Cadiot G, Houillier P, Allouch A, Paillard M, Mignon M
Service de Gastroentérologie, Hopital Bichat-Claude Bernard, Paris, France.
Gut. 1996 Aug;39(2):273-8. doi: 10.1136/gut.39.2.273.
In patients with the Zollinger-Ellison syndrome, the exclusion of multiple endocrine neoplasia type 1 is of important clinical relevance. Its diagnosis often relies on the existence of primary hyperparathyroidism.
To investigate the parathyroid function of patients with the Zollinger-Ellison syndrome by use of an oral calcium tolerance test to identify both hypercalcaemic and normocalcaemic primary hyperparathyroidism, and, accordingly, multiple endocrine neoplasia type 1.
Among 51 consecutive patients with the Zollinger-Ellison syndrome referred to us between 1988 and 1994, 28 had not been investigated for parathyroid function and were prospectively studied.
The investigation of calcium metabolism was abnormal in nine patients. One displayed characteristic features of humoral hypercalcaemia of malignancy. The diagnosis of primary hyperparathyroidism was biologically established in eight patients (29%) and subsequently confirmed by the presence of hyperplasia of the parathyroid glands in the seven patients who underwent neck exploration. Three patients with primary hyperparathyroidism had fasting hyper-calcaemia but the other five had normal fasting serum total calcium concentration and the diagnosis of primary hyperparathyroidism was established by means of the oral calcium tolerance test. Primary hyperparathyroidism was demonstrated in the five patients in whom the diagnosis of multiple endocrine neoplasia type 1 had been previously established on other criteria than primary hyperparathyroidism. By contrast, in three patients, primary hyperparathyroidism, either hypercalcaemic (one patient) or normocalcaemic (two patients) was the sole criteria for the diagnosis of multiple endocrine neoplasia type 1. These results also suggest that primary hyperparathyroidism is present before or close to the time of Zollinger-Ellison syndrome diagnosis.
Complete investigation of the parathyroid function with calcium calcium and parathyroid hormone concentrations.
在卓-艾综合征患者中，排除1型多发性内分泌腺瘤病具有重要的临床意义。其诊断通常依赖于原发性甲状旁腺功能亢进的存在。
通过口服钙耐量试验研究卓-艾综合征患者的甲状旁腺功能，以识别高钙血症和血钙正常的原发性甲状旁腺功能亢进，从而诊断1型多发性内分泌腺瘤病。
1988年至1994年间转诊至我院的51例连续卓-艾综合征患者中，28例未进行甲状旁腺功能检查，对其进行前瞻性研究。
9例患者的钙代谢检查异常。1例表现出恶性肿瘤体液性高钙血症的特征。8例患者（29%）经生物学诊断为原发性甲状旁腺功能亢进，随后在接受颈部探查的7例患者中通过甲状旁腺增生得以证实。3例原发性甲状旁腺功能亢进患者空腹血钙升高，但其他5例空腹血清总钙浓度正常，原发性甲状旁腺功能亢进通过口服钙耐量试验得以诊断。在5例先前根据原发性甲状旁腺功能亢进以外的其他标准诊断为1型多发性内分泌腺瘤病的患者中发现了原发性甲状旁腺功能亢进。相比之下，在3例患者中，原发性甲状旁腺功能亢进，无论是高钙血症（1例患者）还是血钙正常（2例患者），是诊断1型多发性内分泌腺瘤病的唯一标准。这些结果还表明，原发性甲状旁腺功能亢进在卓-艾综合征诊断之前或接近诊断时就已存在。
用钙和甲状旁腺激素浓度对甲状旁腺功能进行全面检查。
