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Serum gastrin, calcitonin, and prolactin as markers of multiple endocrine neoplasia syndromes in patients with primary hyperparathyroidism

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Abstract

Since primary hyperparathyroidism (PHPT) is a component of the multiple endocrine neoplasia syndromes types I and II (MEN I and MEN II), patients presenting with PHPT might represent a population at increased risk for either of the 2 syndromes. To test this hypothesis, serum gastrin, prolactin, and calcitonin concentrations were measured pre- and postoperatively in 100 consecutive patients undergoing surgery for PHPT. Mean preoperative serum gastrin concentrations were within the normal range and did not decrease postoperatively, and there was no correlation between serum gastrin and calcium preoperatively. A high proportion of females (16%) had abnormally high serum gastrin concentrations but no evidence of MEN I. Six females had abnormal secretin stimulation of gastrin release but had achlorhydria or hypochlorhydria with other features suggestive of type A atrophic gastritis. No abnormal calcitonin concentrations were detected. Two elderly females had insignificant elevations of serum prolactin concentrations. These results suggest that serum gastrin, prolactin, and calcitonin are needless determinations in patients who are undergoing surgery for PHPT and who have no clinical indication of MEN syndromes. The interpretation of secretin-stimulated gastrin concentrations in the diagnosis of a gastrinoma may need to be reevaluated. It would appear that a high proportion of females with PHPT have atrophic gastritis and secondary hypergastrinemia.

Résumé

L'hyperparathyroïdisme primitif (PHPT) étant une partie constituante des syndromes endocriniens multiples de type I ou de type II (MEN I ou MEN II) tout malade qui présente une hyperparathyroïdie primitive est susceptible d'appartenir à l'un de ces deux groupes pathologiques. Il convient donc avant d'opérer un malade pour hyperparathyroïdisme primitif de doser la gastrine, la prolactine et la calcitonine. De tels dosages pré-opératoires et post-opératoires ont été pratiqués chez 100 sujets. Leur étude a permis de constater que le taux de gastrine sérique pré-opératoire était dans la moyenne, qu'il ne s'abaissait après l'intervention et qu'il n'y avait pas de corrélation entre la gastrine sérique et le calcium en pré-opératoire. Une proportion notable de femmes (16%) accusait une concentration de gastrine sérique élevée mais ne présentait pas une affection de type I (MEN I). Six femmes présentèrent une production anormale de gastrine après stimulation par la sécrétine mais elles présentaient simultanément une achlorhydrie ou une hyperchlorhydrie avec d'autres facteurs en faveur d'une gastrite atrophique de type A. Aucune concentration anormale de calcitonine ne fut décelée. Deux femmes âgées présentèrent une élévation peu significative des concentration de prolactine sérique. Ces résultats suggèrent que les taux sériques de gastrine, de prolactine et de calcitonine n'ont pas besoin d'être déterminés chez les malades qui doivent être opérés pour hyperparathyroïdisme primitif dès lors qu'ils ne présentent pas d'éléments cliniques en faveur des syndromes MEN. L'interprétation des concentrations de la gastrine après stimulation à la gastrine dans les gastrinomes a peut être besoin d'être réévaluée. Il se pourrait qu'un grand nombre de femmes atteintes d'hyperparathyroïdisme primitif aient une gastrite atrophique et une hypergastrinémie secondaire.

Resumen

Puesto que el hiperparatiroidismo primario (HPTP) es un componente de los síndromes de neoplasia endocrina múltiple tipos I y II (NEM I y NEM II), los pacientes con HPTP pueden representar una población con mayor riesgo de tener uno de estos síndromes. Con el objeto de comprobar tal hipótesis, se realizaron determinaciones de las concentraciones séricas de gastrina, prolactina, y calcitonina pre- y postoperatoriamente en 100 pacientes consecutivos sometidos a cirugía por HPTP. Las concentraciones medias de gastrina aparecieron dentro de los límites normales y no disminuyeron en el postoperatorio; no se observó correlation entre la gastrina y el calcio séricos en las determinaciones preoperatorias. Una alta proporción de las mujeres (16%) presentó concentraciones anormalmente elevadas de gastrina sérica pero sin evidencia de NEM I. Seis mujeres exhibieron una anormal secretion de gastrina estimulada por secretina, pero tenían aclorhidria o hipoclorhidria junto con otras características sugestivas de gastritis atrófica tipo A. No se encontraron concentraciones anormales de calcitonina. Dos mujeres ancianas presentaron elevaciones insignificantes de las concentraciones de prolactina sérica. Estos resultados sugieren que son innecesarias las determinaciones de gastrina, prolactina, y calcitonina en pacientes que van a ser sometidos a cirugía por HPTP y que no exhiben manifestaciones clínicas de sfndromes NEM. La interpretación de las concentraciones de gastrinoma deben ser reevaluadas. Es aparente que una alta proporción de mujeres con HPTP presentan gastritis atrófica e hipergastrinemia secundaria.

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Authors and Affiliations

  1. Departments of Surgery and Pediatrics, Duke University Medical Center, Durham, North Carolina, USA

    John R. Farndon F.R.C.S., John M. Geraghty B.Med.Sci., William G. Dilley Ph.D., Stuart Handwerger M.D. & George S. Leight M.D.

  2. Department of Surgery, Medical School, University of Newcastle upon Tyne, NE2 4HH, UK

    John R. Farndon F.R.C.S., John M. Geraghty B.Med.Sci., William G. Dilley Ph.D., Stuart Handwerger M.D. & George S. Leight M.D.

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  1. John R. Farndon F.R.C.S.
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Supported by grants from the General Clinical Resources Center, Program of the Division of Research Resources, National Institutes of Health, grant no. RR30.

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Farndon, J.R., Geraghty, J.M., Dilley, W.G. et al. Serum gastrin, calcitonin, and prolactin as markers of multiple endocrine neoplasia syndromes in patients with primary hyperparathyroidism. World J. Surg. 11, 252–257 (1987). https://doi.org/10.1007/BF01656411

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