ABSTRACT
A 45-year-old woman was referred to us for hypoglycemia. The patient had been operated on for a duodenal ulcer by bilateral troncular vagotomy and pyloroplasty 20 years ago and, since then, she showed a dumping syndrome. Two months before consultation she developed repetitive episodes of symptomatic hypoglycemia. An oral glucose tolerance test showed hypoglycemia with endogenous hyperinsulinism. The continuous glucose monitoring system sensor demonstrated fasting hypoglycemia. The endoscopic ultrasound of the pancreas showed a pancreatic tumor that was confirmed in the pathologic study after surgery. Moreover, nesidiodysplasia image was found surrounding pancreatic parenchyma. We report, for the first time, both histologic lesions associated in a patient with a history of vagotomy and pyloroplasty for a duodenal ulcer and we discuss the possible pathogenic mechanisms.
Subject(s)
Hypoglycemia/complications , Hypoglycemia/diagnosis , Insulinoma/complications , Insulinoma/diagnosis , Islets of Langerhans/pathology , Pancreatic Diseases/complications , Pancreatic Diseases/diagnosis , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , C-Peptide/metabolism , Duodenal Ulcer/complications , Female , Glucose/metabolism , Glucose Tolerance Test , Humans , Insulin/metabolism , Middle Aged , Pancreatic Neoplasms/pathology , Time Factors , VagotomyABSTRACT
OBJECTIVE: We report the acute effects of cinacalcet on calcium and parathyroid hormone (PTH) levels and the effects of 1 year of therapy on calcium and phosphorus metabolism in 4 patients with persistent primary hyperparathyroidism (PHPT) after unsuccessful parathyroidectomy. PATIENTS: Four patients (3 women; age, 24 to 71 years) were studied after 1 to 3 parathyroid operative procedures. All of them had elevated serum total and ionized calcium levels, decreased serum phosphorus, and increased concentrations of intact PTH. METHODS: Calcium and PTH responses to an acute dose of oral cinacalcet (30 mg) were studied at baseline. Effects of cinacalcet (30 mg b.i.d.) on serum calcium, phosphorus, and PTH, and urinary calcium and phosphorus were studied at 1, 3, 6, and 12 months of therapy. RESULTS: PTH concentrations were reduced by 13.0% to 86.7% after acute cinacalcet administration. Chronic therapy with cinacalcet was followed by a decrement in serum total calcium (10.2% at 12 months) and ionized calcium (10.1%) and an increase in serum phosphorus (20.8%), with only a modest decrement in PTH levels (5.1%). All patients had normal serum total and ionized calcium levels at 3 to 12 months of therapy. Urinary calcium decreased by 20.0% at 12 months. CONCLUSIONS: Cinacalcet was effective in normalizing calcium and phosphorus concentrations in patients with persistent PHPT after unsuccessful parathyroidectomy.
