Effect of parathyroidectomy in patients with hyperparathyroidism, Zollinger-Ellison syndrome, and multiple endocrine neoplasia type I: a prospective study.

Abstract

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.

• Authors: J A Norton, M J Cornelius, J L Doppman, P N Maton, J D Gardner, R T Jensen
• Journal: Surgery (Surgery) Vol. 102 Issue 6 Pg. 958-66 (Dec 1987) ISSN: 0039-6060 [Print] United States
• PMID: 2891201 (Publication Type: Journal Article)

Chemical References

• Gastrins
• Histamine H2 Antagonists

Topics

• Adult
• Female
• Gastric Acid (metabolism)
• Gastrins (metabolism)
• Histamine H2 Antagonists (therapeutic use)
• Humans
• Hyperparathyroidism (drug therapy, surgery)
• Male
• Middle Aged
• Multiple Endocrine Neoplasia (drug therapy, surgery)
• Parathyroid Glands (surgery)
• Prospective Studies
• Zollinger-Ellison Syndrome (drug therapy, surgery)