Reversible basal gastric hypersecretion with parathyroid adenomas and duodenal ulcer.

Abstract

Summary: Profound hypersecretion of gastric acid, basally, was detected in a duodenal ulcer patient with familial primary hyperparathyroidism. Repeated fasting serum gastrin estimations were normal. Following surgical treatment of the hyperparathyroidism, there was a sustained fall in basal acid output from 34 to 4.5 mEq per hour. Two years later, an infusion of calcium intravenously re-produced dramatic gastric acid hyper-secretion, up to 64 mEq per hour, confirming the extreme hypersensitivity to mild hypercalcaemia. The infusion also provoked a rise in serum gastrin levels. This study has demonstrated that pronounced basal acid hypersecretion with ulcer may occur in hyperparathyroidism in the absence of the Zollinger-Ellison syndrome. Thus, parathyroid adenomas do sometimes influence gastric secretion like a gastrin-producing tumour, or a retained excluded gastric antrum. This exaggerated response may be mediated by rises in serum gastrin, stimulated by calcium.