Extreme Nausea due to Hyperparathyroidism in Multiple Endocrine Neoplasia-1

Abstract

We describe a young woman with multiple endocrine neoplasia-1 (MEN-1) who presented with severe nausea as a result of hyperparathyroidism (HPT). We present a case report, review the relevant literature in regards to physiology, and offer a target source for symptom control. A 19-year female with MEN-1 initially presented with neuroglycopenia and hyperinsulinism. She had concomitant HPT. She underwent a distal pancreatectomy with enucleation of neuroendocrine tumors from the pancreatic head. Postoperatively, she developed severe nausea and was found to have worsening HPT. She was placed on a calcimimetic and had immediate resolution of symptoms. She ultimately underwent a subtotal parathyroidectomy and has been symptom-free since that time. Severe nausea can occur in up to 25% of patients with HPT. Two theories exist regarding the mechanism behind this symptomatology. The first involves destruction of gastric mucosa leading to peptic ulcer disease. The second suggests that the etiology is gastrointestinal atony due to high calcium levels or parathyroid hormone (PTH). Based on the available data, therapies to treat nausea in HPT should focus on decreasing high levels of calcium. How to cite this article Pandian TK, Thompson G, Benzon Dy. Extreme Nausea due to Hyperparathyroidism in Multiple Endocrine Neoplasia-1. World J Endoc Surg 2015;7(3):69-71.