gastrin: the calcium-stimulated secretion of hydrochloric acid was on the average in cases of duodenal ulcer 40% (2 to 68%), in the ulcera peptica jejuni 47% (17 to 75%), in the 4 comparative examinations of the two patients with Zollinger-Ellison-syndrome, however, always more than 100% (106 to 177%) of the pentagastrin-stimulated peak secretion. The comparative test of the pentagastrin and calcium-stimulated secretion of hydrochloric acid could be a help for the proof of autonomous places of the formation of gastrin.

Topics: Acute Disease; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Hypercalcemia; Jejunum; Peptic Ulcer; Recurrence; Zollinger-Ellison Syndrome

In healthy controls (n = 7), patients with duodenal ulcer (n = 7), primary hyperparathyroidism (n = 7), and 1 case of excluded gastric antrum the effects of intravenous secretin ("Karolinska"; 3 U/kg/h for 90 min) upon serum calcium fractions, total protein, and the integrated response of gastrin and glucagon were investigated. In all groups total calcium, total protein, and protein-bound calcium fraction rose significantly but the inonized calcium fraction remained stable. Since serum concentration of gastrin and glucagon could not be altered in any of the groups a direct interference of these hormones with calcium homeostasis during secretin infusion can be ruled out. Hyperparathyroid patients had higher baseline glucagon values (209 +/- 30 pg/ml) than normals (127 +/- 6 pg/ml) and ulcer patients (138 +/- 11 pg/ml) and maintained a higher hormone output throughout the experiment. Together with data on the patient with excluded antral parts it is concluded that the hypercalcemic effect of secretin is not mediated by calcium-regulating hormones but must be of an unspecific nature.

Topics: Adult; Blood Proteins; Calcitonin; Calcium; Female; Gastrins; Glucagon; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Phosphates; Secretin

Topics: Adult; Calcium; Duodenal Ulcer; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Injections, Intravenous; Middle Aged; Radioimmunoassay; Stomach; Time Factors; Zollinger-Ellison Syndrome

In both normal volunteers and in patients with primary hyperparathyroidism, the induction of a metabolic alkalosis by infusion of sodium bicarbonate results in a decrease in serum calcium ion and in an increase of circulating parathyroid hormone concentrations. Bicarbonate infusion may serve in man as a new provocative test for release of parathyroid hormone. Furthermore, we speculate that the metabolic alkalosis which is found at times in patients with the Zollinger-Ellison syndrome and severe peptic ulcer disease may result in parathyroid gland stimulation.

Topics: Adult; Aged; Alkalosis; Bicarbonates; Calcium; Female; Gastric Juice; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Metabolic Clearance Rate; Middle Aged; Pancreatic Neoplasms; Parathyroid Hormone; Peptic Ulcer; Sodium Chloride; Zollinger-Ellison Syndrome

Topics: Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism, Secondary; Parathyroid Glands; Renal Dialysis; Zollinger-Ellison Syndrome

Topics: Calcium; Gastric Juice; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Peptic Ulcer

Topics: Adult; Catheterization; Child; Female; Follow-Up Studies; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Parathyroid Hormone; Pedigree; Thyroid Gland

Topics: Animals; Calcium; Dose-Response Relationship, Drug; Gastric Juice; Gastrins; Haplorhini; Histamine; Hypercalcemia; Infusions, Parenteral; Macaca; Male; Radioimmunoassay; Secretory Rate; Spectrophotometry, Atomic; Stimulation, Chemical; Time Factors

Topics: Animals; Gastric Juice; Gastrins; Haplorhini; Hypercalcemia; Macaca; Male

Topics: Adenoma, Islet Cell; Adult; Calcium; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Hyperplasia; Male; Neoplasm Metastasis; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Diazoxide; Female; Gastric Mucosa; Gastrins; Glucagon; Glucose Tolerance Test; Humans; Hypercalcemia; Insulin; Insulin Secretion; Islets of Langerhans; Male; Middle Aged; Multiple Endocrine Neoplasia; Pedigree; Tolbutamide; Zollinger-Ellison Syndrome

Topics: Adrenal Cortex Hormones; Calcium; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Hyperparathyroidism; Multiple Endocrine Neoplasia; Stomach Ulcer; Zollinger-Ellison Syndrome

Topics: Adrenal Gland Diseases; Endocrine System Diseases; Erythrocytes; Female; Gastrins; Gynecomastia; Hormones, Ectopic; Humans; Hypercalcemia; Hyperplasia; Hyperthyroidism; Hypoglycemia; Male; Malignant Carcinoid Syndrome; Metabolic Diseases; Neoplasms; Neurologic Manifestations; Polycythemia; Prognosis; Puberty, Precocious; Vasopressins

Topics: Adenoma; Calcium; Gastric Juice; Gastrins; Gastrointestinal Hormones; Humans; Hypercalcemia; Parathyroid Glands; Parathyroid Neoplasms; Pentagastrin; Peptides; Stomach

The clinical data are presented of two women with profound metabolic upset from exceptional water and electrolyte losses in diarrhoea. One had an islet-cell adenoma of the pancreas and the other abnormal islets. Gastric and pancreatic function were abnormal in both, consistent with the subsequent demonstration of a pancreatic and choleretic secretagogue in the tumour tissue and pancreatic and gastric secretagogues in circulating blood (Cleator, Thomson, Sircus, and Coombes, 1970).

Topics: Adenoma, Islet Cell; Adult; Diarrhea; Female; Gastrins; Humans; Hypercalcemia; Hypokalemia; Hyponatremia; Islets of Langerhans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Peptides; Radionuclide Imaging; Water-Electrolyte Balance

Topics: Adult; Aged; Diarrhea; Female; Gastric Juice; Gastrins; Glucocorticoids; Glucose Tolerance Test; Humans; Hypercalcemia; Islets of Langerhans; Male; Middle Aged; Pancreatic Neoplasms; Preoperative Care; Radiography; Secretin

Topics: Adult; Animals; Atropine; Calcium; Dogs; Duodenal Ulcer; Fluorometry; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hypercalcemia; Middle Aged; Radioimmunoassay; Secretory Rate

Topics: Adenoma, Islet Cell; Adult; Calcium; Gastric Acidity Determination; Gastric Juice; Gastrins; Glucagon; Humans; Hypercalcemia; Insulin; Magnesium; Male; Pancreatic Neoplasms; Stimulation, Chemical; Vagotomy; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Adrenal Gland Diseases; Gastrins; Glucagon; Glucose Tolerance Test; Humans; Hypercalcemia; Hyperinsulinism; Immunoassay; Insulin; Insulin Antibodies; Insulin Secretion; Multiple Endocrine Neoplasia; Neoplasm Metastasis; Parathyroid Diseases; Tolbutamide; Zollinger-Ellison Syndrome

Topics: Animal Feed; Animals; Calcium; Denervation; Dogs; Female; Gastric Juice; Gastrins; Glucose; Histamine; Hypercalcemia; Infusions, Parenteral; Insulin; Neostigmine; Peptides; Stimulation, Chemical; Vagus Nerve

Topics: Animals; Calcium; Dogs; Gastric Acidity Determination; Gastric Juice; Gastrins; Histamine; Hypercalcemia; Hyperparathyroidism; Peptic Ulcer; Secretory Rate; Stomach