Effect of parathyroidectomy in patients with hyperparathyroidism, Zollinger-Ellison syndrome, and multiple endocrine neoplasia type I: a prospective study.
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.
D000328:Adult; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005755:Gastrins / Q000378:metabolism; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009377:Multiple Endocrine Neoplasia / Q000188:drug therapy / Q000601:surgery*; D010280:Parathyroid Glands / Q000601:surgery*; D011446:Prospective Studies; D015043:Zollinger-Ellison Syndrome / Q000188:drug therapy / Q000601:surgery*
D005755:Gastrins; D006635:Histamine H2 Antagonists