RESUMO
Helicobacter pylori (H pylori) infection is a leading world-wide infectious disease as it affects more than half of the world population and causes chronic gastritis, peptic ulcer disease and gastric malignancies. The infection elicits a chronic cellular inflammatory response in the gastric mucosa. However, the effects of this local inflammation may not be confined solely to the digestive tract but may spread to involve extra-intestinal tissues and/or organs. Indeed, H pylori infection has been epidemiologically linked to extra-digestive conditions and diseases. In this context, it has been speculated that H pylori infection may be responsible for various endocrine disorders, such as autoimmune thyroid diseases, diabetes mellitus, dyslipidemia, obesity, osteoporosis and primary hyperparathyroidism. This is a review of the relationship between H pylori infection and these endocrine disorders.
Assuntos
Doenças do Sistema Endócrino , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori/metabolismo , Diabetes Mellitus/microbiologia , Diabetes Mellitus/fisiopatologia , Dislipidemias/microbiologia , Dislipidemias/fisiopatologia , Doenças do Sistema Endócrino/microbiologia , Doenças do Sistema Endócrino/fisiopatologia , Humanos , Hiperparatireoidismo/microbiologia , Hiperparatireoidismo/fisiopatologia , Obesidade/microbiologia , Obesidade/fisiopatologia , Osteoporose/microbiologia , Osteoporose/fisiopatologia , Doenças da Glândula Tireoide/microbiologia , Doenças da Glândula Tireoide/fisiopatologiaRESUMO
A patient with duodenal ulcer and primary hyperparathyroidism was found to have an abnormally high intragastric pH. The pH level returned to normal after surgical removal of the parathyroid adenoma followed by normalization of parathyroid hormone (PTH) and serum calcium concentrations. The patient was positive for Helicobacter pylon (H. pylori) infection. Although the exact mechanism by which chronic hypercalcemia or high PTH level inhibited gastric acid secretion in this case remains unclear, our findings suggest that hypercalcemia may play some role in H. pylori associated gastroduodenal diseases through induction of proinflammatory cytokines or by enhancing the attachment of H. pylori to gastric epithelial cells.
Assuntos
Úlcera Duodenal/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Hiperparatireoidismo/complicações , 2-Piridinilmetilsulfinilbenzimidazóis , Adenoma/patologia , Adenoma/cirurgia , Idoso , Antiulcerosos/uso terapêutico , Benzimidazóis/uso terapêutico , Úlcera Duodenal/microbiologia , Famotidina/uso terapêutico , Determinação da Acidez Gástrica , Infecções por Helicobacter/tratamento farmacológico , Humanos , Concentração de Íons de Hidrogênio , Hiperparatireoidismo/microbiologia , Masculino , Omeprazol/análogos & derivados , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , RabeprazolRESUMO
OBJECTIVES: Neck exploration is usually required in all cases of primary hyperparathyroidism. Without a precise localization preoperatively cervicotomy may be unsuccessful, especially in case of an ectopic adenoma. CASE REPORT: A patient with primary hyperparathyroidism due to a solitary adenoma localized in the middle mediastinum was identified on preoperative computed tomography and technetium-99m-sestamibi radionuclide scan. The tumor was successfully removed at thoracoscopy without neck exploration. DISCUSSION: Preoperative localization of primary hyperparathyroid tumors is not indicated in all patients. In some selected cases (acute hypercalcemia, reoperation, serious illness) prior neck exploration would be useful in guiding the surgeon.
