Cimetidine in the management of synchronous crises of MEA I

The clinical problems associated with the simultaneous and critical presentation of acute hyperparathyroidism and perforated jejunal ulceration in multiple endocrine adenopathy (MEA type I) require a multidisciplinary approach to management. In the patient described here, the use of cimetidine, a histamine‐2 receptor blocker, provided sufficient time after surgical closure of the ulcer to control the hypercalcemic crisis medically and surgically, until the persistent hypergastrinemia could be corrected by sequential excisions of the stomach and pancreaticoduodenal apudomas and hyperplasia. The serum gastrin levels, basal and stimulated (by secretin), provide necessary indications for surgical management of otherwise undetected islet cell pathology. The simultaneously associated pituitary hyperprolactinemia in this patient required both surgical and radiologic therapy.