Yamagishi K
Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Nihon Geka Gakkai Zasshi. 1992 May;93(5):494-504.
This study was designed to investigate pancreatic exocrine and endocrine secretion stimulated with secretin and thyrotropin-releasing hormone (TRH) in hyperparathyroidism. Pancreatic exocrine secretion during 30 min stimulated by constant secretin infusion of 1U/kg/hour was significantly increased in patients with secondary hyperparathyroidism compared with controls and patients with primary hyperparathyroidism. Intravenous administration of TRH at a dose of 20 micrograms/kg/hour, superimposed on secretin, produced a significant decrease of pancreatic exocrine secretion in both primary and secondary hyperparathyroidism but not in control. Serum insulin, glucagon and secretin levels were significantly higher in the subjects of both primary and secondary hyperparathyroidism than those of controls. Serum glucagon and secretin levels were significantly higher in secondary hyperparathyroidism than primary hyperparathyroidism. The pancreatic endocrine secretion was not influenced by TRH administration. Pancreatic exocrine secretion was not changed by parathyroidectomy in patients with primary hyperparathyroidism. As for endocrine secretion, however, only serum secretin level decreased to the level before parathyroidectomy. In this study, it was speculated that the increase of pancreatic secretion in secondary hyperparathyroidism may be due to hypersecretinemia, and the decrease of exocrine secretion by TRH in primary and secondary hyperparathyroidism may be resulted from the direct effect of TRH on the pancreatic acinar cells.
本研究旨在调查甲状旁腺功能亢进症患者中，促胰液素和促甲状腺激素释放激素（TRH）刺激下的胰腺外分泌和内分泌分泌情况。与对照组及原发性甲状旁腺功能亢进症患者相比，继发性甲状旁腺功能亢进症患者在以1U/kg/小时的速度持续输注促胰液素刺激30分钟期间，胰腺外分泌显著增加。在促胰液素基础上静脉注射剂量为20微克/千克/小时的TRH，原发性和继发性甲状旁腺功能亢进症患者的胰腺外分泌均显著减少，而对照组则无此现象。原发性和继发性甲状旁腺功能亢进症患者的血清胰岛素、胰高血糖素和促胰液素水平均显著高于对照组。继发性甲状旁腺功能亢进症患者的血清胰高血糖素和促胰液素水平显著高于原发性甲状旁腺功能亢进症患者。胰腺内分泌分泌不受TRH给药影响。原发性甲状旁腺功能亢进症患者行甲状旁腺切除术后，胰腺外分泌无变化。然而，就内分泌分泌而言，只有血清促胰液素水平降至甲状旁腺切除术前水平。在本研究中，推测继发性甲状旁腺功能亢进症中胰腺分泌增加可能是由于促胰液素血症，而原发性和继发性甲状旁腺功能亢进症中TRH导致外分泌减少可能是TRH对胰腺腺泡细胞直接作用的结果。
