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Certain clinical features in a patient with an apparently single endocrine tumor should serve to alert the physician to consider multiglandular involvement.

The clinical and pathologic features of five patients with pheochromocytoma associated with congenital cyanotic cardiac malformations have been described. This association appears to be more than mere coincidence. Chronic hypoxemia may be a significant factor in the development of this rare endocrine tumor in such patients. The finding of systemic hypertension combined with episodes of nervousness and sweating or repeated severe headaches initially aroused suspicion of a pheochromocytoma in the three patients in which this tumor was diagnosed clinically.

Excerpt To the editor: The glucagon stimulation test was initially described by Lawrence and Forland (1) as an adjunct to the diagnosis of pheochromocytoma, to avoid the side effects commonly encou...

Three patients with carcinoid tumor associated with hyperparathyroidism are described. All patients showed a high circulating immunoreactive calcitonin level with no differential increase in the neck venous catheterization specimens, suggesting that the high concentrations of circulating immunoreactive calcitonin may have come from the carcinoid tumor. We think that the hyperparathyroidism in these patients was primary and that the association with carcinoid tumor represents another form of multiple endocrine tumor formation. Hyperparathyroidism should be investigated in patients with carcinoid tumor.

INTEREST in the association between endocrine tumors and gastrointestinal lesions has been quite active in the last decade, stimulated mainly by the delineation of the Zollinger-Ellison syndrome.1However, other endocrine-gastrointestinal relationships have been studied as well, in particular, gastrointestinal symptoms with hyperparathyroidism.2Furthermore, a high incidence of peptic ulcer has been found to be associated with the syndrome of multiple endocrine adenomatosis3(adenomas affecting the anterior pituitary, parathyroid, pancreas, adrenal, or thyroid glands). However, the exact mechanism of symptoms, the incidence and the significance of the coexisting lesions, and the relationship between the endocrine tumor and the gastrointestinal lesion remain obscure. Because of the relative rarity of these syndromes and the importance of early diagnosis, we are presenting three case reports of hyperparathyroidism that initially were associated with gastrointestinal symptoms. Report of Cases Case 1. —A 44-year-old woman was first examined at the Cleveland Clinic in September 1963, because of