gastrins and Hyperparathyroidism--Secondary

Proton pump inhibitors (PPI) are one of the most widely used groups of drugs and their potential toxicity is periodically reviewed, emphasizing aspects originally considered secondary. The present review analyzes the physiological and pharmacological bases and the scarce clinical evidence for a potential association between the continued administration of PPI and the development of osteoporosis and bone fractures. Both disorders are clearly related to calcium homeostasis and are highly important in elderly patients due to their poor general prognosis and disabling consequences.

Topics: Achlorhydria; Aging; Calcium; Calcium, Dietary; Comorbidity; Disease Susceptibility; Fractures, Spontaneous; Gastric Acid; Gastrins; Homeostasis; Humans; Hyperparathyroidism, Secondary; Intestinal Absorption; Malabsorption Syndromes; Models, Biological; Osteoporosis; Proton Pump Inhibitors; Risk

On the basis of the existing experimental and clinical studies about the factors affecting the appearance of hypergastrinemia in renal failure, it can be concluded that the kidney plays an important, but not the only, role in the degradation of endogenous gastrin in humans. In this process the key role is played by the blood flow through the kidney, the preservation of the peritubular capillary system, and the functional kidney mass. Glomerular filtration has no particular importance in the extraction of gastrin from the circulation, while through the urine only a small amount of gastrin is excreted. In the decomposition of a part or at least some molecular gastrin forms, an important role is played by the capillary systems of extra-renal tissue. One further conclusion is that hypergastrinemia in patients with renal failure is the result of the combined effects of the reduced catabolism of gastrin in the kidney and its increased synthesis which is for the most part connected with hypochlohydria and secondary hyperparathyroidism. In patients with renal failure there exists the inhibition of the gastrin acid secretion which is the cause of the weakening of the mechanism of the feedback connection between HCl and gastrin, while because of a permanent stimulation of G-cells, the hyperplasia of these cells develops, as well as the increased secretory activity, and hypergastrinemia. Parietal cells become less sensitive to a permanently increased serum gastrin concentration but still capable of reacting to the maximal stimulus. In patients with renal failure, especially those with extreme hypergastrinemia, there develops the increased concentration of large, mainly biologically inactive (big big gastrin, component I) molecular forms of gastrin.

Topics: Animals; Gastric Acid; Gastrins; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic

The islet cell tumors of the pancreas are now known to produce a variety of polypeptides in addition to insulin. These include glucagon, serotonin, corticotropin, melanocyte-stimulating hormone, gastrin and a secretinlike hormone that may be VIP or a combination of such polypeptides. The development and wide availability of the newer immunoassays for the various recognized hormones as well as candidate hormones of the gut will simplify the diagnosis of these challenging tumors, which up until this time have produced symptoms that were bizarre and often fatal to the patient.

Topics: Achlorhydria; Adenoma, Islet Cell; Angiography; Calcium; Diagnosis, Differential; Diarrhea; Gastrins; Glucagon; Hormones, Ectopic; Humans; Hyperinsulinism; Hyperparathyroidism, Secondary; Neoplasm Metastasis; Pancreatic Neoplasms; Paraneoplastic Endocrine Syndromes; Zollinger-Ellison Syndrome

Topics: Adolescent; Adult; Age Factors; Aged; Alkalosis; Calcium; Female; Gastrectomy; Gastric Juice; Gastrins; Humans; Hyperparathyroidism, Secondary; Lymphatic Metastasis; Male; Middle Aged; Parathyroid Hormone; Recurrence; Vagotomy; Zollinger-Ellison Syndrome

Topics: Adult; Aged; Calcitonin; Female; Gastrins; Gastritis; Gastrointestinal Hemorrhage; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Adult; Gastrins; Humans; Hyperparathyroidism, Secondary; Male; Multiple Endocrine Neoplasia; Parathyroid Hormone; Parathyroid Neoplasms; Pituitary Neoplasms; Prolactin; Zollinger-Ellison Syndrome

In 46 kidney patients aged from 30 to 71 years, after an overnight fast, serum levels of trypsin (TLI), gastrin (Gas), parathromone (PTH), calcium (Ca), magnesium (Mg), phosphate (iP), amylase, were evaluated. Ten patients had a normal renal function; in 18 patients glomerular filtration rate (GFR) ranged from 5 to 70 ml/m'; 18 patients with GFR below 2 ml/m' were treated with 4 hours hemodialysis. In dialysed patients TLI was evaluated before and after dialysis. In patients with FGR ranging from 120 to 5 ml/m' a significant inverse correlation (p < 0.001) appeared between TLI and GFR values. In the same group a significant direct correlation (p < 0.001) was found between PTH and TLI. The study showed also a significant direct correlation between amylase and TLI (p < 0.001); likewise TLI, amylase was inversely correlated to GFR (p < 0.01) and directly to PTH (p < 0.001). No correlation was found between TLI and Gas, Ca, Mg, iP. A significant inverse correlation was found between PTH and GFR (p < 0.01). Because serum level of PTH, amylase and TLI were related to GFR values, we calculated partial correlation between these parameters. The partial correlation coefficients of the relation between PTH and TLI, PTH amylase, holding GFR constant, were higly significant (p < 0.001). On the contrary, holding a constant PTH, the correlations between pancreatic enzymes and GFR were not confirmed. Pre-dialysis TLI levels were significantly higher than post-dialysis (p < 0.05).. 1) TLI and amylase have the same behaviour in renal failure; 2) the levels of both enzymes are high in renal insufficiency; their values seem to be correlated to secondary byperparathyroidism.

Topics: Adult; Aged; Amylases; Calcium; Female; Gastrins; Glomerular Filtration Rate; Humans; Hyperparathyroidism, Secondary; Kidney Diseases; Magnesium; Male; Middle Aged; Parathyroid Hormone; Phosphates; Renal Dialysis; Trypsin

Fortyseven uremic patients on RDT underwent a gastric secretion study and a contemporary evaluation of serum levels of Calcium (Ca), Phosphate (iP), Magnesium (Mg), Alkaline Phosphatase (AP), immunoreactive gastrin (Gas), parathyroid hormone (PTH), calcitonin (CT). Secretory test (pentagastrin 6 microgram/kg) was performed in the morning, after 12 hours of fasting, in the interdialytic interval. Female patients, male patients on RDT from less 1 year and hyposecretor patients were excluded from the study. On the basis of these criteria 25 normal or hypersecretor males between 20 and 55 years old were selected. A significant positive correlation was found between PTH and CT, while a negative significant correlation was found between CT and BAO and CT and PAO. Similarly, a significant negative correlation was found between PTH and BAO and PTH and PAO. Multiple regression study showed that the negative influence of CT on BAO and PAO is more relevant than the positive influence of PTH. These data suggest that PTH and CT are involved in gastric acid secretion in uremia. Since the inhibitory effect of CT is prevailing on the stimulating effect of PTH, patients with higher levels of PTH and CT have a lower gastric acid secretion. CT might therefore be considered as a protective factor against hypersecretion in uremia.

Topics: Adult; Alkaline Phosphatase; Antigens; Calcitonin; Calcium; Gastric Juice; Gastrins; Humans; Hyperparathyroidism, Secondary; Magnesium; Male; Middle Aged; Parathyroid Hormone; Pentagastrin; Phosphates; Renal Dialysis; Uremia

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

Topics: Age Factors; Calcium; Gastrins; Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Parathyroid Hormone; Renal Dialysis; Serum Albumin

Topics: Adenoma, Islet Cell; Calcium; Endocrine Glands; Gastric Acidity Determination; Gastrins; Humans; Hyperparathyroidism, Secondary; Pancreatic Neoplasms; Secretory Rate; Thyroid Neoplasms; Zollinger-Ellison Syndrome

Topics: Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Calcium; Diabetes Complications; Female; Gastrins; Humans; Hyperparathyroidism, Secondary; Male; Parathyroid Diseases; Parathyroid Neoplasms; Pituitary Neoplasms