Prevalence and Causes of Hypergastrinemia in Primary Hyperparathyroidism: A Prospective Study¹

Abstract

Gastrin levels have been reported to be often increased in patients with primary hyperparathyroidism (PHPT) considered to be caused by hypercalcemia. To determine the prevalence of increased basal gastrin and to investigate its causes, 52 consecutive patients with PHPT were studied prospectively, undergoing a clinical, biochemical, and gastric morphofunctional assessment before any parathyroid surgical procedure. This included evaluation of basal and secretin-stimulated gastrin, basal and pentagastrin-stimulated gastric acid secretion, upper gastrointestinal endoscopy, with histological evaluation for gastritis and Helicobacter pylori infection. Twenty of the 52 PHPT patients (38.5%) had increased fasting gastrin. Further investigation allowed us to clearly demonstrate the causes of hypergastrinemia in 16 of these 20 patients. In 7 of 20 (35%), hypergastrinemia was caused by gastric fundus atrophy; in 3 patients (15%), Zollinger-Ellison syndrome with Multiple Endocrine Neoplasia type I was diagnosed; whereas in another 20% of patients, mild hypergastrinemia was ascribed to Helicobacter pylori gastritis. Finally, in 2 patients, additional clinical history revealed an occasional use of the gastric antisecretory drug omeprazole a few days before the serum gastrin determination. This study shows that the hypercalcemic status per se is not sufficient to produce an increase in fasting gastrin levels. Furthermore, gastric fundus atrophy, and not gastrinoma, is the major cause of relevant (>160 pg/mL) hypergastrinemia.

Primary hyperparathyroidism and concurrent severe hypergastrinemia in a dog

“…Hypergastrinemia in cases of hypercalcaemia of parathyroid origin has already been described in humans, with the presence of peptic ulcers reported in less than 15% of patients with hyperparathyroidism 2 . One study suggested that the hypergastrinemia seen in PHPT patients might be imputed to concurrent diseases such as gastritis by Helicobacter pylori , ingestion of proton pump inhibitors, atrophic gastritis or ZES in context of MEN1 11 . H. pylori gastritis and administration of proton pump inhibitors were only associated with a mild increase in gastrin levels in this study.…”

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“…However, increased PTH with normocalcemia was presumably caused by vitamin D deficiency in our patient and it later normalized upon proper treatment. In addition, primary hyperparathyroidism should have been ruled out as a possible reason for the increase in gastrin levels ( 16 ).…”

Helicobacter pylori Current Chemotherapy and New Targets for Drug Design

“…There is some indication that some very young or very elderly patients may exhibit non-H. pylori caused DU. These H. pylorinegative DUs most likely result from NSAID ingestion or Zollinger-Ellison syndrome [23][24][25]. Similar claims have been made with regard to the As many as 40% of the United States population seek medical treatment for dyspepsia at some point during their lifetimes.…”

“…Although H. pylori is not always present in patients with these diseases, there is overwhelming evidence suggesting that it is involved in their causation [12]. On the other hand, H. pylori cannot be attributed to every gastric disease, for example etiology of gastric ulcers (GU), however it appears that GU develop in association with pangastritis, and that only 75-85% of GU patients have concurrent H. pylori infection [25]. A large majority of GU is believed to be associated with NSAID consumption [26].…”