Treatments for Multiple endocrine neoplasia type 1
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Discussion of treatments for Multiple endocrine neoplasia type 1:
There is no cure for MEN1 itself, but most of
the health problems caused by MEN1 can be recognized at an early stage and
controlled or treated before they become serious problems.
If you have been diagnosed with MENl, it is important to get periodic
checkups because MEN1 can affect different glands, and even after
treatment, residual tissue can grow back. Careful monitoring enables your
doctor to adjust your treatment as needed and to check for any new
disturbances caused by MEN1.
Most people with MEN1 will have long and
productive lives.
(Source: excerpt from Multiple Endocrine Neoplasia Type 1: NIDDK)
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Multiple endocrine neoplasia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment must eradicate the tumors. Subsequent therapy controls residual symptoms. In MEN I, peptic ulceration is usually the most urgent clinical feature, so primary treatment emphasizes control of bleeding or resection of necrotic tissue. In hypoglycemia caused by insulinoma, oral administration of diazoxide or glucose can keep blood glucose levels within acceptable limits. Subtotal (partial) pancreatectomy is required to remove the tumor. Because all parathyroid glands have the potential for neoplastic enlargement, subtotal parathyroidectomy may also be required along with transsphenoidal hypophysectomy. In MEN II, treatment of an adrenal medullary tumor includes antihypertensives and resection of the tumor. Bromocriptine may be used for pituitary tumors that secrete prolactin. Hormonal replacement therapy is necessary when glands are removed or secretion is inadequate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Peptic ulcers:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Experts recommend treating the patient with antibiotics to eradicate H. pylori. The patient taking NSAIDs may take a prostaglandin analog (misoprostol) to suppress ulceration (or the patient may take the analog with NSAIDs to prevent ulceration). Histamine-2 (H2) receptor antagonists or proton pump inhibitors may reduce acid secretion. A coating agent or bismuth may be administered to the patient with a duodenal ulcer to protect the lining.
If GI bleeding occurs, emergency treatment begins with passage of a nasogastric (NG) tube to allow for iced saline lavage, possibly containing norepinephrine. Gastroscopy allows visualization of the bleeding site and coagulation by laser or cautery to control bleeding. This type of therapy allows postponement of surgery until the patient’s condition stabilizes. Surgery is indicated for perforation, unresponsiveness to conservative treatment, and suspected malignancy. Surgery for peptic ulcers may include:
❑ vagotomy and pyloroplasty: severing one or more branches of the vagus nerve to reduce hydrochloric acid secretion and refashioning the pylorus to create a larger lumen and facilitate gastric emptying
❑ distal subtotal gastrectomy (with or without vagotomy): excising the antrum of the stomach, thereby removing the hormonal stimulus of the parietal cells, followed by anastomosis of the rest of the stomach to the duodenum or the jejunum
❑ pyloroplasty: surgical enlargement of the pylorus to provide drainage of gastric secretions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Peptic ulcers:
Treatment
(Handbook of Diseases)
H. pylori can be treated with a combination of agents and eradicated with antibiotics. Pharmacologic treatments include antisecretory agents, such as proton pump inhibitors and histamine-2 (H2)-receptor antagonists. Proton pump inhibitors work by binding to hydrogen-potassium adenosine triphosphatase, located at the surface of gastric parital cells to block formation of gastic acid. H2-receptor antagonists inhibit histamine binding to H2 receptors on the gastric parietal cell, which in turn decreases acid secretion. Drug therapy, which protects the mucosa, includes prostaglandin analogs and antacids. Prostaglandin analogs may be given to patients taking NSAIDs to suppress ulceration.
GI bleeding may be treated by giving H2-receptor antagonists I.V. as a continuous infusion. Upper endoscopy is preferred as a diagnostic tool when GI bleeding is present because an injection of epinephrine or saline (to surround the ulcer) can be performed to stop the bleeding during the procedure; cautery may also be used for hemostasis.
Surgery is indicated for perforation of the ulcer, continued bleeding despite medical treatment, and suspected malignancy. Surgical procedures for peptic ulcers and gastric outlet obstruction include:
❑ vagotomy and pyloroplasty: severing one or more branches of the vagus nerve to reduce hydrochloric acid secretion and refashioning the pylorus to create a larger lumen and facilitate gastric emptying
❑ distal subtotal gastrectomy (with or without vagotomy): excising the antrum of the stomach, thereby removing the hormonal stimulus of the parietal cells, followed by anastomosis of the remainder of the stomach to the duodenum or the jejunum.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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