gastrins and Hyperparathyroidism

Topics: Biomarkers; Diagnostic Techniques, Endocrine; Gastrins; Gastritis, Atrophic; Helicobacter Infections; Helicobacter pylori; Humans; Hyperparathyroidism; Radioimmunoassay; Reagent Kits, Diagnostic; Reference Values; Zollinger-Ellison Syndrome

Despite general awareness of Zollinger-Ellison syndrome (ZES) by most physicians and more than 3000 articles written about it since 1955, the diagnosis of ZES is still delayed for a mean of 5 years. Recent studies show it is being delayed even more with the widespread use of proton pump inhibitors. A number of tumor markers, in addition to assessing serum gastrin, such as chromogranin A, neuron-specific enolase, and subunits of chorionic gonadotropin, have been proposed for use in either the diagnosis of pancreatic endocrine tumors, such as gastrinomas, or for assessment of tumor extent and growth. In this article important recent insights into the diagnosis of ZES as well as the clinical usefulness of assessing tumor markers for diagnosis and determination of disease extent and growth are discussed. Approximately 25% of ZES cases are due to multiple endocrine neoplasia type 1 (MEN1). A number of important studies in this group of patients are also reviewed. Finally, almost every patient with ZES has marked gastric acid hypersecretion, and its current treatment as well as the long-term possible side effects are reviewed briefly.

Topics: Algorithms; Biomarkers, Tumor; Carcinoid Tumor; Chorionic Gonadotropin; Chromogranin A; Chromogranins; Gastric Acid; Gastrinoma; Gastrins; Gastrointestinal Agents; Humans; Hyperparathyroidism; Multiple Endocrine Neoplasia Type 1; Octreotide; Pancreatic Neoplasms; Phosphopyruvate Hydratase; Proton Pump Inhibitors; Stomach Neoplasms; Zollinger-Ellison Syndrome

Topics: Acromegaly; Duodenal Ulcer; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Gastroesophageal Reflux; Gastrointestinal Motility; Humans; Hyperparathyroidism; Ileal Diseases; Pyloric Antrum; Stomach Ulcer; Zollinger-Ellison Syndrome

Topics: Achlorhydria; Acromegaly; Adenoma; Adenoma, Islet Cell; Adolescent; Adult; Aged; Calcium; Cushing Syndrome; Diarrhea; Female; Gastric Acid; Gastrins; Glucagon; Humans; Hyperinsulinism; Hyperparathyroidism; Hypoglycemia; Hypokalemia; Male; Middle Aged; Neoplasms, Multiple Primary; Pancreatic Polypeptide; Pancreatitis; Parathyroid Glands; Parathyroid Neoplasms; Pituitary Neoplasms; Syndrome; Thyroid Diseases; Zollinger-Ellison Syndrome

After reviewing the more recent acquisitions on the physiology and pathophysiology of gastrin, the authors concentrate on situations of hypergastrinemia, which they divide into a hyperhydrochloric and a hypohydrochloric variety. Among the former, which they subdivide into preoperative and postoperative, the authors discuss problems of differential diagnosis versus peptic ulcers in patients so afflicted. To that end they propose diagnostic policies comprising among other instrumental and laboratory tests the study of gastric secretion, blood gastrin levels in basal conditions and after stimulation by a protein meal, BBS, secretin, and calcium. From analysis of the results of such tests they were able to find a precise nosographic placement for postoperative hypergastrinemia, and from there they arrived at surgical programs aiming to correct postoperative peptic ulcers on the basis of their etiology and pathogenesis.

Topics: Gastrectomy; Gastrins; Humans; Hyperparathyroidism; Peptic Ulcer; Postoperative Complications; Pyloric Stenosis; Stomach Diseases; Vagotomy; Zollinger-Ellison Syndrome

Topics: Gastric Mucosa; Gastrins; Humans; Hydrogen-Ion Concentration; Hyperparathyroidism; Paraneoplastic Endocrine Syndromes; Peptic Ulcer; Pyloric Antrum; Radioimmunoassay; Zollinger-Ellison Syndrome

Topics: Gastrectomy; Gastrins; Humans; Hyperparathyroidism; Pepsinogens; Peptic Ulcer; Vagotomy; Zollinger-Ellison Syndrome

Functioning tumors of the pancreatic islets are now recognized as the source of clinical syndromes affecting the gastrointestinal tract which have a wide variety of catastrophic symptoms. Experiences with thirty-six cases suggest at least four separate diagnostic categories in the ulcerogenic tumor syndrome. These include: a typical history, gastric analysis, and roentgenographic findings with boderline fasting serum gastrin levels; ulcerogenic tumor with evidence of hyperparathyroidism; iatrogenic ulcerogenic syndrome associated with failure of a previous operation for duodenal ulcer; and the classic ulcerogenic syndrome associated with a fulminating ulcer diathesis or diarrhea and high serum gastrin levels. The problems presented at operation include: decisions to be make in the presence of a negative exploration; the finding of a solitary tumor in the wall of the duodenum; solitary pancreatic tumors particularly in the body and tail; ulcerogenic tumors in the very young; liver metastases in the elderly; and the wisdom of removing gross metastases in combination with total gastrectomy. The long-term survival in the ulcerogenic tumor syndrome approximated 50 per cent, with 40 per cent of those having proved malignancy living five years. Evidence of hyperparathyroidism is relatively common in association with both the ulcerogenic and the diarrheogenic tumor syndromes. The association may by a result of a congenital abnormality, metabolic alkalosis, or a direct effect of the islet cell tumor. Parathyroidectomy may be indicated when both the serum calcium and parathormone levels are elevated in the presence of borderline fasting gastrin levels. The latter may return to normal after parathyroidectomy. The evidence of hyperparathyroidism closely parallels the episodes of diarrhea in the diarrheogenic syndrome, and hyperparathyroidism may regress spontaneously after total removal of the pancreatic tumor. Just as routine calcium determinations made the diagnosis of hyperparathyroidism more commonplace, it is suggested that the gastrointestinal syndromes associated with islet cell tumor would receive wider recognition if radioimmunoassays for gastrin as well as secretin, and the other secretin-like polypeptides, were carried out routinely.

Topics: Adenoma, Islet Cell; Age Factors; Celiac Disease; Diagnosis, Differential; Diarrhea; Duodenal Neoplasms; Follow-Up Studies; Gastrins; Humans; Hyperparathyroidism; Liver Neoplasms; Neoplasm Metastasis; Pancreatic Hormones; Pancreatic Neoplasms; Preoperative Care; Secretin; 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: Acute Kidney Injury; Adenoma, Islet Cell; Amino Acid Sequence; Animals; Catecholamines; Dehydration; Diarrhea; Duodenal Ulcer; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Intestinal Mucosa; Peptic Ulcer; Secretory Rate; Stimulation, Chemical; Stomach Ulcer; Syndrome; Zollinger-Ellison Syndrome

Topics: Adrenocorticotropic Hormone; Animals; Antibodies; Chromatography, Gel; Electrophoresis, Starch Gel; Gastrins; Growth Hormone; Humans; Hyperparathyroidism; Insulin; Iodine Radioisotopes; Molecular Weight; Parathyroid Hormone; Radioimmunoassay; Species Specificity; Trypsin

Topics: Adenoma, Islet Cell; Angiography; Antacids; Celiac Disease; Diarrhea; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Malabsorption Syndromes; Pancreatic Neoplasms; Physical Examination; Radioimmunoassay; Radionuclide Imaging; Zollinger-Ellison Syndrome

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

Topics: Achlorhydria; Animals; Calcitonin; Calcium; Dogs; Gastric Juice; Gastrins; Glucagon; Humans; Hyperparathyroidism; Magnesium; Parathyroid Glands; Parathyroid Hormone; Peptic Ulcer; Phosphates; Rats

Topics: Afferent Loop Syndrome; Deglutition Disorders; Diet Therapy; Dumping Syndrome; Gastric Acidity Determination; Gastrins; Gastroenterostomy; Gastroscopy; Humans; Hyperparathyroidism; Malabsorption Syndromes; Pentagastrin; Peptic Ulcer; Postgastrectomy Syndromes; Postoperative Complications; Stomach; Stomach Ulcer; Sutures; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Blood Glucose; Diagnosis, Differential; Gastrins; Glucose Tolerance Test; Humans; Hyperparathyroidism; Insulin; Pancreatic Neoplasms; Parathyroid Neoplasms; Radioimmunoassay; Tolbutamide; Zollinger-Ellison Syndrome

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

We analyzed gastrin, PTH, and calcitonin responses to oral calcium and peptones in hypocalciuric hypercalcemia, mild primary hyperparathyroidism, and normal controls. We observed diverse hormonal responses that may help in the differential diagnosis of these conditions.. Hypocalciuric hypercalcemia (HH) is consequent to calcium-sensing receptor (CaSR) genetic mutations or anti-CaSR antibodies. CaSR is expressed in parathyroid tissue, thyroid C cells, and gastrin-secreting cells, where it has been suggested that on calcium and/or amino acid allosteric activation, promotes gastrin secretion.. We evaluated gastrin, PTH, and calcitonin responses to oral calcium (1 g) and peptones (10 g) in 10 patients with HH (mean age, 58.5 +/- 10.3 years; F/M = 9/1), 15 patients with primary hyperparathyroidism (PH; mean age, 60.4 +/- 8.3 years; F/M = 11/4), and 30 healthy controls (mean age, 60.3 +/- 8.1 years). Statistical analyses for differences during oral loading tests were calculated with ANOVA for repeated measurements and comparisons between two groups were performed with Student's t-test.. PTH response to peptones was markedly increased in patients with PH compared with flat responses in controls and HH patients (p < 0.05). Gastrin increase after oral calcium was absent in HH and PH subjects (p < 0.05 versus controls), and gastrin responses to peptones were blunted in HH and PH subjects compared with controls (p < 0.05). PTH drop and calcitonin increase after calcium load observed in controls were absent in HH and PH subjects (p < 0.05).. The marked difference in PTH response elicited by peptones observed in PH compared with subjects with HH may help in the differential diagnosis of these conditions without genetic studies. Peptones may stimulate CaSR-controlled hormones as an allosteric regulatory pathway. CaSR abnormalities may help to explain the different calcium- and peptones-induced hormonal responses observed in PH and HH compared with normal subjects.

Topics: Aged; Calcitonin; Calcium; Diagnosis, Differential; Female; Gastrins; Humans; Hyperparathyroidism; Hypocalcemia; Male; Middle Aged; Parathyroid Hormone; Peptide Hormones; Peptones

Until recently, the association of primary hyperparathyroidism and gastric carcinoid, with or without hypergastrinaemia, had been considered an incomplete form of multiple endocrine neoplasia type 1. This is because it seemed unlikely that the rare joint appearance of these diseases could occur only by chance. It is now possible to evaluate the pathogenetic involvement of the multiple endocrine neoplasia type 1 gene in many, apparently sporadic, clinical conditions. This is a case report of a female mimicking multiple endocrine neoplasia type 1 due to the presence of hyperparathyroidism, gastric carcinoid, and hypergastrinaemia. However, involvement of the MEN-1 gene (exons 2-10) was not detected, whereas hypergastrinaemia was attributed to a chronic atrophic gastritis.

Topics: Aged; Carcinoid Tumor; Diagnosis, Differential; Female; Gastrins; Gastritis, Atrophic; Gene Expression; Humans; Hyperparathyroidism; Multiple Endocrine Neoplasia Type 1; Stomach Neoplasms

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

In the accessible literature we did not find data about the connection between Helicobacter pylori (H. pylori) infection and parathyroid hormone (PTH) abnormalities in patients on hemodialysis (HD pts). It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. We speculate that it should be connected with susceptibility to H. pylori infection in HD pts. The aim of our study was the assessment of relationships between PTH abnormalities and parameters of H. pylori infection expressed by concentration of IgG antibodies against H. pylori and histologically performed urease test. The study was conducted in 65 (37 M, 28 F) stable HD pts. They were dialyzed for 6 to 288 months (102.9 +/- 84.5). Simultaneously in 25 HD pts qualified for renal transplantation biopsy specimens taken during gastroscopy were examined by a histological test and urease test (CLO-test). According to the PTH concentration HD pts were divided into 3 groups with PTH < 100 pg/ml; with PTH 100-350 pg/ml and with > 350 pg/ml. Positive IgG H. pylori test > 24 U/ml was found in 60 (92%) HD pts. Mean IgG H. pylori concentration was similar in tree groups of HD pts. (82 vs 91 vs 88 U/ml) and did not differ significantly from control group. We found significant negative correlation between IgG H. pylori concentration and time on dialysis therapy (r = -0.50067, p = < 0.0001). Positive test in biopsy specimen was found in 14 HD pts (56%). PTH level in this group of HD pts not differ significantly from PTH level in pts with negative test (426 vs 398 pg/ml) and IgG H. pylori concentration was significantly higher in positive pts than in negative pts (104 vs 48 U/ml).. We did not find significant relationship between PTH abnormalities and H. pylori infection in HD pts. Longer period of dialysis therapy is connected with decreased ability to produce antibodies againts H. pylori.

Topics: Adult; Female; Gastric Juice; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Hyperparathyroidism; Immunoglobulin G; Male; Middle Aged; Parathyroid Hormone; Renal Dialysis; Renal Insufficiency

The major phenotypes of multiple endocrine neoplasia type 1 (MEN 1) consist of three lesions characterized by hyperparathyroidism, pituitary tumors, and endocrine pancreatic tumors. The endocrine pancreatic tumors are a significant cause of disease-related mortality in MEN 1. Although symptomatic pancreatic tumors such as insulinoma and gastrinoma should be resected, the management of asymptomatic pancreatic tumors is not established. In asymptomatic pancreatic tumors, the most important factor is the propensity for malignant transformation of the tumors. Although there are no means to foresee it, the size of the pancreatic tumors might be predictive of malignant development in MEN 1. We report here a patient with MEN 1 who had a large asymptomatic pancreatic tumor. The patient (72-yr-old man) was diagnosed with primary hyperparathyroidism and underwent a total parathyroidectomy. Genetic examination showed a germline mutation of the MEN1 gene (E45G). Abdominal magnetic resonance imaging revealed a large (>6 cm) tumor with a heterogeneous pattern in the tail of the pancreas. No metastases of the tumor were evident. Serum levels of insulin, gastrin, and glucagon were normal, and the patient had no symptoms. Operative resection was performed, and microscopic examination revealed that the tumor was an islet cell tumor stained with multiple hormones. This is a case indicating that asymptomatic pancreatic tumors associated with MEN 1 might be indolent independent of their size.

Topics: Adenoma, Islet Cell; Aged; Angiography; Gastrins; Germ-Line Mutation; Glucagon; Humans; Hyperparathyroidism; Immunohistochemistry; Insulin; Magnetic Resonance Imaging; Male; Multiple Endocrine Neoplasia Type 1; Pancreatic Neoplasms; Parathyroidectomy; Serotonin; Spleen

Gastrin levels have been reported to be often increased in patients with primary hyperparathyroidism (PHPT) considered to be caused by hypercalcemia. To determine the prevalence of increased basal gastrin and to investigate its causes, 52 consecutive patients with PHPT were studied prospectively, undergoing a clinical, biochemical, and gastric morphofunctional assessment before any parathyroid surgical procedure. This included evaluation of basal and secretin-stimulated gastrin, basal and pentagastrin-stimulated gastric acid secretion, upper gastrointestinal endoscopy, with histological evaluation for gastritis and Helicobacter pylori infection. Twenty of the 52 PHPT patients (38.5%) had increased fasting gastrin. Further investigation allowed us to clearly demonstrate the causes of hypergastrinemia in 16 of these 20 patients. In 7 of 20 (35%), hypergastrinemia was caused by gastric fundus atrophy; in 3 patients (15%), Zollinger-Ellison syndrome with Multiple Endocrine Neoplasia type I was diagnosed; whereas in another 20% of patients, mild hypergastrinemia was ascribed to Helicobacter pylori gastritis. Finally, in 2 patients, additional clinical history revealed an occasional use of the gastric antisecretory drug omeprazole a few days before the serum gastrin determination. This study shows that the hypercalcemic status per se is not sufficient to produce an increase in fasting gastrin levels. Furthermore, gastric fundus atrophy, and not gastrinoma, is the major cause of relevant (>160 pg/mL) hypergastrinemia.

Topics: Adult; Aged; Atrophy; Female; Gastric Acid; Gastric Fundus; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Pentagastrin; Prospective Studies; Secretin

Enteropancreatic malignancy is an important cause of morbidity and mortality associated with multiple endocrine neoplasia type 1 (MEN 1). However, the risk factors and mechanisms of the tumorigenesis of this malignancy are poorly understood.. The authors conducted a retrospective study of factors associated with the development of malignant enteropancreatic tumor in 69 patients with MEN 1 belonging to a single family.. Metastatic enteropancreatic tumor and gastrinoma were identified in 20% and 36% of patients, respectively. Compared with MEN 1 patients who did not have an immediate family history of enteropancreatic malignancy, MEN 1 patients with a first-degree relative affected by enteropancreatic malignancy had an increased risk of developing disseminated tumor (odds ratio, 3.7; P < 0.05). In addition, hypergastrinemia and advanced age were both associated with a significant increase in the risk of enteropancreatic malignancy. Elevated serum glycoprotein alpha subunit levels were associated with enterochromaffin-like cell hyperplasia, gastric carcinoid formation, and disseminated enteropancreatic tumor in hypergastrinemic patients (P < 0.05).. Disease modifier factors act in concert with the MEN 1 gene to modulate the development of enteropancreatic neoplasia. It is possible to identify MEN 1 patients at high risk for developing aggressive enteropancreatic tumors. Heritable disease modifier factor(s) affecting enteropancreatic malignancy appear to reside at loci distinct from that of the MEN 1 gene.

Topics: Adenoma; Adult; Female; Gastrinoma; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Neoplasm Metastasis; Pancreatic Neoplasms; Retrospective Studies; Risk Factors

We have investigated the prevalence of MEN 1 in patients with recognized pituitary adenomas. Since hyperparathyroidism is present in nearly 95-100% of patients with MEN 1 and frequently is the first condition to be identified, the study was limited to the identification of patients with hyperparathyroidism while the screening for gastroenteropancreatic (GEP) lesions was carried out in patients with both pituitary and parathyroid lesions.. Serum total and ionized calcium, phosphate and intact PTH 1-84 (EASIA) were measured in 166 patients (68 with non-functioning pituitary adenoma, 42 with prolactinoma, 35 with GH-secreting adenoma, 17-with ACTH-screening adenoma, 1 with TSH-secreting adenoma, 1 with FSH-secreting adenoma and 2 with an only alpha-subunit secreting adenoma) referred to our clinic from 1990 to 1996. Plasma gastrin, somatostatin, pancreatic polypeptide and vasoactive intestinal peptide were measured by RIA in patients with hyperparathyroidism.. Eight of 166 patients (4.8%) were found to have primary hyperparathyroidism and among these 2 also had a gastrinoma while there was no evidence of other GEP tumours. Considering the tumour type, 6 had prolactinoma (14.3%), 1 GH-secreting adenoma (2.8%) and 1 non-functioning adenoma (1.5%). In most patients the diagnosis of pituitary tumour was made several years before that of hyperparathyroidism (from 1 to 15 years) although 6 patients had previously suffered from urolithiasis and one had undergone gastric resections for recurrent peptic ulcers. One patient was identified as a MEN 1 gene carrier and 2 had relatives with signs and symptoms referable to parathyroid or GEP lesions.. The study shows a prevalence of 4.8% of primary hyperparathyroidism in unselected patients with known pituitary tumours similar to that reported in a previous study. By contrast, the prevalence of MEN 1 in patients with prolactinoma was definitely high (14.3%). In most patients the diagnosis of pituitary tumours was made several years before that of hyperparathyroidism. Although the patients were believed to harbour a sporadic pituitary tumour, most of them had had signs and/or symptoms referable to one or both of the other organs involved in MEN 1, often concomitantly with those of pituitary tumours. These data indicate that the diagnosis of MEN 1 syndrome is missed in a substantial proportion of patients with prolactinomas and therefore the screening of these patients for the syndrome is strongly recommended.

Topics: Adenoma; Adolescent; Adult; Aged; Biomarkers; Calcium; Female; Gastrinoma; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Pancreatic Polypeptide; Parathyroid Hormone; Phosphates; Pituitary Neoplasms; Prevalence; Prolactinoma; Somatostatin; Vasoactive Intestinal Peptide

A case of MEN type I in a 64-year-old man is reported. He had undergone partial duodenectomy because of gastric ulcer and multiple duodenal polyps (gastrin secreting carcinoid). Blood examination revealed hypercalcemia, hyperPTHemia, and hyperprolactinemia. Neck US and CT showed enlargement of 4 parathyroid glands. Brain MRI revealed the microadenoma in left pituitary gland. Total parathyroidectomy with auto-transplantation in the left forearm were performed. Histological examination showed the hyperplasia of the parathyroid. Three and a half year after parathyroidectomy, there was no evidence of recurrence of gastrin secreting tumor and hyperparathyroidism, and enlargement of pituitary microadenoma. This is the first MEN type I case in Japan which have detected 3 endocrine tumors clinically with gastrin secreting duodenal carcinoid.

Topics: Adenoma; Carcinoid Tumor; Duodenal Neoplasms; Gastrins; Humans; Hyperparathyroidism; Hyperplasia; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Parathyroid Glands; Pituitary Neoplasms; Prolactin

It is well known that primary hyperparathyroidism is often associated with peptic ulcer. The purpose of this study is to confirm the relationship between the gastrin-levels before and after parathyroidectomy in fourteen patients with primary hyperparathyroidism, and to determine the localization of gastrin in the surgically resected parathyroid tumor. The results obtained were as follows: 1) Three patients had peptic ulcer (gastric ulcer and duodenal ulcer), the incidence being 21%. 2) The basal serum gastrin levels were 123.0% +/- 68.1 pg/ml before operation and decreased to 90.2 +/- 44.5 pg/ml after operation. In the 3 patients with slightly elevated gastrin levels, the mean level before operation was 209.1 +/- 61.2 pg/ml. The gastrin level decreased to 116.4 +/- 62.0 pg/ml after operation. 3) Gastrin immunoreactivity was detected in 10 out of 14 tumors and its localization was at the periphery of tumor cells. From these results, we conclude that extragastric gastrin secretion from parathyroid tumors may be one of the cause of peptic ulcer in patients with primary hyperparathyroidism.

Topics: Calcium; Duodenal Ulcer; Gastrins; Humans; Hyperparathyroidism; Parathyroid Glands; Parathyroid Neoplasms; Stomach Ulcer

Topics: Anemia, Aplastic; Calcium; Gastrins; Humans; Hyperparathyroidism; Radioimmunoassay; Secretin; Zollinger-Ellison Syndrome

The prevalence of peptic ulcer disease was retrospectively analysed in 35 patients affected by primary hyperparathyroidism consecutively observed from 1977 through 1987. Eight of the examined patients (22.8%) had peptic ulcer (7 duodenal and 1 gastric ulcer), that in five cases (14%) represented the first clinical manifestation of the endocrine disease. A Zollinger-Ellison syndrome was demonstrated in three cases (8.5% of the total series, 37% of the patients with ulcer). There was no difference in calcium, gastrin and parathormone serum level between patients with and without ulcer, excluding patients with Zollinger-Ellison syndrome. These data confirm the high prevalence of peptic ulcer disease in hyperparathyroidism, but the mechanism causing this association remains to be elucidated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcium; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone; Peptic Ulcer; Retrospective Studies; Zollinger-Ellison Syndrome

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

Recent studies have suggested that patients with multiple endocrine neoplasia type I (MEN I) may have abnormal serum gastrin secretion in the absence of gastrin producing tumours. G-(gastrin) cell function by three provocation tests in 20 patients with hyperparathyroidism from six MEN I-families were studied: each patient was an obligate carrier of the MEN I-gene. The serum gastrin response to secretin was used to identify the presence of gastrinoma, that to a test meal of G-cell hyperfunction of the antral and/or duodenal mucosa, and that to bombesin to differentiate antral from duodenal G-cell hyperfunction. Seven patients had basal hypergastrinaemia and hyperchlorhydria. These patients had increased serum gastrin responses to secretin (p less than 0.01) and to bombesin (p less than 0.02), but normal postprandial responses. In the 13 normogastrinaemic patients the responses to the three stimuli were normal. In families with MEN-I gastrinoma is the only endocrine disorder accounting for abnormal gastrin secretion. G-cell function is normal in obligate carriers of the MEN I-gene.

Topics: Adult; Aged; Bombesin; Duodenum; Eating; Female; Gastrinoma; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pyloric Antrum; Secretin

Our previous secretin provocation studies in normal volunteers and unoperated duodenal ulcer patients suggested that the gastrin rise in gastrinoma may be an exaggeration of the normal response rather than paradoxical. We report further studies in various clinical settings having normogastrinemia (normal, n = 17; unoperated duodenal ulcer, n = 13; primary hyperparathyroidism, n = 7) and hypergastrinemia (postvagotomy, n = 5; hypochlorhydria, n = 7; achlorhydria, n = 10; chronic renal failure, n = 10; gastrinoma, n = 5). Under all nongastrinoma conditions, there were similar gastrin rises of 9-19% between 2 and 5 min after bolus intravenous GIH secretin (2 CU/kg), which fell to baseline by 8 min, except for chronic renal failure. In chronic renal failure, gastrin remained elevated from 7 to 30 min and was significantly different (p less than 0.05) at 10-30 min compared to all other nongastrinoma conditions except hyperparathyroidism. Peak rises occurred within 5 min in all entities, but only three gastrinoma patients had positive secretin provocation tests by the predefined criterion of a gastrin rise greater than 200 pg/ml. The results of secretin provocation in various clinical entities with and without hypergastrinemia further support the hypothesis that the gastrin rise in gastrinoma is an exaggeration of the normal response. The prolonged gastrin rise seen in chronic renal failure may be due to altered renal clearance, inasmuch as other hypergastrinemic states had responses similar to normal and duodenal ulcer.

Topics: Adult; Aged; Duodenal Ulcer; Female; Gastric Acid; Gastrins; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged; Secretin; Vagotomy

Topics: Adult; Aged; Aged, 80 and over; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands

Topics: Calcitonin; Female; Gastrins; Gastritis, Atrophic; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Prolactin

This study evaluates prospectively the effect of parathyroidectomy on basal acid output (BAO), maximal acid output (MAO), fasting serum gastrin, secretin-stimulated serum gastrin, and sensitivity to antisecretory medication in 10 consecutive patients with primary hyperparathyroidism (PHP), Zollinger-Ellison syndrome (ZES), and multiple endocrine neoplasia type I (MEN-I). After parathyroidectomy, 9 of 10 patients remained normocalcemic, and each had a lower BAO; 6 of 9 no longer had gastric acid hypersecretion (less than 15 mEq/hr). Seven of 9 normocalcemic patients had a lower MAO, and a decrease in fasting serum gastrin. Two patients showed no evidence of ZES, a normal BAO, normal fasting serum gastrin concentration, and a negative secretin response after parathyroidectomy. Parathyroidectomy also reduced the dose of histamine H2-receptor antagonist required to control gastric acid secretion in 60% of patients. After successful parathyroidectomy three patients were studied for drug sensitivity, and each had greater acid inhibition with a given dose of histamine H2-receptor antagonist than preoperatively. One patient remained hypercalcemic after surgery and had no change in BAO, MAO, or gastrin. All patients with postoperative normocalcemia will have a lower BAO, 80% a lower MAO, 80% a decreased fasting serum gastrin, and 33% a negative secretin test. Antisecretory medication dose can be reduced because patients have reduced BAO and increased sensitivity to histamine H2-receptor antagonist. The study supports parathyroidectomy as the initial surgical procedure of choice in patients with PHP, ZES, and MEN-I.

Topics: Adult; Female; Gastric Acid; Gastrins; Histamine H2 Antagonists; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Parathyroid Glands; Prospective Studies; Zollinger-Ellison Syndrome

Management of patients with multiple endocrine neoplasia type I (Wermer's syndrome) who have concurrent hypercalcemia and hypergastrinemia is controversial. The usual therapeutic approach has been to perform parathyroidectomy first before surgery for ulcer disease in an effort to decrease serum calcium concentration and presumably remove one of the stimuli for both gastrin and gastric acid secretion. We present the history of a 48-year-old man with primary hyperparathyroidism and Zollinger-Ellison syndrome who underwent acid secretory studies and secretin stimulation tests before and after parathyroidectomy. We also studied the effect of calcium channel blockade on gastrin and gastric acid secretion, since calcium influx into endocrine cells, such as the gastrinoma cell, is thought to be critical in hormone secretion. Although parathyroidectomy reduced serum calcium and parathormone levels to normal, basal serum gastrin concentration and basal acid output remained unchanged. The peak rise in serum gastrin concentration after secretin injection was less after parathyroidectomy than before parathyroidectomy but was still abnormal. During administration of verapamil, a calcium channel antagonist, no change was seen in the serum gastrin concentration, secretin test response, or acid secretion. Basal acid output was 45.4 mmol/hr before parathyroidectomy or verapamil and 54.0 and 50.4 mmol/hr after parathyroidectomy or verapamil, respectively. In contrast, a small but significant decrease (p less than 0.05) in serum parathormone concentration occurred during treatment with verapamil, an observation that to the best of our knowledge has not been previously reported in humans.

Topics: Calcium Channel Blockers; Gastric Acid; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Pedigree; Peptic Ulcer; Verapamil; 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

Between 1971 and 1983, 31 males and 13 females were found to have peptic ulceration associated with hypergastrinaemia. An antral G-cell lesion was present in 11 (25 per cent) and a gastrinoma in 14 (32 per cent). There were 11 patients with multiple endocrine adenomatosis (MEA) (25 per cent) and 4 (9 per cent) with primary hyperparathyroidism. Four patients (9 per cent) were unclassified. Length of history and level of gastrin did not differentiate between the groups and an average of 2.5 operations was performed per patient, while the overall mortality was 27.3 per cent. The patients with G-cell lesions were significantly younger than all the other groups (P less than 0.01). Partial gastrectomy adequately treated G-cell hyperplasia. Total gastrectomy was required to treat pancreatic gastrinomata but additional pancreatic resection did not improve the outcome. In MEA, parathyroidectomy did not influence the treatment of a gastrinoma. This is the first recorded experience of surgery for hypergastrinaemia in the United Kingdom and the outcome of such a retrospective study may be a guide to the future management of these conditions.

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Female; Gastrectomy; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatectomy; Pancreatic Neoplasms; Peptic Ulcer; Zollinger-Ellison Syndrome

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: Female; Gastrins; History, 20th Century; Humans; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia; Secretin; Zollinger-Ellison Syndrome

To determine if gastrin in hyperparathyroid glands is true gastrin or artifact and to determine the frequency of gastrin in parathyroid glands, 20 parathyroid glands from 11 patients with hyperparathyroidism but without MEA were extracted and analyzed for gastrin. The parathyroid glands from 4 out of 11 patients had measurable gastrin immunoreactivity (10.7 + 6 pg/mg tissue). Column separation chromatography confirmed that this was true gastrin (40% G-34; 50% G-17). Immunohistochemistry with ABC (avidin biotin complex) immunoperoxidase confirmed the presence of gastrin in cytoplasmic vesicles in scattered parathyroid cells. True gastrin does exist in some cells in some patients with hyperparathyroidism.

Topics: Adenoma; APUD Cells; Gastrins; Humans; Hyperparathyroidism; Hyperplasia; Immunoenzyme Techniques; Parathyroid Glands; Parathyroid Neoplasms; Protein Precursors; Radioimmunoassay

A 45-min gastrin assay with a minimum detection limit of 50 pg/ml plasma has been developed which makes use of delayed addition of labeled tracer. The precision of the rapid assay compares favorably with standard methods for measurement of plasma gastrin concentrations in excess of 100 pg/ml. The rapid method can be used for emergency preoperative diagnosis of Zollinger-Ellison syndrome and as an aid in localizing gastrinomas before or during surgery.

Topics: Fasting; Gastrins; Humans; Hyperparathyroidism; Radioimmunoassay; Time Factors; Zollinger-Ellison Syndrome

The diagnosis of multiple endocrine neoplasia (MEN) in patients with presumed hyperparathyroidism has important ramifications for patient management especially since as many as 20% of patients with hyperparathyroidism may have associated MEN. Gut hormone levels were measured before and after surgery in 28 patients who underwent resection of a single parathyroid adenoma for biochemical or clinical evidence of hyperparathyroidism. The mean serum calcium level was 11.9 +/- 0.2 mg/dl before surgery and 9.3 +/- 0.3 mg/dl after surgery (p less than 0.001). Two or more hormone levels were elevated in 32% of patients before surgery and 21% after surgery. The same hormone abnormalities (pancreatic polypeptide [PP] and gastrin) occurred 56% of the time. Of elevated preoperative levels of PP, 91% were in the normal range after surgery. In patients with elevated preoperative PP levels, the postoperative level of PP decreased by an average of 64% of the preoperative level. In 27% of patients the level increased more than double the preoperative value. In two of four patients with high levels of PP after surgery the serum calcium level failed to fall. Of 18 patients whose PP levels fell, 17 had a fall in serum calcium levels. Of six patients whose PP levels rose, four had a significant fall in calcium levels. There was no correlation between the absolute levels or the decremental change of calcium and the change in PP. Several abnormalities in gut hormone secretion occur in patients with primary hyperparathyroidism and a parathyroid adenoma. An elevated serum level of PP does not signify MEN syndrome and must be reevaluated after resection of the parathyroid adenoma. Failure of adequate tumor resection is attended by persistent elevation of serum calcium and PP levels.

Topics: Adult; Aged; Female; Gastrins; Gastrointestinal Hormones; Glucagon; Glucagon-Like Peptides; Humans; Hyperparathyroidism; Male; Middle Aged; Motilin; Multiple Endocrine Neoplasia; Pancreatic Hormones; Pancreatic Polypeptide; Parathyroid Glands; Somatostatin; Substance P; Vasoactive Intestinal Peptide

Results of preparathyroidectomy and postparathyroidectomy studies in a patient with multiple endocrine neoplasia type I and gastrinoma suggest that hyperparathyroidism unmasks occult gastrinoma and related secretory abnormalities. Three of four diagnostic findings were later obscured by parathyroidectomy and normalization of serum calcium concentration. Basal acid output, basal acid output/maximal acid output ratio, and serum gastrin concentration were decreased from values consistent with gastrinoma to normal. The secretin stimulation test, though still positive, was attenuated. These observations suggest that in multiple endocrine neoplasia type I, normal values for serum gastrin concentration, gastric secretion, and secretin stimulation may not exclude gastrinoma. The investigations clarify the interpretation of a voluminous but confusing literature on the interrelationship between hyperparathyroidism and altered gastric function in the presence or absence of Zollinger-Ellison syndrome.

Topics: Adenoma; Adult; Calcium; Drug Interactions; Female; Gastric Acid; Gastrins; Humans; Hyperparathyroidism; Multiple Endocrine Neoplasia; Parathyroid Hormone; Pituitary Neoplasms; Secretin; Thyroid Neoplasms; Zollinger-Ellison Syndrome

In vitro studies have demonstrated that secretin can stimulate the release of parathyroid hormone (PTH), but reports concerning its effects on PTH and calcium in vivo are contradictory. To examine this question further, a bolus injection of secretin (75 IU) was given to 12 normal subjects and 10 patients with primary hyperparathyroidism (HPT). Six of the patients had multiple endocrine neoplasia and five had endocrine pancreatic tumours (EPT). Three normocalcaemic patients with EPT were also included in the study. The mean serum gastrin level rose significantly (from 19 to 40 pmol/l, p less than 0.01) within 15 min of secretin injection in the normal subjects. HPT patients without EPT had a somewhat higher mean basal level of gastrin (39 pmol/l, p less than 0.05 compared with controls), but it did not increase significantly after the secretin bolus. In six EPT patients the gastrin concentrations rose by more than 300 pmol/l. Although secretin had a biological capacity to release gastrin, it had no discernible effects on either serum PTH or serum calcium in any of the groups studied. Nor were any changes in PTH or calcium observed when secretin was given as a continuous infusion (3 IU/kg/h) over 90 min. Thus, our data do not support the concept that secretin, in vivo, is a secretagogue of PTH.

Topics: Adult; Aged; Calcium; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Parathyroid Glands; Parathyroid Hormone; Secretin; Zollinger-Ellison Syndrome

In 63 consecutive patients with primary hyperparathyroidism (HPT) a prospective screening study was undertaken for coexistent multiple endocrine neoplasma-(MEN)-syndrome type 1. The screening consisted of a clinical examination, a radiological examination of the sella turcica with skeletal tomography (and in equivocal cases computed tomography), visual field examination by perimetry and a hormonal evaluation including measurements of the serum levels of prolactin, gastrin, pancreatic polypeptide (PP) and subunits of human chorionic gonadotrophin (HCG-alpha and -beta). Clinical examination did not reveal any signs of endocrine disease suggestive of a MEN-1 syndrome. In only one case there was a radiological abnormality of the sella turcica; this patient had an empty sella syndrome and a raised serum prolactin value. All other prolactin values were within the normal range. In 41% of the patients raised serum gastrin levels were found; these tended to normalize after parathyroidectomy. As a group, patients with raised gastrin values were older than the others and generally they had hypo- or achlorhydria. The serum PP levels were raised in 28% of the patients but there was no clinical evidence of a pancreatic tumour in any of these cases, and the serum HCG-alpha and -beta levels were within the normal range in all patients but two. We conclude that the incidence of MEN-1 syndrome in unselected patients with primary HPT must be low, and that investigations for this syndrome are justified only in HPT patients with specific symptoms or with a positive family history.

Topics: Adult; Aged; Chorionic Gonadotropin; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Polypeptide; Prolactin; Radiography; Sella Turcica

The prevalence of hypergastrinemia was determined in 38 consecutive patients with proved primary hyperparathyroidism. Uncorrected serum calcium levels ranged from 2.6 to 4.0 mmol/L and parathyroid hormone levels from 260 to 8750 ng/L (normal less than 600 ng/L). Preoperative serum gastrin levels were grossly elevated (1000 to 4000 ng/L) in three patients (normal median 63 ng/L; range 30 to 120 ng/L). Two patients were achlorhydric. After parathyroidectomy (adenomatous hyperplasia) in the third patient, the serum gastrin level decreased from 4000 to 3000 ng/L, with a negative response to both a secretin challenge and a meal test. The latter patient was subsequently shown to have an adrenal ganglioneuroma and islet cell hyperplasia, neither containing gastrin, and at 4-year follow-up she still has no symptoms from the hypergastrinemia. Eight patients had a modest hypergastrinemia. Serum gastrin levels returned to normal in three of the four patients after parathyroidectomy. The fourth patient had rheumatoid arthritis, which can be associated with hypergastrinemia. The mean plasma gastrin level before operation (100.3 +/- 26.1 ng/L) was similar to the postoperative value (67.0 +/- 18.5 ng/L). There was no correlation between parathyroid hormone and gastrin levels nor between serum calcium and gastrin levels. The three patients with duodenal ulcers did not have elevated gastrin levels. Therefore it would appear that routine screening of patients with primary hyperparathyroidism adds little to their clinical management.

Topics: Adult; Aged; Calcium; Female; Gastrins; Humans; Hyperparathyroidism; Hyperplasia; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Zollinger-Ellison Syndrome

Topics: Adult; Duodenal Neoplasms; Gastrins; Humans; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia

In approximately 20% of the cases the Zollinger-Ellison syndrome (ZES) is associated with primary hyperparathyroidism (HPT). In view of this frequent association, serum calcium and phosphorus levels should be measured in all patients with ZES. Conversely, all patients with HPT I accompanied or preceded by peptic ulcer and/or diarrhoea should have their gastric acid secretion and serum gastrin level measured. Since the association may reflect a type I multiple endocrine neoplasia (MENI), involvement of other endocrine systems, notably the pituitary gland, should be investigated in the patients and their family. A rise in basal plasma pancreatic polypeptide has been observed in about 50% of cases of familial MEN I (Wermer's syndrome) and appears to be a good index of pancreatic endocrine tumour. When ZES is associated with HPT I, the latter should be treated first for three reasons: (7) lethal acute hypercalcaemia may occur after abdominal surgery; (2) HPT I itself may increase the gastric acid secretion and hypergastrinaemia of the ZES, and (3) parathyroidectomy and medical treatment with gastric antisecretory drugs may postpone the need for total gastrectomy.

Topics: Adult; Female; Gastric Acid; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Polypeptide; Parathyroid Glands; Zollinger-Ellison Syndrome

In three families with the multiple endocrine adenomatosis type I (MEA I) trait, 51 members were investigated by measurement of circulating peptide hormones as tumor markers. Twenty-five of 51 members (49 percent) were considered to be affected by MEA I disorders. The incidence rose with age (75 percent in generation II). Both sexes were affected equally. Hyperparathyroidism was present in 20 of 25 affected members (80 percent), and pituitary tumors (prolactinomas) were found in four of 25 (16 percent). Endocrine pancreatic tumors were found in nine of 25 affected members (36 percent), but when "probable" tumors (seven) are included the frequency rises to 72 percent. Hyperparathyroidism was found in all except one member with proved lesions in other organs. Among patients with proved and possible endocrine pancreatic tumors, elevated serum levels of gastrin and pancreatic polypeptide were frequently found, 78 percent and 67 percent, respectively, and we suggest that serum gastrin and pancreatic polypeptide levels are the most useful screening markers at present for pancreatic lesions in MEA I.

Topics: Adenoma; Adolescent; Adult; Age Factors; Aged; Female; Gastrins; Humans; Hyperparathyroidism; Insulinoma; Liver Neoplasms; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Neoplasms; Pancreatic Polypeptide; Parathyroid Neoplasms; Pedigree; Vasoactive Intestinal Peptide; Zollinger-Ellison Syndrome

In order to evaluate the possible causal relationship between raised serum gastrin levels and the development of primary hyperparathyroidism (HPT) which is suggested from experimental studies we evaluated parathyroid function in a group of 32 patients with hypergastrinaemia and pernicious anaemia. The values for serum calcium and parathyroid hormone were determined as well as the fasting urinary excretions of cyclic AMP and calcium. There was no relationship between the serum gastrin levels and any of the other studied parameters and there was no consistent pattern suggesting parathyroid hyperfunction. A retrospective analysis of hospital records from 441 patients operated for primary HPT showed a prevalence of pernicious anaemia of 1.8%. This figure is higher than that found in the unselected age-matched population (0.31%). However, taken together this study does not support the hypothesis that hypergastrinaemia is of particular importance for the pathogenesis of primary HPT.

Topics: Adult; Aged; Anemia, Pernicious; Calcium; Cyclic AMP; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone

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

Treatment with cimetidine (1000 mg daily in four divided doses) was given for 3--30 weeks to 10 patients with primary hyperparathyroidism (HPT). All patients had hypercalcaemia and raised serum concentrations of parathyroid hormone (PTH). During treatment no consistent effects were noted on neither serum calcium or PTH and normalization did not occur in any case. Hypergastrinaemia was demonstrated in 6 patients and was also unaffected by therapy while in the 4 patients with normal pre-treatment gastrin values a slight increase was seen. This study does not support the view that cimetidine can be of use for the treatment of primary HPT.

Topics: Adult; Aged; Calcium; Cimetidine; Dose-Response Relationship, Drug; Female; Gastrins; Guanidines; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone; Time Factors

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

In 36 patients with verified hyperparathyroidism (HPT), serum gastrin and its response to secretin was studied before and after parathyroidectomy. In most of the patients gastric secretion-basal acid output (BAO) and maximal acid output (MAO)--was also studied. Seventeen patients had increased serum gastrin values preoperatively and/or postoperatively. Most of the serum gastrin increases were moderate and all but one of the patients with values above 250 pmol/l had hypochlorhydria. Nine patients had a positive secretin test according to conventional criteria preoperatively or postoperatively, but showed no other signs suggestive of a gastrin-producing tumour. Most of the patients with a serum gastrin increase after injection of secretin had hypochlorhydria or achlorhydria. The BAO/MAO ratio was less than 0.6 in all patients. The results of this study do not support the view that primary HPT is often associated with a gastrin-producing tumour as part of a multiple endocrine adenomatosis (MEA type I), but indicate that the observed hypergastrinemia in HPT is almost exclusively related to hypo- or achlorhydria. The findings also give reason to doubt the value of the secretin test.

Topics: Adenoma; Female; Gastric Acid; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms; Peptic Ulcer; Secretin

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; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Phosphorus; Zollinger-Ellison Syndrome

The causal relationship of primary hyperparathyroidism and ulcer disease is reviewed. In contrast to earlier ideas careful clinical and clinico-chemical investigations have shown that in patients with manifest primary hyperparathyroidism neither is the incidence of ulcer disease raised nor are deviations from the normal behavior of acid secretion or the serum gastrin level to be observed in comparison with the average population.

Topics: Calcium; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Peptic Ulcer

Antral somatostatin- and gastrin-producing cells (D and G cells) were studied in a group of patients with chronic renal failure (CRF) in comparison with a control group. Gastric acid secretion and serum gastrin, phosphate, and parathormone (PTH) levels were also evaluated in every patient. The group with CRF showed a mild increase both in G- and in D-cell denisty. In this group serum phosphate and PTH levels were higher than normal, showing hyperparathyroidism in every patient. A direct correlation was found between G-cell density and parathyroid function in patients with CRF. Hyperparathyroidism, therefore, seems to play a role in the mechanism of increased serum gastrin levels in CRF.

Topics: Adult; Cell Count; Female; Fluorescent Antibody Technique; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Pentagastrin; Phosphates; Pyloric Antrum

A rare case of the Zollinger-Ellison syndrome associated with hyperparathyroidism and ectopic gastric tissue in the lower esophageal mucosa is reported. Preoperatively the patient, a 53-year-old woman, had hyperchlorhydria and her fasting serum gastrin concentration was mildly elevated. There was a considerable increase in the gastric acid output and concentration of serum calcium after secretin infusion. At operation the patient had a gastric ulcer 10 cm in diameter, an islet cell tumour of the pancreas 14 cm in diameter, and ectopic gastric mucosa in the distal third of the esophagus. A gastrectomy was perfomed, the pancreatic tumour excised and part of the distal esophagus removed through a left thoracotomy. Four months after the operation the gastrin concentration had returned to low normal, but the serum calcium values remained high. One month later two parathyroid adenomas were removed which effectively cured the hypercalcemia.

Topics: Adenoma; Calcium; Choristoma; Esophageal Neoplasms; Esophagus; Female; Gastric Juice; Gastric Mucosa; Gastrins; Hormones, Ectopic; Humans; Hyperparathyroidism; Middle Aged; Paraneoplastic Endocrine Syndromes; Parathyroid Hormone; Parathyroid Neoplasms; Stomach; Zollinger-Ellison Syndrome

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

Mean fasting levels of pancreatic polypeptide (PP) in 24 patients with Zollinger-Ellison syndrome (ZES) and in 12 patients with hyperparathyroidism originating from families with multiple endocrine adenomatosis type I (MEAI-HPT) were significantly higher than in 72 normal controls. The overlap between the 3 groups, however, was large. In patients with ZES, increased PP levels were not related to the presence of MEAI or metastases; nor was there a correlation between serum PP and gastrin concentrations. The post-prandial PP release in 10 ZES patients and in 10 patients with MEAI-HPT was lower than in 9 normal controls. The physiological significance of the present findings is unclear.

Topics: Adolescent; Adult; Aged; Fasting; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Neoplasm Metastasis; Pancreatic Polypeptide; Zollinger-Ellison Syndrome

Case report on the successful gastric ulcer treatment of a patient with primary hyperparathyroidism with the H2-receptor antagonist cimetidine. After four weeks of therapy with 0.8 g/d cimetidine stomal ulcerations were seen by x-rays and endoscopy to be healed. The patient was discharged on a regimen of 400 mg daily of oral cimetidine. Peptic ulcer did not recur after 1/2 year of treatment with this H2-receptor antagonist, although the signs of primary hyperparathyroidism were still present.

Topics: Aged; Cimetidine; Gastrins; Guanidines; Humans; Hyperparathyroidism; Male; Parathyroid Hormone; Peptic Ulcer

Topics: C-Peptide; Calcitonin; Gastrins; Humans; Hyperparathyroidism; Insulin; Parathyroid Hormone

Topics: Achlorhydria; Aged; Female; Gastrins; Humans; Hyperparathyroidism; Middle Aged

Twenty-three patients with hyperparathyroidism from six families with the multiple endocrine adenomatosis (MEA) I-syndrome were tested by secretin provocation. In nine cases this led to increases in serum gastrin ranging from 298 to 13 300 pg/ml, whereas the maximum rise in gastrin in the other 14 patients was 32 pg/ml. In all nine patients with marked gastrin responses to secretin, the Zollinger-Ellison syndrome was diagnosed by gastric acid hypersecretion and large increases in gastrin after calcium administration. Six of these nine patients had, at most, minor postprandial rises in gastin and two had demonstrable tumors. In 34 normal subjects, 23 nonaffected members of families with MEA I-syndrome, and 42 patients with various diseases the maximum gastrin response to secretin was 21 pg/ml. We conclude that secretin provocation is helpful in the diagnosis of the Zollinger-Ellison syndrome, especially when basal serum gastrin levels are only slightly elevated.

Topics: Adolescent; Adult; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Secretin

The gastric acid output was studied in the 11 patients of hyperparathyroidism before and after parathyroidectomy. The gastric acid output before operation was almost equal to the normal control in our hospital. After the correction of serum calcium by parathyroidectomy, the gastric acid output and serum gastrin were decreased. The decreased gastric acid output was recovered as the days passed since operation and approached to the preoperative level. The acid output in hyperparathyroidism was less in the case whose activity of alkaline phosphatase was more, which suggested that the calcium deposition on gastric mucosa might damage the parietal cell as the result of long lasting hypercalcemia.

Topics: Adolescent; Adult; Alkaline Phosphatase; Calcium; Female; Gastric Juice; Gastrins; Humans; Hydrogen-Ion Concentration; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands

The morphology of the parathyroids in rats with hypergastrinemia, induced by antral exclusion, was compared with that of glands from untreated rats and animals from which the main source of gastrin- 17 was excluded (antral resection). Fourteen weeks after induction of hypergastrinemia the volume of the parathyroids was significantly increased owing to hyperplasia of the parenchymal cells. Removal of the antral gastrin-producing capacity of the same duration was not accompanied by any significant changes in the parathyroids. These findings suggest that hypergastrinemia could be a stimulus for the development of hyperplasia of the parathyroids, and that it may be an etiological factor in the production of hyperparathyroidism.

Topics: Animals; Body Weight; Calcium; Cell Count; Gastrins; Hyperparathyroidism; Hyperplasia; Male; Organ Size; Parathyroid Glands; Pyloric Antrum; Rats

Topics: Animals; Calcitonin; Cats; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Zollinger-Ellison Syndrome

Plasma hCT levels were less than 50 pg/ml in 50 normal subjects. In 16 patients with medullary carcinoma of the thyroid (MCT), plasma hCT levels were distinctively elevated and they fell significantly after total thyroidectomy, but in 11 of them plasma levels were still high, indicating the presence of metastases. In 74 patients with the other types of malignancy, plasma hCT levels were found to be high in 9 cases (3 oat cell carcinoma of the lung, 4 malignant carcinoids, one malignant pheochromocytoma and one acute myelocytic leukemia). Except for the leukemic case, all these tumors were derived from neural crest. In 12 patients with primary hyperparathyroidism, plasma hCT levels were less than 20 pg/ml. In 13 hypoparathyroid patients, two with pseudohypoparathyroidism and one with pseudoidiopathic hypoparathyroidism, plasma hCT levels were slightly elevated. Some patients with uremia had elevated plasma hCT levels, but there was no relation between plasma levels of hCT and those of PTH, urea nitrogen or creatinine. In response to Ca (4.5 mg/kg/10 min) or tetragastrin (4 mug/kg/5 min) infusion, a marked increase in plasma hCT was observed in all patients with MCT, but not in normal subjects. In 5 hypoparathyroid patients, a significant increase to both stimuli was also observed in all cases. Two patients with pseudopseudohypoparathyroidism responded to the Ca load. These results indicate that the determination of plasma hCT levels especially after a short Ca or tetragastrin infusion is important to study various pathological conditions.

Topics: Calcitonin; Calcium; Carcinoma; Carcinoma, Small Cell; Cross Reactions; Dose-Response Relationship, Drug; Gastrins; Humans; Hyperparathyroidism; Infusions, Parenteral; Lung Neoplasms; Thyroid Neoplasms; Thyroidectomy

An adequate therapy must be directed towards the cause of the recurrent ulcer. This is incomplete vagotomy in most cases, more seldom a hypergastrinemia with stasis in the antrum after insufficient drainage, in hyperparathyroidism, in hyperplasia of the antral G cells or in gastrinoma. After confirmation of the diagnosis by endoscopy, a causal diagnosis must therefore be made which includes secretion analysis and determination of the gastrin profile (feeding test, glucagon provocation test, secretion or calcium infusion). Criteria for evaluation and clinical conclusiveness are shown in examples. The indication scheme, whether revagotomy alone, resection alone or the combination of the two corrective operations should be performed is determined according to these criteria. So far, 41 patients have been operated on with good results in accordance with this graduated indication.

Topics: Gastrectomy; Gastric Juice; Gastrins; Gastroscopy; Glucagon; Humans; Hyperparathyroidism; Insulin; Peptic Ulcer; Recurrence; Vagotomy; Zollinger-Ellison Syndrome

To define the relationship between hyperparathyroidism (HPT) and gastric function, 31 patients with HPT were prospectively studied before and 2 to 25 months after parathyroidectomy. The gastrin response to a standard test meal (STM), the basal acid output (BAO), and the peak acid output (PAO) were determined. Parathormone and calcium were elevated in all patients and returned to normal following parathyroidectomy. The mean fasting gastrin concentration, mean integrated gastrin response (IGR) to feeding, mean basal acid output (BAO), and mean peak acid output (PAO) were not changed by successful parathyroidectomy. There was no significant correlation between gastrin concentration or gastrin response to feeding and gastric acid secretion. Eight of 31 HPT patients had fasting gastrin concentrations above normal preoperatively and remained so postoperatively. Hypergastrinemia in six of these eight patients could be explained by the Zollinger-Ellison (Z-E) syndrome or chronic atrophic gastritis. The hypothesis that peptic ulcer disease seen in some HPT patients is the result of calcium-induced hypergastrinemia causing gastric hypersecretion is not supported by this study.

Topics: Adolescent; Adult; Aged; Calcium; Female; Food; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Phosphorus; Radioimmunoassay; Zollinger-Ellison Syndrome

Hyperparathyroidism has been associated with an increased incidence of duodenal ulcer, increased acid secretion, and increased plasma gastrin levels. A relationship between these changes, increased serum calcium levels, and the increased incidence of peptic ulceration has been suggested, especially since increased plasma gastrin levels, serum calcium levels, and gastric acid secretion decrease after parathyroidectomy. We have previously suggested that the decrease in plasma gastrin levels after parathyroidectomy may suggest an extragastric source of gastrin, whereas others using immunofluorescent studies have suggested that the parathyroid adenomas themselves might be the source of this gastrin. We prospectively studied in fifteen patients with primary hyperparathyroidism, plasma gastrin and serum calcium levels before and after parathyroidectomy, as well as the gastrin content of parathyroid tumor tissue. The mean basal plasma gastrin level before operation was significantly greater than that of a control group and decreased insignificantly after operation, in contrast to serum calcium levels. No positive correlation could be found between plasma gastrin and serum calcium levels before and after operation. Parathyroid tumor tissue was assayed for gastrin content by radioimmunoassay and no detectable amounts of gastrin could be recovered from any tumor. The results do not support the concept that the extragastric source of gastrin in patients with hyperparathyroidism is the parathyroid adenoma itself.

Topics: Adenoma; Adult; Aged; Duodenal Ulcer; Female; Gastrins; Hormones, Ectopic; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms

After removal of two large pancreactic insulinomas, although the presenting spontaneous hypoglycaemia was eliminated, severe and persisting haematemesis and melaena supervened with a rise in serum gastrin. The patient had multiple endocrine adenopathy (pituitary, parathyroids and islet cells), but no evidence of a pancreatic gastrin-producing tumour. After emergency gastric operation for the bleeding, the serum gastrin remained high until the hypercalcaemia and hyperparathyroidism had been corrected by subtotal parathyroidectomy. Immunofluorescence studies showed gastrin in the parathyroid tissue.

Topics: Adenoma, Islet Cell; Endocrine System Diseases; Fluorescent Antibody Technique; Gastrins; Glucose Tolerance Test; Hormones, Ectopic; Humans; Hyperparathyroidism; Hypoglycemia; Male; Middle Aged; Pancreatic Neoplasms; Parathyroid Glands

Topics: Antibodies; Female; Gastric Acidity Determination; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Male

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

A survey of pathogenesis, pathobiochemistry, pathological anatomy, clinic, diagnostics and therapy of the Zollinger-Ellison-syndrome is given. The Zollinger-Ellison-syndrome is, it is true, relatively rare, but its limitation from the usual peptic ulcer has great practical consequences. The suspicion of a Zollinger-Ellison-syndrome is aroused by therapy-resistent ulcers, which in every third person are associated with a diarrhoea, by recidivations of ulcer after gastric operations and by a large basal secretion of acid. The decisive diagnostic means is the serum gastrin determination. The only promising therapy is, as a rule, the gastrectomy.

Topics: Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Postoperative Complications; Prognosis; Stomach; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Adolescent; Adult; Age Factors; Calcium; Child; Fasting; Female; Gastric Acidity Determination; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatic Neoplasms; Peptic Ulcer; Zollinger-Ellison Syndrome

Topics: Calcium; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Parathyroid Glands; Postoperative Care; Renal Dialysis

Topics: Adenoma; Adult; Cushing Syndrome; Female; Follow-Up Studies; Gastrectomy; Gastrins; Glucagon; Humans; Hyperinsulinism; Hyperparathyroidism; Male; Middle Aged; Pancreatic Neoplasms; Secretin; Streptozocin; 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: Adult; Calcium; Gastric Acidity Determination; Gastric Juice; Gastrins; Histamine; Humans; Hyperparathyroidism; Middle Aged; Parathyroid Glands; Radioimmunoassay; Secretory Rate; Stimulation, Chemical

Topics: Adult; Calcium; Duodenal Ulcer; Female; Fluorescent Antibody Technique; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Glands; Peptic Ulcer; Radioimmunoassay

Topics: Calcitonin; Calcium; Depression, Chemical; Duodenal Ulcer; Eating; Gastrectomy; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Injections, Intravenous; Radioimmunoassay; Zollinger-Ellison Syndrome

Topics: Adenoma; Adult; Aged; Carcinoid Tumor; Diagnosis, Differential; Duodenal Neoplasms; Endocrine Glands; Female; Gastrins; Glucagon; Humans; Hyperparathyroidism; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Parathyroid Neoplasms; Radiography; Stomach Neoplasms; Syndrome; Zollinger-Ellison Syndrome

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

Topics: Acromegaly; Anemia, Pernicious; Duodenal Neoplasms; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Pancreatic Neoplasms; Peptic Ulcer; Pyloric Antrum; Time Factors; Zollinger-Ellison Syndrome

Topics: Adult; Celiac Disease; Diarrhea; Esophagitis; Female; Gastrins; Humans; Hyperparathyroidism; Male; Middle Aged; Neoplasm Metastasis; Radiography; Zollinger-Ellison Syndrome

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

Topics: Adult; Barium Sulfate; Gastrins; Hematemesis; Humans; Hyperparathyroidism; Hypertension; Laparotomy; Male; Methyldopa; Multiple Endocrine Neoplasia; Peptic Ulcer; Pituitary Diseases; Zollinger-Ellison Syndrome

Topics: Adenoma; Adult; Aged; Blood Glucose; Diazoxide; Duodenal Ulcer; Female; Gastrectomy; Gastrins; Glucagon; Hormones, Ectopic; Humans; Hyperparathyroidism; Hypoglycemia; Insulin; Insulin Secretion; Lymphatic Metastasis; Male; Middle Aged; Multiple Endocrine Neoplasia; Pancreatectomy; Pancreatic Neoplasms; Parathyroid Neoplasms; Peptic Ulcer Perforation; Splenectomy; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Adolescent; Adult; Aged; Female; Gastrectomy; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Radioimmunoassay; Secretory Rate; Zollinger-Ellison Syndrome

Topics: Adenoma; Adult; Aged; Calcium; Female; Gastric Acidity Determination; Gastric Juice; Gastrins; Histamine; Humans; Hyperparathyroidism; Intestinal Mucosa; Male; Middle Aged; Parathyroid Neoplasms; Pepsin A; Phosphorus; Stimulation, Chemical; Stomach

Topics: Animals; Biliary Tract Diseases; Brain Diseases; Calcium; Cholecystectomy; Cholelithiasis; Cholesterol; Dihydroxyphenylalanine; Dogs; Duodenal Ulcer; Gastrectomy; Gastric Juice; Gastrins; Gastrointestinal Diseases; Humans; Hyperparathyroidism; Liver Diseases; Norepinephrine; Pancreas; Secretin; Serotonin; Stimulation, Chemical; Vagotomy

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

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Gastric Juice; Gastrins; Humans; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia; Pedigree; Prospective Studies

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

Topics: Animals; Calcium; Gastric Juice; Gastric Mucosa; Gastrins; Humans; Hyperparathyroidism; Immune Sera; Parathyroid Hormone; Peptic Ulcer; Rabbits; Radioimmunoassay; Serum Albumin, Radio-Iodinated

Topics: Adenoma; Adult; Aged; Biological Assay; Calcium; Female; Gastric Juice; Gastrins; Histamine; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms; Radioimmunoassay

Topics: Adenoma; Adenoma, Islet Cell; Adult; Calcium; Gastrectomy; Gastrins; Humans; Hyperparathyroidism; Male; Pancreatic Neoplasms; Parathyroid Glands; Zollinger-Ellison Syndrome

Topics: Adenoma; Animals; Biopsy; Cell Count; Fluorescent Antibody Technique; Gastric Mucosa; Gastrins; Histocytochemistry; Humans; Hyperparathyroidism; Hyperplasia; Microscopy; Microscopy, Electron; Parathyroid Neoplasms; Peptides; Pylorus; Rabbits; Television; Thyroid Diseases

Topics: Acromegaly; Adenoma; Adult; Anemia, Pernicious; Animals; Biopsy; Gastric Mucosa; Gastrins; Guinea Pigs; Histocytochemistry; Humans; Hyperparathyroidism; Microscopy, Electron; Rats; Zollinger-Ellison Syndrome

Topics: Anemia, Pernicious; Animals; Cholecystokinin; Gastrins; Gastrointestinal Diseases; Gastrointestinal Hormones; Hyperparathyroidism; Pancreas; Rats; Secretin; Zollinger-Ellison Syndrome

Topics: Animals; Calcium; Carnivora; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Gluconates; Histamine; Humans; Hyperparathyroidism; Injections, Intravenous; Zollinger-Ellison Syndrome

Topics: Duodenal Ulcer; Gastric Mucosa; Gastrins; Gastrointestinal Hormones; Humans; Hyperparathyroidism; Peptic Ulcer; Stomach Ulcer; Vagotomy; Zollinger-Ellison Syndrome

Topics: Adenoma, Islet Cell; Adrenal Gland Neoplasms; Adult; Aged; Biological Assay; Female; Gastrectomy; Gastric Acidity Determination; Gastrins; Humans; Hyperinsulinism; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia; Peptic Ulcer; Pituitary Neoplasms; Radiography; Thyroid Neoplasms; Zollinger-Ellison Syndrome

Topics: Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Gastrins; Gastrointestinal Hemorrhage; Humans; Hyperparathyroidism; Male; Multiple Endocrine Neoplasia; Parathyroid Hormone

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