Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

1008 Multifocal Atrial Tachycardia (MAT) Multiple Endocrine Neoplasia 1

differential diagnosis

■Atrial fibrillation: irregularly irregular QRS but no recognizable P

waves.

management

What to Do First

■Treatment of underlying pulmonary process. Administration of oxy-

gen to correct hypoxia.

General Measures

■As above

specific therapy

■Antiarrhythmic drugs ineffective. Amiodarone and calcium channel

blockers may be tried. Potassium and magnesium replacement.

Side Effects & Contraindications

■Excessive suppression of AVN by calcium channel blockers or amio-

darone. Exacerbation of existing lung disease from amiodarone lung

toxicity. beta blockers usually contraindicated because of underlying

COPD.

follow-up

■Optimize chronic treatment for underlying lung disease.

complications and prognosis

■Deterioration of exiting lung disease.

MULTIPLE ENDOCRINE NEOPLASIA 1

COLEMAN GROSS, MD

REVISED BY ANDREW R. HOFFMAN, MD

history & physical

History

■Hypercalcemia (hyperparathyroidism) presenting abnormality in

85%; eventually almost all develop hyperparathyroidism

■Pancreatic islet cell tumors second commonest; as many as 80%;

many malignant or multifocal; gastrinoma with peptic ulcer disease

most common

■Other islet tumors: insulinoma, glucagonoma, VIPoma, somatostati-

noma, pancreatic polypeptide, GHRH-producing