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Sample records for asymptomatic primary hyperparathyroidism

  1. Primary hyperparathyroidism

    OpenAIRE

    Madkhali, Tarıq; Alhefdhi, Amal; Chen, Herbert; Elfenbein, Dawn

    2016-01-01

    Primary hyperparathyroidism is a common endocrine disorder caused by overactivation of parathyroid glands resulting in excessive release of parathyroid hormone. The resultant hypercalcemia leads to a myriad of symptoms. Primary hyperparathyroidism may increase a patient’s morbidity and even mortality if left untreated. During the last few decades, disease presentation has shifted from the classic presentation of severe bone and kidney manifestations to most patients now being diagnosed on rou...

  2. Neuropsychological Changes and Health-related Quality of Life in Patients with Asymptomatic Primary Hyperparathyroidism

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    Banu Aktaş Yılmaz

    2017-03-01

    Full Text Available Purpose: Data about neuropsychological impairment and health-related quality of life (HRQOL in patients with asymptomatic primary hyperparathyroidism (APHPT is limited. We aimed to investigate the HRQOL, neuropyschological impairment, including depression, anxiety in patients with APHPT who have mildly elevated serum calcium (Ca levels. Material and Method: Thirty-seven patients with APHPT and 37 controls were included. The Beck Depression Inventory (BDI, Spielberger State-Trait Anxiety Inventory (STAI, and the General Health Questionnaire were administered in all patients, HRQOL was investigated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36. Results: Serum levels of Ca and parathyroid hormone (PTH were significantly higher in patients than in controls [(10.92±0.66 vs. 9.49±0.66, p=0.016, and 133 (34-736 vs. 52.95 (25-75.50, p<0.001, respectively]. The levels of serum vitamin D were lower in patients than in controls [12.85 (4.0-62.50 vs. 20.30 (5.90-55.00, p=0.041]. The patient group had higher BDI scores than controls (12.49±10.34 vs. 7.46±5.33, p=0.011. Patients with APHPT showed lower scores in SF-36 mental health (60.55±20.75 vs. 69.62±14.31, p=0.034, SF-36 physical functioning (55.83±27.30 vs. 75.67±24.18, p=0.002, SF-36 social functioning (66.32±27.69 vs. 82.08±14.89, p=0.003, and SF-36 emotional role functioning (42.55±37.85 vs. 69.30±35.43, p=0.003. The patients showed higher STAI-1 scores (39.95±11.52 vs. 34.70±8.01, p=0.026. We observed that STAI-1 score positively correlated with serum Ca level (r=0.391; p=0.018; and PTH (r=0.341; p=0.042. Discussion: Our study demonstrated that patients with APHPT have more depressive and anxiety symptoms and lower HRQOL. Our results suggest that HRQOL and neuropsychological changes should also be considered during the clinical follow-up of patients with APHT.

  3. Primary hyperparathyroidism and nephrolithiasis.

    Science.gov (United States)

    Vestergaard, Peter

    2015-05-01

    Calcifications in the kidneys may occur in the parenchyma (nephrocalcinosis), pelvis renis (nephrolithiasis) or ureters (ureterolithiasis). Several factors may protect against stone formation or promote precipitation of stones. Most stones contain calcium, and the hypercalciuria seen in primary hyperparathyroidism is a contributing factor to stone formation in the kidneys and urinary tract. In early case series, renal stone formation was frequent, whereas the proportion of patients with symptomatic renal stones has declined in recent years. However, a substantial proportion of patients presents with asymptomatic nephrocalcinosis or nephrolithiasis. Before diagnosis and treatment of primary hyperparathyroidism, renal stone events are more frequent than in the general population. However, even after surgical cure, an increased rate of renal stone events may be seen. This may to some extent be the result of stones or calcifications already present at the time of diagnosis or sequelae to prior stones such as infections or ureter strictures.

  4. Primary hyperparathyroidism: adenoma or hyperplasia

    OpenAIRE

    2012-01-01

    Introduction: primary hyperparathyroidism (PH) is a symptomatic or asymptomaticclinical entity, characterized by the autonomous production of parathyroid hormone (PTH). Its classical presentation exhibits an increase of the serum calcium andparathyroid hormone levels. Parathyroid scintigrafy, among other imaging modalities,is frequently used to detect the hyperfunctioning glands.Clinical case: number 1. Female, 69 years old, asymptomatic, hypertension of recentonset, osteopenia, increased int...

  5. Primary Hyperparathyroidism: An Overview

    OpenAIRE

    Jessica MacKenzie-Feder; Sandra Sirrs; Donald Anderson; Jibran Sharif; Aneal Khan

    2011-01-01

    Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider...

  6. Primary Hyperparathyroidism: An Overview

    Directory of Open Access Journals (Sweden)

    Jessica MacKenzie-Feder

    2011-01-01

    Full Text Available Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider emerging trends in detection and measurement of parathyroid hormone as well as available imaging modalities for the parathyroid glands. Surgical indications and approach will be reviewed as well as medical management of primary hyperparathyroidism with bisphosphonates and calcimimetics.

  7. Sick sinus syndrome secondary to primary hyperparathyroidism

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    Osman Beton

    2016-03-01

    Full Text Available The effects of hypercalcemia on the heart and the resulting alternations of the electrocardiogram have been well established. However, there are only limited number of reports in the literature on primary hyperparathyroidism leading to clinically significant arrhythmias. We present a patient who was diagnosed with symptomatic sick sinus syndrome in the setting of moderate hyper-calcemia secondary to primary hyperparathyroidism in this case report. After the surgical opera-tion for primary hyperparathyroidism, serum calcium level returned to normal range and patient’s complaints and arrhytmic findings recovered. The patient was asymptomatic for the following 13 years.

  8. {sup 99m}Tc-MIBI/{sup 123}I-Na subtraction scanning for localized parathyroid adenoma in patients with asymptomatic/mild primary hyperparathyroidism

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    Tanaka, Yuji; Funahashi, Hiroomi; Imai, Tsuneo [Nagoya Univ. (Japan). School of Medicine] [and others

    1996-09-01

    Primary hyperparathyroidism is most commonly detected as a mild elevation of the serum calcium concentration. In the present study, the utility of {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) imaging before initial surgery was evaluated for localizing abnormal parathyroid glands in patients with asymptomatic and mild primary hyperparathyroidism. The results were compared with those of thallium-technetium subtraction scanning (TTSS). {sup 99m}Tc-MIBI/{sup 123}I-Na subtraction scanning was performed in 11 patients, and TTSS was performed in 10 of them. The sensitivity was 100% and the positive predictive value was 92% for {sup 99m}Tc-MIBI/{sup 123}I-Na, while the sensitivity was 50% and the positive predictive value was 100% for TTSS. The smallest gland detected weighed 85 mg in {sup 99m}Tc-MIBI/{sup 123}I-Na, and 570 mg in TTSS. There was a difference between the median weight of adenomas which were detected by {sup 99m}Tc-MIBI/{sup 123}I-Na (754 mg), and those which were detected by TTSS (1,195 mg). These results suggest that TTSS parathyroid scintigraphy could give way to {sup 99m}Tc-MIBI/{sup 123}I-Na parathyroid scintigraphy for improved detection of low-weight abnormal parathyroid glands. (author)

  9. Primary hyperparathyroidism in pregnancy.

    Science.gov (United States)

    Kamenický, Peter; Lecoq, Anne-Lise; Chanson, Philippe

    2016-06-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders in the general population but is rarely diagnosed during pregnancy. Symptoms of gestational PHPT may be unrecognized, or masked by physiological changes in calcium homeostasis associated with pregnancy. Gestational PHPT may have severe consequences for both mother and fetus. However, nowadays, gestational PHPT is usually diagnosed in earlier stages and milder forms, with low complication rates. Treatment should be individually tailored according to gestational age, the severity of hypercalcemia, and the risk-benefit balance. The conservative approach is preferred in mild forms, whereas surgery, usually performed during the second trimester, is reserved for symptomatic hypercalcemic PHPT. Given the young age of the patients, genetic causes should be considered.

  10. Apoptosis in Primary Hyperparathyroidism.

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    Segiet, Oliwia Anna; Mielańczyk, Łukasz; Piecuch, Adam; Michalski, Marek; Tyczyński, Szczepan; Brzozowa-Zasada, Marlena; Deska, Mariusz; Wojnicz, Romuald

    2017-03-31

    Primary hyperparathyroidism (PHPT) is defined by inappropriate elevation of parathormone, caused by parathyroid hyperplasia, also known as multi-gland disease (MGD), parathyroid adenoma (PA), or parathyroid carcinoma (PC). Although several studies have already been conducted, there is a lack of a definite diagnostic marker, which could unambiguously distinguish MGD from PA or PC. The accurate and prompt diagnosis has the key meaning for effective treatment and follow-up. This review paper presents the role of apoptosis in PHPT. The comparison of the expression of Fas, TRAIL, BCL-2 family members, p53 in MGD, PA, and PC, among others, was described. The expression of described factors varies among proliferative lesions of parathyroid gland; therefore, these could serve as additional markers to assist in the diagnosis.

  11. Single and multiple gland disease in primary hyperparathyroidism

    NARCIS (Netherlands)

    H.J. Bonjer (Jaap)

    1992-01-01

    textabstractThe scope of this thesis is: To review diagnostic procedures in primary hyperparathyroidism To review localization studies of parathyroid glands in hyperparathyroidism primary To assess the optima! surgical hyperparathyroidism by studying the recurrent hyperparathyroidism treatment of pr

  12. Turner syndrome with primary hyperparathyroidism

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    Park, Jungmee; Kim, Yoo-Mi; Choi, Jin-Ho; Lee, Beom Hee; Yoon, Jong Ho; Jeong, Woon-Young

    2013-01-01

    Turner syndrome has multiple comorbidities such as osteoporosis, obesity, diabetes, hypothyroidism, and hypertension. As they are treatable conditions in Turner syndrome, early recognition and proper treatment should be needed. We report on a 23-year-old woman with Turner syndrome who presented with severe osteoporosis and hypercalcemia. Laboratory tests showed elevated levels of serum calcium and parathyroid hormone. Dual-energy X-ray absorptiometry showed severe osteopo-rosis (z score, -3.5). Ultrasound and 99mTc scintigraphy of parathyroid glands showed an adenoma in the right inferior gland. She was diagnosed with primary hyperparathyroidism due to an adenoma of the parathyroid gland. After excision of the adenoma, the patient's serum calcium and parathyroid hormone levels returned to normal. Although only a few cases of Turners syndrome with primary hyperparathyroidism have been reported, hyperparathyroidism should be considered in cases of Turner syndrome with severe osteoporosis and hypercalcemia. PMID:24904858

  13. Primary Hyperparathyroidism: Effects on Bone Health.

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    Zanocco, Kyle A; Yeh, Michael W

    2017-03-01

    Primary hyperparathyroidism (PHPT) is the most common cause of chronic hypercalcemia. With the advent of routine calcium screening, the classic presentation of renal and osseous symptoms has been largely replaced with mild, asymptomatic disease. In hypercalcemia caused by PHPT, serum parathyroid hormone levels are either high, or inappropriately normal. A single-gland adenoma is responsible for 80% of PHPT cases. Less frequent causes include 4-gland hyperplasia and parathyroid carcinoma. Diminished bone mineral density and nephrolithiasis are the major current clinical sequelae. Parathyroidectomy is the only definitive treatment for PHPT, and in experienced hands, cure rates approach 98%.

  14. Primary Hyperparathyroidism in Patients with Multiple Endocrine Neoplasia Type 1

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    Grzegorz Piecha

    2010-01-01

    Full Text Available Primary hyperparathyroidism may occur as a part of an inherited syndrome in a combination with pancreatic endocrine tumours and/or pituitary adenoma, which is classified as Multiple Endocrine Neoplasia type 1 (MEN-1. This syndrome is caused by a germline mutation in MEN-1 gene encoding a tumour-suppressor protein, menin. Primary hyperparathyroidism is the most frequent clinical presentation of MEN-1, which usually appears in the second decade of life as an asymptomatic hypercalcemia and progresses through the next decades. The most frequent clinical presentation of MEN-1-associated primary hyperparathyroidism is bone demineralisation and recurrent kidney stones rarely followed by chronic kidney disease. The aim of this paper is to present the pathomechanism, screening procedures, diagnosis, and management of primary hyperparathyroidism in the MEN-1 syndrome. It also summarises the recent advances in the pharmacological therapy with a new group of drugs—calcimimetics.

  15. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M

    1994-01-01

    .9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism...

  16. Osteoprotegerin Levels in Primary Hyperparathyroidism

    DEFF Research Database (Denmark)

    Stilgren, L S; Hegedüs, L M; Beck-Nielsen, H

    2003-01-01

    The effect of parathyroid hormone (PTH) on the production of osteoprotegerin (OPG) remains controversial. Most in vitro studies indicate that PTH decreases OPG secretion by the osteoblast, but in vivo observations are conflicting. In primary hyperparathyroidism (PHPT), hypersecretion of PTH leads...

  17. Cinacalcet Treatment of Primary Hyperparathyroidism

    OpenAIRE

    H. M. Rothe; Liangos, O.; Biggar, P.; Petermann, A.; Ketteler, M

    2011-01-01

    Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet HCl has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. PTH levels are lowered, and cognitive parameters improve. While an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than hal...

  18. Unusual florid skeletal manifestations of primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Ashebu, Samuel D.; Dahniya, Mohamed H.; Muhtaseb, Sayeed A.; Aduh, Prosper [Department of Radiology, Al-Adan Hospital (Kuwait)

    2002-12-01

    We report a case of primary hyperparathyroidism (PHPT) with advanced and unusual skeletal manifestations - a rare occurrence in developed countries nowadays. The literature is briefly reviewed. (orig.)

  19. Preoperative localization in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sanson; Kitamura, Hiroyuki; Takagita, Shin-ichi; Maetani, Toshiki; Iwahashi, Yuka; Miyazaki, Masakazu; Yamamoto, Norio [Tenri Hospital, Nara (Japan)

    1998-04-01

    Between 1992 and 1996, 31 cases (8 men and 23 women) with primary hyperparathyroidism (PHPT) were treated in our department. In this study, we compared which of the preoperative localization methods was most useful in the detection of PHPT. The sensitivity for detection of abnormal parathyroid glands was 88.6% on ultrasonography (US), 76.9% on magnetic resonance imaging (MRI), 74.3% on Tl-Tc subtraction scintigraphy and 68.8% on computed tomography. We concluded that US should be performed first, with MRI as a supplementary method, for the detection of abnormal parathyroid glands and the evaluation of invasion within the body. (author)

  20. Primary Hyperparathyroidism [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Leonardo Bandeira

    2016-01-01

    Full Text Available Over the past several generations, primary hyperparathyroidism (PHTP has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation. It is clear that even in asymptomatic patients, evidence for microstructural disease in the skeleton and calcifications in the kidneys can be demonstrated often. Potential non-classical manifestations of PHPT related to neurocognition and the cardiovascular system continue to be of interest. As a result of these advances, revised guidelines for the management of asymptomatic PHPT have been recently published to help the clinician determine whether surgery is appropriate or whether a more conservative approach is acceptable.

  1. Parathyroid scintigraphy during hypocalcaemia in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Øgard, Christina G; Thomsen, Jørn Bo; Jakobsen, Henrik

    2005-01-01

    Minimally invasive parathyroid surgery in patients with primary hyperparathyroidism (PHPT) demands high imaging accuracy. By increasing blood flow to the parathyroid adenoma before injection of a perfusion marker, we intended to improve the parathyroid scintigraphy. We have named the technique...

  2. Cinacalcet Treatment of Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    H. M. Rothe

    2011-01-01

    Full Text Available Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet HCl has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. PTH levels are lowered, and cognitive parameters improve. While an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than half of patients after parathyroidectomy. Medical therapy should be first choice in patients with hyperplasia in all glands rather than an isolated adenoma (10–15%, patients with persisting HPT following unsuccessful surgery or inoperable cases due to comorbidities, and patients detected in lab screens for hypercalcemia before developing symptoms who should be treated early but are usually reluctant to undergo surgery. Nephrolithiasis was not found to occur more frequently in cinacalcet trial groups, but urine calcium excretion as one major risk factor of this complication of primary HPT may increase on cinacalcet. Patients carrying the rs1042636 polymorphism of the calcium-sensing receptor gene respond more sensitively to cinacalcet and have a higher risk of calcium stone formation. Cinacalcet is usually administered twice daily but three or four doses per day should be discussed to mimic the beneficial pulsatile PTH-pattern.

  3. Cinacalcet Treatment of Primary Hyperparathyroidism

    Science.gov (United States)

    Rothe, H. M.; Liangos, O.; Biggar, P.; Petermann, A.; Ketteler, M.

    2011-01-01

    Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet HCl has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. PTH levels are lowered, and cognitive parameters improve. While an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than half of patients after parathyroidectomy. Medical therapy should be first choice in patients with hyperplasia in all glands rather than an isolated adenoma (10–15%), patients with persisting HPT following unsuccessful surgery or inoperable cases due to comorbidities, and patients detected in lab screens for hypercalcemia before developing symptoms who should be treated early but are usually reluctant to undergo surgery. Nephrolithiasis was not found to occur more frequently in cinacalcet trial groups, but urine calcium excretion as one major risk factor of this complication of primary HPT may increase on cinacalcet. Patients carrying the rs1042636 polymorphism of the calcium-sensing receptor gene respond more sensitively to cinacalcet and have a higher risk of calcium stone formation. Cinacalcet is usually administered twice daily but three or four doses per day should be discussed to mimic the beneficial pulsatile PTH-pattern. PMID:21461394

  4. Primary Hyperparathyroidism-A Review of this Disorder and an Interesting Case Treated with Cinacalcet

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    Abdul Rafi Mohammed

    2009-06-01

    Full Text Available Primary hyperparathyroidism is not an uncommon disorder and there can be a delay in the diagnosis as it remains mostly asymptomatic. We discuss about this disorder and review the literature. Treatment options which include both surgical and medical therapy are also discussed. We also report an interesting case of primary hyperparathyroidism which was treated with Cinacalcet. Turk Jem 2009; 13: 37-9

  5. Usefulness of diagnostic imaging in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Sekiyama, Kazuya; Akakura, Koichiro; Mikami, Kazuo; Mizoguchi, Ken-ichi; Tobe, Toyofusa; Nakano, Koichi; Numata, Tsutomu; Konno, Akiyoshi; Ito, Haruo [Chiba Univ. (Japan). Graduate School of Medicine

    2003-01-01

    In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy. (author)

  6. Primary hyperparathyroidism: A changing scenario in India

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    Jha, Sangeeta; Jayaraman, Muthukrishnan; Jha, Aman; Jha, Ratan; Modi, Kirtikumar D.; Kelwadee, Jayant V.

    2016-01-01

    Introduction: Primary hyperparathyroidism (PHPT) is largely a symptomatic disease with varied systemic manifestations, complicated by coexisting Vitamin D (Vit D) deficiency. Increasing awareness, developments in diagnostics, and Vit D supplementation may have an impact on the disease profile of PHPT. Methods: Clinical, biochemical, and pathological profile of PHPT presenting to a tertiary care center in South India were compared in two groups separated as per the period of presentation (Group A: January 1994–May 2007 - 51 cases and Group B: June 2007–January 2015 - 59 cases). Results: PHPT has remained a disease of female preponderance with similar age of presentation. It is being diagnosed earlier (mean duration of symptoms prior to diagnosis was 38.7 months in Group A, significantly longer than 26 months in Group B). Bone pain and metabolic myopathy were the most common presentations (60%) followed by pathological fracture (16%), renal calculi (13%), and pancreatitis (7%). Pathological fractures have become less frequent. Vit D deficiency is still a widespread co-morbidity. Radionuclide scintigraphy is an effective localizing tool, but ultrasound can be an inexpensive and widely available screening modality. Conclusion: PHPT still remains asymptomatic disease of bones and stones, although it is being diagnosed early. Greater awareness, Vit D supplementation, and better diagnostic tools have made it a disease with lesser morbidity and effective cure. PMID:26904473

  7. Management of Primary Hyperparathyroidism: Can We Do Better?

    Science.gov (United States)

    Sharata, Ahmed; Kelly, Tracy L; Rozenfeld, Yelena; Hammill, Chet W; Schuman, Earl; Carlisle, James R; Aliabadi-Wahle, Shaghayegh

    2017-01-01

    The failure to follow national guidelines in management of various diseases has been previously established. We sought to quantify primary care providers' familiarity with primary hyperparathyroidism as it affects adherence to the 2009 National Institute of Health (NIH) consensus recommendations in treatment of primary hyperparathyroidism. A large primary care group was surveyed to determine their familiarity with the 2009 NIH consensus recommendations for management of primary hyperparathyroidism (PHPT). Retrospective review of the group's records (2009-2011) was performed to verify compliance. Survey responders included 109 clinicians, 31 per cent were familiar with all criteria for surgical intervention in asymptomatic patients and 34 per cent correctly identified appropriate surveillance testing for patients undergoing observation. Chart review identified 124 patients with PHPT. Of the patients who met NIH criteria, 34 per cent had a parathyroidectomy. Younger age, higher intact parathyroid hormone, hypercalciuria, and history of nephrolithiasis were associated with surgery in multivariable analysis. Of the observed patients, 16 per cent had appropriate surveillance studies. In conclusion, this study confirms suboptimal adherence with consensus recommendations in management of PHPT. A minority of clinicians demonstrated solid familiarity with management strategies, paralleling their treatment approach. Educational efforts may improve adherence with upcoming national recommendations.

  8. Primary hyperparathyroidism presenting as acute gallstone pancreatitis

    Institute of Scientific and Technical Information of China (English)

    HE Jian-hong; ZHANG Quan-bao; LI Yu-min; ZHU You-quan; LI Xun; SHI Bin

    2010-01-01

    @@ Primary hyperparathyroidism (PHPT) is a generalized disorder of calcium metabolism resulting from an abnormally high level of serum calcium and an increased level of parathormone (PTH).1,2 Traditionally, symptomatic PHPT patients present with a variety of disorders including fatigue, amyotrophy, memory impairment, emotional instability, hallucination, irritation, loss of consciousness, abdominal distention, nausea, vomiting, constipation, acute pancreatitis, refractory peptic ulcer, osteopenia, hypertension, etc.3-5 Acute pancreatitis (AP) is an uncommon presentation of PHPT.6-8 We report a typical case of primary hyperparathyroidism with hypercalcemic crisis presenting as acute gallstone pancreatitis.

  9. ATYPICAL PRIMARY HYPERPARATHYROIDISM DUE TO HYPOVITAMINOSIS D.

    Science.gov (United States)

    Gaţu, Alina-Andreea; Velicescu, C; Novac, Roxana; Mogoş, Voichiţa; Brănişteanu, D D

    2015-01-01

    Vitamin D deficiency is nowadays very common in the general population and also in patients with primary hyperparathyroidism. Hypovitaminosis D may modify the clinical features and the severity of primary hyperparathyroidism. We present the case of a 75-year-old woman with a 10 year history of nephrolithiasis and severe osteoporosis, with multiple fragility fractures. Her bone and kidney status required a more thorough metabolic assessment. Despite minimal changes in serum calcium and phosphate levels, parathyroid hormone (PTH) level was markedly elevated. Ultrasound and specific Sesta-MIBI scintigraphy diagnosed and localized a left parathyroid adenoma. Vitamin D assessment showed levels in the range of hypovitaminosis. Vitamin D deficiency may mask hypercalcemia despite high serum PTH levels, and does not seem to diminish but on the contrary increases the risk of kidney lithiasis, as well as the deleterious effects of hyperparathyroidism on bone.

  10. PHARMACODYNAMIC BEHAVIOR OF VECURONIUM IN PRIMARY HYPERPARATHYROIDISM

    NARCIS (Netherlands)

    ROLAND, EJL; WIERDA, JMKH; EURIN, BG; ROUPIE, E

    1994-01-01

    This study evaluated the potency and time course of action of vecuronium in patients with primary hyperparathyroidism (HPT) and marked hypercalcaemia during nitrous oxide-opioid anaesthesia. Twenty ASA physical status I and Il patients were studied by measuring the force of contraction of the adduct

  11. Oro-mandibular manifestations of primary hyperparathyroidism

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    Sachin Rai

    2012-01-01

    Conclusion : Loss of lamina dura, ground glass appearance, and mandibular cortical width reduction are common findings in primary hyperparathyroidism and these are significantly correlated with elevated parathormone and alkaline phosphatase. However, the presence of brown tumors and oral tori are less commonly encountered features.

  12. BMD improvements after operation for primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Rolighed, Lars; Vestergaard, Peter; Heickendorff, Lene

    2013-01-01

    PURPOSE: This study aims to quantify bone mineral density (BMD) changes following surgery in patients with primary hyperparathyroidism (PHPT) and to assess their relationship with clinical and biochemical variables. METHODS: A historic cohort of 236 PHPT patients with DXA scans pre- and 1-year...

  13. Medical treatment of primary, secondary, and tertiary hyperparathyroidism

    DEFF Research Database (Denmark)

    Thomsen, Súsanna v.; Vestergaard, Peter

    2011-01-01

    Hyperparathyroidism is a condition with elevated parathyroid hormone (PTH). The increase may be due to a) primary hyperparathyroidism which is caused by adenoma of one or more parathyroid glands or hyperplasia of all four glands, b) secondary hyperparathyroidism, which may be caused by deficiency...

  14. Molecular Alterations in Sporadic Primary Hyperparathyroidism

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    Maria Inês Alvelos

    2011-01-01

    Full Text Available Primary hyperparathyroidism (PHPT is a frequent endocrine disorder characterized by an excessive autonomous production and release of parathyroid hormone (PTH by the parathyroid glands. This endocrinopathy may result from the development of a benign lesion (adenoma or hyperplasia or from a carcinoma. Most of the PHPT cases occur sporadically; however, approximately 10% of the patients present a familial form of the disease. The molecular mechanisms underlying the pathogenesis of sporadic PHPT are incompletely understood, even though somatic alterations in MEN1 gene and CCND1 protein overexpression are frequently observed. The MEN1 gene is mutated in about 30% of the parathyroid tumours and the protooncogene CCND1 is implicated in parathyroid neoplasia by rearrangements, leading to an overexpression of CCND1 protein in parathyroid cells. The aim of this work is to briefly update the molecular alterations underlying sporadic primary hyperparathyroidism.

  15. High frequency of asymptomatic hyperparathyroidism in patients with fibromyalgia: random association or misdiagnosis?

    Directory of Open Access Journals (Sweden)

    Juliana Maria de Freitas Trindade Costa

    Full Text Available ABSTRACT Fibromyalgia (FM and hyperparathyroidism may present similar symptoms (musculoskeletal pain, cognitive disorders, insomnia, depression and anxiety, causing diagnostic confusion. Objectives: To determine the frequency of asymptomatic hyperparathyroidism in a sample of patients with FM and to evaluate the association of laboratory abnormalities to clinical symptoms. Methods: Cross-sectional study with 100 women with FM and 57 healthy women (comparison group. Parathyroid hormone (PTH, calcium and albumin levels were accessed, as well as symptoms in the FM group. Results: In FM group, mean serum calcium (9.6 ± 0.98 mg/dL and PTH (57.06 ± 68.98 pg/mL values were considered normal, although PTH levels had been significantly higher than in the comparison group (37.12 ± 19.02 pg/mL; p = 0.001. Hypercalcemic hyperparathyroidism was diagnosed in 6% of patients with FM, and 17% of these women exhibited only high levels of PTH, featuring a normocalcemic hyperparathyroidism, with higher frequencies than those expected for their age. There was no significant association between hyperparathyroidism and FM symptoms, except for epigastric pain, which was more frequent in the group of patients concomitantly with both diseases (p = 0.012. Conclusions: A high frequency of hyperparathyroidism was noted in women with FM versus the general population. Normocalcemic hyperparathyroidism was also more frequent in patients with FM. Longitudinal studies with greater number of patients are needed to assess whether this is an association by chance only, if the increased serum levels of PTH are part of FM pathophysiology, or even if these would not be cases of FM, but of hyperparathyroidism.

  16. Parathyroid and bone imaging in primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    ZHU Rui-Sen; LU Han-Kui; LUO Quan-Yong; CHEN Li-Bo; MA Ji-Xiao

    2004-01-01

    Skeletal derangements occur quite often in patient with primary hyperparathyroidism (PHPT). We investigated parathyroid and bone imagings in 59 cases of pathologically proven PHPT. Forty-nine cases were pathologically proven parathyroid adenomas; 8 presented hyperplasia and the other 2 were adenocarcinomas. Parathyroid imaging (early phase imaging, EPI) was conducted at 30 min after injecting 740~925MBq 99mTc-MIBI and 2~3h later (delayed phase imaging, DPI) separately. The following thyroid imagings were performed at the same posture 10 min after intravenous injection of 74~111MBq 99mTcO4-. The 99mTc- MIBI subtraction imaging data were obtained by subtracting thyroid imaging from that of DPI. Among 49 cases of proven hyperparathyroid adenoma 45 yielded positive imagings. Eight cases with hyperplasia gave negative results. The results were positive in 2 cases of parathyroid adenocarcinoma. Results of 99mTc-MDP/bone imaging: 35 cases of hyperparathyroid adenocarcinoma (disease duration 1-6 months) showed normal bone images, while 14 cases showed superscan images, course being 4-12 months. Bone imaging for 2 cases of adenocarcinoma showed multiple, radioactive aggregated foci (brown tumor imaging); course lasting 10-24 months. The results of bone imaging in 8 cases of hyperplasia/ hyperparathyroidism were normal. It was concluded that diagnostic accuracy for parathyroid was 79.6% and for parathyroid adenoma was 91.8%, and the technique has no diagnostic value for hyperplasia. The 99mTc-MDP / bone imaging results for PHPT can be classified into three categories, i.e. normal, superscan and brown tumor. The imaging results correlated well with the different categories and degrees of bone damage, the duration of clinical course and the pathological types. Therefore, it's important to use bone imaging data in association with therapy to reflect the stage and progress of PHPT.

  17. Preoperative diagnosis of primary hyperparathyroidism by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Inouye, Takahiro; Tomita, Toshiki; Nitta, Seiichi [Tochigi Prefecture Saiseikai Utsunomiya Hospital (Japan); Kanou, Shigeru; Sato, Toshihiko

    1996-06-01

    We evaluated 12 patients with primary hyperparathyroidism by MRI. Nine patients presented parathyroid adenomas and the others hypertrophy of the parathyroid. Abnormal parathyroid was detected in 10 patients (83%) by T2-weighed image. And abnormal parathyroid was detected in one of the other two cases by MRI combined with {sup 99m}Tc{center_dot}MIBI-{sup 99m}Tc subtraction scintigraphy. Although we usually employ the axial view of MRI, it is incompatible with the operative field. We therefore hope that three-dimensional MRI will become compatible with the operative field in the future. (author)

  18. [Etiology and pathogenesis of primary hyperparathyroidism.

    Science.gov (United States)

    Yamauchi, Mika; Sugimoto, Toshitsugu

    2017-01-01

    Primary hyperparathyroidism(pHPT)is a frequent endocrine disease in which abnormal calcium(Ca)regulation leads to hypercalcemia. The most frequent cause of pHPT in more than 80% of patients is an adenoma, followed by hyperplasia in about 15%, and cancer in 1~5%. Although most cases of pHPT are sporadic, a few are familial(hereditary), and this is known as familial hyperparathyroidism(FHPT). Gene abnormalities that affect cyclin D1 signaling(CCND1, CDC73, CDKN1B), Wnt/β-catenin signaling(MEN1), and calcium-sensing receptor signaling(CaSR, GNA11, AP2S1)play a role in the etiology and pathogenesis of pHPT. Vitamin D insufficiency/deficiency and CaSR dysfunction also play a role in pHPT severity. Continued elucidation of the etiology and pathogenesis of pHPT may lead to development of new treatments for pHPT as well as further understanding of Ca regulation.

  19. Primary hyperparathyroidism: intraoperative PTH-measurements

    DEFF Research Database (Denmark)

    Rolighed, L; Heickendorff, L; Hessov, I

    2004-01-01

    measurement as a predictor of successful cure. MATERIAL AND METHODS: From September 1999 to April 2002 143 patients with pHPT underwent a parathyroid operation (bilateral neck exploration with identification of all parathyroid glands) with intraoperative measurements of plasma PTH (immediately prior......BACKGROUND: With the development of rapid assays and intraoperative measurement of intact parathyroid hormone (PTH), new strategies in the handling of patients with primary hyperparathyroidism (pHPT) have evolved. AIM: The aim of our study was to illustrate the performance of the intraoperative PTH...... to surgery (T0) and 5 minutes after gland excision (T5)). A positive test result was defined as plasma PTH values at T5 below 20% of T0 or a value in the normal range below 7.6 pmol/l. Hence T5 values above 20% of T0 and above 7.6 pmol/l were considered test negative. RESULTS: 122 patients (85%) were test...

  20. Risk factors for treatment failure in surgery for primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Madsen, Anders Rørbæk; Rasmussen, Lars; Godballe, Christian

    2016-01-01

    Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction...

  1. Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism

    Science.gov (United States)

    Sabanis, Nikos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Papanikolaou, Dimitrios; Ioannidou, Pinelopi; Vasileiou, Sotirios

    2015-01-01

    Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism. PMID:26664767

  2. Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Nikos Sabanis

    2015-01-01

    Full Text Available Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism.

  3. Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Ekram Ullah

    2012-01-01

    Full Text Available Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of primary hyperparathyroidism.

  4. Primary hyperparathyroidism at nishi kobe medical center

    Energy Technology Data Exchange (ETDEWEB)

    Omori, Koichi; Yamashita, Masaru; Kishimoto, Masanao [Nishi Kobe Medical Center, Hyogo (Japan); Tsuji, Tomoko [Kyoto Univ. (Japan). Hospital

    2002-03-01

    Since 1994, there have been 10 cases (1 male, 9 females, 37-72 years old) of primary hyperparathyroidism at our hospital. CT, ultrasonography (US), and MIBI scintigraphy (MIBI) were undertaken for preoperative imaging of the parathyroid tumor. In 9 adenoma cases, accurate localization was obtained in 6 of 9 cases for US, in 8 of 8 cases for CT, and in 9 of 9 cases for MIBI. After the surgery, laboratory data of Ca and i-PTH were in the normal range. Histopathological diagnosis showed 9 adenoma cases and 1 hyperplasia case. Three cases were associated with thyroid diseases. This paper presents two cases with rare clinical symptoms. The chief complaint of the first case was hoarseness. Transient recurrent nerve palsy was observed two times in 2 years. During the surgery, the tumor existed just behind the right recurrent nerve. By histological examination, the tumor was diagnosed as parathyroid adenoma. There has been no recurrent nerve palsy since the surgery. The second case had been treated after diagnosis of deglusion for 3 years in a psychiatry clinic. CT and MIBI showed parathyroid tumor just below the right lobe of the thyroid. After surgery, psychological symptoms were dramatically improved. (author)

  5. Further insights into the pathogenesis of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Amstrup, Anne Kristine; Mollerup, Charlotte

    2013-01-01

    CONTEXT: The pathogenesis of primary hyperparathyroidism (PHPT) is largely unknown. OBJECTIVE: The objective of the study was to ascertain the plasma levels of calcium, PTH, and 25-hydroxyvitamin D (25OHD) as measured prior to a clinical diagnosis of PHPT. STUDY SUBJECTS: Within three population......, undiagnosed PHPT was present in 63% of the cases. Among those without PHPT at inclusion (n = 43), 55% had normocalcemic hyperparathyroidism (vs. 21% in the matched controls, P ... controls, 25OHD levels were lower in normocalcemic hyperparathyroidism but not in normoparathyroid hypercalcemia. An adenoma was removed from 78% of the cases with normocalcemic hyperparathyroidism, whereas 39% of the cases with normoparathyroid hypercalcemia had parathyroid hyperplasia (P = 0.02). Overlap...

  6. Primary hyperparathyroidism with rare presentation as multiple brown tumours

    Directory of Open Access Journals (Sweden)

    Smit Doshi

    2012-04-01

    Full Text Available We present a case of primary hyperparathyroidism with an uncommon presentation as multiple brown tumours, which may easily be mistaken for a primary bone neoplasm. A brief literature review and its clinical and surgical management are also discussed here.

  7. Imaging for primary hyperparathyroidism -- what beginners should know

    Energy Technology Data Exchange (ETDEWEB)

    Ahuja, A.T. E-mail: aniltahuja@cuhk.edu.hk; Wong, K.T.; Ching, A.S.C.; Fung, M.K.; Lau, J.Y.W.; Yuen, E.H.Y.; King, A.D

    2004-11-01

    For patients with primary hyperparathyroidism surgical removal of the hyperfunctioning parathyroid gland is curative. With advances in minimally invasive surgery, accurate pre-operative localization of the hyperfunctioning parathyroid tissue is essential to aid successful surgical treatment. The onus of identifying this hyperfunctioning parathyroid tissue therefore falls on imaging techniques such as high-resolution ultrasound, radionuclide imaging, computed tomography and magnetic resonance imaging. This article is not an exhaustive review, and its main aim is to familiarize the general radiologist, trainee radiologists and clinicians with the basics of various imaging techniques and their roles in practical management of patients with primary hyperparathyroidism.

  8. Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

    Directory of Open Access Journals (Sweden)

    Andrea Percivale

    2015-12-01

    Full Text Available Primary hyperparathyroidism (PHPT is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

  9. Vitamin D metabolites and skeletal consequences in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Moosgaard, Bjarke; Christensen, Signe Engkjær; Vestergaard, Peter

    2008-01-01

    BACKGROUND: Primary hyperparathyroidism (PHPT) is associated with reduced bone mineral density (BMD) mainly at sites rich in cortical bone. However, successful parathyroidectomy causes an increase in BMD especially at sites rich in trabecular bone. Plasma 25-hydroxyvitamin D (25OHD) levels...

  10. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis.

    Science.gov (United States)

    Jain, Monica; Krasne, David L; Singer, Frederick R; Giuliano, Armando E

    2017-02-01

    Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations. The majority of parathyromatosis cases are diagnosed in the setting of secondary hyperparathyroidism. Consensus regarding the preoperative diagnosis and evaluation is lacking due to the paucity of cases of this rare clinical entity. Management involves complete surgical extirpation of all identifiable rests of parathyroid tissue. Intra-operative parathyroid hormone level monitoring and frozen section examination are excellent tools that could increase the rates of initial operative success. Despite this, long-term disease remission is rare, and medical therapy, including calcimimetics and bisphosphonates, may be required for postoperative or non-operative management.

  11. Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    Jeroen; I; Lenz; Jimmy; M; Jacobs; Bart; Op; de; Beeck; Ivan; A; Huyghe; Paul; A; Pelckmans; Tom; G; Moreels

    2010-01-01

    We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a kno...

  12. A Case of Primary Hyperparathyroidism due to Intrathyroidal Parathyroid Cyst

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    Yavuz Yalcin

    2014-01-01

    Full Text Available Parathyroid cysts constitute 0.08–3.41% of all parathyroid masses. Intrathyroidal parathyroid cysts, however, are rare conditions with only a few cases being reported. Most of the parathyroid cysts are found to be nonfunctional and functional cysts are generally thought to be due to cystic degeneration of parathyroid adenomas. A cystic, smooth contoured lesion of 24 × 19 × 16 mm was observed in left thyroid lobe of a 76-year-old woman during ultrasonography which was performed as routine workup for primary hyperparathyroidism. It was defined as a cystic thyroid nodule at first. Tc99m sestamibi scintigraphy was performed to see any parathyroid lesions, but no radioactive uptake was observed. Intact parathormone (iPTH level was found to be >600 pg/mL in cyst aspiration fluid. Left lobectomy was performed, with a diagnosis of primary hyperparathyroidism due to functional parathyroid cyst. Serum iPTH level was decreased >50% postoperatively and histopathological evaluation was consistent with an encapsulated parathyroid adenoma with a cystic center. Parathyroid cysts are among rare causes of primary hyperparathyroidism. Diagnosis is made by markedly increased iPTH level in cyst fluid and observation of parathyroid epithelium lining the cyst wall.

  13. High-intensity focused ultrasound to treat primary hyperparathyroidism: a feasibility study in four patients

    DEFF Research Database (Denmark)

    Kovatcheva, Roussanka D; Vlahov, Jordan D; Shinkov, Alexander D;

    2010-01-01

    Many patients with primary hyperparathyroidism either decline or are not candidates for surgical parathyroidectomy. There are drawbacks to medical therapy as well as percutaneous ethanol injection as alternative therapies for primary hyperparathyroidism. Therefore, in this pilot study, our aim...... was to test the feasibility, safety, and efficacy of a newly developed noninvasive high-intensity focused ultrasound (HIFU) technique for the nonsurgical management of primary hyperparathyroidism....

  14. 18F-FET-PET in Primary Hyperparathyroidism

    DEFF Research Database (Denmark)

    Krakauer, Martin; Kjær, Andreas; Bennedbæk, Finn Noe

    2016-01-01

    Preoperative localisation of the diseased parathyroid gland(s) in primary hyperparathyroidism (PHP) is a prerequisite for subsequent minimally invasive surgery. Recently, as alternatives to conventional sestamibi parathyroid scintigraphy, the (11)C-based positron emission tomography (PET) tracers......-isotope parathyroid subtraction single photon emission computed tomography had determined the exact location of the parathyroid adenoma. A dynamic FET PET/CT scan was performed with subsequent visual evaluation and calculation of target-to-background (TBR; parathyroid vs. thyroid). The maximum TBR in the two patients...

  15. Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

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    A. D. Herrera-Martínez

    2015-01-01

    Full Text Available Primary hyperparathyroidism (PHPT in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

  16. Usefulness of ultrasonographic evaluation in primary and secondary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Tae Joo; Kim, Eun Kyung; Lee, Jong Doo; Park, Jung Soo; Lee, Jong Tae; Yoo, Hyung Sik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-09-15

    To evaluate the accuracy and ultrasonographic findings of primary and secondary hyperparathyroidism (HPT) and correlate them with pathologic results. We reviewed 31 cases of surgically confirmed primary (n=22) and secondary (n=9) hyperparathyroidism. We used 10 or 7.5 MHz linear transducer and reviewed the location, contour, size and echogenicity of lesions. Then we evaluated the detection rate of parathyroid lesions based on surgical result and compared the result of {sup 99m}Tc-sestamibi scan (15 cases). Location of primary HPT was left lower in 9, left upper in 5, right lower in 4, right upper in 3, left midportion in 1 and superior mediastinum in 1. Lesions showed variable echogenicity-mild low echo (2), moderate low echo (10), severe low echo (2), isoecho (4) and heterogeneous echo pattern (1). All the lesions except 5 were well defined and 3 lesions had echogenic rim. Posterior enhancement and lateral shadowing were noted in 3 and 4 lesions, respectively. Nineteen of 23 primary lesions were detected by ultrasonography (82.6%) and well correlated with sestamibi scan. In case of secondary HPT, most were well defined low echoic nodular lesions, and we could detect 6 of 9 patients (67%) and 15 of 36 lesions (41.7%). Only 6 of 24 secondary lesion were detected by sestamibi scan (25%). The detection rate of ultrasonography in primary HPT was fairly good and well correlated with the result of the {sup 99m}Tc-sestamibi scan, but both diagnostic modalities were not promising in secondary HPT.

  17. Lithium-associated primary hyperparathyroidism complicated by nephrogenic diabetes insipidus.

    Science.gov (United States)

    Aksakal, Nihat; Erçetin, Candaş; Özçınar, Beyza; Aral, Ferihan; Erbil, Yeşim

    2015-01-01

    Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness.

  18. [Surgical and non-surgical management of primary hyperparathyroidism:How do calcimimetics work?

    Science.gov (United States)

    Takeuchi, Yasuhiro

    2017-01-01

    Primary hyperparathyroidism is a common endocrine disease. The first line therapy for the disease is surgical removal of affected parathyroid gland(s). Other therapeutic options with medication are needed to be established, because many of patients with primary hyperparathyroidism have few or no symptoms and are expected to have a long life expectancy without surgery. Cinacalcet as a calcimimetic, bisphosphonates and denosumab are promising candidates for medical management of the disease. Effectiveness and efficiency of these drugs for patients with primary hyperparathyroidism is to be evaluated in comparison with surgical treatment.

  19. Evaluation of clinical manifestations and laboratory findings of primary hyperparathyroidism in Imam Hospital (1988-1998

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    Alam Salimi M

    2002-11-01

    Full Text Available Introduction: Clinical manifestations of primary hyper-para-thyroidism (pHPT had been dramatically changed during last 25 years. Evaluation of changes in clinical findings was the aim of this study. Materials and methods: In a retrospective, descriptive case series, patients' records of all 47 pHPT (44 females, 3 males from 1988 till 1998 were studied. Patients’ clinical presentations, signs and symptoms, laboratory and radiologic findings were reviewed and the results were compared with 34 patients' studied during 1978-1987. Serum Ca>10.5 mg/dl with increased or high normal PTH were the diagnostic criteria of pHPT. Results: Patients’ age range was 11-70 and mean ±SD was 38±16 years, with a female to male ratio of 14:1. 57 percent of the patients had bone pain and muscle weakness, 12 percent were asymptomatic, 10 percent had pathologic fractures, 8 percent had renal stones, 8 percent had symptoms of hypercalcemia, and 2 percent had giant cell lesion. The mean±SD of serum calcium was 11.48±1.16 mg/dl, phosphorus was 2.4±0.6 mg/dl and 24-h urinary Ca was 294±197 mg. Serum PTH was increased from 1.5 to 500 folds. The frequency of single adenoma in right inferior, left inferior, and left superior gland were 43 percent, 30 percent, and 13 percent respectively. Conclusion: In the study 12 percent of patients were asymptomatic whereas there was no asymptomatic case in the previous study. Prevalence of severe bone disease and the interval between onset of symptoms and diagnosis was also reduced. According to this study detection of pHPT in asymptomatic phase remarkably increased.

  20. Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary?

    Science.gov (United States)

    Lunn, Mitchell R; Muñoz Mendoza, Jair; Pasche, Lezlee J; Norton, Jeffrey A; Ayco, Alexander L; Chertow, Glenn M

    2010-08-01

    Objective . This study aims to highlight the challenges in the diagnosis of hyperparathyroidism (HPT) in patients with advanced chronic kidney disease (CKD). Methods . In this report, we describe a middle-aged Filipino gentleman with underlying CKD who presented with intractable nausea, vomiting, severe and medically refractory hypercalcaemia and parathyroid hormone (PTH) concentrations in excess of 2400 pg/mL. The underlying pathophysiology as well as the aetiologies and current relevant literature are discussed. We also suggest an appropriate diagnostic approach to identify and promptly treat patients with CKD, HPT and hypercalcaemia. Results . Evaluation confirmed the presence of a large parathyroid adenoma; HPT and hypercalcaemia resolved rapidly following resection. Conclusion . This case report is remarkable for its severe hypercalcaemia requiring haemodialysis, large adenoma size, acute-on-chronic kidney injury and markedly elevated PTH concentration in association with primary HPT in CKD.

  1. Hyperparathyroidism

    Science.gov (United States)

    ... Hajj Fuleihan G. Pathogenesis and etiology of primary hyperthyroidism. http://www.uptodate.com/home. Accessed Feb. 15, 2014. Papadakis MA, et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The ...

  2. Primary Hyperparathyroidism: 11-Year Experience in a Single Institute in Thailand

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    Poramaporn Prasarttong-Osoth

    2012-01-01

    Full Text Available Primary hyperparathyroidism (PHPT is not an uncommon disease in the western countries. In Thailand, on the contrary, PHPT was a rare condition with various clinical presentations. All 45 PHPT patients who underwent parathyroidectomy at the Department of Surgery, Siriraj Hospital during January 1997 and December 2007 were retrospectively reviewed. Demographic data, clinical presentation, localizations imaging, operative procedures, findings, complications, and pathological reports were analyzed. Median age was 49 years (range 15–89 years with female: male ratio of 3 : 1. Only one patient (2.2% was asymptomatic PHPT. Of all symptomatic cases, 30 (66.7% had skeletal symptoms, 7 (15.6% had renal impairment, and 39 (86.7% had mixed symptoms. 42 patients (93.3% had parathyroid scan and all had bilateral exploration of the neck. Postoperative hungry bone syndrome was noted in 10 patients (22%. On followup, skeletal and neuropsychiatric symptoms were improved but the renal impairment was remained. The s small number of asymptomatic PHPT in our study may refer to large number of underdiagnosed PHPT in general population. The guideline for screening serum calcium for diagnosis of PHPT in Thai populations will improve the long-term consequence of the disease but will need further information to identify the target group.

  3. Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

    Science.gov (United States)

    Choi, Ju Hee; Kim, Kyoung Jin; Lee, Ye Jin; Kim, Sun Hwa; Kim, Sin Gon; Jung, Kwang Yoon; Choi, Dong Seop

    2015-01-01

    A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients. PMID:26354493

  4. Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

    Directory of Open Access Journals (Sweden)

    Ju Hee Choi

    2015-12-01

    Full Text Available A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

  5. Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    U.E.M. Oliveira

    2007-04-01

    Full Text Available Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

  6. Abnormal muscle and hematopoietic gene expression may be important for clinical morbidity in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Reppe, Sjur; Stilgren, Lis; Abrahamsen, Bo

    2007-01-01

    In primary hyperparathyroidism (PHPT), excess PTH secretion by adenomatous or hyperplastic parathyroid glands leads to elevated serum [Ca(2+)]. Patients present complex symptoms of muscular fatigue, various neuropsychiatric, neuromuscular, and cardiovascular manifestations, and, in advanced disease...

  7. Image guided, minimally invasive adenomectomy for solitary gland disease in primary hyperparathyroidism

    NARCIS (Netherlands)

    Smit, Pieter Casper

    2001-01-01

    Introduction: Since the introduction in the 1970s of the unilateral approach in surgery for primary hyperparathyroidism by Wang, authors have increasingly been recommending limited forms of parathyroid surgery. Although unilateral explorations reduce operation time and admission days, decrease opera

  8. Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

    NARCIS (Netherlands)

    T.M. van Ginhoven (Tessa); A.N. Morks; T. Schepers (Tim); P.W. de Graaf; P.C. Smits (Pieter)

    2011-01-01

    textabstractBackground: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities.

  9. Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism

    NARCIS (Netherlands)

    van Ginhoven, T. M.; Morks, A. N.; Schepers, T.; de Graaf, P. W.; Smit, P. C.

    2011-01-01

    Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe

  10. Tumor pardo como manifestación inicial de hiperparatiroidismo primario Brown tumor as the initial manifestation of primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Hernán C. Chavin

    2008-06-01

    Full Text Available El tumor pardo es una forma localizada de osteítis fibrosa quística, parte del compromiso óseo por hiperparatiroidismo. Como primera expresión de hiperparatiroidismo es infrecuente, debido a que actualmente éste se diagnostica en estadios asintomáticos o mínimamente sintomáticos. Presentamos el caso de una paciente con un tumor pardo localizado en el maxilar superior izquierdo, como primera manifestación de hiperparatiroidismo primario causado por un adenoma paratiroideo. Posterior a la realización de una paratiroidectomía el tumor evolucionó con franca regresión, sin necesidad de ningún otro procedimiento quirúrgico local.Brown tumor is a localized form of osteitis fibrosa cystica, being part of the hyperparathyroid bone disease. It rarely is the first manifestation of hyperparathyroidism, since nowadays, the diagnosis is made at an asymptomatic or minimally symptomatic stage. We present a case of a left superior maxillar brown tumor as the first manifestation of primary hyperparathyroidism due to a parathyroid adenoma. A parathyroidectomy was performed, and there was a regression of the bone lesion, without the need of performing other local surgical procedures.

  11. [A patient with coexistence of primary hyperparathyroidism, Marfan's syndrome and von Willebrand's disease].

    Science.gov (United States)

    Bednarek-Tupikowska, Grazyna; Rakowska-Chort, Anna; Adamarczuk-Janczyszyn, Maria

    2008-01-01

    We presented a case of a 58 year old women suffering from three diseases: primary hyperparathyroidism, Marfan's syndrome and von Willebrand's disease. The coexistence of these diseases is not mentioned in medical literature. Because of the coexistence of Marfan's syndrome with primary hyperparathyroidism, the examinations of other endocrinopathy including multiple endocrine neoplasia (MEN). Their coexistence was not confirmed at the present time. In this paper the new views on both patogenesis and treatment of the mentioned diseases were included.

  12. Image guided, minimally invasive adenomectomy for solitary gland disease in primary hyperparathyroidism

    OpenAIRE

    Smit, Pieter Casper

    2001-01-01

    Introduction: Since the introduction in the 1970s of the unilateral approach in surgery for primary hyperparathyroidism by Wang, authors have increasingly been recommending limited forms of parathyroid surgery. Although unilateral explorations reduce operation time and admission days, decrease operative risk and give better cosmetic results, the debate about the best surgical treatment for primary hyperparathyroidism has never been settled. ‘Bilateralists’ oppose less invasive approaches beca...

  13. Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Raiz A Misgar

    2011-01-01

    Full Text Available The association between pancreatitis and primary hyperparathyroidism (PHPT is controversial. We report a 32-year-old man who presented with recurrent episodes of acute pancreatitis. Primary hyperparathyroidism was diagnosed after the fourth episode of pancreatitis. He had no additional risk factors for pancreatitis. Eighteen months after successful parathyroid surgery, there has been no recurrence of abdominal pain and his serum calcium is within the normal range.

  14. Brown tumor of the mandible as first manifestation of primary hyperparathyroidism: diagnosis and treatment.

    Science.gov (United States)

    Fernández-Sanromán, Jacinto; Antón-Badiola, Iosu María; Costas-López, Alberto

    2005-01-01

    Brown tumor is one of the lesions that develop in patients with hyperparathyroidism. Any of the skeletal bones can be affected including the cranio-maxillofacial ones. Most of the times the brown tumor appears after a final diagnosis of hyperparathyroidism is made. However brown tumor can be the first clinical sign of the disease. A clinical case in which a brown tumor located in the anterior part of the mandible appears as the first sign of primary hyperparathyroidism is presented. The possible differential clinical diagnosis and the recommended treatments are revised.

  15. Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K. [Toolo Trauma Center, Helsinki University Central Hospital, Topeliuksenkatu 5, 00029, Helsinki (Finland); Stahls, Anders; Bohling, Tom [Department of Pathology, Haartman Institute, University of Helsinki, 00014, Helsinki (Finland); Kivioja, Aarne [Department of Orthopedics and Traumatology, Helsinki University Central Hospital, 00029, Helsinki (Finland)

    2004-08-01

    Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

  16. Primary hyperparathyroidism associated with a giant cell tumor: One case in the distal radius.

    Science.gov (United States)

    Ouzaa, M R; Bennis, A; Iken, M; Abouzzahir, A; Boussouga, M; Jaafar, A

    2015-10-01

    Hyperparathyroidism can present itself as brown tumors (or osteolytic expansive lesions) that usually disappear after normalization of calcium and phosphate levels. It rarely occurs simultaneously with a giant cell tumor. The authors report one case of a localized form at the distal radius in a patient being followed for primary hyperparathyroidism. The diagnostic challenges related to the clinical and radiological similarities of these two pathological entities are discussed, as they can lead to delays in therapeutic management.

  17. Potential utility of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism: a case report.

    Science.gov (United States)

    Sato, Takeshi; Muroya, Koji; Hanakawa, Junko; Yamashita, Sumimasa; Nozawa, Kumiko; Masudo, Katsuhiko; Yamakawa, Tadashi; Asakura, Yumi; Hasegawa, Tomonobu; Adachi, Masanori

    2016-07-01

    We report a Japanese pedigree with familial primary hyperparathyroidism due to a CDC73 mutation. To our knowledge, this is the first report of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism. The proband had severe psychomotor retardation and received laryngotracheal separation surgery. At 19 yr of age, he developed acute pancreatitis. Hypercalcemia (12.2-13.8 mg/dL), elevated levels of intact PTH (86-160 pg/mL), and a tumor detected upon neck ultrasonography led to the diagnosis of primary hyperparathyroidism. Family history and biochemical examinations revealed that three family members (the proband's mother, elder brother, and maternal grandfather) had primary hyperparathyroidism. We identified a novel heterozygous mutation, c.240delT, p.Glu81Lysfs*28, in the CDC73 gene in three affected family members, excluding the proband's elder brother who refused genetic testing. Parathyroidectomy for the proband was considered as high-risk, because the tumor was located close to the tracheostomy orifice. After receiving approval from the institutional review board and obtaining the consent, we initiated cinacalcet treatment. At 22 yr of age, treatment with 100 mg of cinacalcet maintained serum calcium levels below 11.0 mg/dL with no apparent side effects. Our report presents the potential efficacy of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism, in particularly inoperative cases.

  18. Post-surgical follow-up of primary hyperparathyroidism associated with multiple endocrine neoplasia type 1

    Directory of Open Access Journals (Sweden)

    Flavia L. Coutinho

    2012-01-01

    Full Text Available The bone mineral density increments in patients with sporadic primary hyperparathyroidism after parathyroidectomy have been studied by several investigators, but few have investigated this topic in primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Further, as far as we know, only two studies have consistently evaluated bone mineral density values after parathyroidectomy in cases of primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Here we revised the impact of parathyroidectomy (particularly total parathyroidectomy followed by autologous parathyroid implant into the forearm on bone mineral density values in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Significant increases in bone mineral density in the lumbar spine and femoral neck values were found, although no short-term (15 months improvement in bone mineral density at the proximal third of the distal radius was observed. Additionally, short-term and medium-term calcium and parathyroid hormone values after parathyroidectomy in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1 are discussed. In most cases, this surgical approach was able to restore normal calcium/parathyroid hormone levels and ultimately lead to discontinuation of calcium and calcitriol supplementation.

  19. A 20-year study on 190 patients with primary hyperparathyroidism in a developing country: Turkey experience.

    Science.gov (United States)

    Usta, Arif; Alhan, Etem; Cinel, Akif; Türkyılmaz, Serdar; Erem, Cihangir

    2015-04-01

    The aim of this study was to present our 20-year experience regarding primary hyperparathyroidism (PHPT). PHPT patients who underwent parathyroidectomy in our clinic were reviewed retrospectively. There were 190 PHPT patients, of whom 137 were asymptomatic (72%). The mean serum calcium at the time of diagnosis was 11.9 ± 2.2 mg/dL. The mean parathyroid hormone (PTH) level was 467 ± 78 pg/mL. Ultrasonography (USG) identified all abnormal glands accurately (82.6%) and Technetium-99m sestamibi scintigraphy (MIBI) was used in 89.4% of the patients and magnetic resonance imaging (MRI) in 61%. The common use of USG and MIBI detected 92% of the lesions. Bilateral neck exploration (BNE) was performed in 12.2% of the patients and focused unilateral neck exploration (FUNE) in the remaining 87.8%. Surgical intervention was unsuccessful in 1 patient (0.5%). The conversion ratio from FUNE to BNE was 5.2%. The mean operation time and mean hospital stay decreased significantly in patients with FUNE. Pathologic examination revealed single adenoma in 93% of the patients. New imaging techniques result in the conversion of surgical treatments of PHPT. FUNE in parathyroidectomy performed by an experienced surgeon may provide successful treatment rates.

  20. Scintigraphic techniques in primary hyperparathyroidism: from pre-operative localisation to intra-operative imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rubello, Domenico [S. Maria della Misericordia Hospital, Service of Nuclear Medicine, Rovigo (Italy); Gross, Milton D. [Department of Veterans Affairs Health System, Nuclear Medicine Service, Ann Arbor, MI (United States); Mariani, Giuliano [University of Pisa, Regional Center of Nuclear Medicine, Pisa (Italy); Al-Nahhas, Adil [Hammersmith Hospital, Department of Nuclear Medicine, London (United Kingdom)

    2007-06-15

    Primary hyperparathyroidism (PHPT) is an increasingly diagnosed disease worldwide. In most cases, PHPT is related to the presence of a solitary parathyroid adenoma (PA). Fifty percent or more of newly diagnosed PHPT patients are asymptomatic, and there is debate among endocrinologists and endocrine surgeons about whether or not such patients should be treated. Usually, in a PHPT patient with a solitary PA that is well localised pre-operatively, a parathyroidectomy with limited or minimally invasive neck exploration is offered. The diffusion of minimally invasive neck exploration procedures is a consequence of the significant improvement in the accuracy of pre-operative imaging (mainly scintigraphic) techniques; these techniques have changed the surgical strategy to PHPT, from the wide traditional bilateral neck exploration to limited neck exploration. The present review considers developments during the past 10-15 years with regard to both the accuracy of pre-operative localising imaging techniques and intra-operative minimally invasive procedures in order to provide endocrinologists and endocrine surgeons with further information about the newly available diagnostic and therapeutic tools for use in PHPT patients with a solitary PA. (orig.)

  1. Current Indications for Surgical Treatment of Primary Hyperparathyroidism in the Elderly.

    Science.gov (United States)

    Polistena, Andrea; Lucchini, Roberta; Monacelli, Massimo; Triola, Roberta; Avenia, Stefano; Barillaro, Ivan; Johnson, Louis Banka; Sanguinetti, Alessandro; Avenia, Nicola

    2017-03-01

    This study presents the results of surgery in the elderly for primary hyperparathyroidism (PHPT) from a single institution's experience. We retrospectively analyzed 898 cases of surgically treated PHPT, divided into two groups: 135 elderly patients (A) and 763 patients younger than 65 years (B). PHPT was symptomatic in 68.8 per cent patients in group A and in 81.6 per cent in group B. Unilateral temporary recurrent laryngeal nerve palsy was observed in 0.9 per cent in group A and 0.1 per cent in group B (P > 0.05). No cervical hematomas, mortality or major cardiovascular, neurological, respiratory or metabolic postoperative complications were registered. All the patients evaluated at one year had improvement in the quality of life, with increase of bone mineral density (BMD) in 85.6 per cent and 79.8 per cent of patients in groups A and B, with no significant differences between symptomatic and asymptomatic patients. Parathyroidectomy in elderly PHPT patients is safe, with rate of morbidity similar to what observed in younger individuals. Further investigations are recommended to confirm the role of surgery as an effective approach in elderly PHPT patients.

  2. Primary hyperparathyroidism masquerading as rickets: diagnostic challenge and treatment outcomes.

    Science.gov (United States)

    Dutta, Deep; Kumar, Manoj; Das, Ram Narayan; Datta, Saumik; Biswas, Dibakar; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2013-01-01

    Primary hyperparathyroidism (PHPT) is extremely uncommon among children and is more likely to be associated with genetic syndromes, multiglandular involvement, and more severe symptoms. Rickets can very rarely be the presenting feature of PHPT in children. Rickets was diagnosed in a 12-year-old girl presenting with short stature, genu valgum, eversion deformity at the ankle joints, and flat feet. Radiograms showed generalized osteopenia, widening of the distal ends of the long bones along with splaying, cupping and fraying. Biochemical evaluation revealed low serum calcium (7.8 mg/dL), low phosphorus (1.4 mg/dL), vitamin-D deficiency [25-hydroxy-vitamin-D (25(OH)D): 8.7 ng/mL], and elevated intact parathyroid hormone (PTH, 811 pg/mL). Re-evaluation due to lack of clinical improvement following vitamin-D and calcium supplementation revealed hypercalcemia 11.9 mg/dL, normal 25(OH)D 41 ng/mL, persistence of elevated PTH 632 pg/mL. A 99mTc-sestamibi scan showed increased uptake at the lower pole of the right lobe of the thyroid. A right inferior parathyroidectomy was performed. Histopathology revealed chief cell type parathyroid adenoma. Last evaluated 4 months after surgery, the bone pains and proximal weakness had resolved, with significant improvement in the patient's quality of life. Rickets in the setting of PHPT often masks the classical phenotype of PHPT. In a child with rickets, lack of improvement following vitamin-D supplementation, hypercalcemia at presentation or following vitamin-D supplementation are warning signs which necessitate further evaluation to rule out PHPT.

  3. Vitamin D status in primary hyperparathyroidism: effect of genetic background.

    Science.gov (United States)

    Battista, Claudia; Guarnieri, Vito; Carnevale, Vincenzo; Baorda, Filomena; Pileri, Mauro; Garrubba, Maria; Salcuni, Antonio S; Chiodini, Iacopo; Minisola, Salvatore; Romagnoli, Elisabetta; Eller-Vainicher, Cristina; Santini, Stefano A; Parisi, Salvatore; Frusciante, Vincenzo; Fontana, Andrea; Copetti, Massimiliano; Hendy, Geoffrey N; Scillitani, Alfredo; Cole, David E C

    2017-01-01

    Primary hyperparathyroidism (PHPT) is associated with hypovitaminosis D as assessed by serum total 25-hydroxyvitamin D (TotalD) levels. The aim of this study is to evaluate whether this is also the case for the calculated bioavailable 25-hydroxyvitamin D (BioD) or free 25-hydroxyvitamin D (FreeD), and whether the vitamin D status is influenced by genetic background. We compared vitamin D status of 88 PHPT patients each with a matched healthy family member sharing genetic background, i.e., first-degree relative (FDR), or not, namely an in-law relative (ILR). We compared TotalD and vitamin D-binding protein (DBP), using the latter to calculate BioD and FreeD. We also genotyped two common DBP polymorphisms (rs7041 and rs4588) likely to affect the affinity for and levels of vitamin D metabolites. TotalD was lower (p < 0.001) in PHPT (12.3 ± 6.6 ng/mL) than either family member group (FDR: 19.4 ± 12.1 and ILR: 23.2 ± 14.1), whether adjusted for DBP or not. DBP levels were also significantly lower (p < 0.001) in PHPT (323 ± 73 mg/L) versus FDR (377 ± 98) or ILR (382 ± 101). The differences between PHPT and control groups for TotalD, BioD, and FreeD were maintained after adjustment for season, gender, and serum creatinine. 25-hydroxyvitamin D, evaluated as total, free, or bioavailable fractions, is decreased in PHPT. No difference was seen between first-degree relative and in-law controls, suggesting that neither genetic nor non-genetic background greatly influences the genesis of the hypovitaminosis D seen in PHPT.

  4. Regional cerebral blood flow abnormalities in patients with primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Cermik, Tevfik F. [Hospital of the University of Trakya, Department of Nuclear Medicine, Edirne (Turkey); Trakya Universitesi Hastanesi, Nukleer Tip Anabilim Dali, Gullapoglu Yerleskesi, Edirne (Turkey); Kaya, Meryem; Bedel, Deniz; Berkarda, Sakir; Yigitbasi, Oemer N. [Hospital of the University of Trakya, Department of Nuclear Medicine, Edirne (Turkey); Ugur-Altun, Betuel [Hospital of the University of Trakya, Department of Internal Medicine, Division of Endocrinology, Edirne (Turkey)

    2007-04-15

    We assessed the alterations in regional cerebral blood flow (rCBF) in patients with primary hyperparathyroidism (PHP) before parathyroidectomy by semiquantitative analysis of brain single photon emission computed tomography (SPECT) images. Included in this prospective study were 14 patients (mean age 47.6 {+-} 10.4 years; 3 male, 11 female) and 10 control subjects (mean age 36.0 {+-} 8.5 years, 6 male, 4 female) were SPECT imaging was performed using a dual-headed gamma camera 60-90 min after intravenous administration of 925 MBq Tc-99m HMPAO. The corticocerebellar rCBF ratios were calculated from 52 brain areas and reference lower values (RLVs) were calculated from the rCBF ratios of control subjects. The regional ratios that were below the corresponding RLV were considered abnormal (hypoperfused). Hypoperfusion was shown in 171 out of 728 regions (23%) and there was a significant correlation between serum calcium, PTH levels and the sum of hypoperfused regions in the patient group (R = 0.75 and P = 0.001, and R = 0.75, P = 0.001, respectively). Significantly reduced rCBF were found in the following cortical regions: bilateral cingulate cortex, superior and inferior frontal cortex, anterior temporal cortex, precentral gyrus, postcentral gyrus and parietal cortex, and right posterior temporal cortex. Our results indicate that alterations in rCBF in patients with PHP can be demonstrated with brain SPECT. The correlation between serum calcium, PTH levels and the sum of hypoperfused regions indicates that there may be a strong relationship between rCBF abnormalities and increased levels of serum calcium and PTH. In addition, the degree of rCBF abnormalities could be determined by brain SPECT in PHP patients with or without psychiatric symptoms. (orig.)

  5. Circulating leptin and adiponectin levels in patients with primary hyperparathyroidism.

    Science.gov (United States)

    Delfini, Enrica; Petramala, Luigi; Caliumi, Chiara; Cotesta, Darlo; De Toma, Giorgio; Cavallaro, Giuseppe; Panzironi, Giuseppe; Diacinti, Daniele; Minisola, Savatore; D' Erasmo, Emilio; Mazzuoli, Gian Franco; Letizia, Claudio

    2007-01-01

    Primary hyperparathyroidism (PHPT) has been associated with high cardiovascular morbidity and mortality; its pathogenesis is not fully understood. Moreover, many metabolic abnormalities are frequently present in patients with PHPT. Several substances (such as leptin and adiponectin) are secreted from adipocytes, which may contribute to regulate energy homeostasis and the development of cardiovascular diseases. We examined the relationship between leptin and adiponectin levels and metabolic disorders in 67 newly diagnosed never-treated patients with PHPT and in 46 healthy subjects (HS). Twenty (29.8%) patients with PHPT presented a metabolic syndrome (as defined by Adult Treatment Panel III criteria). Serum leptin and adiponectin levels in HS were 6.28 +/- 3.3 ng/mL (range, 1.7-19.2 ng/mL) and 6.65 +/- 1.7 microg/mL (range, 3.72-10.86 microg/mL), respectively. In all patients with PHPT, the mean leptin levels (34.28 +/- 20.4 ng/mL) were significantly higher than those of HS (P < .01) and, in particular, in PHPT patients with metabolic syndrome (52.63 +/- 31.2 ng/mL) and positively correlated with body mass index, waist circumference, and cholesterol. The mean adiponectin level was significantly lower (4.34 +/- 3.5 mug/mL) only in PHPT patients with metabolic syndrome (P < .005) and negatively correlated with waist circumference and fasting glucose. We concluded that increased serum level of leptin and decreased serum level of adiponectin coexist in patients with PHPT and may represent a pathogenetic factor for cardiovascular disease in this condition.

  6. Multifactorial Hypercalcemia and Literature Review on Primary Hyperparathyroidism Associated with Lymphoma

    Directory of Open Access Journals (Sweden)

    Jelena Maletkovic

    2014-01-01

    Full Text Available The most common cause of hypercalcemia in hospitalized patients is malignancy. Primary hyperparathyroidism most commonly causes hypercalcemia in the outpatient setting. These two account for over 90% of all cases of hypercalcemia. Hypercalcemia can be divided into PTH-mediated and PTH-independent variants. Primary hyperparathyroidism, familial hypocalciuric hypercalcemia, familial hyperparathyroidism, and secondary hyperparathyroidism are PTH mediated. The most common PTH-independent type of hypercalcemia is malignancy related. Several mechanisms lead to hypercalcemia in malignancy-direct osteolysis by metastatic disease or, more commonly, production of humoral factors by the primary tumor also known as humoral hypercalcemia of malignancy that accounts for about 80% of malignancy-related hypercalcemia. The majority of HHM is caused by tumor-produced parathyroid hormone-related protein and less frequently production of 1,25-dihydroxyvitamin D or parathyroid hormone by the tumor. We report the rare case of a patient with hypercalcemia and diagnosed primary hyperparathyroidism. The patient had persistent hypercalcemia after surgical removal of parathyroid adenoma with recorded significant decrease in PTH level. After continued investigation it was found that the patient also had elevated 1,25-dihydroxyvitamin D and further studies confirmed a large spleen mass that was later confirmed to be a lymphoma. This is a rare example of two concomitant causes of hypercalcemia requiring therapy.

  7. Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Eleni I. Efremidou

    2007-06-01

    Full Text Available A patient admitted for acute abdomen was incidentally found with elevated serum calcium level. In surgery, under conservative treatment of the hypercalcemia, a perforated duodenal ulcer was found and simple closure was performed. Postoperatively, calcium level continued to rise, parathyroid hormone was elevated and ultrasonographic examination showed a lesion in the right anterior neck, while serum gastrin level was normal, thus documenting the diagnosis of primary hyperparathyroidism. Conservative treatment had no effect on calcium level and the patient was subjected to emergency neck exploration, where a large parathyroid adenoma was removed. After surgery, calcium and PTH levels were normalized and the patient was discharged on the 5th postoperative day. Peptic ulcer and its complications are usual manifestations of primary hyperparathyroidism, with or without increased gastrin level. On the other hand, cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare.

  8. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Persson, Anita; Bollerslev, Jens; Rosen, Thord

    2011-01-01

    The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery.......The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery....

  9. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia; a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns require a focused management and are discussed.

  10. Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977-1993 in Denmark

    DEFF Research Database (Denmark)

    Øgard, Christina G; Engholm, Gerda; Almdal, Thomas P

    2004-01-01

    The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population. In a ra......The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population...

  11. Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report

    Directory of Open Access Journals (Sweden)

    Proimos Efklidis

    2009-07-01

    Full Text Available Abstract Introduction Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. Case presentation We present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%. Conclusions Differential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.

  12. Primary hyperparathyroidism in pregnancy leading to hypercalcaemic crisis and uraemic encephalopathy

    Science.gov (United States)

    Nash, E; Ranka, P; Tarigopula, G; Rashid, T

    2015-01-01

    Primary hyperparathyroidism is rare during pregnancy. Recognition may be challenging as symptoms overlap with those of other common disorders of pregnancy. Furthermore, physiological changes of pregnancy affecting calcium homoeostasis mean awareness of the condition and careful interpretation of results in the light of pregnancy are essential for diagnosis. Maternal complications of primary hyperparathyroidism include nephrolithiasis, pancreatitis, cardiac arrhythmias, hypertension and peptic ulcers. At its most severe, hypercalcaemic crisis may occur, presenting with acute neurological disturbance. Most commonly, the underlying aetiology is a solitary parathyroid adenoma whereby parathyroidectomy is the only cure. A 30-year-old Caucasian woman booked under Consultant care presented at 32 weeks gestation with vomiting and right-sided loin pain. Following presentation, she was diagnosed with renal calculi. She was delivered by caesarean section (CS) due to deterioration in renal function. Post-CS, she had a grand mal seizure. She was found to have hypercalcaemia with underlying hyperparathyroidism. PMID:25819820

  13. Neonatal, severe primary hyperparathyroidism: a 7-year clinical and radiological follow-up of one patient

    Energy Technology Data Exchange (ETDEWEB)

    Doria, Andrea S.; Daneman, Alan [Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario (Canada); Huang, Carol; Makitie, Outi; Kooh, Sang W.; Sochett, Etienne [Department of Endocrinology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8 (Canada); Thorner, Paul [Department of Laboratory Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario (Canada)

    2002-09-01

    Neonatal primary hyperparathyroidism is a rare entity characterized by marked hypercalcemia, diffuse parathyroid hyperplasia, and skeletal demineralization. It is often lethal unless total parathyroidectomy is performed. Long-term outcome of treated patients is poorly documented. We report the clinical and radiographic outcome of this disease in a 7-year-old boy who underwent a total parathyroidectomy and autotransplantation of a fragment of one parathyroid gland to his thigh in the neonatal period. This paper demonstrates the importance of prompt diagnosis and management in neonatal hyperparathyroidism and the role of various imaging modalities in its diagnosis and follow-up. (orig.)

  14. Brown tumor mimicking maxillary sinus mucocele as the first manifestation of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Guldfred, Liviu-Adelin; Daugaard, Søren; von Buchwald, Christian

    2012-01-01

    We describe the first case of brown tumor mimicking a maxillary sinus mucocele as the first manifestation of the patient's primary hyperparathyroidism. A 34-year old woman presented with a 14 days history of elevation of the right orbit, retrobulbar pain and cheek anesthesia. The CT and MR...... evaluation showed a mass, initially described as mucocele of the right maxillary sinus. The laboratory studies revealed hyperparathyroidism. The patient underwent acute surgery, and the mass appeared clinically as mucocele. The histological examination of the resected lesion revealed changes representing...... either giant cell granuloma or brown tumor. The finding of hyperparathyroidism confirmed the diagnosis of brown tumor. To our knowledge, this is the first report of cystic brown tumor mimicking a mucocele of the maxillary sinus....

  15. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Bollerslev, Jens; Rosen, Thord; Mollerup, Charlotte

    2009-01-01

    CONTEXT: Mild primary hyperparathyroidism (pHPT) seems to have a good prognosis, and indications for active treatment (surgery) are widely discussed. The extraskeletal effects of PTH, such as insulin resistance, arterial hypertension, and cardiovascular (CV) risk, may however be reversible...

  16. Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Lundstam, Karolina; Heck, Ansgar; Mollerup, Charlotte

    2015-01-01

    CONTEXT: Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed. OBJECTIVE: To study the effect of parathyroidectomy (PTX) compared with observation (OBS...

  17. Skeletal effects of vitamin D deficiency among patients with primary hyperparathyroidism.

    Science.gov (United States)

    Lee, J H; Kim, J H; Hong, A R; Kim, S W; Shin, C S

    2017-02-07

    Little is known about the association between vitamin D deficiency and the skeletal phenotypes in primary hyperparathyroidism (PHPT) patients. A low 25-hydroxyvitamin D level was associated with a low bone mineral density and deteriorated hip geometry in women with PHPT in an Asian population where vitamin D deficiency is prevalent.

  18. Rational use of localization studies in the management of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    美国,康涅狄格州,纽黑文市,耶鲁大学医学院外科

    2016-01-01

    [Summary] Parathyroidectomy is the first choice for primary hyperparathyroidism(1 HPTH). With the help of pre-operation imaging modalities, focused parathyroidectomy is now widely used. However, the imaging tests play no role in the diagnosis of 1 HPTH, and negative imaging results should not preclude the pursuit of a surgical cure.

  19. Prevalence of primary hyperparathyroidism in a referred sample of fibromyalgia patients.

    Science.gov (United States)

    Ferrari, Robert; Russell, Anthony Science

    2015-07-01

    The objective of this study is to determine the prevalence of primary hyperparathyroidism in a referred sample of fibromyalgia patients. Consecutively, referred patients with confirmed fibromyalgia (FM group) had measurements of serum levels of vitamin D, alkaline phosphatase, total calcium, magnesium, phosphate, creatinine, total protein, albumin, and parathyroid hormone. The same measurements were also conducted in a group of patients with widespread pain (WP group) who did not meet the 2010 Modified ACR criteria for fibromyalgia and a group with localized musculoskeletal pain (MSK group). A case of primary hyperparathyroidism was defined as a subject whose results showed any of the following: (1) parathyroid hormone levels above 6.8 pmol/L; (2) an ionized calcium above 1.25 mmol/L; or (3) both elevated, in the presence of normal range creatinine, alkaline phosphatase, vitamin D, phosphate, and magnesium. The mean age and the proportion of subjects who met the case definition of primary hyperparathyroidism were calculated for all groups. There were 125 subjects in the FM group, 127 in the WP group, and 138 in the MSK group. The prevalence rates of primary hyperparathyroidism were 6.4, 5.5, and 6.1%, respectively, for these groups. Comparison of these prevalence rates to published figures for general clinical and non-clinical populations reveals no differences. The prevalence of primary hyperparathyroidism in fibromyalgia patients is not different than that in other patients with WP or those with localized pain, nor is it likely different than that seen in the general population.

  20. {sup 131}I treatment for thyroid cancer and risk of developing primary hyperparathyroidism: a cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Chien-Mu [Taipei Medical University - Shuang Ho Hospital, Department of Nuclear Medicine, Taipei (China); Taipei Medical University, Department of Radiology, College of Medicine, Taipei (China); Doyle, Pat [London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London (United Kingdom); Tsan, Yu-Tse [National Taiwan University College of Public Health, Institute of Occupational Medicine and Industrial Hygiene, Taipei (China); Taichung Veterans General Hospital, Department of Emergency Medicine, Taichung (China); Chung Shan Medical University, School of Medicine, Taichung (China); Lee, Chang-Hsing [Ton Yen General Hospital, Department of Occupational Medicine, Hsinchu County (China); Wang, Jung-Der [National Taiwan University College of Public Health, Institute of Occupational Medicine and Industrial Hygiene, Taipei (China); National Cheng Kung University College of Medicine, Department of Public Health, Tainan (China); Chen, Pau-Chung [National Taiwan University College of Public Health, Institute of Occupational Medicine and Industrial Hygiene, Taipei (China); National Taiwan University College of Public Health, Department of Public Health, Taipei (China); National Taiwan University College of Medicine and Hospital, Department of Environmental and Occupational Medicine, Taipei (China); Collaboration: Health Data Analysis in Taiwan (hDATa) Research Group

    2014-02-15

    To evaluate the association between {sup 131}I therapy for thyroid cancer and risk of developing primary hyperparathyroidism. This was a nationwide population-based cohort study of patients with thyroid cancer diagnosed during the period 1997-2008. The data were obtained from the Taiwan National Health Insurance Research dataset. The cumulative {sup 131}I dose in each patient was calculated. Hazard ratios (HRs) were calculated using a proportional hazards model to estimate the effect of {sup 131}I therapy on the risk of developing primary hyperparathyroidism in the cohort. A total of 8,946 patients with thyroid cancer were eligible for the final analysis. Among these patients, 8 developed primary hyperparathyroidism during the follow-up period that represented 38,248 person-years giving an incidence rate of 20.9 per 10{sup 5} person-years. {sup 131}I was used in the treatment of 6,153 patients (68.8 %) with a median cumulative dose of 3.7 GBq. The adjusted HRs were 0.21 (95% CI 0.02-1.86) and 0.46 (95% CI 0.10-2.10) for those receiving a cumulative {sup 131}I dose of 0.1-3.6 GBq and ≥3.7 GBq, respectively, compared to no therapy. The risk of developing primary hyperparathyroidism did not increase with increasing {sup 131}I dose (test for trend p = 0.51). No interaction was found between {sup 131}I dose and age (p = 0.94) or {sup 131}I dose and sex (p = 0.99). {sup 131}I treatment for thyroid cancer did not increase risk of primary hyperparathyroidism during a 10-year follow-up in this study population. Further research with a longer follow-up period is needed to assess late adverse effects beyond 10 years. (orig.)

  1. Cinacalcet HCl Reduces Hypercalcemia in Primary Hyperparathyroidism across a Wide Spectrum of Disease Severity

    Science.gov (United States)

    Peacock, Munro; Bilezikian, J. P.; Bolognese, M. A.; Borofsky, Michael; Scumpia, Simona; Sterling, L. R.; Cheng, Sunfa; Shoback, Dolores

    2011-01-01

    Context: Primary hyperparathyroidism (PHPT) is characterized by elevated serum calcium (Ca) and increased PTH concentrations. Objective: The objective of the investigation was to establish the efficacy of cinacalcet in reducing serum Ca in patients with PHPT across a wide spectrum of disease severity. Design and Setting: The study was a pooled analysis of data from three multicenter clinical trials of cinacalcet in PHPT. Patients : Patients were grouped into three disease categories for analysis based on the following: 1) history of failed parathyroidectomy (n = 29); 2) meeting one or more criteria for parathyroidectomy but without prior surgery (n = 37); and 3) mild asymptomatic PHPT without meeting criteria for either above category (n = 15). Intervention: The intervention in this study was treatment with cinacalcet for up to 4.5 yr. Outcomes: Measurements in the study included serum Ca, PTH, phosphate, and bone-specific alkaline phosphatase, and areal bone mineral density (aBMD). Vital signs, safety biochemical and hematological indices, and adverse events were monitored throughout the study period. Results: The extent of cinacalcet-induced serum Ca reduction, proportion of patients achieving normal serum Ca (≤10.3 mg/dl), reduction in serum PTH, and increase in serum phosphate were similar across all three categories. Except for decreased aBMD at the total femur indicated for parathyroidectomy group at 1 yr, no significant changes in aBMD occurred. The efficacy of cinacalcet was maintained for up to 4.5 yr of follow-up. AEs were mild and similar across the three categories. Conclusions: Cinacalcet is equally effective in the medical management of PHPT patients across a broad spectrum of disease severity, and overall cinacalcet is well tolerated. PMID:20943783

  2. Multiple brown tumors of the jaws in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyoung A; Koh, Kwang Joon [School of Dentisity, Chonbuk National University, Jeonju (Korea, Republic of)

    2010-09-15

    Brown tumor is usually diagnosed at the terminal stage of hyperparathyroidism. Diagnosis of this tumor is confirmed by endocrinologic investigations along with clinical and radiographic examination. Radiographical differential diagnosis of this tumor includes central giant cell granuloma, aneurysmal bone cyst, metastatic tumor, multiple myeloma, and Paget disease. This report presents a rare case of multiple brown tumors occurring at the maxilla and mandible, which was initially misdiagnosed as central giant cell granuloma. Plain radiographs demonstrated multiple well-defined multilocular radiolucency. CT images showed soft tissue mass with low attenuated lesions, perforation of the lingual cortical plate, and a heterogeneous mass at the right thyroid lobe. These findings were consistent with parathyroid adenoma. The patient had hypercalcemia, hypophosphatemia, and elevated alkaline phosphatase level. Surgical excision of the tumor was performed. No recurrence was observed during a 28-month follow-up.

  3. No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Rolighed, Lars; Rejnmark, Lars; Sikjaer, Tanja

    2014-01-01

    Context: Impairments of muscle function and strength in patients with primary hyperparathyroidism (PHPT) are rarely addressed although decreased muscle function may contribute to increased fracture risk. Objective: We aimed to assess changes in muscle strength, muscle function, postural stability...

  4. Value of ultrasonography, Ct and MR imaging in the diagnosis of primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Tziakouri, C. [Nicosia General Hospital (Cyprus). Dept. of Radiology; Eracleous, E. [Nicosia General Hospital (Cyprus). Dept. of Radiology; Skannavis, S. [Nicosia General Hospital (Cyprus). Dept. of Radiology; Pierides, A. [Nicosia General Hospital (Cyprus). Dept. of Nephrology; Symeonides, P. [Nicosia General Hospital (Cyprus). Dept of General Surgery; Gourtsoyiannis, N. [Univ. of Crete, Heraklion (Greece). Dept. of Radiology

    1996-09-01

    Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery. (orig.).

  5. Localization of primary hyperparathyroidism using {sup 99m}Tc-MIBI scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yane, Katsunari; Emoto, Mie; Okamoto, Hideyuki; Yuki, Kazue; Hosoi, Hiroshi [Nara Medical Univ., Kashihara (Japan); Miyahara, Hiroshi [Osaka Prefectural Hospital (Japan)

    2003-03-01

    To determine the clinical utility of 99mTc-MIBI scintigraphy (MIBI) in the localization of hyperfunctioning parathyroid lesions, detection of lesions in 14 patients with primary hyperparathyroidism was compared between MIBI, ultrasonography and computed tomography (CT). MIBI (85.7%) and ultrasonography (78.5%) demonstrated higher detection rates than CT (50%). Furthermore, combination of MIBI and ultrasonography (92.8%) increased the detection rate. One case of ectopic parathyroid adenoma was detected only on MIBI. The smallest parathyroid lesion detected using MIBI was a parathyroid adenoma weighing 300 mg. A combination of MIBI and ultrasonography is therefore useful for the localization of primary hyperparathyroidism, and MIBI is particularly useful for detecting ectopic lesions. (author)

  6. Failure of thiazide diuretics to increase plasma calcium in mild primary hyperparathyroidism.

    OpenAIRE

    Farquhar, C. W.; Spathis, G. S.; J. L. Barron; Levin, G. E.

    1990-01-01

    Thirteen patients with mild primary hyperparathyroidism who were taking thiazide diuretics intermittently for periods of up to 18 months were followed up for a mean of 5.3 years. No significant difference was found in either plasma total calcium corrected for albumin or whole blood ionized calcium in these patients between the periods on or off thiazides. We conclude that thiazide diuretics are not contraindicated in such patients.

  7. Brown tumor of the patella caused by primary hyperparathyroidism: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Irie, Tomoko; Mawatari, Taro; Ikemura, Satoshi; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki [Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka (Japan)

    2015-06-15

    It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.1.

  8. The role of ultrasound and nuclear medicine methods in the preoperative diagnostics of primary hyperparathyroidism

    Science.gov (United States)

    Cacko, Marek; Królicki, Leszek

    2015-01-01

    Primary hyperparathyroidism (PH) represents one of the most common endocrine diseases. In most cases, the disorder is caused by parathyroid adenomas. Bilateral neck exploration has been a widely used treatment method for adenomas since the 20's of the twentieth century. In the last decade, however, it has been increasingly replaced by a minimally invasive surgical treatment. Smaller extent, shorter duration and lower complication rate of such a procedure are emphasized. Its efficacy depends on a precise location of parathyroid tissue during the preoperative imaging. Scintigraphy and ultrasound play a major role in the diagnostic algorithms. The efficacy of both methods has been repeatedly verified and compared. The still-current guidelines of the European Association of Nuclear Medicine (2009) emphasize the complementary role of scintigraphy and ultrasonography in the preoperative diagnostics in patients with primary hyperparathyroidism. At the same time, attempts are made to improve both these techniques by implementing new study protocols or innovative technologies. Publications have emerged in the recent years in the field of ultrasonography, whose authors pointed out the usefulness of elastography and contrast media. Nuclear medicine studies, on the other hand, focus mainly on the assessment of new radiotracers used in the positron emission tomography (PET). The aim of this article is to present, based on literature data, the possibilities of ultrasound and scintigraphy in the preoperative diagnostics in patients with primary hyperparathyroidism. Furthermore, the main directions in the development of imaging techniques in PH patients were evaluated. PMID:26807297

  9. Surgical diagnosis and treatment of primary hyperparathyroidism: analysis of 19 cases.

    Science.gov (United States)

    Gao, Bo; Jiang, Yan; Zhang, Shu; Guo, Lingji; Tian, Wuguo; Wen, Yayuan; He, Yujun; Luo, Donglin

    2015-01-01

    This study was to discuss the surgical diagnosis and treatment experience of primary hyperparathyroidism. Clinical data of 19 primary hyperparathyroidism patients who were treated surgically in our department from Jan. 2005 to Jul. 2014 were retrospectively analyzed. Besides, general data, clinical manifestations, laboratory and imaging test results, surgical procedures and postoperative follow-up information were comprehensively analyzed. 15 of 19 patients had adenoma, among whom 1 case was complicated with goiter, 3 cases with parathyroid hyperplasia, and 1 case with parathyroid carcinoma. One case of bilateral parathyroid adenoma was explored bilaterally, and the bilateral parathyroid adenoma was excised. 14 cases of unilateral parathyroid adenoma were explored unilaterally and the unilateral parathyroid adenoma was excised. 3 cases of parathyroid hyperplasia were explored bilaterally, and parathyroid glands were removed subtotally, and only half gland was reserved. 1 case of parathyroid carcinoma experienced excision of thyroid gland and parathyroid at the affected side and isthmus excision, subtotal excision of thyroid gland at the healthy side and functional cervical lymphonode dissection at the affected side. All the 19 cases recovered well after operation, and symptoms of hyperparathyroidism were controlled. No relapse was found after follow-up of 3 months to 5 years. In conclusion, local parathyroid excision with small wounds after pre-operative locative image test and qualitative laboratory test is effective. Timely surgical treatment could reduce joint and urinary damage. Post-operative follow-up should be emphasized for early detection of the patients with hypoparathyroidism and recurrence.

  10. Functioning glucagonoma associated with primary hyperparathyroidism: multiple endocrine neoplasia type 1 or incidental association?

    Directory of Open Access Journals (Sweden)

    Erdas Enrico

    2012-12-01

    Full Text Available Abstract Background Diagnosis of multiple endocrine neoplasia type 1 (MEN1 is commonly based on clinical criteria, and confirmed by genetic testing. In patients without known MEN1-related germline mutations, the possibility of a casual association between two or more endocrine tumors cannot be excluded and subsequent management may be difficult to plan. We describe a very uncommon case of functioning glucagonoma associated with primary hyperparathyroidism (pHPT in which genetic testing failed to detect germline mutations of MEN-1 and other known genes responsible for MEN1. Case presentation The patient, a 65-year old woman, had been suffering for more than 1 year from weakness, progressive weight loss, angular cheilitis, glossitis and, more recently, skin rashes on the perineum, perioral skin and groin folds. After multidisciplinary investigations, functioning glucagonoma and asymptomatic pHPT were diagnosed and, since family history was negative, sporadic MEN1 was suspected. However, genetic testing revealed neither MEN-1 nor other gene mutations responsible for rarer cases of MEN1 (CDKN1B/p27 and other cyclin-dependent kinase inhibitor genes CDKN1A/p15, CDKN2C/p18, CDKN2B/p21. The patient underwent distal splenopancreatectomy and at the 4-month follow-up she showed complete remission of symptoms. Six months later, a thyroid nodule, suspected to be a malignant neoplasia, and two hyperfunctioning parathyroid glands were detected respectively by ultrasound with fine needle aspiration cytology and 99mTc-sestamibi scan with SPECT acquisition. Total thyroidectomy was performed, whereas selective parathyroidectomy was preferred to a more extensive procedure because the diagnosis of MEN1 was not supported by genetic analysis and intraoperative intact parathyroid hormone had revealed “adenoma-like” kinetics after the second parathyroid resection. Thirty-nine and 25 months after respectively the first and the second operation, the patient is well

  11. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    Energy Technology Data Exchange (ETDEWEB)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo, E-mail: leiervolino@hotmail.com [Discipline of Endocrinology, Department of Medicine, Faculdade de Medicina da Santa Casa de Sao Paulo (FMSCSP), Sao Paulo, SP (Brazil)

    2012-06-15

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as {sup 99m}Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  12. Persistent Primary Hyperparathyroidism, Severe Vitamin D Deficiency, and Multiple Pathological Fractures

    Directory of Open Access Journals (Sweden)

    Victoria Mendoza-Zubieta

    2016-01-01

    Full Text Available Persistent primary hyperparathyroidism (PHPT refers to the sustained hypercalcemia state detected within the first six months following parathyroidectomy. When it coexists with severe vitamin D deficiency, the effects on bone can be devastating. We report the case of a 56-year-old woman who was sent to this center because of persistent hyperparathyroidism. Her disease had over 3 years of evolution with nephrolithiasis and hip fracture. Parathyroidectomy was performed in her local unit; however, she continued with hypercalcemia, bone pain, and pathological fractures. On admission, the patient was bedridden with multiple deformations by fractures in thoracic and pelvic members. Blood pressure was 100/80, heart rate was 86 per minute, and body mass index was 19 kg/m2. Calcium was 14 mg/dL, parathormone 1648 pg/mL, phosphorus 2.3 mg/dL, creatinine 2.4 mg/dL, urea 59 mg/dL, alkaline phosphatase 1580 U/L, and vitamin D 4 ng/mL. She received parenteral treatment of hypercalcemia and replenishment of vitamin D. The second surgical exploration was radioguided by gamma probe. A retroesophageal adenoma of 4 cm was resected. Conclusion. Persistent hyperparathyroidism with severe vitamin D deficiency can cause catastrophic skeletal bone softening and fractures.

  13. Persistent Primary Hyperparathyroidism, Severe Vitamin D Deficiency, and Multiple Pathological Fractures

    Science.gov (United States)

    Carvallo-Venegas, Mauricio; Vargas-Castilla, Jorge Alberto; Balcázar-Hernández, Lourdes Josefina; Gregor-Gooch, Julián Malcolm Mac

    2016-01-01

    Persistent primary hyperparathyroidism (PHPT) refers to the sustained hypercalcemia state detected within the first six months following parathyroidectomy. When it coexists with severe vitamin D deficiency, the effects on bone can be devastating. We report the case of a 56-year-old woman who was sent to this center because of persistent hyperparathyroidism. Her disease had over 3 years of evolution with nephrolithiasis and hip fracture. Parathyroidectomy was performed in her local unit; however, she continued with hypercalcemia, bone pain, and pathological fractures. On admission, the patient was bedridden with multiple deformations by fractures in thoracic and pelvic members. Blood pressure was 100/80, heart rate was 86 per minute, and body mass index was 19 kg/m2. Calcium was 14 mg/dL, parathormone 1648 pg/mL, phosphorus 2.3 mg/dL, creatinine 2.4 mg/dL, urea 59 mg/dL, alkaline phosphatase 1580 U/L, and vitamin D 4 ng/mL. She received parenteral treatment of hypercalcemia and replenishment of vitamin D. The second surgical exploration was radioguided by gamma probe. A retroesophageal adenoma of 4 cm was resected. Conclusion. Persistent hyperparathyroidism with severe vitamin D deficiency can cause catastrophic skeletal bone softening and fractures. PMID:27525132

  14. Non-psychogenic polydipsia in 45-year-old man with primary hyperparathyroidism and recurrent bilateral nephrolithiasis

    Directory of Open Access Journals (Sweden)

    Rahmat Cahyanur

    2012-11-01

    Full Text Available Non-psychogenic polydipsia with hyponatremia is a rare clinical presentation. Primary hyperparathyroidism is a disorder of calcium, phosphate, and bone metabolism caused by increased level of parathyroid hormone (PTH. It is estimated the incidence of primary hyperparathyroidism are 21.6 per 100,000 person a year. This case report describe a 45-year-old man presented with non-psychogenic polydipsia. This patient drank a lot of water out of the fear of recurrent kidney stones. He had history of recurrent nephrolithiasis with hypercalcemia. We investigate further the cause of hypercalcemia and we diagnosed primary hyperparathryoidism as the cause. (Med J Indones. 2012;21:230-4Keywords: Hyponatremia, non-psychogenic polydipsia, primary hyperparathyroidism

  15. Primary Hyperparathyroidism. Statistical Study about Patient to bed in Imam Khomeiny and Shariaty Hospitals (67-1376 Years

    Directory of Open Access Journals (Sweden)

    Kafie N

    1998-09-01

    Full Text Available In this study we try to clear the prevalance of age and sex and clinical and radiographic"nmanifestations of primary hyperparathyroidism. In this duration 47 patients with primary"nhyperparathyroidism that bed in two important hospitals in Tehran were studied."nThe ratio between women to men was 7 to 1 and most prevalance of disease were in fouyth decade. The pain boon was the cheif complain of patients and osteopenia was the most radiographic findings."nIn addition a case of primary hyperparathyroidism with mandibular and other bone involvement was reported.

  16. Skeletal changes after restoration of the euparathyroid state in patients with hypoparathyroidism and primary hyperparathyroidism.

    Science.gov (United States)

    Cipriani, Cristiana; Abraham, Alice; Silva, Barbara C; Cusano, Natalie E; Rubin, Mishaela R; McMahon, Donald J; Zhang, Chengchen; Hans, Didier; Silverberg, Shonni J; Bilezikian, John P

    2017-02-01

    Restoration of the euparathyroid state is associated with improvement of bone dynamics both in hypoparathyroidism and primary hyperparathyroidism. To date, no study has directly compared these two groups following correction of parathyroid hormone excess or deficiency. The study was designed to investigate changes in bone mineral density and trabecular bone score with restoration of the euparathyroid state by parathyroidectomy in primary hyperparathyroidism or recombinant parathyroid hormone [rhPTH(1-84)] replacement in hypoparathyroidism. This was a 2-year prospective intervention study in which we evaluated areal bone mineral density by DXA and trabecular bone score in 52 hypoparathyroid patients on rhPTH(1-84) replacement and 27 patients with primary hyperparathyroidism who underwent parathyroidectomy. We evaluated changes in areal bone mineral density by DXA and trabecular bone score at baseline, 6, 12, 18, and 24 months. After parathyroidectomy, areal bone mineral density increased from baseline at the lumbar spine and total hip at 6 months and at the femoral neck at 12 months, while there were no changes at the distal 1/3 radius. Treatment with rhPTH(1-84) was associated with significant increases in lumbar spine and decreases in distal 1/3 radius areal bone mineral density by 18 months in hypoparathyroid patients. At this time point, hypoparathyroid subjects demonstrated a significant increase in trabecular bone score from baseline, while there were no significant changes in trabecular bone score following parathyroidectomy. Bone mineral density increases both with administration of parathyroid hormone in a state of parathyroid hormone deficiency or removal of parathyroid hormone in a state of parathyroid hormone excess. However, only hypoparathyroid patients on rhPTH(1-84) appeared to have improvements in micro-architectural pattern as assessed by trabecular bone score.

  17. Topical diagnostics methods in primary hyperparathyroidism. Comparative features

    Directory of Open Access Journals (Sweden)

    N S Kuznetsov

    2012-06-01

    Full Text Available Topical diagnostics of parathyroids an important stage in preoperative inspection of patients with a primary hyperparathyreosis. Methods of diagnostics existing for today not always demand use of all methods for each patient. A research problem was studying of diagnostic value of each of research methods separately and their combinations. The obtained data testifies to high sensitivity and specificity of each of methods of preoperative topical diagnostics of a pathology of parathyroids at patients with a primary hyperparathyreosis. Sensitivity of US, the Scintigraphy, US + Scintigraphy and the Multispiral computer tomography (MSCT has compounded – 96,8 %, 91,8 %, 99,2 % and 95,2 % accordingly. Specificity of US, the Scintigraphy, US+ Scintigraphy and a MSCT has compounded – 91,9 %, 84,2 %, 94,1 % and 94,1 % accordingly. Findings of investigation have taped absence of statistically significant differences in sensitivity and specificity parametres between US and «the gold standard» diagnostics of a pathology of parathyroids that allows to recommend US, as a unique method of primary topical diagnostics of a pathology of parathyroids at a primary hyperparathyreosis. However any doubts in diagnostic accuracy of US demand expansion of all complex of diagnostic actions scintigraphy, including an SPECT, and also MSCT, especially in case of atypical a locating of parathyroids. On the basis of findings of investigation the optimum diagnostic algorithm is developed at a primary hyperparathyreosis.

  18. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis.

    Science.gov (United States)

    Cating-Cabral, Monica Therese; Cabungcal, Arsenio Claro; Villafuerte, Cesar Vincent; Añel-Quimpo, Joselynna

    2012-06-08

    This is a case of a 44-year-old woman with an anterior neck mass and hypothyroidism who presented with an incidental finding of an elevated serum calcium level and was found to have primary hyperparathyroidism and osteoporosis. During surgical exploration no parathyroid adenoma was found, although a nodule was palpated within the right thyroid lobe. Examination of the excised right thyroid lobe revealed an intrathyroidal parathyroid adenoma and chronic lymphocytic thyroiditis. After surgery, she did not develop severe hypocalcaemia and this was attributed to preoperative treatment with pamidronate. In the months following surgery, parathyroid hormone remained undetectable.

  19. Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism.

    Science.gov (United States)

    Rastegar, Mandana; Levine, Barton S; Felsenfeld, Arnold J

    2014-06-01

    A 58-year-old man with Stage 3b chronic kidney disease and primary hyperparathyroidism treated with cinacalcet was admitted for acute cholecystitis. A cholecystostomy tube was placed, estimated glomerular filtration rate decreased, metabolic acidosis developed and ionized calcium increased from 1.33 to 1.76 mM despite cinacalcet administration. A sodium bicarbonate infusion corrected the metabolic acidosis restoring ionized calcium to normal despite no improvement in renal function. The correlation between the increase in serum bicarbonate and decrease in ionized calcium was r = -0.93, P metabolic acidosis increasing calcium efflux from bone while renal failure decreased the capacity to excrete calcium.

  20. Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Chakrabarti

    2013-01-01

    Full Text Available Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL; low phosphate (2.9 mg/dL with elevated parathyroid hormone (PTH, 156.7 pg/mL and HbA1c (6.9%. Diagnosis of primary HPT (PHPT was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

  1. Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Berczi, C.; Lukacs, G.; Balazs, G. [Department of Surgery, University of Debrecen (Hungary); Mezosi, E.; Bajnok, L. [1. Department of Internal Medicine, University of Debrecen (Hungary); Galuska, L.; Varga, J. [Department of Nuclear Medicine, University of Debrecen (Hungary)

    2002-03-01

    A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US (p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy. (orig.)

  2. Primary Hyperparathyroidism in Young People. When Should We Perform Genetic Testing for Multiple Endocrine Neoplasia 1 (MEN-1)?

    DEFF Research Database (Denmark)

    Lassen, Tina Harmer; Friis-Hansen, Lennart Jan; Rasmussen, Åse Krogh

    2014-01-01

    CONTEXT: Multiple endocrine neoplasia (MEN-1) is a rare, autosomal dominant inherited disorder. Primary hyperparathyroidism (pHPT) is the most frequent and usually the earliest expression of MEN-1, with typical age of onset at 20-25 years. Early detection of the disease and correct treatment...... endocrine neoplasia 1 OR multiple endocrine neoplasia type 1 AND Mutational analysis OR genetic testing OR testing OR Hyperparathyroidism, primary [majr]. A total of 625 abstracts were reviewed. RESULTS AND DISCUSSION: Whether to perform screening of patients with pHPT under the age of 30, 35, or 40 years...

  3. Low dose four-dimensional computerized tomography with volume rendering reconstruction for primary hyperparathyroidism: How I do it?

    Institute of Scientific and Technical Information of China (English)

    Timothy; A; Platz; Moshim; Kukar; Rania; Elmarzouky; William; Cance; Ahmed; Abdelhalim

    2014-01-01

    Abstract Modification of 4-dimensional computed tomography(4D-CT)technique with volume rendering reconstruc-tions and significant dose reduction is a safe and ac-curate method of pre-operative localization for primary hyperparathyroidism.Modified low dose 4D-CT with volume rendering reconstructions provides precise preoperative localization and is associated with a sig-nificant reduction in radiation exposure compared to classic preoperative localizing techniques.It should be considered the preoperative localization study of choice for primary hyperparathyroidism.

  4. Cinacalcet therapy in patients affected by primary hyperparathyroidism associated to Multiple Endocrine Neoplasia Syndrome type 1 (MEN1).

    Science.gov (United States)

    Giusti, Francesca; Cianferotti, Luisella; Gronchi, Giorgio; Cioppi, Federica; Masi, Laura; Faggiano, Antongiulio; Colao, Annamaria; Ferolla, Piero; Brandi, Maria Luisa

    2016-06-01

    Primary hyperparathyroidism is the main endocrinopathy associated with Multiple Endocrine Neoplasia type 1 syndrome. Cinacalcet is a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease, and for the reduction of marked hypercalcemia in patients with parathyroid carcinoma and sporadic hyperparathyroidism requiring surgery but for whom parathyroidectomy is contraindicated. It may provide a medical alternative for the management of primary hyperparathyroidism in subjects affected by Multiple Endocrine Neoplasia type 1. In this longitudinal, intervention study, 33 MEN1 patients had been enrolled, 10 males and 23 females with a mean age of 40 ± 11.9 years, range 20-63. Primary hyperparathyroidism was the first clinical manifestation in 12 patients. All subjects commenced with Cinacalcet 30 mg/day, 22 patients starting therapy with calcimimetics as an alternative to surgery, and 11 patients opting for the medication after the onset of persistent post-surgical primary hyperparathyroidism. Duration of follow-up was 12 months. The results of this study show significant reductions in serum calcium. The changes in hormonal secretions of pituitary and gastroenteropancreatic glands were not significant, demonstrating the overall safety of this drug in this disease. Cinacalcet has been well tolerated by 28 patients, whereas five individuals complained of heartburn and grade 1 nausea, which did not prevent the completion of the study. In conclusion, Cinacalcet has resulted to be well tolerated and safe in patients with MEN1 syndrome and the calcium homeostasis was stabilized.

  5. [Sacroiliac changes, HLA-B27 negative, in primary hyperparathyroidism and osteomalacia].

    Science.gov (United States)

    Gerster, J C; Saudan, Y; Strub-Mayor, F; Guggi, S

    1979-07-14

    Radiological sacroiliac (SI) changes were found in 3 patients, 2 with primary hyperparathyroidism (1 also with associated chondrocalcinosis) and 1 with osteomalacia. Osteomalacia was due to celiac disease. None of the 3 patients, all females, had a history of psoriasis, urethritis, iritis or chronic colitis. There was no renal function impairment. Peripheral joints were affected in the patient with associated condrocalcinosis. HLA B 27 was negative in all cases. Low back pain and vertebral stiffness were present in the patient with osteomalacia. A dramatic improvement in pain and stiffness ensued after vitamin D injections. These SI lesions, which may simulate ankylosing spondylitis, were attributable to subchondral bone changes related to the metabolic bone diseases. In the case of osteomalacia the SI lesions were predominantly on the right side, where there was a Looser's zone on the ischial ramus suggesting that pseudofractures could be a cause of SI changes. Metabolic osseous diseases such as osteomalacia or primary hyperparathyroidism should be investigated in cases of HLA B 27 negative radiological "sacroiliitis".

  6. Nuclear medicine in the diagnosis of primary hyperparathyroidism; Nuklearmedizinische Diagnostik des primaeren Hyperparathyreoidismus (pHPT)

    Energy Technology Data Exchange (ETDEWEB)

    Luster, M. [Klinik fuer Nuklearmedizin der Univ. Wuerzburg (Germany); Timm, S. [Chirurgische Universitaetsklinik Wuerzburg (Germany)

    2003-03-01

    Nuclear medicine recently has gained importance in the diagnosis of primary hyperparathyroidism. Stimulated by the introduction of minimal invasive surgery preoperative imaging is mandatory for the planning of the surgical approach. Sestamibi scintigraphy has proven its superiority in sensitivity concerning the lesion detection especially in primary hyperparathyroidism as compared to other imaging modalities. Therefore this test is not only used for the diagnosis of relapsing or persistent disease but also successfully implemented in the initial work-up. The wider use of SPECT contributed significantly to a further increase of the detection rate and is recommended as a standard procedure. (orig.) [German] Die nuklearmedizinische Nebenschilddruesendiagnostik hat in juengerer Vergangenheit zunehmende Bedeutung erlangt. Durch die Einfuehrung minimal invasiver Operationstechniken ist eine praeoperative Bildgebung fuer die Planung des Eingriffs Voraussetzung. Die Sestamibi-Szintigraphie hat in diesem Zusammenhang in zahlreichen Studien eine Ueberlegenheit gegenueber anderen Verfahren im Hinblick auf die Sensitivitaet bei der Detektion von Laesionen, insbesondere beim primaeren Hyperparathyreoidismus, gezeigt. Demzufolge wird dieses Untersuchungsverfahren nicht nur wie bisher vor Rezidiveingriffen oder bei persistierender Erkrankung, sondern auch erfolgreich vor Erstoperationen eingesetzt. Die vermehrte Nutzung der SPECT-Technik konnte in den letzten Jahren zu einer weiteren Steigerung der Detektionsrate beitragen und sollte grosszuegig Verwendung finden. (orig.)

  7. Is Primary Hyperparathyroidism a Risk Factor for Papillary Thyroid Cancer? An Exemplar Study and Literature Review

    Directory of Open Access Journals (Sweden)

    Cinamon, Udi

    2014-12-01

    Full Text Available Introduction Primary hyperparathyroidism (PHPT is associated with several cancer types, including papillary thyroid carcinoma (PTC. Objective To explore further the relation between PHPT and PTC. Methods By considering patients with PHPT as extra-suspicious for PTC, we studied an exemplar group of patients with PHPT with a small (≤1 cm thyroid nodule, which was negative in preoperative cytologic examination. During parathyroidectomy, a frozen section biopsy of the thyroid nodule confirmed PTC, as did the final surgical specimen, revealing that the preoperative cytology was false-negative. Additionally, relevant reports retrieved from the English literature addressing thyroid cancer and hyperparathyroidism were reviewed and processed. Results Four patients with PHPT were studied. Three had a multifocal thyroid disease, and three had neck lymph node metastasis. Processing previous report data supported an association between PHPT and PTC. Although thyroid nodularity among patients with PHPT was similar to the general population, PTC incidence was higher. This was true also for patients with secondary hyperparathyroidism. Conclusions This study emphasized that PHPT should be considered as a noteworthy risk factor for PTC. Fine needle aspiration of a thyroid nodule is the most valuable diagnostic procedure for thyroid cancer. Yet, false-negative results were reported in up to 10% of cases, especially in small, subcentimeter nodules. In line with our data and the literature, patients with PHPT should have both a detailed ultrasound addressing the thyroid and cytology of any thyroid nodule, including small subcentimeter lesions. Moreover, surgical flexibility, allowing intraoperative thyroid nodule sampling, should be considered even for “innocent” nodules.

  8. Evaluation of Conventional Imaging Techniques on Preoperative Localization in Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Mesut Ozkaya

    2015-02-01

    Full Text Available We aimed to evaluate the diagnostic and preoperative localization capacity of 99mTc methoxyisobutylnitrile (MIBI parathyroid scintigraphy and ultrasonography (USG in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH levels, calcium (Ca, phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.

  9. Successful treatment of recurrent renal stones with Cinacalcet in a patient with primary hyperparathyroidism.

    Science.gov (United States)

    Chauhan, Priyesh; Gittoes, Neil J; Geberhiwot, Tarekegn

    2016-08-12

    A man aged 72 years with long-standing primary hyperparathyroidism (HPT), a background of recurrent bilateral renal stones and failed parathyroid surgery is described. During the 27 months preceding treatment, episodes of renal colic became increasingly frequent and he required multiple surgical interventions. Given the lack of medical therapies to definitively treat his symptoms, he was started on a trial of the calcimimetic, Cinacalcet. Cinacalcet has previously been shown to reduce hypercalcaemia in patients with primary HPT. Despite this, there is a paucity of evidence to suggest that its use is associated with a long-term reduction in urinary calcium excretion and renal stone recurrence. In our case, within 4 months of starting treatment, serum and urinary calcium had normalised and parathyroid hormone concentrations were within reference ranges. To date, over a 50-month treatment period, there has been a complete cessation in stone formation, and no further urological intervention has been required.

  10. A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

    Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

  11. Primary Hyperparathyroidism

    Science.gov (United States)

    ... may be embedded in the thyroid, in the thymus—an immune system organ located in the chest— ... plays an important role in bone and tooth development and, combined with phosphorus, strengthens bones and teeth. ...

  12. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    V N Shah

    2012-01-01

    Full Text Available Background: The geographical difference in presentation of primary hyperparathyroidism (PHPT is known. However, there is sparse literature on the influence of age and gender on presentation of PHPT. Aim: To analyze the effect of age and gender on presentation of symptomatic primary hyperparathyroidism. Setting and Design: This is a retrospective analysis of data from the primary hyperparathyroidism registry of a north Indian tertiary care teaching institute. Materials and Methods: Analysis of 184 histopathologically proven PHPT patients registered between March 1990 and March 2010 from a single centre of north India. PHPT patients were divided into three different age groups i.e. children and adolescents less than 25 years, adults 25-49 years, and ≥ 50 years. Clinical presentations, biochemical parameters and parathyroid weight were compared between different age groups and gender using appropriate statistical methods. Results: Mean age of patients was 38.5±13.8 years with female: male ratio of 7:3. Rickets as presenting manifestations were seen in one child and adolescent each. Prevalence of renal stones (P=0.03 and gall stones (P=0.02 was higher in the adult groups compared to the younger and older. There was no difference in bone pain (P=0.7, fracture (P=0.3, osteitis fibrosa cystica (P=0.2, fatigue (P=0.6 and other symptoms among different age groups. There was no difference in serum calcium, phosphate, parathyroid hormone (PTH and 25 (OH D levels among different age groups, however, as expected alkaline phosphatase was higher in adolescents compared to adults (P=0.03. Bone pain and muscle aches (P<0.001, fracture (P=0.04, osteitis fibrosa cystica (P=0.01, and gall stones (P=0.03 were more common among women while renal stones (P=0.05 and pancreatitis (P=0.02 were common in men. Serum calcium and phosphate levels were similar in either sex but parathyroid hormone (iPTH level was higher among women (P=0.02. Parathyroid adenoma weight was

  13. Unmasked renal impairment and prolonged hyperkalemia after unilateral adrenalectomy for primary aldosteronism coexisting with primary hyperparathyroidism: report of a case.

    Science.gov (United States)

    Hibi, Yatsuka; Hayakawa, Nobuki; Hasegawa, Midori; Ogawa, Kimio; Shimizu, Yoshimi; Shibata, Masahiro; Kagawa, Chikara; Mizuno, Yutaka; Yuzawa, Yukio; Itoh, Mitsuyasu; Iwase, Katsumi

    2015-02-01

    We herein report the case of a patient with critical hyperkalemia after unilateral adrenalectomy (ADX) for aldosterone-producing adenomas, which were coexisting with primary hyperparathyroidism. A right adrenal tumor oversecreting mineral corticoid was identified in a 62-year-old female whose kidney function had been impaired due to primary hyperaldosteronism and hyperparathyroidism. The ADX improved her hypertension with normalization of the plasma aldosterone concentration, but without adequately increasing her plasma renin activity. Her eGFR further decreased postoperatively, hyperkalemia appeared and the serum potassium level rose to 6.3 mEq/L at 3 months after ADX. Then, treatment with calcium polystyrene sulfonate jelly was started. Eight months after ADX, a left lower parathyroidectomy was performed, and the serum calcium and intact parathyroid hormone levels decreased to the normal range. The hyperkalemia was difficult to control within 20 months postoperatively without treatment with calcium polystyrene sulfonate jelly or hydrocortisone. This suggests that unmasking the renal impairment and relative hypoaldosteronism after ADX might induce critical hyperkalemia.

  14. Hiperparatiroidismo Primário na Pós-menopausa Primary Hyperparathyroidism after Menopause

    Directory of Open Access Journals (Sweden)

    Martha Katherine Paniagua Huayllas

    2000-05-01

    Full Text Available A osteoporose é uma doença que acomete milhões de pacientes no mundo inteiro, levando a complicações muitas vezes graves e até ao óbito. A prevenção e o diagnóstico precoce se fazem necessários para o sucesso da terapêutica, porém existem doenças que podem cursar concomitantemente. O hiperparatiroidismo primário é um diagnóstico que deve ser lembrado em mulheres na pós-menopausa.Osteoporosis is an important disease which can affect millions of patients all over the world, leading to complications, often even to death. Prevention and the early diagnosis may help in the success of treatment but there are diseases which can occur at the same time. Primary hyperparathyroidism is a diagnosis which must be remembered in women after the menopause.

  15. Pseudoarthrosis and fracture: interaction between severe vitamin D deficiency and primary hyperparathyroidism.

    Science.gov (United States)

    Rastogi, Ashu; Bhadada, Sanjay Kumar; Bhansali, Anil

    2013-11-01

    A young woman with severe vitamin D deficiency presented with proximal muscle weakness, fragility fracture and pseudoarthrosis. On evaluation, she was found to have hypercalcaemia, a single parathyroid adenoma and an undetectable 25-hydroxyvitamin D level. She received parenteral cholecalciferol and subsequently underwent curative parathyroidectomy. Postoperatively, she had hungry bone syndrome, which she gradually recovered from with calcium and calcitriol replacement. Notably, her calcium levels were in the lower limit of normal range and associated with elevated alkaline phosphatase levels at postoperative Day 14. Follow-up for the next four years showed that the patient had remarkable symptomatic and radiological improvements. In this report, we discuss the pathophysiological interactions between vitamin D deficiency and associated primary hyperparathyroidism.

  16. Surgical Management of Calciphylaxis Associated with Primary Hyperparathyroidism: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jennifer Bishop

    2010-01-01

    Full Text Available Calciphylaxis, or calcific uremic arteriolopathy, commonly affects people with end-stage renal disease and carries with it a high rate of morbidity and mortality. Here, we present the unusual case of a 56-year-old woman, with extensive medical problems, who developed calciphylaxis in the presence of primary hyperparathyroidism. Our patient initially presented with bilateral, exquisitely tender thigh lesions. The diagnosis of calciphylaxis was rendered histologically by extensive calcification of the subcutaneous blood vessels. Subsequent parathyroidectomy identified the presence of a hyperactive mediastinal parathyroid adenoma, weighing 0.62 grams. Postoperatively, the patient had normalization of hypercalcemia and parathyroid hormone levels, with subsequent healing of her thigh wounds. Currently, there have been sixteen cases described in the English literature, with only nine being offered a potentially therapeutic parathyroidectomy. It is contingent upon the vigilant physician to diagnose and properly manage this difficult yet treatable condition.

  17. Feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies.

    Science.gov (United States)

    Calò, Pietro Giorgio; Medas, Fabio; Loi, Giulia; Erdas, Enrico; Pisano, Giuseppe; Nicolosi, Angelo

    2016-06-01

    The purpose of this study was to examine the feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies. We included in our study 72 patients with preoperative diagnosis of primary hyperparathyroidism who had negative or discordant preoperative studies. In 66 patients, studies were discordant while in six were both negative. In 40 (55.6 %) patients initial approach was a bilateral exploration. In 32 cases (44.4 %) initial surgery was a unilateral exploration: in 26 conservative approach was successful, in six mini-invasive surgery failed and a bilateral exploration was necessary due to IOPTH negative test (five cases) or to the impossibility to find a pathological gland during exploration (one case). Intra-operative PTH test showed a sensitivity of 93.2 %, a specificity of 92.3 %, and an accuracy of 93.1 %. Multiple gland disease was found in 8 (11.1 %) patients (two double adenoma and six multiple gland hyperplasia). Mean operative time was lower in unilateral exploration group (87.9 ± 43.8 min). Comparing unilateral surgery in negative or discordant studies with 77 consecutive patients who underwent focused surgery with positive and concordant studies, conversion to bilateral exploration rate was statistically significantly higher in the first group (15.6 %). We believe that unilateral parathyroidectomy can be safely performed also in patients with discordant localization studies with a high cure rate; in these cases, however, the use of intra-operative PTH is absolutely necessary. We suggest the need for referral of these patients to high-volume medical centers for thyroid and parathyroid surgery.

  18. Technetium-99m tetrofosmin parathyroid imaging in patients with primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Hiromatsu, Yuji; Ishibashi, Masatoshi; Nishida, Hidemi; Okuda, Seiya; Miyake, Ikuyo [Kurume Univ., Fukuoka (Japan). School of Medicine

    2000-02-01

    To confirm the clinical significance of {sup 99m}Tc-tetrofosmin imaging for the localization of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism. All patients were imaged with {sup 99m}Tc-tetrofosmin at 10 minutes and 2 hours after radiotracer injection, and with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The parathyroid/ thyroid uptake ratio of {sup 99m}Tc-tetrofosmin (P/T uptake ratio) was calculated. Twenty patients with primary hyperparathyroidism were referred to our clinic, underwent surgical neck exploration or mediastinotomy and were diagnosed as having parathyroid adenoma. These patients were investigated for the preoperative localization by {sup 99m}Tc-tetrofosmin scintigraphy. {sup 99m}Tc-tetrofosmin imaging demonstrated focal uptake in 19 out of 20 patients with parathyroid adenoma. Two of the lesions were ectopic. US identified 17 parathyroid glands. CT and MRI initially detected 17 parathyroid glands. However, two additional parathyroid glands were localized on repeated CT and MRI in tandem with the results of the {sup 99m}Tc-tetrofosmin imaging. Thus, the sensitivity and specificity of tetrofosmin imaging were 95% (19/20) and 95% (19/20); US, 85% (17/20) and 94% (16/17); initial CT, 85% (17/20) and 94% (16/17); and initial MRI, 88% (17/20) and 94% (16/17), respectively. The P/T uptake ratio at 2 hours after tetrofosmin injection was correlated with the serum concentration of intact parathyroid hormone (PTH) (rs=0.47, p<0.05) and the resected tumor weight (rs=0.53, p<0.05). {sup 99m}Tc-tetrofosmin scintigraphy is useful for localization of parathyroid adenoma. Tetrofosmin uptake depends on the tumor weight and serum intact PTH levels. (author)

  19. Fenofibrate for patients with asymptomatic primary biliary cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Kazufumi Dohmen; Toshihiko Mizuta; Makoto Nakamuta; Naoya Shimohashi; Hiromi Ishibashi; Kyosuke Yamamoto

    2004-01-01

    AIM: Primary biliary cirrhosis (PBC) is a chronic, cholestatic disease of autoimmune etiology, the histology of which shows a destruction of the intrahepatic bile duct and portal inflammation. Ursodeoxycholic acid (UDCA) is now used as a first-line drug for asymptomatic PBC (aPBC) because it is reported that UDCA decreases mortality and prolongs the time of liver transplantation. However, only 20-30% of patients respond fully to UDCA. Recently, lipoproteinlowering agents have been found to be effective for PBC. The aim of this study was to examine the safety and efficacy of fenofibrate, a member of the fibrate class of hypolipidemic and anti-inflammatory agent via peroxysome proliferatory activated receptor α, in patients with aPBC. METHODS: Fenofibrate was administered for twelve weeks in nine patients with aPBC who failed to respond to UDCA. UDCA was used along with fenofibrate during the study. The data from aPBC patients were analyzed to assess the biochemical effect of fenofibrate during the study. RESULTS: The serum levels of alkaline phosphatase (ALP) (285±114.8 IU/L) and immunoglobulin M (IgM) (255.8±85.9 mg/dl) significantly decreased to 186.9±76.2 IU/L and 192.9±67.5 mg/dL respectively, after fenofibrate treatment in patients with aPBC (P<0.05). Moreover, the titer of antimitochondrial antibody (AMA) also decreased in 4 of 9 patients with aPBC. No adverse reactions were observed in any patients.CONCLUSION: Fenofibrate appears to be significantly effective in treating patients with aPBC who respond incompletely to UDCA alone. Although the mechanism of fenofibrate on aPBC has not yet been fully clarified, combination therapy using fenofibrate and UDCA might be related to the anti-immunological effects, such as the suppression of AMA production as well as its anti inflammatory effect.

  20. DIFFERENTIAL DIAGNOSIS OF NORMOCALCEMIC HYPERPARATHYROIDISM

    Directory of Open Access Journals (Sweden)

    N. A. Kravchun

    2015-01-01

    Full Text Available Objective: to describe a case of normocalcemic hyperparathyroidism.Materials and methods. A female patient aged 51 years sought medical advice for complaints of spinal column and bone pains, periodic dizziness, and hand numbness. The patient underwent clinical and biochemical blood tests, determination of the blood levels of calcium, phosphorus, parathyroid hormone, concentrations of total vitamin D, calciuria, electrocardiography, thyroid ultrasonography, and neck computed tomography.Results. Based on her complaints, examination evidence, evaluation of the clinical presentations of the disease, and objective and instrumental examination findings, the patient was diagnosed with left parathyroid adenoma and primary hyperparathyroidism; stage II hypertensive disease, grade I, a moderate risk; retinal angiopathy of both eyes; stage I dyscirculatory encephalopathy with liquor and venous dyscirculation and moderate vestibular ataxia; urolithiasis; kidney stones; and spondylosis mainly involving the lumbar spine. The diagnostic determinants for verifying the diagnosis were the results of neck computed tomography, namely: the signs of space-occupying lesion in the projection of the left parathyroid gland; the blood level of parathyroid hormone 118.6 pg/ml (normal value (N 9.5–75.0 pg/ml; total vitamin D 21.64 nmol/l (N 75–250 nmol/l; and calcium 2.48 mmol/l (N 2.15–2.50 mmol/l. The history of urolithiasis, repeated lithotripsy, as well as spondylosis with lumboischalgia was an absolute indication for surgical treatment.Conclusion. The practical interest in this case is due to the complexity of diagnosing normocalcemic hyperparathyroidism after vitamin D deficiency. The early stages of primary hyperparathyroidism are asymptomatic and frequently give rise to irreversible renal complications, causing renal failure and, as a consequence, disability. This clinical case demonstrates the importance of routinely determining vitamin D concentrations

  1. Interest of the tomo-scintigraphy coupled to the computed tomography in the primary hyperparathyroidism; Interet de la tomoscintigraphie couplee a la tomodensitometrie dans les hyperparathyroidies primaires

    Energy Technology Data Exchange (ETDEWEB)

    Castilla-Lievre, M.A.; Benelhadj, S.; Helal, B. [Service de medecine nucleaire, hopital Antoine-Beclere, Clamart, (France)

    2009-05-15

    The aim of this study is to evaluate the contribution of the tomo-scintigraphy coupled to the computerized tomography (SPECT-T.D.M.) compared with planar imaging, for patients having a primary hyperparathyroidism. In our series, the SPECT-T.D.M. allowed to improve the anatomical localization of parathyroid adenomas, often useful to the surgeon in the management of primary hyperparathyroidism. In case of ambiguous image, it allowed to identify them. (N.C.)

  2. Hyperparathyroidism in pregnancy: Report of two cases

    Directory of Open Access Journals (Sweden)

    Adem Güngör

    2013-09-01

    Full Text Available Primary hyperparathyroidism is a quite rare, life-threateningsituation for mother and fetus in pregnancy. The diagnosisis difficult when hyperemesis gravidarum is present.At diagnosis, the increase in PTH and calcium level andthe decrease in phosphorus level is quite important. Thegold Standard in radiological diagnosis is technetium-99msestamibi scintigraphy screening method. However, it iscontraindicated in pregnancy. Previously diagnosed pregnantwomen are given to surgery if they are symptomaticif they asymptomatic they are followed up until the end ofpregnancy by medical treatment. If it is possible surgicalprocedure most be performed in the second trimester ofpregnancy. In this report, two patients with hyperparathyroidismthat diagnosed during pregnancy are presented.Key words: Primary hyperparathyroidism, pregnancy,hyperemesis gravidarum

  3. Rapid Progression of Metastatic Pulmonary Calcification and Alveolar Hemorrhage in a Patient with Chronic Renal Failure and Primary Hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Eun Joo; Kim, Dong Hun; Yoon, Seong Ho [Chosun University College of Medicine, Gwangju (Korea, Republic of); Suk, Eun Ha [Dept. of Anaesthesiology and Pain Medicine, Seonam University College of Medicine, Namwon (Korea, Republic of)

    2013-06-15

    Metastatic pulmonary calcification (MPC) is common in patients with chronic renal failure. The authors experienced a patient with chronic renal failure and primary hyperparathyroidism by parathyroid adenoma accompanied with rapid progressions of MPC and alveolar hemorrhage. Recent chest radiographs, compared with previous chest radiographs, showed rapid accumulation of calcification in both upper lungs. Following up on the high-resolution CT scan after five years demonstrates more increased nodules in size and ground glass opacity. The patient was diagnosed with MPC and alveolar hemorrhage by transbronchial lung biopsy. We assumed rapid progression of MPC and alveolar hemorrhage in underlying chronic renal failures could be a primary hyperparathyroidism which may be caused by parathyroid adenoma detected incidentally. Therefore parathyroid adenoma was treated with ethanol injections. Herein, we have reported on CT findings of MPC with alveolar hemorrhage and reviewed our case along with other articles.

  4. Primary Hyperparathyroidism: The Influence of Bone Marrow Adipose Tissue on Bone Loss and of Osteocalcin on Insulin Resistance

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    Maira L. Mendonça

    Full Text Available OBJECTIVES: Bone marrow adipose tissue has been associated with low bone mineral density. However, no data exist regarding marrow adipose tissue in primary hyperparathyroidism, a disorder associated with bone loss in conditions of high bone turnover. The objective of the present study was to investigate the relationship between marrow adipose tissue, bone mass and parathyroid hormone. The influence of osteocalcin on the homeostasis model assessment of insulin resistance was also evaluated. METHODS: This was a cross-sectional study conducted at a university hospital, involving 18 patients with primary hyperparathyroidism (PHPT and 21 controls (CG. Bone mass was assessed by dual-energy x-ray absorptiometry and marrow adipose tissue was assessed by 1H magnetic resonance spectroscopy. The biochemical evaluation included the determination of parathyroid hormone, osteocalcin, glucose and insulin levels. RESULTS: A negative association was found between the bone mass at the 1/3 radius and parathyroid hormone levels (r = -0.69; p<0.01. Marrow adipose tissue was not significantly increased in patients (CG = 32.8±11.2% vs PHPT = 38.6±12%. The serum levels of osteocalcin were higher in patients (CG = 8.6±3.6 ng/mL vs PHPT = 36.5±38.4 ng/mL; p<0.005, but no associations were observed between osteocalcin and insulin or between insulin and both marrow adipose tissue and bone mass. CONCLUSION: These results suggest that the increment of adipogenesis in the bone marrow microenvironment under conditions of high bone turnover due to primary hyperparathyroidism is limited. Despite the increased serum levels of osteocalcin due to primary hyperparathyroidism, these patients tend to have impaired insulin sensitivity.

  5. Primary hyperparathyroidism:20 cases%原发性甲状旁腺功能亢进症20例

    Institute of Scientific and Technical Information of China (English)

    王金; 徐祗顺; 姜先洲; 陈军; 亓天伟

    2005-01-01

    我国原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)发病率较低,而且确诊多为出现严重并发症的晚期病例。故其早期诊断和治疗尚存在一些问题值得探讨。

  6. A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma

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    Mario Molina-Ayala

    2015-01-01

    Full Text Available Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%. Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL, high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30, compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.

  7. A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma

    Science.gov (United States)

    Molina-Ayala, Mario; Ramírez-Rentería, Claudia; Manguilar-León, Analleli; Paúl-Gaytán, Pedro; Ferreira-Hermosillo, Aldo

    2015-01-01

    Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later. PMID:26161274

  8. Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism

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    Viral N Shah

    2014-01-01

    Full Text Available Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT. This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT. The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30% were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%, constipation 55 (36%, and nausea/or vomiting 46 (30%. Nearly one-fourth 34 (22% of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05. Imaging and biochemical evidence of pancreatitis was found in 27 (18% patients. Pancreatitis was more common in men compared to women (P<0.05 despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05 was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with

  9. Use of cinacalcet in nephrolithiasis associated with normocalcemic or hypercalcemic primary hyperparathyroidism: results of a prospective randomized pilot study

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    Simone Brardi

    2015-03-01

    Full Text Available Objectives: To evaluate, by means of a prospective randomized study, the efficacy of cinacalcet in the forms of nephrolithiasis associated with primary hyperparathyroidism in both the hypercalcemic and normocalcemic variant. Materials and Methods: Ten patients suffering from active nephrolithiasis associated with primary hyperparathyroidism (4 hypercalcemics and 6 normocalcemics, equally divided between males and females, were randomly but not blindly addressed to treatment with potassium citrate and allopurinol, or to the same therapeutic regimen in combination with cinacalcet. The dosage of cinacalcet was optimized for each patient in order to obtain a reduction of parathyroid hormone (PTH within normal limits while enabling the maintenance of adequate calcemic values. All study participants were given the same diet based on a reduction in sodium intake, oxalate-rich foods and animal protein with standardized intake of calcium and an increase in hydration. After a follow up period of 10 months , cinacalcet was associated to standard therapy and diet in patients who were not taken it, conversely cinacalcet was withdrawn in the remaining patients who remained on standard therapeutic regimen and diet. Follow up was continued for a second period of observation of the same duration of the first. Results: At the end of the period of treatment with cinacalcet, for both variants of hyperparathyroidism, a statistically significant reduction in the overall number and in the diameter of renal stones was found. Conclusions: This prospective randomized study shows the effectiveness of cinacalcet used in combination with a diet with normalized calcium intake, in reducing the number and size of urinary stones in hypercalemic and normocalcemic forms of primary hyperparathyroidism.

  10. Usefulness of {sup 99m}Tc-methoxy-isobutyl-isonitrile scintigraphy for preoperative localization of adenoma in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Seiji; Kobayashi, Yoshiyuki; Tsujikawa, Kozo [Ikeda Municipal Hospital, Osaka (Japan)] (and others)

    2001-09-01

    We evaluated the usefulness of {sup 99m}Tc-methoxy-isobutyl-isonitrile (MIBI) dual phase scintigraphy for detecting hyperfunctioning parathyroid adenoma. We retrospectively reviewed 18 hyperparathyroid patients who received MIBI prior to neck exploration and compared the radiological findings of MIBI with ultrasonography (US) and magnetic resonance imaging (MRI). Fifteen patients were studied with MRI, and 17 patients were examined with US. All patients were found to have a solitary parathyroid adenoma histopathologically. MIBI correctly revealed the location of 17 adenomas among 18 confirmed tumors. In our series, there was one false-positive case that was found to have thyroid adenoma. The diagnostic sensitivity of MIBI MRI and US and 94.4%, 80% and 52.5%, respectively. The positive predictive value (PPV) was 94.4% for MIBI, 81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and accurate for the preoperative localization of adenoma in primary hyperparathyroidism. (author)

  11. Contribution of the Technetium-99m-sestamibi (MIBI) scintigraphy in primary hyperparathyroidism to determination of parathyroidectomy

    Energy Technology Data Exchange (ETDEWEB)

    Nishida, Takuro; Hayakawa, Katsumi; Nishimura, Kazumasa; Kawakami, Satoshi; Sakamoto, Makoto; Koh, Toshikiyo; Hida, Shuichi [Kyoto City Hospital (Japan)

    1999-02-01

    We reviewed retrospectively the 12 patients who underwent parathyroidectomy because of hyperparathyroidism and judged to what degree the Technetium-99m-sestamibi (MIBI) scintigraphy contributed to determination of parathyroidectomy. From the view point that weather parathyroidectomy could be decided without the MIBI scintigraphy, we classified the cases into three groups; great, fair, and poor contribution. We judged 4 cases as great contribution, 5 cases as fair contribution and 3 cases as poor contribution. We concluded that if the MIBI scintigraphy is positive in patients with primary hyperparathyroidism, parathyroidectomy is strongly recommended, because of its high sensitivity and accuracy for detection of parathyroid adenomas and because there were no false-positive cases with the MIBI scintigraphy. (author)

  12. Reduced immunostaining for the extracellular Ca{sup 2+} - sensing receptor in primary and uremic secondary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Kifor, O.; Moore, F.D. Jr.; Wang, P. [Brigham and Women`s Hospital, Boston, MA (United States)] [and others

    1996-04-01

    Most parathyroid adenomas and some pathological parathyroid glands from patients with primary parathyroid hyperplasia or severe uremic secondary/tertiary hyperparathyroidism show an elevated set-point. In the present study, we investigated whether expression of the Ca{sup 2+}{sub o}-sensing receptor protein recently cloned from bovine parathyroid, a key component in Ca{sup 2+}{sub o}-regulated PTH release, is altered in primary and uremic hyperparathyroidism. Using immunohistochemistry with specific antireceptor antibodies, we compared immunoreactivity of the receptor protein in 14 adenomas, biopsies of 24 normal glands from this same group of patients, and 8 hyperplastic parathyroid glands from 2 individuals with uremic hyparathyroidism. The results show a substantial reduction in the intensity of immunostaining for the receptor protein that averaged nearly 60% for both adenomas and hyperplastic glands, as quantitated by image analysis. There was considerable variation in staining intensity among different pathological parathyroid glands, even in those from the same patient with secondary hyperparathyroidism. In addition, both adenomas and hyperplastic glands had, in some cases, isolated chief cells and groups of cells, sometimes around the periphery of an abnormal gland, with receptor staining equivalent to that of normal parathyroid cells, whereas the bulk of the cells in the same gland showed a marked decrease in staining. Thus, there is a variable, but substantial, reduction in the immunoreactivity of the Ca{sup 2+}{sub o}-sensing receptor protein in both parathyroid adenomas and uremic hyperparathyroidism, as assessed by immunohistochemistry, that probably results from reduced expression of the receptor protein and may contribute to the increase in the set-point often observed in these patients. 49 refs., 8 figs., 1 tab.

  13. Image diagnosis of hyperparathyroidism

    OpenAIRE

    森川, 満; 佐賀, 裕司; 渡部, 嘉彦; 藤沢, 真; 金子, 茂男; 徳中, 荘平; 八竹, 直

    1989-01-01

    Between January, 1983 and January 1988, the diagnosis of hyperparathyroidism was made on 14 patients (8 primary and 6 secondary), and was identified operatively in all. The procedures for image diagnosis were computed tomography (CT), ultrasonography and scintigraphy. Scintigraphy was performed using Tc-99m and Tl-201 by a subtraction technique. For primary hyperparathyroidism, the accuracy of localization was 100% by CT, 87.5% by ultrasonography, 100% by scintigraphy, and 100% by the combina...

  14. Comparisons of serum sclerostin levels among patients with postmenopausal osteoporosis, primary hyperparathyroidism and osteomalacia.

    Science.gov (United States)

    Kaji, H; Imanishi, Y; Sugimoto, T; Seino, S

    2011-07-01

    Wnt-β-catenin signaling is important for bone formation. Sclerostin inhibits bone formation mainly by suppressing this signal, and several studies suggest that the suppression of sclerostin expression contributes to the bone anabolic action of parathyroid hormone (PTH). We therefore examined serum sclerostin levels using enzyme-linked immunosolvent assay in 18 patients with postmenopausal osteoporosis, 9 postmenopausal women with primary hyperparathyroidism (pHPT) and 7 patients with osteomalacia. Serum levels of sclerostin were significantly lower in the group with pHPT, compared with those with postmenopausal osteoporosis. Moreover, serum sclerostin levels were significantly lower in the group with tumor-induced osteomalacia, but not in the group with osteomalacia without tumor, compared with those with postmenopausal osteoporosis. In patients with pHPT, serum sclerostin levels were significantly and negatively correlated to serum calcium and PTH levels. In patients with postmenopausal osteoporosis, serum levels of sclerostin levels were significantly and positively related to serum calcium and creatinine levels. In conclusion, we showed that serum sclerostin levels are decreased presumably through endogenous PTH elevation in postmenopausal women with pHPT, compared with the patients with postmenopausal osteoporosis.

  15. Improvement of Hypertension after Parathyroidectomy of Patients Suffering from Primary Hyperparathyroidism

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    P. D. Broulik

    2011-01-01

    Full Text Available Background. Primary hyperparathyroidism (PHPT is one of the most common endocrine conditions and is accompanied by hypertension and increased cardiovascular mortality. The purpose of this study was to evaluate the effect of parathyroidectomy on systolic and diastolic blood pressure (BP in hypertensive patients with PHPT and whether hypertension occurs more frequently in PHPT than in control group. Methods. A total of 1020 patients with proved PHPT who underwent surgery were compared with with 1020 age, sex, BMI, and smoking status matched controls. We evaluated changes in serum calcium, parathyroid hormone (PTH, uric acid, and BP before and 6 months after surgery. Results. Parathyroidectomy corrected PHPT and resulted in a substantial fall in both mean systolic (150±3.8 to 138±3.6 mmHg and mean diastolic pressures (97±3 to 88±2.8 mmHg of the hypertensive subjects; P<.01. In these patients, PTH, calcium, and uric acid normalized. 726 patients from 1020 with PHPT (69.8% were found to be hypertensive whilst only 489 (47.8% from 1020 of our control group. Conclusion. Parathyroidectomy in hypertensive patients reduces systolic and diastolic BP. PHPT is accompanied by a variety of metabolic complications, which are a risk factor for hypertension, and parathyroidectomy can improve these metabolic complications.

  16. A retrospective study of primary hyperparathyroidism after neck irradiation. Report of 14 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kanbe, Masako; Obara, Takao; Yamazaki, Kiyomi; Hirose, Kenzo; Okamoto, Takahiro; Yamashita, Tomoyuki; Ito, Yukio; Fujimoto, Yoshihide [Tokyo Women`s Medical Coll. (Japan)

    1997-11-01

    A retrospective review of 396 patients with primary hyperparathyroidism (pHPT) treated surgically revealed a past history of neck external irradiation in 14 patients (35%). The mean interval between radiation exposure and the diagnosis of pHPT was 41 years (range, 31-49 years). All of the patients were women who had been exposed to radiation more than 31 years before. There was a significant difference in the male:female ratio of affected patients (p<0.001). The parathyroid histology was adenoma in 13 patients and carcinoma in one. In ten patients, normal parathyroid gland biopsies were undertaken. Among normal parathyroid glands from two patients, there were nodular lesions. Thirteen (93%) of the 14 patients who had undergone neck irradiation had thyroid nodular disease. In contrast, only 98 (26%) of the 382 patients who had not undergone neck external irradiation had thyroid nodular disease, and the difference between the two groups was significant (p<0.001). Neck irradiation has been shown to increase the risk of parathyroid and thyroid nodular diseases. If neck exploration is necessary in a patient who has received neck irradiation, both the thyroid and parathyroid glands should be carefully evaluated before and during surgery. (author)

  17. Evaluation of Postural Parathyroid Hormone Change in Patients with Primary Hyperparathyroidism

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    Cevdet Aydin

    2014-01-01

    Full Text Available Purpose. In the present study, we aimed to investigate postural change of PTH in normal individuals and in patients with primary hyperparathyroidism (PHPT. Methods. Twenty-two patients with PHPT and nine healthy controls were enrolled. Following 12 h of fast, patients stayed in recumbent position for an hour and PTH and total Ca measurements were performed at the 45th and 60th minutes of resting. Afterwards, the patients resumed an upright posture for an hour and again blood samples were taken at the 45th and 60th minutes of standing. Results. In the PHPT group, mean PTH was calculated as 153.9 pg/mL in the recumbent position while it was 206.3 during upright position (Δ change was 47.7 (P<0.001. In the control group mean serum PTH was measured as 41.2 pg/mL in the recumbent position while it was 44.8 pg/mL in the upright position (Δ change was 1.7 (P=0.11. In both groups, serum Ca was higher in the upright position compared to the recumbent position (P<0.001. Conclusion. Postural change of serum PTH is significant only in PHPT group. Postural PTH test may give a clue to the clinician when the diagnosis of PHPT is equivocal.

  18. Pre-operative sestamibi-technetium subtraction scintigraphy in primary hyperparathyroidism: Experience with 156 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Jones, J. Mark; Russell, Colin F.J.; Ferguson, W. Rodney; Laird, James D

    2001-07-01

    AIM: The aim of this study was to assess the usefulness of pre-operative sestamibi-technetium subtraction scintigraphy in a large cohort of patients with primary hyperparathyroidism (HPT). MATERIALS AND METHODS: A group of 156 consecutive patients with biochemically proven HPT underwent sestamibi-technetium subtraction scintigraphy before cervical exploration. Images were interpreted and reported prospectively and influenced the extent of surgical exploration. The intraoperative findings were compared retrospectively with the pre-operative scintigram reports in 154 individuals with technically satisfactory scintigrams. RESULTS: Of the 154 patients with satisfactory scintigrams, 122 (78.2%) demonstrated a single focus of activity following subtraction, 31 (19.9%) had negative findings and the remaining scintigram showed four foci of activity. At operation 138 (89.6%) solitary adenomas were removed, 13 patients (8.4%) had multi-gland disease and in three individuals (2.0%) no abnormal parathyroid tissue was found. The pre-operative scintigram accurately localized 91 of 98 (92.9%) solitary tumours weighing > 500 mg but only 18 of 35 (51.4%) adenomas weighing < 500 mg, (P < 0.0001). Overall sensitivity of sestamibi-technetium scintigraphy for localizing single parathyroid adenomas was 83.7%. CONCLUSION: Sestamibi-technetium subtraction scintigraphy will accurately localize a high proportion of solitary parathyroid adenomas but its usefulness is diminished by its inability to consistently identify smaller tumours. Jones, J.M. et al. (2001)

  19. [Diagnostic approach and management of hypercalcaemia in dogs exemplary of primary hyperparathyroidism].

    Science.gov (United States)

    Ballhausen, Bianca Désirée; Wehner, Astrid; Zöllner, Martin; Hartmann, Katrin; Unterer, Stefan

    2017-03-29

    Hypercalcaemia can be caused by many different diseases. This article summarizes the causes, pathophysiologic mechanisms and diagnostic procedures as well as treatment recommendations. The main focus is on hypercalcaemia in primary hyperparathyroidism (PH), complemented by a case report. An elevated total calcium level should generally be investigated and verified by measurement of ionized calcium concentration. The further diagnostic approach depends on the phosphate level. Tumour screening, measurement of parathormone and parathromone-related protein and sonography of parathyroid glands may be necessary. If the calcium-phosphate-product exceeds 60 mg/dl, there is a risk of tissue mineralisation and a rapid treatment of hypercalcaemia is required. For acute therapy, sodium chloride infusion, furosemide and glucocorticoids can be used. Glucocorticoids should only be given after strict indication and after a definite diagnosis. For long-term management, bisphosphates, particularly alendronate, are increasingly used successfully. Causal therapy of PH can be performed by parathyreoidectomy, heat ablation or ethanol ablation. Thereafter, particularly in cases of severe preoperative hypercalcaemia, hypocalcaemia can occur. Treatment is performed using vitamin D3 (calcitriol), which may also be given preoperatively in cases of severe hypercalcaemia. A concomitant oral calcium supplementation using calcium carbonate as medication of choice is contentious. Due to a potential relapse after successful excision of the affected parathyroid gland in PH, the serum calcium level should be monitored periodically.

  20. Radioguided Parathyroidectomy with Portable Mini Gamma-Camera for the Treatment of Primary Hyperparathyroidism

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    Claudio Casella

    2015-01-01

    Full Text Available Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP. The recent introduction of portable mini gamma-cameras (pMGCs enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys. Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound and Tc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared. Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87% and scintigraphy with Tc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%. Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques.

  1. An integrated approach for the surgical treatment of patients with primary hyperparathyroidism

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    D D Dolidze

    2013-09-01

    Full Text Available This paper presents the treatment results of 75 patients with primary hyperparathyroidism (PHPT caused by a solitary parathyroid adenoma (SPA. Patients in Group 1 had PHPT with concomitant diseases of the thy roid gland (TG. Group 2 consisted of patients with PHPT without thyroid disease. Group 3 included patients with PHPT and concurrent diseases of the parathyroid glands (PG and thyroid gland, which were operated on without the use of the proposed integrated approach. Patients in groups 1 and 2 were operated on using the following techniques. Patients in group 1 underwent surgery usinga traditional incision with photodynamic visualization (PV of the PG and exposure of the recur rent and superior laryngeal nerves (LN (in some cases with the use of magnifying devices and neuromyog raphy. Patients in group 2 underwent surgery with minimally invasive access, utilizingendoscopic video devices and the universal retractor “Multifiks1”. During the intervention,PVof the PG and electrophysiolog ical monitoring (EMof the recurrent LN were carried out. In groups 1 and 2, adequacy of the operationwas determined by the change in the level of intraoperative parathyroid hormone (PTH and ionized calcium before and after the removal of the PG. Our proposed integrated method for the treatment of patients with PHPT allowed for a significant reduction in the risk of postoperative complications and consequently an improvement in quality of life.

  2. Cinacalcet Reduces Serum Calcium Concentrations in Patients with Intractable Primary Hyperparathyroidism

    Science.gov (United States)

    Marcocci, Claudio; Chanson, Philippe; Shoback, Dolores; Bilezikian, John; Fernandez-Cruz, Laureano; Orgiazzi, Jacques; Henzen, Christoph; Cheng, Sunfa; Sterling, Lulu Ren; Lu, John; Peacock, Munro

    2009-01-01

    Context: Patients with persistent primary hyperparathyroidism (PHPT) after parathyroidectomy or with contraindications to parathyroidectomy often require chronic treatment for hypercalcemia. Objective: The objective of the study was to assess the ability of the calcimimetic, cinacalcet, to reduce serum calcium in patients with intractable PHPT. Design: This was an open-label, single-arm study comprising a titration phase of variable duration (2–16 wk) and a maintenance phase of up to 136 wk. Setting: The study was conducted at 23 centers in Europe, the United States, and Canada. Patients: The study included 17 patients with intractable PHPT and serum calcium greater than 12.5 mg/dl (3.1 mmol/liter). Intervention: During the titration phase, cinacalcet dosages were titrated every 2 wk (30 mg twice daily to 90 mg four times daily) for 16 wk until serum calcium was 10 mg/dl or less (2.5 mmol/liter). If serum calcium increased during the maintenance phase, additional increases in the cinacalcet dose were permitted. Main Outcome Measure: The primary end point was the proportion of patients experiencing a reduction in serum calcium of 1 mg/dl or greater (0.25 mmol/liter) at the end of the titration phase. Results: Mean ± sd baseline serum calcium was 12.7 ± 0.8 mg/dl (3.2 ± 0.2 mmol/liter). At the end of titration, a 1 mg/dl or greater reduction in serum calcium was achieved in 15 patients (88%). Fifteen patients (88%) experienced treatment-related adverse events, none of which were serious. The most common adverse events were nausea, vomiting, and paresthesias. Conclusions: In patients with intractable PHPT, cinacalcet reduces serum calcium, is generally well tolerated, and has the potential to fulfill an unmet medical need. PMID:19470620

  3. Cardiovascular changes in patients with primary hyperparathyroidism%原发性甲状旁腺功能亢进症患者的心血管改变

    Institute of Scientific and Technical Information of China (English)

    朱燕; 邢小平

    2010-01-01

    原发性甲状旁腺功能亢进症(甲旁亢)患者的死亡率明显增高,而其主要死亡原因为心血管系统疾病.目前,原发性甲旁亢的临床谱已经发生了明显变化,无症状原发性甲旁亢的比例逐渐增加.然而,即使在疾病早期原发性甲旁亢患者也会发生-系列心血管异常,包括:左室肥厚、瓣膜钙化、血管反应受损、高血压、血糖及血脂代谢异常等,而这些心血管病变在手术后可以得到一定程度的改善.%Primary hyperparathyroidism(PHPT) has been associated with increased mortality,which mainly due to cardiovascular disease. Nowadays, the clinical spectrum of PHPT have changed to an asymptomatic form. However,even in the early stage,PHPT have overpresented cardiovascular abnormalities including left ventricular hypertrophy, valvular calcification, impaired vascular reaction, hypertension,impaired glucose metabolism and dislipidemia, which can be improved to certain degree after surgery.

  4. Cinacalcet hydrochloride relieves hypercalcemia in Japanese patients with parathyroid cancer and intractable primary hyperparathyroidism.

    Science.gov (United States)

    Takeuchi, Yasuhiro; Takahashi, Shunsuke; Miura, Daishu; Katagiri, Makoto; Nakashima, Noriaki; Ohishi, Hiroko; Shimazaki, Ryutaro; Tominaga, Yoshihiro

    2016-11-21

    Pharmacological treatment of hypercalcemia is essential for patients with parathyroid carcinoma and intractable primary hyperparathyroidism (PHPT). Use of the calcimimetic cinacalcet hydrochloride (cinacalcet) is an option to treat such patients. We investigated the efficacy and safety of cinacalcet in Japanese patients with parathyroid carcinoma and intractable PHPT. Five Japanese patients with parathyroid carcinoma and two with intractable PHPT were enrolled in an open-label, single-arm study consisting of titration and maintenance phases. Cinacalcet doses were titrated until the albumin-corrected serum calcium concentration decreased to 10.0 mg/dL or less or until dose escalation was considered not necessary or feasible. Serum calcium concentration at the baseline was 12.1 ± 1.3 mg/dL (mean ± standard deviation; range 10.4-14.6 mg/dL) and decreased to 10.1 ± 1.6 mg/dL (range 8.6-13.3 mg/dL) at the end of the titration phase with cinacalcet at a dosage of up to 75 mg three times a day. At the end of the titration phase, at least a 1 mg/dL reduction in serum calcium concentration from the baseline was observed in five patients (three with carcinoma and two with PHPT), and it decreased to the normocalcemic range in five patients (three with carcinoma and two with PHPT). Common adverse events were nausea and vomiting. One patient discontinued participation in the study because of an adverse event, liver disorder. Cinacalcet effectively relieved hypercalcemia in 60% of the Japanese patients with parathyroid carcinoma and might be effective in those with intractable PHPT. The drug might be tolerable and safe at a dosage of at most 75 mg three times a day.

  5. Clinical profile of primary hyperparathyroidism from western India: A single center experience

    Directory of Open Access Journals (Sweden)

    Gopal R

    2010-01-01

    Full Text Available Background: Primary hyperparathyroidism (PHPT has a variable clinical presentation and symptomatic PHPT is still the predominant form of the disease in India. Data from western India is lacking. Aim : To present the clinical profile of PHPT from western India. Settings and Design : This retrospective study was conducted at a tertiary care referral center. Materials and Methods : We analyzed the clinical presentation, biochemical, radiological features, and operative findings in adult patients with PHPT (1986-2008 and compared with our published data of children and adolescent patients with PHPT. Statistical Analysis : was done with SPSS 16 software. Results : Seventy-nine patients (F: M-2:1 with age ranging from 21 to 55 years (mean 33.5±8.82 were analyzed. Skeletal manifestations (75.5%, renal calculi (40.5% and proximal muscle weakness (45.5% were the most common symptoms of presentation with mean duration of symptoms being 33.70 (median: 24, range 1-120 months. Biochemical features included hypercalcemia (total corrected calcium 12.55±1.77 mg/dl, low inorganic phosphorus (1.81±0.682 mg/dl, elevated total alkaline phosphatase (mean: 762.2; median: 559; range: 50-4930IU/L and high parathyroid hormone (PTH (mean±SD: 866.61±799.15; median: 639.5; range: 52-3820 pg/ml. Preoperative localization was achieved in 74 patients and single adenoma was found during surgery in 72 patients. Hungry bone disease was seen in 30.3% and transient hypoparathyroidism developed in 62% patients. In comparison to PHPT in children there were no significant differences with regard to clinical, laboratory and radiological features. Conclusions : PHPT in western India is symptomatic disorder with skeletal and renal mani-festations at a much younger age. Clinical profile of PHPT in children is similar to that of adults.

  6. Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study.Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

  7. Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Talavera, Paloma [University Hospital of Valladolid, Department of Nuclear Medicine, Valladolid (Spain); Gonzalez, Carmen; Gomez, Alberto [University Hospital of Salamanca, Department of Surgery, Salamanca (Spain); Garcia-Talavera, Jose Ramon; Martin, Esther; Martin, Mariano [University Hospital of Salamanca, Department of Nuclear Medicine, Salamanca (Spain)

    2010-11-15

    Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative {sup 99m}Tc-MIBI dual phase scintigraphy. Included in the study were 87 patients with a diagnosis of primary hyperparathyroidism who underwent radioguided surgery. They were divided into two groups depending on the presence of concomitant thyroid pathology (TP group, 33 patients) or absence of concomitant thyroid pathology (NTP group, 54 patients). In the TP group, ioPTHi achieved the highest accuracy (90.9%), followed by the gamma probe (81.8%) and scintigraphy (69.7%). In the NTP group, the probe (94.4%) performed better than ioPTH and scintigraphy (both 85.2%). In the TP group, scintigraphy in combination with the gamma probe had a success rate of 90.9%, and 94% in combination with ioPTHi. The three techniques are applied together had a success rate of 97%. For all patients undergoing MIRP, the probe alone worked well, irrespective of the presence or absence of concomitant thyroid pathology. Patients with concomitant thyroid pathology should not be a priori excluded from a MIRP, as long as other adjuvant techniques (scintigraphy or ioPTHi) are used in conjunction with the gamma probe. In these patients, the probe can also be helpful in unilateral or bilateral surgery. (orig.)

  8. Preoperative serum alkaline phosphatase: a predictive factor for early hypocalcaemia following parathyroidectomy of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    Sun Longhao; He Xianghui; Liu Tong

    2014-01-01

    Background Postoperative hypocalcemia is one of the most common complications following parathyroidectomy for primary hyperparathyroidism (PHPT).The aim of this study was to analyze the predictive value of biochemical parameters as indicators for episodes of hypocalcemia in patients undergoing parathyroidectomy for PHPT.Methods The patients with PHPT who underwent parathyroidectomy between February 2004 and February 2014 were studied retrospectively at a single medical center.The patients were divided into biochemical,clinical,and no postoperative hypocalcemia groups,based on different clinical manifestations.Potential risk factors for postoperative hypocalcemia were identified and investigated by univariate and multivariate Logistic regression analysis.Results Of the 139 cases,25 patients (18.0%) were diagnosed with postoperative hypocalcemia according to the traditional criterion.Univariate analysis revealed only alkaline phosphatase (ALP) and the small area under the curve (AUC) of receiver operating characteristics (ROC) curve for ALP demonstrates low accuracy in predicting the occurrence of postoperative hypocalcemia.Based on new criteria,22 patients were added to the postoperative hypocalcemia group and similar biochemical parameters were compared.The serum ALP was a significant independent risk factor for postoperative hypocalcemia (P=0.000) and its AUC of ROC curve was 0.783.The optimal cutoff point was 269 U/L and the sensitivity and specificity for prediction were 89.2% and 64.3%,respectively.Conclusions The risk of postoperative hypocalcemia after parathyroidectomy should be emphasized for patients with typical symptoms of hypocalcemia despite their serum calcium level is in normal or a little higher range.Serum ALP is a predictive factor for the occurrence of postoperative hypocalcemia.

  9. Parathyroid adenoma apoplexy as a temporary solution of primary hyperparathyroidism: a case report

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    Pereira Francisco A

    2007-11-01

    Full Text Available Abstract Introduction The natural history of patients with spontaneous parathyroid necrosis is unknown. In this case report we describe the clinical course, laboratory, radiographic, bone densitometry tests, parathyroid ultrasonography and scintigraphy examinations of a patient performed over a period of eight years after she first presented with a sudden episode of spontaneous resolution of primary hyperparathyroidism (PHPT. Case presentation A 24-year-old woman with a clinical history and laboratory and radiographic tests compatible with PHPT suffered a sudden episode of cervical pain and presented with clinical evidence of hypocalcemia. Biopsy of a cervical nodule revealed necrotic material compatible with ischemia of the parathyroid. The follow-up of the patient presented four distinct phases: the first, which lasted two years, was compatible with a period of bone hunger during which it was necessary to introduce calcitriol and calcium carbonate. During this period, the patient showed bone mass gain. The second phase was characterized by normalization of calcium and parathyroid hormone levels and its end was difficult to define. During the third phase there was a recurrence of hypercalcemia associated with elevated parathyroid hormone (PTH levels and loss of bone mass. The last phase corresponded to the interval after parathyroidectomy, which was characterized by normalization of serum levels of calcium and PTH, as well as bone mass gain. Conclusion This case report indicates that spontaneous resolution of PHPT by adenoma necrosis is potentially temporary. Thus, in cases in which a conservative approach is chosen, clinical and laboratory follow-up is indispensable. Bone mass measurement is a useful tool in the follow-up of these cases. However, this option exposes the patient to a potential roller-coaster ride of bone mass gain and loss, whose long term consequences are still unknown.

  10. Novel multiple endocrine neoplasia type 1 variations in patients with sporadic primary hyperparathyroidism

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    S Birla

    2016-01-01

    Full Text Available Background and Objectives: Primary hyperparathyroidism (PHPT can occur either as a sporadic case or in association with syndromes such as multiple endocrine neoplasia. Multiple endocrine neoplasia type 1 (MEN1 is a rare autosomal-dominant disease resulting from mutations in MEN1 gene encoding a 621 amino acid long tumor suppressor protein “menin.” We report here the results of MEN1 screening in 31 patients diagnosed with sporadic PHPT. Materials and Methods: Diagnosis of sporadic PHPT was made when blood urea and serum creatinine were normal, serum parathyroid hormone was high, and parathyroid enlargement could be localized on ultrasound and/or parathyroid scan. A total of 31 patients and 50 healthy volunteers were recruited for molecular analysis after taking informed consent. Results: Major symptoms at presentation were bone pain, fatigue, muscle weakness, and renal stones. Molecular genetic analysis revealed the presence of two novel intronic variations, c. 913-79T>A and c. 784-129T>A which by human splicing finder are predicted to cause potential alteration of splicing by either activating an intronic cryptic acceptor site or converting a conserved exonic splicing silencer sequence to an exonic splicing enhancer site. Apart from these, two reported polymorphisms rs144677807 and rs669976 were seen only in patients and none of the controls. Other reported polymorphisms rs2071313 and rs654440 were identified both in controls and patients. Conclusions: This is the first study of MEN1 gene screening in sporadic PHPT in India reporting on the clinical and genetic findings, wherein two novel intronic variations c. 913-79T>A and c. 784-129T>A were identified showing their possible role in disease causation.

  11. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Rosaria M. Ruggeri

    2010-01-01

    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  12. Asymptomatic intraventricular lipid leak from a primary pineal teratoma

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, R.L.; Abernethy, L.J. [Royal Liverpool Children' s Hospital (United Kingdom)

    2001-02-01

    We present a case of pineal teratoma in a symptomatically stable 6-year-old child in which MRI revealed intraventricular lipid accumulation in the absence of any primary tumour growth, metastatic disease or tumour degeneration. (orig.)

  13. Concomitant Graves' disease and primary hyperparathyroidism: the first case report in mainland of China and literature review

    Institute of Scientific and Technical Information of China (English)

    肖海鹏; 余斌杰; 王深明; 陈国锐

    2002-01-01

    @@ Concurrent Graves' disease and primary hyperparathyroidism in the same patient is rare, probably accounts for hypercalcemia in no more than 1 percent of thyrotoxic patients.1 Hypercalcemia may be noted during the course of hyperthyroidism in as many as 22 percent of cases.2 The cause of hypercalcemia in a thyrotoxic patient might be due to the activation of osteoclastic bone resorption3,4 by the excess thyroid hormone, as the severity of hyperthyroidism correlates positively with osteoclastic activity in trabecular and cortical bone.5 In 1936, Noble JF et al reported the first case in the world.6 To our knowledge, only 49 such cases have been described in the literature until the year of 1989.7 No case has been reported again afterward. The occurrence of hypercalcemia in a patient with hyperthyroidism may present a challenging diagnostic problem. In this communication, we described the first case in mainland of China with hypercalcemia caused by concurrent hyperthyroidism and primary hyperparathyroidism, and the clinical and laboratory characteristics were studied before and after therapy with anti-thyroid medication.

  14. Usefulness and indication of {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) for preoperative localization in patients with primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Kiyomi; Obara, Takao; Kusakabe, Kiyoko; Ito, Yukio; Okamoto, Takahiro; Tanaka, Reiko; Kanbe, Masako; Iihara, Masatoshi; Okamoto, Joji [Tokyo Women`s Medical Coll. (Japan)

    1997-12-01

    We assessed the efficacy of {sup 99m}Tc-methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) for preoperative localization of parathyroid tumors. Twenty patients (seven male and 13 female, mean age 54 years) with primary hyperparathyroidism underwent both cervical ultrasonography and {sup 99m}Tc-MIBI study for tumor localization. The location of parathyroid adenomas was surgically confirmed in all patients, and the serum calcium level became normal in all cases after parathyroidectomy. Ultrasonography failed to detect any parathyroid tumor in three patients, two of whom had ectopic parathyroid adenomas (intrathyroidal and upper mediastinal), even though {sup 99m}Tc-MIBI scans detected parathyroid adenomas in all patients. The detection efficacy of {sup 99m}Tc-MIBI and ultrasonography was 100% (20/20) and 85% (17/20), respectively (p=0.25), and the 95% confidence intervals were 83.2-100% and 62.2-96.7%, respectively. There was no significant difference in detection efficacy between {sup 99m}Tc-MIBI and ultrasonography. Though {sup 99m}Tc-MIBI is effective for localization of ectopic parathyroid tumors, ultrasound examination of the neck is preferable as a first choice for patients with primary hyperparathyroidism, in view of the risk of radioisotope exposure, and the cost and duration of the examination. (author)

  15. [The effects of Cinacalcet in renal stone formers with primary hyperparathyroidism].

    Science.gov (United States)

    Vitale, Corrado; Bermond, Francesca; Rodofili, Amelia; Soragna, Giorgio; Marcuccio, Cristina; Tricerri, Alberto; Marangella, Martino

    2016-01-01

    Primary hyperparathyroidism (PHPT) may favor nephrolithiasis mainly through an increase in calcium and phosphate urinary excretion. Cinacalcet exhibits good efficacy to control hypercalcemia in PHPT, but it is not so far known whether it might be a useful tool to prevent stone recurrences. Of 67 patients with PHPT and recurrent nephrolithiasis, 55 underwent parathyroidectomy (PTX) and 12, not eligible to PTX, were prescribed Cinacalcet. All the patients were evaluated for mineral metabolism, including estimation of state of saturation for calcium oxalate (CaOx) and brushite (bsh), both at baseline and after either PTX or Cinacalcet. PTX compared to baseline reduced PTH (4617 vs 15786 pg/mL, p<0.01), calcemia (9.40.5 vs 11.30.9 mg/dL, p<0.01), calciuria (3.62.3 vs 9.24.5 mmol/24h, p<0.01), phosphaturia (18.47.1 vs 21.99.9 mmol/24h, p<0.05), CaOx (4.73.9 vs 9.86.8, p<0.01) and bsh (1.10.9 vs 3.22.2, p<0.01). Cinacalcet decreased both PTH (13379 vs 17187 pg/mL, p<0.05) and calcemia (9.70.6 vs 11.20.8 mg/dL, p<0.001), whereas no change was seen in calciuria (7.42.2 vs 7.42.4 mmol/24h, p=ns), phosphaturia (21.97.3 vs 23.06.5 mmol/24h, p=ns), CaOx (6.92.7 vs 5.42.5, p=ns) and bsh (1.71.1 vs 1.31.3, p=ns). We conclude that in patients with PHPT, PTX is able to decrease the risk for crystallization of calcium salts, whereas calcimimetic Cinacalcet did not. Therefore, in patients with PHPT complicated with nephrolithiasis only PTX can improve urine biochemistries thereby reducing the risk for recurrent calcium stone disease.

  16. Experience with cinacalcet in primary hyperparathyroidism: results after 1 year of treatment

    Science.gov (United States)

    García-Martín, Antonia; Luque-Pazos, Alessandra

    2013-01-01

    Objectives: To assess the characteristics of patients with primary hyperparathyroidism (PHPT) treated with cinacalcet and to evaluate its efficacy in reducing serum calcium and parathyroid hormone (PTH) concentrations after 1 year of treatment. Methods: The study included 20 patients with PHPT who had completed at least 12 months of treatment with cinacalcet (eight patients for refusal of parathyroidectomy, three for surgery not possible due to comorbidities and nine for progressive hypercalcemia prior to surgery). We recorded clinical and biochemical data at baseline, and after 3, 6 and 12 months of treatment. We also monitored adverse events. Cinacalcet was administered in increasing doses until normal serum calcium was reached or side effects preventing a further increase occurred. Results: After 3 months of treatment, serum calcium significantly decreased (11.73 ± 0.85 versus 10.71 ± 1.63 mg/dl, p < 0.001) and serum phosphorus significantly increased (2.41 ± 0.48 versus 2.63 ± 0.70 mg/dl, p = 0.004) while no significant change occurred in PTH (181.91 ± 102.37 versus 195.47 ± 111.71 pg/ml, p = 0.695). No further variation was observed after 6 months compared with 3 months of follow up. However, after 12 months of treatment, there was a significant decrease in PTH concentrations compared with baseline (181.91 ± 102.37 versus 152.47± 70.16 pg/ml, p = 0.028) as well as serum calcium (11.73 ± 0.85 versus 10.20± 0.95 mg/dl, p < 0.001); serum phosphorus significantly increased (2.41 ± 0.48 versus 2.71 ± 0.43 mg/dl, p = 0.01). Normocalcemia (S-Ca < 10.2 mg/dl) was achieved in 55% of patients. The medication was usually well tolerated (83.4%). Most common adverse events were nausea and vomiting, especially at the beginning of therapy. Conclusion: Cinacalcet rapidly reduced serum calcium in patients with PHPT and this reduction remained stable after 1 year of treatment. We also observed a decrease in PTH. Cinacalcet is an effective alternative in nonsurgical

  17. Low vitamin D levels have become less common in primary hyperparathyroidism

    Science.gov (United States)

    Walker, M. D.; Cong, E.; Lee, J. A.; Kepley, A.; Zhang, C.; McMahon, D. J.; Bilezikian, J. P.; Silverberg, S. J.

    2016-01-01

    Summary We compared temporal trends in serum 25-hydroxyvitamin D and parathyroid hormone (PTH) in two primary hyperparathyroidism (PHPT) cohorts recruited 20 years apart. The prevalence of 25-hydroxyvitamin D levels <20 and <30 ng/mL declined by 30–50 %, respectively, and was accompanied by lower PTH. In the older cohort, higher PTH may be due to lower 25-hydroxyvitamin D. Introduction Vitamin D deficiency may exacerbate PHPT. Whether there have been temporal trends in 25-hydroxyvitamin D (25OHD) levels in PHPT is unclear. The prevalence of low vitamin D levels (25OHD <20 and <30 ng/mL) and associated biochemical and bone mineral density (BMD) profiles were assessed in two PHPT cohorts recruited over 20 years apart. Methods This is a cross-sectional comparison of serum 25OHD levels, calciotropic hormones, and BMD between two PHPT cohorts recruited at the same hospital: the “old” (N=103) and “new” (N=100) cohorts were enrolled between 1984 and 1991 and between 2010 and 2014, respectively. Results Mean 25OHD levels were 26 % higher in the new cohort (23±10 vs. 29±10 ng/mL, p<0.0001). Levels of 25OHD <20 and <30 ng/mL declined from 46 and 82 %, respectively, to 19 and 54 % (both p<0.0001). Supplemental vitamin D use was common in the new (64 %) but not the old cohort (0 %). The new cohort demonstrated 33 % lower serum PTH levels (p<0.0001). Neither serum nor urine calcium differed. BMD was higher in the new cohort at all skeletal sites (all p<0.001). Conclusion With the rise in vitamin D supplementation over the last two decades, low 25OHD levels are no longer common in PHPT patients in the New York area. Those with 25OHD <20 and <30 ng/mL have declined by over 50 and 30 %, respectively. The lower mean PTH levels in the new cohort are most likely accounted for by higher vitamin D intake. Whether improved vitamin D status also underlies the relatively higher BMD in the more vitamin D replete cohort of PHPT patients is unknown. PMID:26084258

  18. Studies in asymptomatic primary hyperlipidaemia. V. Peripheral circulation.

    Science.gov (United States)

    Olsson, A G; Eklund, B

    1975-09-01

    The occurrence of early signs of peripheral vascular disease (PVD) of the lower limbs has been studied with digital pulse plethysmography in 160 men and 123 women above the age of 35, who were all subjectively healthy but were found to have primary hyperlipoproteinaemia (HLP) at a health control centre. Quantitative analysis of serum lipoproteins with cholesterol and triglyceride (TG) determination of each of the very low (VLDL), low (LDL) and high (HDL) density lipoprotein clases together with lipoprotein paper electrophoresis was performed. Identical investigations were performed on control subjects with non-elevated serum lipids. Inclination time (IT) was substantially prolonged in 12% of HLP males and 7% of HLP females. The frequency of male subjects with prolonged IT was lower when only LDL was elevated (type IIA) than in the other types of HLP. The subjects with prolonged IT had three characteristic features. 1) Moderate elevations of both serum cholesterol and TG. These elevations occurred often in both VLDL and LDL lipoprotein classes. IT prolongations were not seen when VLDL or LDL lipoproteins were singly maredly elevated. 2) High frequency of smokers. 3) Most of the subjects were above the age of 50. The results suggest that the most atherogenic lipoprotein abnormalities to the arteries of the lower limb are on the one hand the relatively TG-rich part of the LDL (LDL1) fraction and on the other hand the relatively cholesterol-rich part of the VLDL fraction. Furthermore the results stress the deleterious influence of smoking even in the preclinical stage of PVD.

  19. ROLE OF 99Tcm-SESTAMIBI DUAL-PHASE PARATHYROID SCINTIGRAPHY IN PREOPERATIVE LOCALIZATION IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of various imaging modalities. Methods Ninety-two consecutive patients, diagnosed as hyperparathyroidism and presented with hypercalcaemia as the predominant symptom, were included. All the patients underwent dual-phase parathyroid scintigraphy using 99Tcm-sestamibi and parathyroid ultrasound scan. Among them, 48 patients underwent parathyroid computed tomography (CT). All patients were referred for parathyroidectomy. Results 99Tcm-sestamibi dual-phase parathyroid scintigraphy revealed the diagnostic sensitivity of 76.5%, 80%, 75% and 33.3% for the subgroup of single adenomas, multiple adenomas, ectopic parathyroid and parathyroid hyperplasia respectively. The specificity was 100% for all leisons. 99Tcm-sestamibi dual-phase parathyroid scintigraphy was proved to be superior to the other imaging modalities (ultrasound and CT) in terms of the preoperative diagnostic accuracy. The lesion weight was found to be an underlying factor leading to the false negative result. Conclusion 99Tcm-sestamibi dual-phase parathyroid scintigraphy was found to have higher diagnostic accuracy in comparison with other imaging modalities and is recommended preoperatively in order to reduce the sugery time and unnecessary neck exploration.

  20. ANALYSIS OF FACTORS AFFECTING OUTCOME OF ULTRASOUND-GUIDED RADIOFREQUENCY HEAT ABLATION FOR TREATMENT OF PRIMARY HYPERPARATHYROIDISM IN DOGS.

    Science.gov (United States)

    Bucy, Daniel; Pollard, Rachel; Nelson, Richard

    2017-01-01

    Radiofrequency (RF) parathyroid ablation is a noninvasive treatment for hyperparathyroidism in dogs. There are no published data assessing factors associated with RF parathyroid ablation success or failure in order to guide patient selection and improve outcome. The purpose of this retrospective analytical study was to determine whether imaging findings, biochemical data, or concurrent diseases were associated with RF heat ablation treatment failure. For inclusion in the study, dogs must have had a clinical diagnosis of primary hyperparathyroidism, undergone cervical ultrasound and RF ablation of abnormal parathyroid tissue, and must have had at least 3 months of follow-up information available following the date of ultrasound-guided parathyroid ablation. Dogs were grouped based on those with recurrent or persistent hypercalcemia and those without recurrent or persistent hypercalcemia following therapy. Parathyroid nodule size, thyroid lobe size, nodule location, and presence of concurrent disease were recorded. Recurrence of hypercalcemia occurred in 9/32 dogs that had ablation of abnormal parathyroid tissue (28%) and one patient had persistent hypercalcemia (3%) following parathyroid ablation. Nodule width (P = 0.036), height (P = 0.028), and largest cross-sectional area (P = 0.023) were larger in dogs that had recurrent or persistent hypercalcemia following ablation. Hypothyroidism was more common in dogs with recurrent disease (P = 0.044). Radiofrequency ablation was successful in 22/32 (69%) dogs. Larger parathyroid nodule size and/or concurrent hypothyroidism were associated with treatment failure in dogs that underwent ultrasound-guided RF parathyroid nodule ablation.

  1. The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism.

    LENUS (Irish Health Repository)

    Glynn, N

    2012-02-01

    BACKGROUND: There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT). AIM: We aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method. METHODS: We performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed. RESULTS: The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation. CONCLUSION: Sestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.

  2. [The concomitance of pericarditis constrictiva in patient with Silver-Russell syndrome, primary hyperparathyroidism and oncologic history: causal coincidence or pathogenetic sequence?].

    Science.gov (United States)

    Banach, Monika; Zapolski, Tomasz; Drozd, Jakub; Wysokiński, Andrzej

    2011-01-01

    The most common cause of calcific pericarditis is idiopathic. We report a case of a 24 year-old woman with Silver-Russell syndrome, history of Wilms' tumour in childhood, constrictive pericarditis and primary hyperparathyroidism. We analyse pathologic mechanisms of disseminated calcification and possible genetic factors that may contribute to aetiology and clinical presentation of calcific pericarditis.

  3. Tumor pardo maxilar: Elemento diagnóstico de hiperparatiroidismo primario Maxillary brown tumor: A diagnostic tool for primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    S. Gallana Álvarez

    2005-08-01

    Full Text Available El hiperparatiroidismo primario es un transtorno generalizado del metabolismo óseo producido por un aumento de la secreción de hormona paratiroidea (PTH. La etiología de este transtorno es múltiple; en la forma primaria la causa de la hipersecreción de la hormona es la propia glándula, y el motivo más frecuente el adenoma paratiroideo. Los tumores pardos son lesiones óseas focales secundarias a hiperparatiroidismo. El tratamiento de elección de los tumores pardos es la extirpación del adenoma de paratiroides, ya que la normalización de la función paratiroidea debería provocar una reducción del tamaño o desaparición del tumor. Presentamos un caso de tumor pardo mandibular en un paciente con hiperparatiroidismo primario, en el cual el tumor recidivó después de la extirpación del adenoma paratiroideo. La finalidad de la presentación de este caso es recordar el interés que para el cirujano oral y maxilofacial representan las manifestaciones orales de la patología sistémica.The primary hyperparathyroidism is a generalized disorder of the osseous metabolism, caused by hypersecretion of PTH. Hyperparathyroidism has a multiple etiology. In its primary form, the hypersecretion of the hormone is caused by the gland itself, the commonest reason being parathyroid adenoma. The treatment of first choice for brown tumor is the parathyroidectomy because the normalization of parathyroid function should lead to a reduction in size or disappearance of the tumor. We present a case of the brown tumor in the mandible and primary hyperparathyroidism in whom the tumor enlarged after removal of parathyroid adenoma. Upon presentation of this report, our aim is to bring forward the significance oral manifestations of systemic pathology has for oral and maxillofacial surgeons.

  4. Compromiso esquelético en el hiperparatiroidismo primario Bone involvement in primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Luis Fernando Arias Restrepo

    2006-04-01

    Full Text Available La enfermedad ósea sintomática es infrecuente en el hiperparatiroidismo primario (HPTP, y cuando se presenta puede transcurrir mucho tiempo antes del diagnóstico. Con el objetivo de revisar y actualizar conceptos acerca del compromiso esquelético en el HPTP buscamos en nuestros archivos casos de pacientes en quienes las manifestaciones iniciales o principales de la enfermedad hubieran sido las alteraciones óseas. Materiales y métodos: revisamos los archivos de la Sección de Ortopedia y del Departamento de Patología de la Facultad de Medicina, Universidad de Antioquia (2000-2006 en busca de casos de hiperparatiroidismo con presentación clínica inicial o principal en los huesos. De cada caso resumimos los hallazgos clínicos, paraclínicos y de seguimiento más relevantes. Basados en estos casos hicimos una revisión del tema. Resultados: encontramos tres casos que cumplían estas características. En los tres la atención inicial fue motivada por una fractura; sin embargo, los tres habían tenido síntomas sistémicos inespecíficos de varios meses o años de evolución. Otras alteraciones óseas detectadas fueron: lesiones osteoblásticas múltiples, desviación de la columna, deformidades en los dedos, osteopenia, dolores óseos y tumor pardo. Los síntomas extraesqueléticos incluían alteraciones gastrointestinales, neurológicas, adinamia y disminución de peso. En los tres casos se detectó adenoma paratiroideo. Conclusiones: aunque infrecuentes, las alteraciones esqueléticas en el HPTP comprometen múltiples huesos y suelen asociarse con síntomas extraesqueléticos inespecíficos. Si se tiene en mente esta enfermedad, se debe medir el calcio sérico como prueba inicial que ayudará al diagnóstico. Symptomatic bone disease is not usual in primary hyperparathyroidism (PHPT. Increased awareness of the various manifestations of the disease may lead to earlier diagnosis before devastating and irreparable effects have occurred. Our

  5. {sup 99m}Tc-MIBI pinhole SPECT in primary hyperparathyroidism: comparison with conventional SPECT, planar scintigraphy and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Carlier, Thomas; Bodet-Milin, Caroline; Kraeber-Bodere, Francoise; Ansquer, Catherine [Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France); INSERM CRCNA, Nantes (France); Oudoux, Aurore [Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France); Mirallie, Eric [Hotel Dieu University Hospital, Surgery Department, Nantes (France); Seret, Alain [University of Liege, Institute of Physics, Experimental Medical Imaging, Liege (Belgium); Daumy, Isabelle [Ultrasonography Center, Nantes (France); Leux, Christophe [Saint Jacques University Hospital, PIMESP, Nantes (France)

    2008-03-15

    A pinhole collimator is routinely used to increase the resolution of scintigraphy. This prospective study was conducted to determine the interest of {sup 99m}Tc-MIBI pinhole single-photon emission computed tomography (SPECT) for the preoperative localisation of parathyroid lesions in primary hyperparathyroidism. All patients underwent a neck ultrasonography (US), {sup 99m}TcO{sub 4}{sup -} and {sup 99m}Tc-MIBI planar images and two consecutive SPECT with a parallel (C-SPECT) and a pinhole collimator (P-SPECT). P-SPECT was performed with a tilted detector equipped with a pinhole collimator and reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive. The results of these preoperative localisation studies were compared with surgical, pathological and 6-month biological findings. Fifty-one patients cured after surgery were included. Surgery revealed 55 lesions (median weight 0.5 g, 11 in ectopy). Sensitivities of US, planar imaging, C-SPECT and P-SPECT were, respectively, 51, 76, 82 and 87%. Nine glands were only detected by tomography and five glands only by P-SPECT. {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} planar scans and P-SPECT were complementary and, when combined together, showed the highest sensitivity (93%). Compared with planar imaging and C-SPECT, P-SPECT increased CS for 42 and 53% of lesions, respectively, and contributed to markedly reduce the number of uncertain results. A combination of planar {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} scintigraphy and P-SPECT appears to be a highly accurate preoperative imaging procedure in primary hyperparathyroidism. (orig.)

  6. 遗传性原发性甲状旁腺功能亢进症%Hereditary primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    孔晶; 王鸥; 邢小平

    2016-01-01

    Primary hyperparathyroidism ( PHPT) is a common endocrine disorder .About 10%of cases are fa-milial forms or part of syndromes , which occur earlier than sporadic form .Clinically, it is important to recognize these hereditary PHPT , because management and prognosis of hereditary PHPT are different from those of sporadic PHPT .In the last decades , numbers of specific genes have been identified responsible for various types of hereditary PHPT .Muta-tion analysis is helpful to improve the diagnostic accuracy allowing proper management of probands and their family mem -bers.%原发性甲状旁腺功能亢进症( primary hyperparathyroidism , PHPT)是一种常见的内分泌疾病,其中约10%的病例为家族性或综合征性。这些遗传性PHPT发病年龄往往早于散发性,呈显性遗传,其遗传背景、临床表现、治疗方法与散发性PHPT均有所不同,因此临床鉴别十分重要。近年来,遗传性PHPT的致病基因逐渐被发现,致病基因的突变分析不仅有助于确定临床诊断,还有助于个体化管理以及家系成员的随访。

  7. Contribution of 18-FDG PET/CT to brown tumor detection in a patient with primary hyperparathyroidism.

    Science.gov (United States)

    Gahier Penhoat, Mélanie; Drui, Delphine; Ansquer, Catherine; Mirallie, Eric; Maugars, Yves; Guillot, Pascale

    2017-03-01

    We report the case of a patient who presented with multiple brown tumors as the inaugural manifestation of primary hyperparathyroidism. Tc-99m hexakis methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy demonstrated increased radiotracer uptake by the bone lesions. The patient was a 65-year-old male who sought advice for a swelling on his right shin. An osteolytic lesion was visible on the radiograph. A bone biopsy showed a benign tumor containing abundant osteoclastic cells. Laboratory abnormalities included hypercalcemia (3.63mmol/L with 1.91mmol/L ionized calcium), hypophosphatemia (0.38mmol/L), and parathyroid hormone elevation (880.8pg/mL; N: 10-70). Serum 25-OH Vitamin D level was lower than 4ng/mL (N: 30-60). An 18-FDG PET/CT scan identified numerous high-uptake bone lesions. By 99mTc-MIBI scintigraphy, a large high-uptake mass was seen in the left parathyroid gland, as well as high-uptake lesions throughout the skeleton, which were less numerous than those seen by 18-FDG PET/CT. Ultrasonography of the neck visualized a mass consistent with an adenoma in the left parathyroid gland. Brown tumors are bone lesions whose diagnosis should be considered in patients with clinical and laboratory evidence of hyperparathyroidism, once a malignant disease is ruled out. Our case report suggests that 18-FDG PET/CT may be more sensitive than whole-body 99mTc-MIBI scintigraphy in detecting brown tumors.

  8. Preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism by {sup 99m}Tc-MIBI scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Noriyuki; Miura, Daisyu; Nakazawa, Hideki [Toranomon Hospital, Tokyo (Japan)

    2000-09-01

    The purpose of this study was to evaluate parathyroid scans obtained by early and late imaging following {sup 99m}Tc-MIBI injection. {sup 99m}Tc-MIBI scintigraphy was performed 15 min and 2 hr after intravenous injection of 300 MBq (or 370 MBq) of {sup 99m}Tc-MIBI. The subjects were 37 patients with primary hyperparathyroidism (adenoma, 34 cases; hyperplasia, 3 cases; and carcinoma 1 case) operated on between January 1994 and March 1996. Sensitivities for localization of adenoma, hyperplasia, and for the both lesions were 84%, 54%, and 76%, respectively. These results were poorer than the results of ultrasonography (US) (adenoma 91%, hyperplasia 54%, and both lesions 81%), and better than by {sup 201}TlCl/{sup 99m}Tc-O{sub 4}{sup -} subtraction scintigraphy (adenoma 69%, hyperplasia 23%, and both lesions 55%). Parathyroid gland weight and associated thyroid lesions decreased the sensitivity of localization detection using {sup 99m}Tc-MIBI. Combined use of {sup 99m}Tc-MIBI scintigraphy and US yielded higher sensitivity (89%), than obtained by either method alone. In the 53 cases operated on between April 1996 and March 2000 (adenoma, 47 cases; hyperplasia, 4 cases; carcinoma, 1 case; and diagnosis uncertain, 1 case), the sensitivities of {sup 99m}Tc-MIBI scintigraphy for the localization adenoma, hyperplasia, and for the both lesions were 83%, 20%, and 71%, respectively, versus 98%, 30%, and 85%, respectively, for US. It is possible that the light weight of parathyroid glands in the patients with hyperplasia decreased the sensitivity of late imaging. {sup 99m}Tc-MIBI scintigraphy is of high diagnostic value in terms of parathyroid function, and US in terms of morphology. The combination of {sup 99m}Tc-MIBI scintigraphy and US appeared to be the optimal diagnostic tool for localization of the lesion in hyperparathyroidism. (K.H.)

  9. Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism: a randomized, double-blind, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Tomaschitz Andreas

    2012-09-01

    Full Text Available Abstract Background Increasing evidence suggests the bidirectional interplay between parathyroid hormone and aldosterone as an important mechanism behind the increased risk of cardiovascular damage and bone disease observed in primary hyperparathyroidism. Our primary object is to assess the efficacy of the mineralocorticoid receptor-blocker eplerenone to reduce parathyroid hormone secretion in patients with parathyroid hormone excess. Methods/design Overall, 110 adult male and female patients with primary hyperparathyroidism will be randomly assigned to eplerenone (25 mg once daily for 4 weeks and 4 weeks with 50 mg once daily after dose titration] or placebo, over eight weeks. Each participant will undergo detailed clinical assessment, including anthropometric evaluation, 24-h ambulatory arterial blood pressure monitoring, echocardiography, kidney function and detailed laboratory determination of biomarkers of bone metabolism and cardiovascular disease. The study comprises the following exploratory endpoints: mean change from baseline to week eight in (1 parathyroid hormone(1–84 as the primary endpoint and (2 24-h systolic and diastolic ambulatory blood pressure levels, NT-pro-BNP, biomarkers of bone metabolism, 24-h urinary protein/albumin excretion and echocardiographic parameters reflecting systolic and diastolic function as well as cardiac dimensions, as secondary endpoints. Discussion In view of the reciprocal interaction between aldosterone and parathyroid hormone and the potentially ensuing target organ damage, the EPATH trial is designed to determine whether eplerenone, compared to placebo, will effectively impact on parathyroid hormone secretion and improve cardiovascular, renal and bone health in patients with primary hyperparathyroidism. Trial registration ISRCTN33941607

  10. Primary Hyperparathyroidism and Hyperthyroidism in a Patient with Myotonic Dystrophy: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Yosra Cherif

    2015-01-01

    Full Text Available Various endocrine manifestations are commonly described in myotonic dystrophy (MD, including primary hypogonadism, diabetes mellitus, and thyroid and parathyroid dysfunction. We describe a 46-year-old woman with a family history of MD with her son. She was diagnosed with cardiac arrhythmia and required the implantation of a pacemaker. She was noted to have a bilateral cataract. She complained of muscle weakness, diffuse myalgia, and palpitation. The electromyography (EMG showed myotonic discharges. Laboratory tests showed high serum calcium 2.83 mmol/L, serum phosphate 1.2 mmol/L, parathormone 362.5 pg/mL, thyroid stimulating hormone TSH 0.02 mIU/L (normal range: 0.34–5.6 mIU/L, FT4 21.17 ng/mL, and negative anti-thyroperoxidase antibodies. Cervical ultrasound revealed a multinodular goiter. The 99mTc-MIBI scintigraphy localized a lower right parathyroid adenoma. The clinical data, the family history of MD, EMG data, and endocrine disturbances were strongly suggestive of MD associated with hyperthyroidism and primary hyperparathyroidism.

  11. Primary hyperparathyroidism simulating motor neuron disease: case report Hiperparatiroidismo primário simulando doença do neurônio motor: relato de caso

    Directory of Open Access Journals (Sweden)

    Alzira Alves Siqueira Carvalho

    2005-03-01

    Full Text Available We report a case of a 26-year-old man who presented a lower motor neuron syndrome due to hyperparathyroidism. Electromyography showed neurogenic features with normal nerve conduction studies. Hypercalcemia led to the discovery of a primary hyperparathyroidism with gland hyperplasia. Following parathyroid surgery there was recovery of the neurological symptoms.Descrevemos o caso de homem de 26 anos que apresentou síndrome do neurônio motor inferior devido a hiperparatiroidismo. A eletromiografia mostrou aspecto neurogênico com estudos da condução normal. Hipercalcemia levou à descoberta de hiperparatiroidismo primário com hiperplasia da glândula. Após a cirurgia de ressecção da paratiróide, houve regressão dos sintomas neurológicos.

  12. Preoperative radiological diagnosis by {sup 99m}Tc{center_dot}MIBI-{sup 99m}Tc subtraction scintigraphy for primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Inouye, Takahiro; Tomita, Toshiki; Shinden, Seiichi; Takagi, Hitoshi [Tochigi Prefecture Saiseikai Utsunomiya Hospital (Japan); Kano, Shigeru

    1996-04-01

    Preoperative radiological diagnosis constitutes the most important factor for the surgical treatment of hyperparathyroidism. In this regard, MRI is useful for detecting the abnormal parathyroid, but it is often difficult to localize it using MRI only. It is thus necessary to combine this procedure with excellent subtraction scintigraphy. We performed both {sup 201}Tl-{sup 99m}Tc and {sup 99m}Tc{center_dot}MIBI-{sup 99m}Tc subtraction scintigraphy in seven patients with primary hyperparathyroidism and compared them the radiological results. Five patients presented parathyroid adenomas and the rest hypertrophy of the parathyroid. We could detect the abnormal parathyroid in four patients (57.1%) by {sup 201}Tl-{sup 99m}Tc subtraction scintigraphy and in six patients (85.7%) by {sup 99m}Tc{center_dot}MIBI-{sup 99m}Tc subtraction scintigraphy. We therefore believe that {sup 99m}Tc{center_dot}MIBI-{sup 99m}Tc subtraction scintigraphy will become an essential examination for primary hyperparathyroidism rather than the presently employed {sup 201}Tl-{sup 99m}Tc subtraction scintigraphy. (author).

  13. (18)F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study.

    Science.gov (United States)

    Kluijfhout, Wouter P; Pasternak, Jesse D; Gosnell, Jessica E; Shen, Wen T; Duh, Quan-Yang; Vriens, Menno R; de Keizer, Bart; Hope, Thomas A; Glastonbury, Christine M; Pampaloni, Miguel H; Suh, Insoo

    2017-01-25

    Purpose To investigate the performance of flourine 18 ((18)F) fluorocholine (FCH) positron emission tomography (PET)/magnetic resonance (MR) imaging in patients with hyperparathyroidism and nonlocalized disease who have negative or inconclusive results at ultrasonography (US) and technetium 99m ((99m)Tc) sestamibi scintigraphy. Materials and Methods This study was approved by the institutional review board. Between May and December 2015, 10 patients (mean age, 70.4 years; range, 58-82 years) with biochemical primary hyperparathyroidism and inconclusive results at US and (99m)Tc sestamibi scintigraphy were prospectively enrolled. All patients gave informed consent. Directly after administration of 3 MBq/kg of FCH, PET imaging was performed, followed by T1- and T2-weighted MR imaging before and after gadolinium enhancement. Intraoperative localization and histologic results were the reference standard for calculating sensitivity and positive predictive value. The Wilcoxon rank test was used to calculate the mean difference in maximum standardized uptake value (SUVmax) between abnormal parathyroid uptake and physiologic thyroid uptake. The Wilcoxon rank-sum test was performed. Results MR imaging alone showed true-positive lesions in five patients and a false-positive lesion in one patient. FCH PET/MR imaging allowed correct localization of nine of 10 adenomas (90% sensitivity), without any false-positive results (100% positive predictive value). One patient had four-gland hyperplasia, of which three hyperplastic glands were not localized. The median SUVmax of the nine preoperatively identified adenomas was 4.9 (interquartile range, 2.45-7.35), which was significantly higher than the SUV, 2.7 (interquartile range, 1.6-3.8), of the thyroid (P = .008). Conclusion FCH PET/MR imaging allowed localization of adenomas with high accuracy when conventional imaging results were inconclusive and provided detailed anatomic information. More patients must be examined to confirm

  14. [A Case of Primary Hyperparathyroidism Complicated with Hypercalcemic Crisis during Treatment with Cinacalcet and Improved by Active Treatment].

    Science.gov (United States)

    Takeda, Tomoki; Okada, Atsushi; Unno, Rei; Umemoto, Yukihiro; Tozawa, Keiichi; Yasui, Takahiro

    2016-12-01

    A 77-year-old man was referred to our department for surgical treatment of a right ureteral stone identified on computed tomography (CT) during intensive examination for spondylolisthesis of L4-L5. At the initial visit, performance status was 4, and renal dysfunction was identified (Cr 1.3 mg/dl). Corrected calcium level was 11.8 mg/dl, and intact parathyroid hormone level was 555 pg/ml. A CT scan showed a well-defined mass measuring 22×16×20 mm on the right side of the esophagus, along with 99mTc-MIBI uptake in the lesion. Based on these findings, we diagnosed the patient with primary hyperparathyroidism. Considering his general condition, we determined that parathyroidectomy was difficult, and we started treatment using cinacalcet. A temporary therapeutic effect was observed, but the turning point was occurrence of hypercalcemic crisis with aspiration pneumonia. After recovery of his general condition and improvement of blood data by multidisciplinary therapy, we performed parathyroidectomy. Histopathological examination showed that the tumor was a parathyroid adenoma. He is free of reccurence at one year postoperatively. In addition, surgery for spondylolisthesis was performed, and he started to walk independently.

  15. Vitamin D Status in Patients Operated for Primary Hyperparathyroidism: Comparison of Patients from Southern and Northern Europe

    Directory of Open Access Journals (Sweden)

    Erik Nordenström

    2013-01-01

    Full Text Available Aim. The interaction between vitamin D deficiency and primary hyperparathyroidism (PHPT is not fully understood. The aim of this study was to investigate whether patients with PHPT from Spain and Sweden differed in vitamin D status and PHPT disease activity before and after surgery. Methods. We compared two cohorts of postmenopausal women from Spain (n=126 and Sweden (n=128 that had first-time surgery for sporadic, uniglandular PHPT. Biochemical variables reflecting bone metabolism and disease activity, including levels of 25-hydroxy vitamin D3 (25(OHD and bone mineral density, BMD, were measured pre- and one year postoperatively. Results. Median preoperative 25(OHD levels were lower, and adenoma weight, PTH, and urinary calcium levels were higher in the Spanish cohort. The Spanish patients had higher preoperative levels of PTH (13.5 versus 11.0 pmol/L, P<0.001, urinary calcium (7.3 versus 4.1 mmol/L, P<0.001, and heavier adenomas (620 versus 500 g, P<0.001. The mean increase in BMD was higher in patients from Spain and in patients with vitamin D deficiency one year after surgery. Conclusion. Postmenopasual women with PHPT from Spain had a more advanced disease and lower vitamin 25(OHD levels. Improvement in bone density one year after surgery was higher in patients with preoperative vitamin D deficiency.

  16. Malignant insulinoma with hepatic and pulmonary metastases associated with primary hyperparathyroidism. Case report and review of the literature.

    Science.gov (United States)

    Albu, A; Zirnea, A; Georgescu, O; Terzea, D; Jinga, D; Fica, S

    2008-01-01

    Malignant insulinomas are rare tumors (10% of insulinomas) that often present as mnulticentric macro nodules with multiple liver metastases before diagnosis. We report the case of a 55 year old female with a medical history of severe hypoglycemic attacks for two months. Blood tests showed a decreased value of glycemia (30 mg/dl) associated with increased insulin level (l6 microU/ml) and an increased glycemia/insulinemia ratio of 1.87 supporting the diagnosis of insulinoma. Abdominal CT showed a 1.5 cm mass localized in the head of the pancreas with disseminated hepatic tumors, confirmed as neuroendocrine metastases by biopsy (which proved the presence of a malignant insulinoma). Primary hyperparathyroidism was diagnosed based on mild elevation of calcium (10.4 mg/dl) associated with a high level of PTH (71.2 pg/ml). The coexistence of the two endocrinopathies suggested the presence of type 1 multiple endocrine neoplasia (MEN 1). Because of multiple hepatic masses and liver function impairment, surgery and hepatic artery embolization were not performed. Somatostatin analog therapy was started with symptomatic control in the beginning, but rapid loss of beneficial effect. Finally, systemic chemotherapy with doxorubicin was administered, but the disease was progressive and after three months we decided to stop it. The patient died at home after one month, probably in hypoglycemic coma.

  17. The immunophenotypic fingerprint of patients with primary antibody deficiencies is partially present in their asymptomatic first-degree relatives.

    Science.gov (United States)

    Bogaert, Delfien J A; De Bruyne, Marieke; Debacker, Veronique; Depuydt, Pauline; De Preter, Katleen; Bonroy, Carolien; Philippé, Jan; Bordon, Victoria; Lambrecht, Bart N; Kerre, Tessa; Cerutti, Andrea; Vermaelen, Karim Y; Haerynck, Filomeen; Dullaers, Melissa

    2017-01-01

    The etiology of primary antibody deficiencies is largely unknown. Beside rare monogenic forms, the majority of cases seem to have a more complex genetic basis. Whereas common variable immunodeficiency has been investigated in depth, there are only a few reports on milder primary antibody deficiencies such as idiopathic primary hypogammaglobulinemia and IgG subclass deficiency. We performed flow cytometric immunophenotyping in 33 patients with common variable immunodeficiency, 23 with idiopathic primary hypogammaglobulinemia and 21 with IgG subclass deficiency, as well as in 47 asymptomatic first-degree family members of patients and 101 unrelated healthy controls. All three groups of patients showed decreased memory B- and naïve T-cell subsets and decreased B-cell activating factor receptor expression. In contrast, circulating follicular helper T-cell frequency and expression of inducible T-cell co-stimulator and chemokine receptors were only significantly altered in patients with common variable immunodeficiency. Asymptomatic first-degree family members of patients demonstrated similar, albeit intermediate, alterations in naïve and memory B- and T-cell subsets. About 13% of asymptomatic relatives had an abnormal peripheral B-cell composition. Furthermore, asymptomatic relatives showed decreased levels of CD4(+) recent thymic emigrants and increased central memory T cells. Serum IgG and IgM levels were also significantly lower in asymptomatic relatives than in healthy controls. We conclude that, in our cohort, the immunophenotypic landscape of primary antibody deficiencies comprises a spectrum, in which some alterations are shared between all primary antibody deficiencies whereas others are only associated with common variable immunodeficiency. Importantly, asymptomatic first-degree family members of patients were found to have an intermediate phenotype for peripheral B- and T-cell subsets.

  18. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology Milan, Genoa (Italy); Giusti, Massimo; Vera, Lara; Minuto, Francesco [University of Genoa, Department of Endocrinological and Metabolic Sciences, Genoa (Italy); Armonino, Riccardo; Ghigliotti, Giorgio; Bezante, Gian Paolo; Morbelli, Silvia; Pomposelli, Elena; Massollo, Michela; Gandolfo, Patrizia; Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Genoa (Italy)

    2010-12-15

    The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using {sup 99m}Tc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 {+-} 0.64 vs. 3.36 {+-} 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 {+-} 0.18 vs. 2.25 {+-} 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

  19. {sup 18}F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Lezaic, Luka; Rep, Sebastijan; Fettich, Jure [University Medical Centre Ljubljana, Department for Nuclear Medicine, Ljubljana (Slovenia); Sever, Mojca Jensterle; Kocjan, Tomaz [University Medical Centre Ljubljana, Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana (Slovenia); Hocevar, Marko [Institute of Oncology, Department of Surgical Oncology, Ljubljana (Slovenia)

    2014-11-15

    Primary hyperparathyroidism is a common endocrine disorder which is diagnosed biochemically and for which therapy is surgical. A prerequisite for minimally invasive surgery, which minimizes morbidity and cost, is accurate localization of the involved gland(s). The aim of this study was to evaluate the usefulness of {sup 18}F-fluorocholine PET/CT for preoperative localization of hyperfunctioning parathyroid tissue. {sup 18}F-Fluorocholine PET/CT and conventional parathyroid scintigraphic imaging consisting of {sup 99m}Tc-sestaMIBI SPECT/CT, {sup 99m}Tc-sestaMIBI dual-phase imaging and {sup 99m}Tc-sestaMIBI/pertechnetate subtraction imaging were performed in 24 patients. The diagnostic performance of the imaging methods was compared against histology as the gold standard and postoperative serum Ca{sup 2+} and iPTH values. The sensitivity and specificity of {sup 18}F-fluorocholine PET/CT were 92 % and 100 %, respectively, in contrast to 49 % and 100 %, 46 % and 100 %, and 44 % and 100 % for {sup 99m}Tc-sestaMIBI SPECT/CT, {sup 99m}Tc-sestaMIBI/pertechnetate subtraction imaging and {sup 99m}Tc-sestaMIBI dual-phase imaging, respectively. Combined conventional scintigraphic imaging had a sensitivity and specificity of 64 % and 100 %, respectively. The performance of {sup 18}F-fluorocholine PET/CT was superior particularly in patients with multiple lesions or hyperplasia. {sup 18}F-Fluorocholine PET/CT appears to be a promising, effective imaging method for localization of hyperfunctioning parathyroid tissue. (orig.)

  20. Clinical utility of ultrasound and {sup 99m}Tc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Patel, C.N., E-mail: chirag_patel@totalise.co.u [Department of Radiology and Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Salahudeen, H.M. [Department of Radiology and Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Lansdown, M. [Department of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Scarsbrook, A.F. [Department of Radiology and Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom)

    2010-04-15

    Aim: To evaluate the accuracy of ultrasound and parathyroid scintigraphy using single photon-emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of solitary parathyroid adenomas in patients with primary hyperparathyroidism who would be suitable for minimally invasive parathyroid surgery. Materials and methods: Retrospective study of 63 consecutive patients with biochemical evidence of primary hyperparathyroidism referred for preoperative localization of parathyroid adenoma that proceeded to surgery in the same institution. All patients underwent high-resolution ultrasound and Technetium-99m sestamibi scintigraphy with planar and SPECT/CT imaging. The accuracy of preoperative imaging was compared to surgical and histological findings as the reference standard. Results: Fifty-nine patients had solitary parathyroid adenomas, three patients had multiglandular hyperplasia, and one patient had multiple parathyroid adenomas confirmed at surgery and histology. Thirty-five solitary parathyroid adenomas were identified preoperatively with ultrasound (64%) and 53 with SPECT-CT (90%). Concordant ultrasound and SPECT/CT findings were found in 35 cases (59%). An additional three adenomas were found with ultrasound alone and 18 adenomas with SPECT/CT alone. Fifty-one of the 56 adenomas localized using combined ultrasound and SPECT/CT were found at the expected sites during surgery. Combined ultrasound and SPECT/CT has an overall sensitivity of 95% and accuracy of 91% for the preoperative localization of solitary parathyroid adenomas. Conclusions: The combination of ultrasound and SPECT/CT has incremental value in accurately localizing solitary parathyroid adenomas over either technique alone, and allows selection of patients with primary hyperparathyroidism who would be suitable for minimally invasive surgery.

  1. A Retrospective Review of Imaging and Operative Modalities Performed in Patients with Primary Hyperparathyroidism at a Mid-Volume Surgical Centre in Southeast Asia

    DEFF Research Database (Denmark)

    Tan, Matthew Zw; Ng, Jeremy Cf; Eisman, John A

    2016-01-01

    in the 1990s. This study aimed to explore what the change has been in preoperative localisation tools compared to the previous study and if the ability of these tools to correctly localise pathologic parathyroid glands has improved. MATERIALS AND METHODS: A retrospective review of patients who had surgery......INTRODUCTION: A paradigm shift appears to have occurred worldwide in surgery for primary hyperparathyroidism with the advent of sensitive preoperative imaging techniques. Preoperative imaging for parathyroid adenoma localisation was not found to be useful in a study conducted in Singapore...

  2. Differential Findings of Tc 99m Sestamibi Dual Phase Parathyroid Scintigraphy Between Benign and Malignant Parathyroid Lesions in Patients with Primary Hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Miju; Choi, Joon Young; Chung, Jae Hoon; Lee, Ji Young; Cho, Sook Kyung; Yoo, Jang; Park, Soo Bin; Lee, Kyung Han; Kim, Byung Tae [Sungkyunkwan, Univ. School of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    This study aimed to investigate the differential findings in clinical and biochemical features, and Tc 99m sestamibi (MIBI) dual phase parathyroid lesions in patients with primary hyperparathyroidism. Subjects were 102 parathyroid lesions from 91 patients with primary hyperparathyroidism. Scintigraphic findings included radioactivity grade, uptake pattern, uptake contour lesion size on early and delayed images, and degree of washout. Clinical and biochemical features were also evaluated. Histopathology confirmed the final diagnosis for all the patients. Final diagnoses were 94 benign parathyroid lesions and 8 parathyroid carcinomas. The patients with parathyroid carcinoma were significantly older (p=0.002) and had significantly higher serum parathyroid hormone concentrations than those with benign parathyroid lesions (p<0.001). All malignant parathyroid lesions showed intense radioactivity similar to or greater than the submandibular gland activity on delayed images (p=0.007), and little radioactivity difference between early and delayed images (p=0.012). The cancer incidence for parathyroid lesions with both intense radioactivity and no washout was 17.0% (8/47). When parathyroid lesions with all of the above mentioned findings were regarded as malignant, the cancer incidence significantly increased from 17.0% to 33.3% (8/24, p<0.001). For Tc 99m MIBI dual phase parathyroid scintigraphy, uptake grade on delayed images and washout were significantly useful diagnostic criteria for differentiating benign from malignant parathyroid lesions, along with age and parathyroid hormone serum concentration.

  3. 原发性甲状旁腺功能亢进的护理分析%Analysis on Nursing of Primary Hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    高丽杰

    2014-01-01

    Objective Analysis on nursing of primary hyperparathyroidism is to be investigated. Methods After the surgery treatment, clinical nursing information of 20 cases of the patients with primary hyperparathyroidism was selected for analysis. Results After the treatment and intensive nursing of medical staffs, al of 20 cases of patients were al improved with significant clinical nursing effect. Conclusion The intensive nursing which prevents the occurrence of complications can accelerate the patients to get better soon.%目的:讨论原发性甲状旁腺功能亢进的护理分析。方法通过对20例原发性甲状旁腺功能亢进症患者行手术治疗后的临床护理进行分析。结果经过医务人员治疗及精心护理下20例患者均有好转,临床护理效果显著。结论精心护理,预防并发症的发生,促进患者早日康复。

  4. A survey of 110 cases of primary hyperparathyroidism in Dr.Shariati Hospital and the results of localizing the adenoma via MIBI scanning

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    Hedayat A

    1998-07-01

    Full Text Available Primary Hyperparathyroidism is a fairly common disease that is much more predominant in females. Treatment is surgery and includes removing the parathyroid adenoma or the hyperplastic parathyroid glands. Considering the difficulty of this operation procedure, localization test are utilized including ultrasound, MRI, CT scan, Thallium-Technesium subtraction scan, MIBI scan and a series of other tests. According to the studies regarding these tests, MIBI scan is superior to all the others. In this survery we have studied 110 primary hyperparathyroidism patients that were operated on in Dr.Shariati Hospital between 1356 and 1376. In order to localize the adenoma ultrasound was used in ten patients, thallium-technesium subtraction scan in 38 patients. MIBI scan in 30 patients and CT scan in 3 patients. The sensitivity of MIBI scan was 86% and its specificity was 100%. In comparison, the sensitivity of thallium-technesium scan was found to be about 65%. Our results show that MIBI scan has had a high degree of sensitivity and specificity in our patients and has shown to be the best localization test. Therefore we suggest this test for the localization of all parathyroid adenomas.

  5. PET with {sup 18}F-DOPA in the imaging of parathyroid adenoma in patients with primary hyperparathyroidism. A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Lange-Nolde, A.; Zajic, T.; Brink, I.; Moser, E.; Hoegerle, S. [Univ. Hospital Freiburg (Germany). Div. of Nuclear Medicine; Slawik, M. [Univ. Cambridge, Addenbrooke (United Kingdom). Dept. of Clinical Biochemistry and Medicine; Reincke, M. [Univ. Hospital Munich (Germany). Dept. of Internal Medicine, Div. Endocrinology and Diabetes

    2006-07-01

    Preoperative localization of parathyroid adenomas (PA) can shorten operation time and improve curative rate; it becomes especially important in minimally invasive surgical techniques: Aim of this study was to investigate whether positron emission tomography (PET) with 3-,4-dihydroxy-6{sup 18}F-fluorophenylalanine ({sup 18}F-DOPA), which showed very promising results in other neuroendocrine tumours, also helps to localize PA. Patients, methods: Eight patients with proven primary hyperparathyroidism were studied preoperatively with PET. Seven also underwent sctintigraphy with {sup 99m}Tc-MIBI and ultrasonography of the neck. All patients were operated and the histological finding was used as a gold standard. Results: All eight patients had a histologically proven PA. None of the PA showed any detectable uptake of {sup 18}F-DOPA. However, ultrasonography detected 5/7 PA, scintigraphy detected 3/7 PA. Conclusion: These results suggest that PET with {sup 18}F-DOPA is not useful in the detection of Pa in patients with primary hyperparathyroidism. (orig.)

  6. "Single nucleotide polymorphisms of the OPG/RANKL system genes in primary hyperparathyroidism and their relationship with bone mineral density"

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    Piedra María

    2011-12-01

    Full Text Available Abstract Background Primary hyperparathyroidism (PHPT affects mainly cortical bone. It is thought that parathyroid hormone (PTH indirectly regulates the activity of osteoclasts by means of the osteoprotegerin/ligand of the receptor activator of nuclear factor-κβ (OPG/RANKL system. Several studies have confirmed that OPG (osteoprotegerin and RANKL (ligand of the receptor activator of nuclear factor-κβ loci are determinants of bone mineral density (BMD in the general population. The aim of this study is to analyze the relationship between fractures and BMD and the rs3102735 (163 A/G, rs3134070 (245 T/G and rs2073618 (1181 G/C SNPs of the OPG and the rs2277438 SNP of the RANKL, in patients with sporadic PHPT. Methods We enrolled 298 Caucasian patients with PHPT and 328 healthy volunteers in a cross-sectional study. We analyzed anthropometric data, history of fractures or renal lithiasis, biochemical determinants including markers for bone remodelling, BMD measurements in the lumbar spine, total hip, femoral neck and distal radius, and genotyping for the SNPs to be studied. Results Regarding the age of diagnosis, BMI, menopause status, frequency of fractures or renal lithiasis, we found no differences between genotypes in any of the SNPs studied in the PHPT group. Significant lower BMD in the distal radius with similar PTH levels was found in the minor allele homozygotes (GG compared to heterozygotes and major allele homozygotes in both OPG rs3102735 (163 A/G and OPG rs3134070 (245 T/G SNPs in those with PHPT compared to control subjects. We found no differences between genotypes of the OPG rs2073618 (1181 G/C SNP with regard to BMD in the PHPT subjects. In the evaluation of rs2277438 SNP of the RANKL in PHPT patients, we found a non significant trend towards lower BMD in the 1/3 distal radius and at total hip in the minor allele homocygotes (GG genotype group versus heterocygotes and major allele homocygotes (AA. Conclusions Our study provides

  7. Preoperative Thyroid Ultrasound Is Indicated in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

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    Cletus A. Arciero, Zita S. Shiue, Jeremy D. Gates, George E. Peoples, Alan P. B. Dackiw, Ralph P. Tufano, Steven K. Libutti, Martha A. Zeiger, Alexander Stojadinovic

    2012-01-01

    Full Text Available Background: Primary hyperaparathyroidism (pHPT is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and complicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US in patients prior to undergoing parathyroidectomy for pHPT.Methods: An Institutional Review Board approved prospective study was undertaken from January 2005 through July 2008. All patients with pHPT meeting inclusion criteria (n=94 underwent preoperative thyroid ultrasound in addition to standard 99mTc-sestamibi scintigraphy for parathyroid localization. Demographics, operative management and final pathology were examined in all cases.Results: Fifty-four of the 94 patients (57% were noted to have a thyroid nodule on preoperative US, of which 30 (56% underwent further examination with fine needle aspiration biopsy. Alteration of the operative plan attributable to underlying thyroid pathology occurred in 16 patients (17%, with patients undergoing either total thyroidectomy (n=9 or thyroid lobectomy (n=7. Thyroid cancer was noted in 33% of patients undergoing thyroid resection, and 6% of all patients with HPT.Conclusions: The routine utilization of preoperative thyroid ultrasound in patients prior to undergoing parathyroid surgery for pHPT is indicated. The added information from this non-invasive modality facilitates timely management of co-incidental, and sometimes malignant, thyroid pathology.

  8. Imaging diagnosis of primary hyperparathyroidism osteopathy%原发甲状旁腺功能亢进性骨病的影像学诊断

    Institute of Scientific and Technical Information of China (English)

    莫梅勋; 李丽银

    2013-01-01

      目的分析甲状旁腺功能亢进(PHPT)性骨病的影像学表现。方法结合相关文献回顾性分析7例手术病理或随访证实为PHPT患者的影像资料。全部病例均行多部位骨骼X线平片检查,其中1例另行头颅CT扫描。结果全部7例病例均有不同程度的骨质疏松,达100%;其中6例见骨膜下或软骨下骨吸收;5例见纤维囊性骨炎改变;3例出现病理性骨折;1例见肾结石。结论骨质疏松、骨膜下、软骨下骨吸收等X线征象对诊断甲状旁腺功能亢进性骨病有较高的价值。%Objective To analyze the imaging fetures of primary hyperparathyroidism(PHPT) osteopathy. Methods Combined with relevant literature,the imaging data of 7 patients with hyperparathyroidism confirmed by surgical pathology or follow-up were retrospectively analyzed.All cases were done multiple sites bone X ray examination,of which 1 case was done head CT scan. Results All 7 cases had different degree of osteoporosis(100%),of which 6 cases had subperiosteal or subchondral bone resorption;5 cases had osteitis fibrosa cystica changes;3 cases had pathologic fracture;1 case had renal calculus. Conclusion Osteoporosis,subperiosteal and subchondral bone resorption of x-ray imaging in the diagnosis of hyperparathyroidism osteopathy have a higher value.

  9. Manifestações musculoesqueléticas no hiperparatireoidismo primário Musculoskeletal manifestations in primary hyperparathyroidism

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    Samuel Katsuyuki Shinjo

    2009-12-01

    Full Text Available OBJETIVO: Avaliar as manifestações musculoesqueléticas do hiperparatireoidismo primário (HPP. PACIENTES E MÉTODOS: Foram avaliados dados clínicos, com ênfase nas manifestações musculoesqueléticas, dados laboratoriais e densitométricos de 21 pacientes com HPP acompanhados no nosso Serviço. RESULTADOS: Foram estudadas apenas mulheres no período menopausa, com média de idade de 67,9 ± 11,2 anos, sendo 16 (76,2% de cor branca. Os níveis séricos do cálcio total, fósforo, 25 hidroxivitamina D e paratormônio (PTH, no diagnóstico, foram respectivamente de 10,6 ± 0,9 mg/dL, 2,9 ± 0,7 mg/dL, 16,6 ± 6,6 ng/mL e 113,7 ± 74,8 pg/mL. Treze (61,9% pacientes apresentavam osteoatrite, sete (33,3% artralgias difusas, seis (28,6% mialgias difusas, três (14,3% condrocalcinose e duas (14,3% tendinopatias. Das 14 (67,8% com osteoporose, metade apresentava história clínica de fratura óssea (duas de rádio distal, quatro de coluna vertebral, duas de quirodáctilos, duas de tornozelos. Com relação às comorbidades, foi observada hipertensão arterial sistêmica em 11 (52,4% casos, cinco (23,8% hipotireoidismo, quatro (18,0% úlcera péptica, três (14,3% litíase renal, duas (9,5% depressão e duas (9,5% psoríase. Quinze pacientes (71,4% foram submetidas à paratiroidectomia, sendo sete com diagnóstico de adenoma de paratireoide, e 61,5% destas pacientes evidenciaram melhora dos sintomas após a cirurgia. CONCLUSÕES: O HPP apresenta uma expressão clínica variável na qual predominam as manifestações musculoesqueléticas. O conhecimento dessa enfermidade e a sua inclusão no diagnóstico diferencial das doenças reumatológicas possibilitam seu diagnóstico precoce, minimizando suas complicações clínicas.OBJECTIVE: To evaluate the musculoskeletal manifestations of primary hyperparathyroidism (PHP. PATIENTS AND METHODS: Clinical, with emphasis on musculoskeletal manifestations, laboratorial, and densitometric data of 21 PHP

  10. Pathophysiology of primary hyperparathyroidism

    OpenAIRE

    Hellman, P.; Carling, T.; Rask, L; Akerstrom, G.

    2000-01-01

    Parathyroid gland is the overall regulatory organ within the systemic calcium homeostasis. Through cell surface bound calcium-sensing receptors external calcium inversely regulates release of parathyroid hormone (PTH). This mechanism, which is voltage independent and most sensitive around physiologic calcium concentrations, is regulated through a 120 kDa calcium sensing receptor, CaR. Inherited inactivation of this receptor is the cause for familial hypocalciur...

  11. Imaging Diagnosis of Primary Hyperparathyroidism%原发性甲旁亢的影像学诊断

    Institute of Scientific and Technical Information of China (English)

    唐永华; 杜联军; 何国祥; 吴达明; 陈克敏

    2000-01-01

    Purpose: To evaluate the imaging examination and diagnostic value of primary hyperparathyroidism (PH) . Materials and Methods: The imaging characteristics and the diagnostic values of multiple modalities (CT, US, ECT) in PH were analyzed respectively. Among 53 cases of PH proved by surgicopathology, CT scan was performed in 35; B mode ultrasound, in 46; and nuclein examination, in 5. Results: 96.23% (51 of 53 PH) parathyroid adenomas and 3.77% (2 of 53 PH)parathyroid hyperplasia were confirmed in this group. Twenty - seven cases performed by CT and 38 cases examined by B ultrasound were totally found before operation. 81.48% (22 of 27 adenomas) lay in lower pole of throid glands and 18.52% (5 of 27) lay in upper pole. The CT acquisition of lesions was significantly increased after contrast - enhanced scans. Conclusion: To establish the diagnosis of PH mainly depends on clinical history and lab examination. To locate the lesion of PH mainly depends on B ultrasound, CT scan and nuclein scintigraphy. There are no significant differences in sensitivity and specificity between B ultrasound and CT scan. With the CT characters of obvious enhancement of parathyroid lesion and the clinical features, the diagnostic accuracy of PH can be improved.%目的:对原发性甲旁亢的影像学检查方法及诊断价值进行评估。材料和方法:对手术病理证实的53例原发性甲旁亢病例的影像学资料进行回顾性分析。其中35例作CT检查,B超检查46例,核素检查5例。结果:53例甲旁亢手术确诊甲旁腺腺瘤51例,占96.23%。甲旁腺增生2例。CT检查有27例诊断为甲旁腺腺瘤(27/35),病灶81.48%位于甲状腺下极(22/27),18.52%位于甲状腺上极(5/27);各病灶增强后通常有明显强化,比平扫时CT值上升约30~40Hu。B超检查有38例诊断为甲旁腺腺瘤(38/46)。核素检查中3例误诊为甲状腺腺瘤。结论:原发性甲旁亢的定性诊断主要依靠

  12. Analysis of clinical laboratory data by biplot methods using a three-dimensional display: discrimination of renal stone-patients with idiopathic hypercalciuria and primary hyperparathyroidism.

    Science.gov (United States)

    Tschöpe, W; Schmidt-Gayk, H; Ritz, E; Weber, E; Berger, J

    1979-08-01

    The biplot technique is a very useful graphical method to display the relationships between row and column characteristics in two-way tables. This method is applicable as long as the rank-2 approximation explains a large part (e.g. 95%) of the whole variability. However, since in large tables only a rank-3 approximation will yield such a high degree of explanation, a three-dimensional biplot technique has been introduced, using a 3d-screen as a matter of presentation of clinical laboratory data. The value of such a procedure is illustrated using as a clinical example a patient population with recurrent renal stone formation due either to primary hyperparathyroidism or to idiopathic hypercalciuria.

  13. A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism

    DEFF Research Database (Denmark)

    Krakauer, Martin; Wieslander, Bente; Myschetzky, Peter Sand

    2016-01-01

    PURPOSE: Preoperative localization of the diseased parathyroid gland(s) in primary hyperparathyroidism allows for minimally invasive surgery. This study was designed to establish the optimal first-line preoperative imaging modality. PATIENTS AND METHODS: Ninety-one patients were studied...... standard. RESULTS: Ninety-seven hyperfunctioning parathyroid glands (HPGs) were identified by the reference standard. Sensitivity and specificity for subtraction PS, dual-phase PS, 4D-CT, and US were 93%, 65%, 58%, and 57% as well as 99%, 99.6%, 86%, and 95%, respectively. Interrater agreement...... consecutively in a prospective head-to-head comparison of dual isotope (Tc-MIBI vs I) subtraction parathyroid scintigraphy (PS), dual-phase PS, 4-dimensional (4D) CT, and ultrasonography (US). Surgery, histological confirmation, and postoperative normalization of Ca and parathyroid hormone were the reference...

  14. Brown Tumors Due to Primary Hyperparathyroidism in a Patient with Parathyroid Carcinoma Mimicking Skeletal Metastases on (18)F-FDG PET/CT

    DEFF Research Database (Denmark)

    Andersen, Kim Francis; Albrecht-Beste, Elisabeth

    2015-01-01

    Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT). Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin-so-called......Parathyroid carcinoma only represents bone and formation of fibrous cysts with deposits of hemosiderin......-so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on (18)F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient...

  15. Brown Tumors Due to Primary Hyperparathyroidism in a Patient with Parathyroid Carcinoma Mimicking Skeletal Metastases on 18F-FDG PET/CT

    Directory of Open Access Journals (Sweden)

    Kim Francis Andersen

    2015-07-01

    Full Text Available Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT. Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin—so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on 18F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient with PHPT due to parathyroid carcinoma and with presence of brown tumors on 18F-FDG PET/CT, visualizing the possible role of this imaging modality in the evaluation of treatment response in these patients.

  16. Asymptomatic De Novo Inflammatory Bowel Disease Late After Liver Transplantation for Primary Sclerosing Cholangitis: A Case Report.

    Science.gov (United States)

    Åberg, F; Abdulle, A; Mäkelä, A; Nissinen, M

    2015-11-01

    Guidelines recommend colonoscopy screening for possible asymptomatic inflammatory bowel disease (IBD) in all patients diagnosed with primary sclerosing cholangitis (PSC). PSC-IBD warrants regular dysplasia-surveillance colonoscopy. However, no consensus exists regarding follow-up colonoscopy in PSC patients without IBD who remain asymptomatic. We describe a 43-year-old female who had undergone liver transplantation (LT) due to advanced PSC. Previous colonoscopies had been normal. The post-transplantation course was uneventful, with no rejections and signs of PSC recurrence. Immunosuppression was by tacrolimus monotherapy. She was asymptomatic with normal inflammation markers. A protocol colonoscopy, performed as general dysplasia surveillance 8 years post-transplantation, revealed mucopurulent-covered small superficial ulcerations and erythema diffusely distributed from the cecal to sigmoid colon with intervening normal mucosa and rectal sparing. Histologic examination showed patchy chronic colitis with crypt architectural distortion and mild-moderate inflammation activity. Infection samples were negative. Findings complied with de novo IBD, type unclassified. In conclusion, the link between PSC and clinically silent IBD may manifest after the PSC diagnosis and even several years after LT. Given the increased colorectal cancer risk associated with PSC, IBD, and LT, repeat colonoscopy might be warranted in PSC patients without IBD at initial assessment, and also after LT.

  17. Hyperparathyroidism: molecular, diagnostic and therapeutic aspec

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    Mikołaj Pietkiewicz

    2010-10-01

    Full Text Available The sensitivity of parathyroid glands to a low calcium level in plasma results in parathyroid hormone (PTH release in order to restore the normal Ca2 concentration. Hyperparathyroidism is a common endocrinopathy, caused by uncontrolled growth of parathyroid cells. In primary hyperparathyroidism, hypercalcemia develops due to extensive autonomous secretion of PTH. Secondary hyperparathyroidism is a well-established complication of chronic renal insufficiency, where marked parathyroid hyperplasia occurs, especially in patients with long dialysis vintage. The elevated PTH level in the circulation is a direct result of renal function disturbances, vitamin D deficiency, and impaired calcium/phosphate metabolism. After successful kidney transplantation, the normalization of kidney function fails to normalize the secretion of PTH by parathyroid glands, which have become relatively autonomous and unresponsive to hypercalcemic conditions in the plasma. The development of tertiary hyperparathyroidism occurs in these conditions.The aim of our report is to present current views on the clinical, pathological and biochemical features of primary, secondary and tertiary hyperparathyroidism. The diagnostics of calcium/phosphate abnormalities in parathyroid gland disorders, as well as some aspects of hyperparathyroidism treatment, are briefly summarized.

  18. Utility of an intraoperabive gamma probe in the surgical management of secondary or tertiary hyperparathyroidism

    NARCIS (Netherlands)

    Jorna, Francisca H.; Jager, Pieter L.; Lemstra, Clara; Wiggers, Theo; Stegeman, Coen A.; Plukker, John T. M.

    2008-01-01

    BACKGROUND: In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism. METHODS: The value of the probe in guiding resection o

  19. Desarrollo de hiperparatiroidismo primario en el seguimiento de un paciente con enfermedad de Paget Development of primary hyperparathyroidism in the follow-up of a patient with Paget´s disease

    Directory of Open Access Journals (Sweden)

    Francisco R Spivacow

    2009-02-01

    Full Text Available La asociación de hiperparatiroidismo primario y enfermedad de Paget varía entre 2.2 y 6%. Hasta el año 2006 se habían descripto 73 casos con simultaneidad de ambos diagnósticos. Se presenta el caso de un paciente varón de 68 años con un Paget poliostótico activo medicado durante 10 años con bisfosfonatos, con buena evolución. A los 10 años de seguimiento se observan elevados niveles de calcemia, calcio iónico, la fosfatasa alcalina (FAL, su isoenzima ósea (FAIO, e intactos los valores de parathormona (PTHi. Se establece el diagnóstico de hiperparatiroidismo primario. Dado el inestable estado general se decide postergar la cirugía y tratarlo con zoledronato IV con buena respuesta.According to the medical literature, the association of primary hyperparathyroidism and Paget's disease varies from 2.2 to 6%. Up to the year 2006, a total of 73 cases had been described, where both diagnoses occurred simultaneously. However, no manifestation of primary hyperparathyroidism during the follow- up of Paget's disease has been reported in the revised literature. We report the case of a well-controlled patient, who developed primary hyperparathyroidism during the 10-year follow-up of Paget's disease. A 68-yearold male patient with active polyostotic Paget's disease was successfully treated with bisphosphonates for ten years. During follow-up, increased levels of calcemia, ionic calcium, alkaline phosphatase, bone alkaline phosphatase and intact parathyroid hormone values were registered. The patient was diagnosed with primary hyperparathyroidism. As a result of his unstable general health condition, surgery was postponed and intravenous zoledronic acid was prescribed, with a favorable outcome.

  20. Video-assisted parathyroidectomy for treatment of primary hyperparathyroidism%原发性甲状旁腺功能亢进的内镜辅助手术

    Institute of Scientific and Technical Information of China (English)

    潘晓峰; 樊友本

    2011-01-01

    Surgery is an important way to treat patients with primary hyperparathyroidism.Recently,conventional bilateral neck exploration is substituted with minimal invasive surgeries gradually due to the development of the technology of pre/intro-operative localization.Video-assisted surgery is one of the minimal invasive surgeries.It includes video-assisted parathyroidectomy and total endoscopic parathyroidectomy.This article summarize the literatures of treatment of primary hyperpatathyroidism with video-assisted surgery in this article.%手术是治疗原发性甲状旁腺功能亢进的重要途径.近年来,随着术前、术中定位技术的发展,传统的颈部双侧甲状旁腺探查手术所占的比例正在逐年减少,微创手术已经成为趋势,借助内镜完成甲状旁腺手术就是其中的主要方法,包括完全内镜下甲状旁腺手术和内镜辅助甲状旁腺手术.本文拟就原发性甲状旁腺功能亢进的内镜辅助甲状旁腺手术进行综述.

  1. Interpretation of Tc-99m sestamibi parathyroid SPECT-CT scans made easy for better surgical outcomes in patients with primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Gayed IW

    2016-12-01

    Full Text Available Isis W Gayed,1 Ron J Karni,2 David Q Wan,1 Jeena M Varghese,3 Kelly L Wirfel,3 Kyoung S Won,4 Usha A Joseph1 1Nuclear Medicine Section, Department of Diagnostic and Interventional Imaging, 2Department of Otorhinolaryngology, Head and Neck Surgery, 3Department of Internal Medicine – Endocrinology, Diabetes and Metabolism, Medical School at Houston Health Science Center, Houston, TX, USA; 4Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea Objective: This study aims to evaluate the accuracy of Tc-99m sestamibi parathyroid scan (SPS with single-photon emission computerized tomography/computerized tomography (SPECT/CT in patients with primary hyperparathyroidism after optimizing the interpretation of the scans with a systematic and simple method for localization of the abnormal parathyroid gland.Materials and methods: Consecutive patients, who underwent SPS followed by surgical intervention, were included. Data were collected retrospectively including patients’ demographics, serum calcium and parathyroid hormone (PTH levels, SPS findings, and surgical and pathological findings. Our optimized systematic method of interpretation of SPS starts by reviewing initial and 3 hours delayed planar images; subsequently we reviewed coronal and axial SPECT/CT images. A simple clockwise localization of the abnormal gland in relation to the trachea and its level in relation to the thyroid in a cranio-caudal level facilitates intraoperative localization of parathyroid adenomas.Results: A total of 53 patients were included; 9 males and 44 females with an average age of 58.3±14 years. The average preoperative serum calcium and PTH were 10.5 mg/dL and 165.4 pg/m, respectively. The median interval between the scan and operative resection was 50 days. Our SPS interpretation method correlated perfectly with the surgical finding in 48/53 patients (90.6%; it was on the correct side of the surgical finding but not the exact

  2. [PTHi value in the surgical treatment of hyperparathyroidism].

    Science.gov (United States)

    Ferrer Baixauli, F; Severá Ferrándiz, G; Menor Ibáñez, F; Infante Matarredona, E

    2004-01-01

    The prevalence of hyperparathyroidism as increased in the last 20 years due to a longer number of biochemical determinations, in which we observe in many cases hipercalcemia by casualty. The simptomatology of the primary hyperparathyroidism is very subtile and sometimes none in an 80% of the patients. Between november 1996 and march 2003 we have operated 55 parathyroidectomies. 36 patients (65,4%) had primary hyperparathyroidism, 16 (29,1%) secondary hyperparathyroidism and the rest (5,4%) tertiary hyperparathyroidism. Our hospital has a device of rapid detection of the parathyroid hormone level since february 2000, allowing us its satisfactory intraoperative determination in few minutes, evaluating the decrease to values inferior to the half of its basal level.

  3. Osteosarcoma associated with hyperparathyroidism

    NARCIS (Netherlands)

    Jutte, PC; Rosso, R; de Paolis, M; Errani, C; Pasini, E; Campanacci, L; Bacci, G; Bertoni, F; Mercuri, M

    2004-01-01

    The fourth case in the literature is presented of a patient with the rare association of hyperparathyroidism and osteosarcoma. A 56-year-old woman presented with hyperparathyroidism and a lesion in the tibia. Initial diagnosis was brown tumor. Histology, however, revealed osteosarcoma, and the patie

  4. Somatostatin analogues do not affect calcium metabolism in patients with acromegaly and primary hyperparathyroidism [corrected] due to MEN 1-like syndrome.

    Science.gov (United States)

    Bogazzi, F; Lombardi, M; Russo, D; Sardella, C; Raggi, F; Brogioni, S; Cetani, F; Ceccarelli, C; Mariani, G; Basolo, F; Martino, E

    2011-02-01

    Patients with clinical features of MEN 1 without mutations in the menin gene fulfill the criteria of MEN1-like syndrome. Primary hyperparathyroidism (PHP) is the most frequent clinical finding in both syndromes and is usually treated by surgery. However, PHP has been reported to respond to somatostatin analogues (SSA) in MEN 1 patients. 7 patients with PHP in the context of MEN 1-like syndrome (and absence of mutations in the menin gene) were enrolled in the study and treated with SSA for 6 months for the non-PHP disease before parathyroidectomy. Serum ionized calcium, phosphorus, and PTH concentrations, and 24-h urinary calcium and phosphorus excretion were measured before and after SSA therapy. Mean serum ionized calcium, phosphorus, and PTH concentrations did not significantly change after a 6-month course with SSA. SSA scintigraphy did not reveal uptake in the neck region corresponding to the parathyroid adenoma identified at surgery and confirmed at histology. However, immunohistochemistry revealed SS-type 2A receptor in parathyroid tissue samples of 6 out of 7 patients. SSA therapy does not affect calcium-phosphorus metabolism in patients with MEN 1-like syndrome, suggesting that the drug has no role in controlling PHP in these subset of patients.

  5. Primary hyperparathyroidism in children and adolescents%儿童和青少年原发性甲状旁腺功能亢进症

    Institute of Scientific and Technical Information of China (English)

    王文博; 王鸥

    2016-01-01

    Primary hyperparathyroidism ( PHPT) is far less common in the children and adolescents than in the adult population .PHPT appears to be a more aggressive disorder in children and adolescents than that in adults .Unlike a-dult patients , most children and adolescents with PHPT are symptomatic .Characteristics of PHPT in children and adoles-cents are different from adults in many aspects .The purpose of this review is to improve the understanding of this rare dis-ease in the children and adolescents population .%原发性甲状旁腺功能亢进症(以下简称甲旁亢)在儿童和青少年的发病率远低于成人。儿童和青少年甲旁亢常比成人严重,成人患者以无症状性甲旁亢居多,而大多数儿童和青少年患者为有症状性甲旁亢。儿童和青少年甲旁亢在很多方面有别于成人甲旁亢患者。本文旨在提高对儿童和青少年甲旁亢的认识。

  6. Use of {sup 99m}Tc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature

    Energy Technology Data Exchange (ETDEWEB)

    Denmeade, Kristie A [Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia); Constable, Chris [Brain and Mind Research Institute, University of Sydney, New South Wales (Australia); Reed, Warren M [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, New South Wales (Australia); Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia)

    2013-06-15

    The use of technetium-99m 2-methoxyisobutyl isonitrile ({sup 99m}Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80–85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing {sup 99m}Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using {sup 99m}Tc MIBI for assistance in MIRS.

  7. The value of oblique pinhole images in pre-operative localisation with {sup 99m}Tc-MIBI for primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Ho Shon, I.A. [Dept. of Nuclear Medicine, Royal North Shore Hospital, Sydney (Australia); Bernard, E.J.; Roach, P.J. [Dept. of Nuclear Medicine, Royal North Shore Hospital, Sydney (Australia); North Shore Radiology and Nuclear Medicine, North Shore Private Hospital, Sydney (Australia); Delbridge, L.W. [Dept. of Surgery, Royal North Shore Hospital, Sydney (Australia)

    2001-06-01

    Technetium-99m labelled 2-methoxyisobutylisonitrile (MIBI) has been extensively utilised for pre-operative localisation of parathyroid adenomas. Imaging techniques have varied widely, with many centres not performing routine oblique images; thus this study aimed to examine the value of routine oblique pinhole imaging. Ninety-two patients underwent pre-operative {sup 99m}Tc-MIBI imaging including early and delayed anterior oblique pinhole images in addition to standard anterior pinhole images and a thyroid study prior to surgery for primary hyperparathyroidism. These studies were reviewed blindly comparing anterior and oblique images and anterior images only in relation to surgical findings. Of the 92 patients, 83 were found to have 86 parathyroid adenomas or parathyroid adenoma/hyperplasia at surgery. When compared to anterior images only, oblique views improved overall sensitivity from 76% to 88% (P<0.05), correctly localised 11 more adenomas than anterior images alone (13%) and improved the confidence of interpretation in 17 patients (20%). In conclusion, routine oblique pinhole views result in greater sensitivity and reporter confidence in pre-operative parathyroid localisation with {sup 99m}Tc-MIBI. (orig.)

  8. Efficacy of C-11 L-methionine positron emission tomography and intraoperative methylene blue staining for localization of parathyroid glands in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Hiromasa; Takahashi, Masato; Taguchi, Kazunori; Takada, Naoyuki; Nakada, Kunihiro; Sasaki, Fumiaki; Todo, Satoru [Hokkaido Univ., Sapporo (Japan). School of Medicine

    2002-12-01

    For localization of parathyroid glands in primary hyperparathyroidism we carried out C-11 L-methionine positron emission tomography (Met-PET) in 10 patients (one with hyperplasia and 9 with adenoma) and intraoperative methylene blue staining in 20 patients (one with hyperplasia and 19 with adenoma) and compared the predictive value with that of US and {sup 99m}Tc-sestamibi scintigraphy (MIBI). Methylene blue was administrated at a calculated dose of 5 mg/kg body weight intravenously for 1 h before surgery. The accuracy of identification of pathological parathyroid glands with Met-PET, US and MIBI was 90%, 80% and 70% respectively. Met-PET was more sensitive than US and MIBI and could identify smaller parathyroid glands, particularly in cases with lower serum calcium levels. Met-PET imaging was not affected even in 2 reoperative cases. Intraoperative methylene blue staining of parathyroid glands was successful in 19 patients without major side effects. Met-PET was the most effective method for preoperative imaging of parathyroid glands. Intraoperative methylene blue staining was a safe and effective method and able to facilitate dissection of pathological glands during surgery. (author)

  9. Comparison study of lesion localization in patients with primary and secondary hyperparathyroidism using double-phase Tc-99m sestamibi scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Tae Joo; Lee, Jong Doo; Rhyu, Young Hoon; Park, Jung Soo; Jang, Hang Seok [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this study was to evaluate and compare the scintigraphic findings and diagnostic accuracy of double-phase Tc-99m sestamibi scan in primary and secondary hyperparathyroidism (HPT). We retrospectively reviewed 16 cases of primary (18 lesions) and 11 cases of secondary HPT (44 lesions) who underwent Tc-99m-sestamibi scan before the surgical intervention. Scan was performed using LEM camera (Siemens, Germany ) after the injection of 740MBq of Tc-99m sestamibi. Routine image consisted of baseline and 3-hour delayed images and each image was obtained using both parallel and pine hole collimator. The study population was 27 patients (male/ females=5/22, age: 49.1{+-}10.8). Eighteen lesions of primary HPT consisted of 13 adenomas and 5 hyperplasias, while while all lesions of secondary but only 2 lesions of 5 hyperplasias, while all lesions of secondary HPT were hyperplasias. Among the case of primary HPT, we could detect all the lesions of 13 adenomas but only 2 lesions of 5 hyperplasias (40%) could be detected by double phase scintigraphy. Three cases of primary lesion showed decreased uptake in delayed images compared with baseline. The sensitivity, specificity, positive predictive value and accuracy of primary and secondary HPT were 58.5% (10/17), 83.3% (10/12), 83.3%(10/12), 75.9%(22/29), and 37.5%(15/40), 50% (2/4), 88.2% (15/17), 38.6% (17/44), respectively. Overall sensitivity, specificity, positive predictive value and accuracy were 43.9% (25/57), 75%(12/16), 86.2% (25/29), and 53.4% (39/73). There were no statistical difference between the weight of primary and secondary HPT lesion (p>0.05). Tc-99m sestamibi scan is fairly good modality to detect parathyroid lesion in patient with primary HPT before the surgical intervention. However, since some of cases may reveal decreased uptake in delayed image, a careful attention to the findings of baseline images may be helpful. Still the low accuracy of sestamibi scan in diagnosis of secondary HPT prohibits

  10. Asymptomatic Primary Fallopian Tube Cancer: An Unusual Cause of Axillary Lymphadenopathy

    Directory of Open Access Journals (Sweden)

    N. A. Healy

    2011-01-01

    Full Text Available Primary Fallopian tube malignancy is considered a rare disease and is often mistaken histologically and clinically for ovarian cancer. The etiology is poorly understood, and it typically presents at an advanced disease stage, as symptoms are often absent in the initial period. As a result, primary fallopian tube cancer is generally associated with a poor prognosis. We present the case of a 45-year-old female who presents with a 5-day history of left axillary swelling and a normal breast examination. Mammogram and biopsy of a lesion in the left breast revealed a fibroadenoma but no other abnormalities. Initial sampling of the axillary node was suspicious for a primary breast malignancy, but histology of the excised node refuted this. PET-CT showed an area of high uptake in the right pelvis, and a laparoscopy identified a tumor of the left fallopian tube which was subsequently excised and confirmed as a serous adenocarcinoma.

  11. 99mTechnetium Sestamibi-123Iodine Scintigraphy Is More Accurate Than 99mTechnetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Eeva M. Ryhänen

    2015-01-01

    Full Text Available Objectives. Studies comparing outcome of single-T99mc-methoxyisobutylisonitrile (T99mc-sestamibi and dual-tracer T99mc-sestamibi scintigraphy in combination with 123I before primary surgery of primary hyperparathyroidism (PHPT are scarce. Methods. We compared T99mc-sestamibi/123I and T99mc-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. T99mc-sestamibi/123I and T99mc-sestamibi were positive in 206 (76.6% and 111 (41.3% of 269 patients, respectively (P < 0.001. Accuracies for T99mc-sestamibi/123I and T99mc-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001. Prevalence of multiglandular disease was 15.2%. In multiglandular disease, T99mc-sestamibi/123I and T99mc-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001. Cure rate was similar for patients with (191/206; 92.7% and without (59 of 63; 93.7% a positive T99mc-sestamibi/123I finding. Duration of targeted surgery (one or two quadrants was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001. Higher serum calcium (P = 0.014 and PTH (P = 0.055 concentrations and larger tumours (P < 0.001 characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. T99mc-sestamibi/123I scintigraphy is more accurate than T99mc-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.

  12. Elevated Alt and Ast in an Asymptomatic Person: What the primary care doctor should do?

    OpenAIRE

    Yin, Loh Keng; Tong, Kew Siang

    2009-01-01

    Abnormal liver function test with raised alanine aminotransferase (ALT) and raised aspartate aminotransferase (AST) are commonly seen in primary care setting.Chronic alcohol consumption, drugs, non-alcoholic steatohepatitis (NASH) and chronic viral hepatitis are common causes associated with raised ALT and AST.In chronic viral hepatitis, the elevation of liver enzyme may not correlate well with the degree of liver damage.Non-hepatic causes of raised ALT and AST include polymyositis, acute mus...

  13. Is carotid artery evaluation necessary for primary prevention in asymptomatic high-risk patients without atherosclerotic cardiovascular disease?

    Directory of Open Access Journals (Sweden)

    Kim GH

    2015-07-01

    Full Text Available GeeHee Kim,1 Ho-Joong Youn,2 Yun-Seok Choi,2 Hae Ok Jung,2 Wook Sung Chung,2 Chul-Min Kim1 1Department of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, 2Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Objective: Routine measurement of the carotid intima–media thickness is not recommended in recent clinical practice guidelines for risk assessment of the first atherosclerotic cardiovascular disease (ASCVD event (the definition of which includes acute coronary syndromes, a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin. The aim of the present study was to elucidate the role of carotid artery evaluation for primary prevention of ASCVD in asymptomatic high-risk patients visiting a teaching hospital.Methods: Eight hundred seventy-three patients (487 male [55.8%], mean age 59.4±11.5 years who were statin-naive and without ASCVD, which was proven by coronary angiography or coronary CT angiography, were enrolled in this study. The patients underwent carotid scanning in the Medical Department of St Mary’s Hospital from September 2003 to March 2009. ASCVD outcomes were evaluated for median follow-up of 1,402 days.Results: A total of 119 participants experienced ASCVD events. In multivariate Cox regression analysis, age (hazard ratio [HR] =1.026, 95% confidence interval [CI] =1.002–1.050, P=0.033, history of smoking (HR =1.751, 95% CI =1.089–2.815, P=0.021, statin therapy (HR =0.388, 95% CI =0.205–0.734, P=0.004, and carotid plaques (HR =1.556, 95% CI =1.009–2.400, P=0.045 were associated with ASCVD events. In middle-aged group (45≤ age <65, n=473, history of smoking (HR =1.995, 95% CI =1.142–3.485, P=0.015, statin therapy (HR =0.320, 95% CI =0.131

  14. Kidney stones and crushed bones secondary to hyperparathyroidism.

    Science.gov (United States)

    Sreelesh, K P; Sreejith, G Nair; Pranab, K Prabhakaran

    2016-01-01

    Here we report a 65-year-old woman with multiple brown tumors and renal stones secondary to primary hyperparathyroidism. This case highlights the need for early recognition of parathyroid hyperactivity.

  15. Cinacalcet for hyperparathyroidism in pregnancy and puerperium.

    NARCIS (Netherlands)

    Horjus, C.S.; Groot, I.; Telting, D.; Setten, P. van; Sorge, A. van; Kovacs, C.S.; Hermus, A.R.M.M.; Boer, H. de

    2009-01-01

    The efficacy and safety of various modes of medical treatment for primary hyperparathyroidism (PHPT) in pregnancy is largely unknown. This report describes two cases of PHPT in pregnancy that were temporarily treated with the calcimimetic cinacalcet. The first case was diagnosed in the 31st week of

  16. Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

    Science.gov (United States)

    MELFA, G.I.; RASPANTI, C.; ATTARD, M.; COCORULLO, G.; ATTARD, A.; MAZZOLA, S.; SALAMONE, G.; GULOTTA, G.; SCERRINO, G.

    2016-01-01

    Background Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70–95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. Patients and methods 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or “open” under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient’s satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student’s, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. Results 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient’s satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). Conclusions MIVAP is more expensive compared to the “open” parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration. PMID:27381690

  17. MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

    Energy Technology Data Exchange (ETDEWEB)

    Sacconi, B.; Argiro, R.; Iannarelli, A; Bezzi, M.; Cipolla, V.; De Felice, C.; Catalano, C. [Sapienza University, Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Diacinti, Daniele [Sapienza University, Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Sapienza Universita di Roma, Department of Radiological Sciences, Oncology and Pathology, Roma (Italy); Cipriani, C.; Minisola, S. [Sapienza University, Department of Clinical Sciences, Rome (Italy); Pisani, D. [Sapienza University, Department of Clinical and Molecular Medicine, Rome (Italy)

    2016-03-15

    To identify frequent MRI features of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT) using a fast protocol with a 3 T magnet. Thirty-eight patients with PHPT underwent a 3 T-MR. All patients had positive US and Tc-99 sestamibi, for a total number of 46 PTAs. T2-weighted IDEAL-FSE and T1 IDEAL-sequences, before and after contrast, were performed. Five features of PTAs were recognised: hyperintensity, homogeneous or ''marbled'' appearance and elongated morphology on T2-sequences; cleavage plane from thyroid gland on T2-outphase; rapid enhancement in post-contrast T1. Image quality for T2-weighted IDEAL FSE and usefulness for IDEAL post-contrast T1-weighted and T2-outphase sequences were also graded. PTAs were hyperintense in T2-sequences in 44/46 (95.7 %), ''marbled'' in 30/46 (65.2 %) and elongated in 38/46 (82.6 %) patients. Cleavage plane was observed in 36/46 (78.3 %), and rapid enhancement in 20/46 (43.5 %) patients. T2-sequences showed both excellent fat suppression and image quality (average scores of 3.2 and 3.1). T2-outphase images demonstrated to be quite useful (score 2.8), whereas, post-contrast T1 images showed a lower degree of utility (score 2.4). A fast protocol with 3.0-T MRI, recognising most common features of PTAs, may be used as a second-line method in the preoperative detection of PTAs. (orig.)

  18. 1,25-dihydroxyvitamin D and the vitamin D receptor gene polymorphism Apa1 influence bone mineral density in primary hyperparathyroidism.

    Directory of Open Access Journals (Sweden)

    Monika H E Christensen

    Full Text Available OBJECTIVE: Parathyroid hormone (PTH and vitamin D are the most important hormones regulating calcium metabolism. In primary hyperparathyroidism (PHPT excessive amounts of PTH are produced. Bone turnover is enhanced, leading to reduced bone mineral density and elevated levels of serum calcium. The aim of this study was to investigate relations between serum levels of 25-hydroxyvitamin D (25(OHD, 1,25-dihydroxyvitamin D (1,25(OH(2D and bone mineral density, as well as known genetic polymorphisms in the vitamin D receptor and enzymes metabolising vitamin D in patients with PHPT. DESIGN/SUBJECTS: We conducted a cross-sectional study of 52 patients with PHPT. RESULTS: Mean level of 25(OHD was 58.2 nmol/L and median 1,25(OH(2D level was 157 pmol/L. Among our patients with PHPT 36.5% had 25(OHD levels below 50 nmol/L. Serum 1,25(OH(2D was inversely correlated to bone mineral density in distal radius (p = 0.002, but not to bone mineral density at lumbar spine or femoral neck. The vitamin D receptor polymorphism Apa1 (rs7975232 was associated with bone mineral density in the lumbar spine. CONCLUSIONS: The results suggest that PHPT patients with high blood concentrations of 1,25(OH(2D may have the most deleterious skeletal effects. Randomized, prospective studies are necessary to elucidate whether vitamin D supplementation additionally increases serum 1,25(OH(2D and possibly enhances the adverse effects on the skeleton in patients with PHPT.

  19. 原发性甲状旁腺功能亢进的定位诊断%Localizing diagnosis of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    周建平; 李昱骥; 董明; 孔凡民; 李继光; 郭克建; 田雨霖

    2005-01-01

    目的探讨超声、ECT、CT和MRI对原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)的定位诊断价值.方法回顾性分析1990年1月1日至2004年3月31日34例手术治疗的PHPT患者的临床资料.结果 25例患者手术前行超声检查,其中22例手术前的超声定位与术中所见相符合,诊断的符合率为88%.21例患者手术前行ECT检查,其中20例患者与手术中所见相符合,诊断符合率为95%.19例患者手术前行CT检查,13人与手术中定位相一致,诊断符合率69%.3例患者手术前行MRI检查均发现病变并且与手术中所见相一致.结论超声和99mTc-MIBI应该作为首选的定位检查方法,尤其是二者联合应用可以提高定位诊断的准确率,若条件允许可以行甲状旁腺三维CT或MRI检查.

  20. {sup 99m}Tc-MIBI SPECT in primary hyperparathyroidism. Influence of concomitant vitamin D deficiency for visualization of parathyroid adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, M.; Thoma, N.; Dietlein, M.; Moka, D.; Eschner, W.; Schicha, H. [Dept. of Nuclear Medicine, Univ. of Cologne (Germany); Faust, M. [Dept. of II of Internal Medicine (Endocrinology), Univ. of Cologne (Germany); Schroeder, W. [Dept. of Surgery, Univ. of Cologne (Germany); Huelst-Schlabrendorff, M. von; Ehses, W. [Dept. of Endocrinology Clinic, Univ. of Cologne (Germany)

    2008-07-01

    Aim of the study was to analyse the influence of a concomitant vitamin D deficiency on the results of {sup 99m}Tc-MIBI studies in patients (pts) with primary hyperparathyroidism (pHPT). Patients, methods: between January 1998 and May 2004, 71 pts with pHPT had undergone operation after a {sup 99m}Tc-MIBI study of whom 54 pts (76%) had normal values of 25-OH-vitamin D3 and 17 pts (24%) had vitamin D deficiency. Results of a dual-phase {sup 99m}Tc-MIBI protocol with SPECT were compared with histopathology. Results: in 54 pts with normal vitamin D values late SPECT images identified more lesions (n = 51, sensitivity 91%) than early planar (n = 45, sensitivity 82%) or late planar images (n = 50, sensitivity 88%). In 17 pts with vitamin D deficiency late SPECT images identified more lesions (n = 13, sensitivity 72%) than early planar (n = 10, sensitivity 56%) or late planar images (n = 10, sensitivity 56%) too. In pts with vitamin D deficiency the sensitivity of a {sup 99m}Tc-MIBI SPECT study was lower than in those with normal vitamin D status (72% vs. 91%) and dependent on the value for PTH. However, the results did not reach statistical significance: early planar: p = 0.1625; late planar: p = 0.0039; {sup 99m}Tc-MIBI SPECT: p = 0.1180. Conclusion: the likelihood of a pathological {sup 99m}Tc-MIBI study being obtained in pts with pHPT is dependent on the parathyroid hormone level. However, a negative influence of a low vitamin D level on the scintigraphic detection rate of a parathyroid adenoma could not be proven which may be due to the low number of pts with vitamin D deficiency. (orig.)

  1. {sup 99m}Tc-M.I.B.I. pinhole SPECT in primary hyperparathyroidism; Tomographie stenopeique au {sup 99m}Tc-MIBI dans l'hyperparathyroidie primaire

    Energy Technology Data Exchange (ETDEWEB)

    Oudoux, A.; Carlier, T.; Bodet-Milin, C.; Kraeber-Bodere, F.; Ansquer, C. [Centre Hospitalier Universitaire, Service de Medecine Nucleaire, Hotel-Dieu, 44 - Nantes (France); Mirallie, E. [Centre Hospitalier Universitaire, Service de Chirurgie, Hotel-Dieu, 44 - Nantes (France); Seret, A. [Liege Univ. (Belgium). Inst. de Physique; Aubron, F.; Daumy, I. [Centre d' Echographie de l' ile Gloriette, 44 - Nantes (France); Leux, C. [Centre Hospitalier Universitaire, PIMESP, Hopital Saint-Jacques, 44 - Nantes (France)

    2007-10-15

    Purpose: this prospective study was conducted to determine the interest of 99 mTc-M.I.B.I. pinhole SPECT compared with conventional SPECT, planar scintigraphy and ultrasonography, for the preoperative localization of parathyroid lesions in primary hyperparathyroidism. Methods: fifty-one patients cured after surgery were studied. Pinhole SPECT was reconstructed with a dedicated O.S.E.M. algorithm. Scintigraphies were analyzed visually. A diagnostic confidence score (C.S.) was assigned to each procedure considering intensity and extra thyroidal location of suspected lesions and was defined as follows: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 positive. Results: surgery revealed 55 lesions. Sensitivity of ultrasonography, planar imaging, conventional SPECT and pinhole SPECT were respectively, 51, 76, 82 and 87%. Five glands were only detected by pinhole SPECT. Combination of ultrasonography, planar and pinhole SPECT showed the highest sensitivity (94.5%). The mean C.S. of the 55 pathologic glands was significantly higher with pinhole SPECT compared with planar imaging and conventional SPECT (p < 0.0001). Compared with planar imaging and conventional SPECT, pinhole SPECT increased C.S. for 42 and 53% of parathyroid lesions, respectively, and contributed to markedly reduce the number of uncertain results. Nevertheless, planar imaging and ultrasonography were useful to analyze thyroid morphology and to detect some ectopic glands. Conclusion: the use of pinhole SPECT increases sensitivity and C.S. of scintigraphy. Combination of ultrasonography, planar and pinhole SPECT appears the optimal preoperative imaging procedure in primary hyperparathyroidism. (authors)

  2. Is there a link between Hashimoto's thyroiditis and primary hyperparathyroidism? A study of serum parathormone and anti-TPO antibodies in 2267 patients.

    Science.gov (United States)

    Ignjatovic, Vesna D; Matovic, Milovan D; Vukomanovic, Vladimir R; Jankovic, Slobodan M; Džodić, Radan R

    2013-01-01

    According to various authors, thyroid disorders like Hashimoto's thyroiditis (HT), diffuse goiter or multinodular goiter, Graves' disease, medullary or papillary carcinoma could be found in a number of patients with primary hyperparathyroidism (PHPT). This association is more common in elderly women. Neck irradiation, lithium treatment and elevated TSH levels have been suggested as some of the possible causes of this co-existance. The aim of this study was to investigate and determine the prevalence of patients having both HT and PHPT, and the possible relation between these two diseases. We conducted a prospective study during three and a half years. This study included 45,231 patients, which were referred by their general practitioner or endocrinologist, under suspicion of having thyroid and/or parathyroid disease. In these patients we measured serum levels of the following parameters: anti-thyroid peroxidase antibodies (antiTPO-Ab), anti-thyroglobulin antibodies (Tg-Ab), anti-TSH-receptor antibodies (TSHR-Ab), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium (Ca). In 2,267 of these 45,231 patients (5.01%) we noticed elevated antiTPO-Ab (3542±3407IU/mL), with statistical significant difference from normal values (normal range 0-70IU/mL), Pantibodies (Tg-Ab, TSHR-Ab). All patients with elevated antiTPO-Ab were assumed to have HT. Within this group, 43 patients (1.89%) also had elevated serum levels of PTH (112.4±33.2pg/mL, normal range 8-76pg/mL) as well as elevated serum levels of calcium (2.92±0.06mmol/L, normal range 2.2-2.65mmol/L). These laboratory findings, accompanied with clinical symptoms, satisfied the criteria for PHPT. The mean age in this subgroup was 60.5±12.2 years. All 2,267 patients had normal or slightly elevated TSH levels. In conclusion, although the reported rate of prevalence of PHPT in the general population is about 0.3%, our results indicated a 1.89% occurrence of PHPT in 2267 patients with HT in central Serbia

  3. The Diagnosis and Treatment of Primary Hyperparathyroidism%原发性甲状旁腺功能亢进症的诊治

    Institute of Scientific and Technical Information of China (English)

    胡慧; 刘宁; 易辛; 韦伟

    2013-01-01

      Objective:To summarize the experience in diagnosis and treatment of primary hyperparathyroidism(PHPT).Method:The clinica1 and pathological data of 12 cases were reviewed from 2006 to 2012 in our hospita1.Result:The average age of the 12 cases was 46 years.The average course of the 12 cases was 3.15 years.The serum calcium and PTH leve1 elevated in all the 12 cases.The location methods included sonography and ECT. The positive rate of sonography was 75.0%,of ECT was 83.0%.Conclusion:Patients with chronic bone diseases,nephrolithiasis or pancreatitis should be considered of suspectable cases of PHPT.The PTH test should be performed as routine procedure.Serum calcium and PTH assays are both reliable methods for the diagnosis of PHPT. Sonography and ECT are enough to locate lesion. Accompanied by intraoperative PTH test and pathological examination,neck exploration is an acceptable approach for the patients with definitive preoperative lesions 1ocalization.%  目的:探讨原发性甲状旁腺功能亢进症(PHPT)的诊治方法。方法:回顾性分析本院2006-2011年间收治的12例原发性甲状旁腺功能亢进患者的临床资料。结果:12例患者平均年龄46岁,病程3.15年,所有患者血清钙水平及甲状旁腺激素(PTH)水平明显升高,术后临床症状均有不同程度改善。超声和ECT的定位阳性率分别为75.0%及83.0%。结论:慢性骨疾病、肾结石或胰腺炎等疾病的患者应考虑到有原发性甲状旁腺功能亢进症的可能性。在PHPT的诊断中PTH的检测应该做为常规。超声及ECT定位联合术中甲状旁腺素检测及术中快速病理能较好地诊断PHPT,对术前定位明确的原发性甲旁亢患者来说手术探查是较好的选择。

  4. Osteosarcoma associated with hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Jutte, Paul C. [Istituti Orthopedici Rizzoli, Via Pupilli 1, 40136, Bologna (Italy); University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen (Netherlands); Rosso, Renato [Anatomia Patologica Universita di Pavia, via Forlanini 16, 27100, Pavia (Italy); Paolis, Massimiliano de; Errani, Costatino; Pasini, Elisabetta; Campanacci, Laura; Bacci, Gaetano; Bertoni, Franco; Mercuri, Mario [Istituti Orthopedici Rizzoli, Via Pupilli 1, 40136, Bologna (Italy)

    2004-08-01

    The fourth case in the literature is presented of a patient with the rare association of hyperparathyroidism and osteosarcoma. A 56-year-old woman presented with hyperparathyroidism and a lesion in the tibia. Initial diagnosis was brown tumor. Histology, however, revealed osteosarcoma, and the patient was treated accordingly. The experimental induction of osteosarcoma by parathormone in rodent studies makes this finding alarming, considering the increasing use of parathormone in the treatment of osteoporosis. The mechanism by which osteosarcoma is induced in humans cannot be explained based on current knowledge of mechanisms of action of parathyroid hormone. (orig.)

  5. Management of hyperparathyroidism (PHP) in MEN2 syndromes in Europe.

    Science.gov (United States)

    Alevizaki, Maria

    2013-03-14

    Hyperparathyroidism occurs in 20-30% of MEN2A syndrome patients. It is usually associated with mild disease and is frequently asymptomatic, especially in younger age. There is genotype/phenotype association and PHP is usually associated with codon 634 mutations; however association with more "rare" mutations has also been reported. The pathology of the parathyroid glands includes hyperplasia, adenoma or a combination of the two. The optimal surgical management of this entity has not been defined yet.

  6. [Pathophysiology of secondary hyperparathyroidism.

    Science.gov (United States)

    Kawarazaki, Hiroo

    2017-01-01

    Secondary hyperparathyroidism(SHPT)is the result of a compensatory response of the calcium phosphate homeostatic mechanism. Vitamin D deficiency and chronic kidney disease, both representative pathophysiological causes of SHPT, have been related not only to skeletal disorders but also cardiovascular diseases, ADL and QOL. This relates the importance of SHPT as a pathological cause or marker of such states.

  7. The clinic research of surgical therapy for primary hyperparathyroidism%原发性甲状旁腺功能亢进症手术疗效分析

    Institute of Scientific and Technical Information of China (English)

    戴大江; 黄蓉蓉; 张海宏; 郑爱民

    2015-01-01

    ObjectiveTo discuss the operation mode for primary hyperparathyroidism (PHPT), and evaluate the difference of clinic symptoms and the change of serum calcium, parathyroid hormone beforeand after the surgical therapy. MethodsIn this study, 20 patients with PHPT who received surgical therapy between 2006 and 2011 were selected. Among them, 12 cases of parathyroid adenoma received adenoma resection, 8 cases of parathyroid hyperplasia received total resection(part of the relatively normal parathyroid gland were cut into 1 mm diameter size, and 15 to 25 pieces of gland were buried withinthe sternocleidomastoid). Serum calcium and parathyroid hormone were detected after the surgery and follow-up were achieved in some of the patients.ResultsSerum calcium, parathyroid hormone significantly decreased(P<0.01), and serum calcium returned to normal in 1~8 d after surgery. Among the 10 follow-up patients, symptoms of urinary calculi, pathological fractures and bone defects were significantly improved.ConclusionSurgical therapy can obviously improve clinical symptoms and quality of life in patients with PHPT.%目的:探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)手术方式,比较手术前后血清钙、甲状旁腺素变化及临床症状的改善情况。方法2006—2011年共手术治疗PHPT患者20例,其中甲状旁腺瘤12例行单纯腺瘤切除,甲状旁腺增生8例行甲状旁腺全部切除,将部分较正常甲状旁腺切割成直径为1 mm的15~25块埋藏缝合于胸锁乳突肌内。检测手术前后血清钙、甲状旁腺素水平,术后随访部分患者。结果术后血清钙、甲状旁腺素较术前明显降低,差异有统计学意义(P<0.01),其中血清钙于术后1~8 d恢复正常。随访10例,泌尿系结石、病理性骨折症状及骨骼畸形明显改善。结论手术治疗能明显改善PHPT患者临床症状,提高生活质量。

  8. Diagnosis and surgical treatment of primary hyperparathyroidism%原发性甲状旁腺亢进症的外科诊治

    Institute of Scientific and Technical Information of China (English)

    曹厚军; 魏学明; 王石林; 黄蓉蓉; 郑爱民

    2010-01-01

    Objective To discuss the diagnosis and surgical treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 6 cases of PHPT were retrospectively analyzed in the past 14 years in our hospital.Results Serum PTH level of five Cases was elevated(2.5 to 15 folds).Five cases undergone preoperative ultrasound scan were diagnosed as parathyroid tumor.Of which 4 cases undergone CT scan.2 cases were diagnosed as parathyroid tumor,2 cases were misdiagnosed as thyroiditis.1 case was misdiagnosed as thyroid nodule.3 cases undergone ~(99)Tcm-MIBI Scan,1 case was diagnosed as parathyroid adenoma,parathyroid tumor was not found in two cases.Postoperative pathological diagnosis:five parathyroid adenoma,1 parathyroid hyperplasia.The parathyroid hyperplasia recurred postoperatively.No operative complications were found.Conclusions Blood calcium concentration play an important seaning diagnosis role.Osteoporosis and multiple urinary stones must be considered of this disease.Intact parathyroid hormone examination is helpful for diagnosis.Ultrasound scan and ~(99)Tcm-MIBI scanning program have great significance to make surgery plan.Unilateral neck exploration is appropriate for most cases of PHPT.Parathyroid hyperplasia need bilateral parathyroid exploration,may recur after operation.Parathyroid Cancer is relatively rare.%目的 总结6例原发性甲状旁腺功能亢进症(PHPT)的外科诊治经验.方法 回顾性分析我院近14年间6例手术治疗的PHPT的临床资料.结果 5例术前全段甲状旁腺激素均高于正常值(2.5~15倍),术前B超检查均诊断甲状旁腺肿瘤.CT检查4例,2例诊断为甲状旁腺肿瘤,1例误诊为甲状腺炎,1例误诊为甲状腺结节.~(99)Tcm-MIBI检查3例,1例诊断为甲状旁腺瘤,2例未发现甲状旁腺肿瘤.术后病理诊断:甲状旁腺腺瘤5例,甲状旁腺增生1例.1例甲状旁腺增生复发.无手术并发症.结论 血钙浓度检查具有重要的诊断价值.骨质疏松和多发泌尿系结石

  9. Dominantly inherited isolated hyperparathyroidism: a syndromic association?

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, K. [Department of Radiology, Royal Alexandra Hospital for Children, Sydney (Australia)]|[Department of Radiology, New Children`s Hospital, PO Box 3515, Parramatta, NSW 2124 (Australia); Czerminska-Kowalska, A. [Department of Radiology, Children`s Memorial Health Institute, Warsaw (Poland); Kulczycka, H.; Rowinska, E.; Pronicka, E. [Department of Metabolism, Children`s Memorial Health Institute, Warsaw (Poland)

    1999-01-01

    Dominantly inherited isolated hyperparathyroidism (DIIH) is rare in childhood. It may be the first biochemical abnormality in the multiple endocrine neoplasia type I (MEN I) and type II (MEN II) syndromes. Its clinical course is usually asymptomatic or of low morbidity. Radiographic examination is most often normal. We describe six members of a family with distinctive phenotype and DIIH. Limited systemic symptoms and severe radiographic osteitis fibrosa cystica were further unusual features in this family. The diagnosis of DIIH was made only after a 9-year-old girl developed hypercalcaemic crisis after a pathological femoral fracture. Distinctive phenotype, unusual clinical course and unparalleled radiographic changes suggest a not yet described syndromic association. (orig.) With 7 figs., 3 tabs., 23 refs.

  10. Clinical analysis for 51 cases of primary hyperparathyroidism%原发性甲状旁腺功能亢进症51例临床分析

    Institute of Scientific and Technical Information of China (English)

    李硕良; 黄知敏; 卫国红; 肖海鹏; 李延兵

    2011-01-01

    目的 探讨原发性甲状旁腺功能亢进症(PHPT)的临床特点、误诊状况及诊疗措施.方法 对我院1997年6月至2010年11月收治的51例PHPT患者的临床资料,进行回顾性分析.47例术后病理检查确诊,4例未手术者综合血钙、血碱性磷酸酶(ALP)、血甲状旁腺素全段(iPTH)、CT或者99mTc-甲氧基异丁基异腈双时相显像(99mTcMIBI)检查诊断.结果 PHPT临床表现以骨型最常见,占51% (26/51).病因中腺瘤最多见,占72%( 34/47).原位病变以右下极最常见,占41%( 19/46),其次为左下极,占28% (13/46),异位病变占10%( 5/51).PHPT易误诊,误诊率92%(47/51),较多误诊为泌尿系结石、风湿性疾病、原发性骨质疏松症等.不同临床类型、病理分型患者术前血钙、ALP及iPTH水平存在差异,以肾骨型及甲状旁腺癌患者水平最高,分别为(3.22±0.35)mmoL/L、( 1455±1091) U/L、( 1669±515) ng/L及(3.46±0.40) mmol/L、(1410±426) U/L、(1861±768) ng/L.术前定位甲状旁腺彩色超声、CT及99m TcMIBI的检出率分别为88% (35/40)、97%(30/31)和97%(31/32).结论 PHPT误诊率高,血钙应列为常规体检项目,辅以ALP、iPTH、影像学等检查有助于避免误诊;联合99mTc-MIBI和CT可提高术前定位的准确性.%Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51% (26/51 ) of the cases,and adenoma,a benign

  11. Clinical Use of Cinacalcet in MEN1 Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    V. J. Moyes

    2010-01-01

    Full Text Available Background. Management of multiple-endocrine neoplasia type 1- (MEN1- associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations. Cinacalcet, a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma, may provide a medical alternative for the management of these complex patients. Methods. A prospective audit was performed of eight patients; three males and five females, aged 20–38 at diagnosis. Two patients commenced cinacalcet as primary treatment and six had previous surgery. Six patients had complications of hyperparathyroidism: renal calculi, renal dysfunction, and reduced bone mineral density. All were commenced on cinacalcet 30 mg bd for MEN1 associated hyperparathyroidism; doses were subsequently reduced to 30 mg od in four patients. Results. Significant reductions were observed in serum calcium and PTH measurements. Serum calcium reduced by a median of 0.35 mmol/L (=.012 Wilcoxon Signed Rank. Serum PTH levels decreased by a median of 5.05 pmol/L (=.012. There was no change in urine calcium. Duration ranged from 10–35 months with maintenance of control. Cinacalcet was well tolerated by six patients; one experienced nausea and one experienced diarrhoea. Conclusion. Cinacalcet is an effective and well-tolerated medical treatment for the management of complex primary hyperparathyroidism.

  12. Clinical Use of Cinacalcet in MEN1 Hyperparathyroidism

    Science.gov (United States)

    Moyes, V. J.; Monson, J. P.; Chew, S. L.; Akker, S. A.

    2010-01-01

    Background. Management of multiple-endocrine neoplasia type 1- (MEN1-) associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations. Cinacalcet, a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma, may provide a medical alternative for the management of these complex patients. Methods. A prospective audit was performed of eight patients; three males and five females, aged 20–38 at diagnosis. Two patients commenced cinacalcet as primary treatment and six had previous surgery. Six patients had complications of hyperparathyroidism: renal calculi, renal dysfunction, and reduced bone mineral density. All were commenced on cinacalcet 30 mg bd for MEN1 associated hyperparathyroidism; doses were subsequently reduced to 30 mg od in four patients. Results. Significant reductions were observed in serum calcium and PTH measurements. Serum calcium reduced by a median of 0.35 mmol/L (P = .012 Wilcoxon Signed Rank). Serum PTH levels decreased by a median of 5.05 pmol/L (P = .012). There was no change in urine calcium. Duration ranged from 10–35 months with maintenance of control. Cinacalcet was well tolerated by six patients; one experienced nausea and one experienced diarrhoea. Conclusion. Cinacalcet is an effective and well-tolerated medical treatment for the management of complex primary hyperparathyroidism. PMID:20585352

  13. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients.

    Science.gov (United States)

    Blaha, Michael J; Silverman, Michael G; Budoff, Matthew J

    2014-03-01

    Although risk factors have proven to be useful therapeutic targets, they are poor predictors of risk. Traditional risk scores are moderately successful in predicting future CHD events and can be a starting place for general risk categorization. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden, with event rates predominantly driven by burden of atherosclerosis. Serum biomarkers have yet to show any clinically significant incremental value to the FRS and even when combined cannot match the predictive value of atherosclerosis imaging. As clinicians, are we willing to base therapy decisions on risk models that lack optimum-achievable accuracy and limit personalization? The decision to treat a patient in primary prevention must be a careful one because the benefit of therapy in an asymptomatic patient must clearly outweigh the potential risk. CAC, in particular, provides a personalized assessment of risk and may identify patients who will be expected to derive the most, and the least, net absolute benefit from treatment. Emerging evidence hints that CAC may also promote long-term adherence to aspirin, exercise, diet, and statin therapy. When potentially lifelong treatment decisions are on the line, clinicians must arm their patients with the most accurate risk prediction tools, and subclinical atherosclerosis testing with CAC is, at the present time, superior to any combination of risk factors and serum biomarkers.

  14. Asymptomatic dystrophinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Morrone, A. [Univ. of Pittsburgh School of Medicine, PA (United States)]|[Univ. of Florence (Italy); Hoffman, E.P.; Hoop, R.C. [Univ. of Pittsburgh School of Medicine, PA (United States)] [and others

    1997-03-31

    A 4-year-old girl was referred for evaluation for a mild but persistent serum aspartate aminotransferase (AST) elevation detected incidentally during routine blood screening for a skin infection. Serum creatine kinase activity was found to be increased. Immuno-histochemical study for dystrophin in her muscle biopsy showed results consistent with a carrier state for muscular dystrophy. Molecular work-up showed the proposita to be a carrier of a deletion mutation of exon 48 of the dystrophin gene. Four male relatives also had the deletion mutation, yet showed no clinical symptoms of muscular dystrophy (age range 8-58 yrs). Linkage analysis of the dystrophin gene in the family showed a spontaneous change of an STR45 allele, which could be due to either an intragenic double recombination event, or CA repeat length mutation leading to identical size alleles. To our knowledge, this is the first documentation of an asymptomatic dystrophinopathy in multiple males of advanced age. Based on molecular findings, this family would be given a diagnosis of Becker muscular dystrophy. This diagnosis implies the development of clinical symptoms, even though this family is clearly asymptomatic. This report underscores the caution which must be exercised when giving presymptomatic diagnoses based on molecular studies. 28 refs., 4 figs., 1 tab.

  15. Mandibular brown tumor revealing primary hyperparathyroidism. Contribution of the {sup 99}Tc-MIBI scintigraphy (report of case); Tumeur brune mandibulaire revelant une hyperparathyroidie primaire. Apport de la scintigraphie au {sup 99}Tc-MIBI: (a propos d'un cas)

    Energy Technology Data Exchange (ETDEWEB)

    Bahri, H.; Mhiri, A.; Zayed, S.; Letaief, B.; Slim, I.; Kraiem, T.; Ben Slimen, M.F. [Institut Salah Azaiez, Service de Medecine Nucleaire (Tunisia); Sellem, A.; Hammami, H. [Hopital Militaire Principal d' Instruction, Service de Medecine Nucleaire (Tunisia); Ladgham, A. [Institut Salah Azaiez, Service d' ORL (Tunisia)

    2006-06-15

    Thanks to the development of new diagnostic and therapeutic techniques, it has became rare to discover a primary hyperparathyroidism at the stage of renal and/or bony complications. The contribution of the {sup 99m}Tc-MIBI scintigraphy has been well described in the detection of the parathyroid adenoma but few publications showed its capacity to detect also brown tumors. We report a case of mandible brown tumor, revealing a primary hyperparathyroidism. {sup 99m}Tc-MDP scintigraphy, done in the setting of the bony lesion balance, showed the multifocal character of this tumor. {sup 99m}Tc-MIBI scintigraphy pointed out both parathyroid adenoma and brown tumor that fixed the radio tracer. (author)

  16. Usefulness of 99mTc MIBI scintigraphy in hyperparathyroidism. A retrospective analysis of the surgical patients

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Toshiyuki; Kobayashi, Shinya; Fujimori, Minoru [Shinshu Univ., Matsumoto, Nagano (Japan). School of Medicine] [and others

    1998-10-01

    In patients who receive surgery for primary or secondary hyperparathyroidism, preoperative diagnosis of the location of the parathyroid glands is important. Ninety-nine-m Technetium methoxyisobutylisonitrile (MIBI) accumulates in the pathological parathyroid. We used MIBI scintigraphy to detect diseased parathyroid glands in 20 patients with hyperparathyroidism, and successfully located the glands in seventeen. The accuracy of MIBI scintigraphy (100%) is significantly (p<0.05) better than that of Thallium-Technetium subtraction scintigraphy (56%). In a patient with hyperparathyroidism due to an ectopic parathyroid gland, MIBI scintigraphy showed accumulation in a mediastinal gland. MIBI scintigraphy is thus useful for gland location in hyperparathyroidism. (author)

  17. Surgical treatment of hyperparathyroidism : with an analysis of 267 cases

    NARCIS (Netherlands)

    H.A. Bruining (Hajo)

    1971-01-01

    textabstractIt is generally accepted that for autonomous hyperparathyroidism, whether primary or tertiary, surgery is still the only suitable method of treatment available. Analysis of a series of cases treated in t his way over the past twenty years has shown that there are certain problems associa

  18. Nontyphoidal salmonella urinary tract infection in a case of hyperparathyroidism and nephrocalcinosis.

    Science.gov (United States)

    Chen, C-P; Shi, Z-Y; Chen, C-H; Chen, W-M; Lin, Y-H; Tsai, C-A; Lin, S-P; Huang, S-R; Liu, P-Y

    2014-01-01

    Nontyphoidal Salmonella infections often present with self-limited gastroenteritis. Extraintestinal focal infections are uncommon but have high mortality and morbidity. Urinary tract infection caused by nontyphoidal Salmonella is usually associated with structural abnormalities of the urinary tract. Nephrocalcinosis and nephrolithiasis are the major risk factors. Although primary hyperparathyroidism has been reported to increase the risk of nephrocalcinosis and nephrolithiasis, little is known about the association between hyperparathyroidism and Salmonella urinary tract infection. We report the case of a 37-year old man who had a history of primary hyperparathyroidism and bilateral nephrocalcinosis and who developed urinary tract infection. Salmonella Group D was isolated from his urine specimen. Salmonella should be considered as a possible causality organism in patients with primary hyperparathyroidism and nephrocalcinosis who develop urinary tract infection. These patients need to be aware of the potential risks associated with salmonellosis.

  19. Hyperparathyroidism of Renal Disease

    Science.gov (United States)

    Yuen, Noah K; Ananthakrishnan, Shubha; Campbell, Michael J

    2016-01-01

    Renal hyperparathyroidism (rHPT) is a common complication of chronic kidney disease characterized by elevated parathyroid hormone levels secondary to derangements in the homeostasis of calcium, phosphate, and vitamin D. Patients with rHPT experience increased rates of cardiovascular problems and bone disease. The Kidney Disease: Improving Global Outcomes guidelines recommend that screening and management of rHPT be initiated for all patients with chronic kidney disease stage 3 (estimated glomerular filtration rate, < 60 mL/min/1.73 m2). Since the 1990s, improving medical management with vitamin D analogs, phosphate binders, and calcimimetic drugs has expanded the treatment options for patients with rHPT, but some patients still require a parathyroidectomy to mitigate the sequelae of this challenging disease. PMID:27479950

  20. Radiographic Enlargement of Mandibular Canal as an Extranodal Primary Non-Hodgkin’s Lymphoma Early Sign in an Asymptomatic Patient

    Directory of Open Access Journals (Sweden)

    Luciana Munhoz

    2017-01-01

    Full Text Available Non-Hodgkin’s lymphoma (NHL is a lymphoproliferative disorder, from a subgroup of heterogeneous hematologic malignancies; the term “extranodal” refers to malignant involvement of tissues other than lymph nodes, tonsils, spleen, pharyngeal lymphatic ring, or thymus. Only 0.6% of all NHL are at mandible alone, and it may involve the inferior alveolar canal. We describe a case of bilateral enlargement of the mandibular canal without symptomatology, which was shown in a panoramic radiograph and cone beam computed tomography in a rehabilitation routine exam, as an early sign of primary extranodal NHL.

  1. Asymptomatic colonic metastases from primary squamous cell carcinoma of the lung with a positive fecal occult blood test

    Institute of Scientific and Technical Information of China (English)

    Shoji Hirasaki; Seiyuu Suzuki; Shigeki Umemura; Haruhito Kamei; Masato Okuda; Kenichiro Kudo

    2008-01-01

    We describe a 74-year-old man with a colonic metastatic squamous cell carcinoma (SCC) from the lung.His chest X-ray revealed an abnormal shadow in the right upper lobe.Computed tomography (CT) of the chest demonstrated a large lung tumor in the right upper lobe obstructing the right upper bronchus.Bronchoscopy revealed an easy-bleeding tumor in the right upper bronchus that was diagnosed as poorly differentiated squamous cell lung carcinoma.He underwent colonoscopy because he had a positive fecal occult blood test.Colonoscopy revealed a large protruding lesion with central ulceration in the descending colon.Histological examination of the biopsy specimen obtained from the colonic lesion revealed SCC.The lesion was diagnosed as metastatic colonic SCC.He had no abdominal symptoms.He underwent chemotherapy with an infusion of cisplatin 130 mg I.v.day 1,and docetaxel hydrate 100 mg I.v.day 1,repeated every 4 wk,followed by 4 courses of chemotherapy.The primary lesion shrank by less than 10% and was judged to be "Partial Response" (PR)after 3 courses of treatment.The patient still lived 23 wk after the diagnosis of metastatic colonic SCC.Colonic metastasis of primary SCC of the lung is rare.

  2. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  3. Renal secondary hyperparathyroidism in dogs.

    Science.gov (United States)

    Stillion, Jenefer R; Ritt, Michelle G

    2009-06-01

    The parathyroid glands secrete parathyroid hormone (PTH), which is important for maintaining calcium homeostasis. Parathyroid gland hyperplasia and subsequent hyperparathyroidism can occur secondary to chronic renal failure in dogs, resulting in significant alterations in calcium metabolism. Renal secondary hyperparathyroidism is a complex, multifactorial syndrome that involves changes in circulating levels of calcium, PTH, phosphorus, and 1,25-dihydroxycholecalciferol (calcitriol). An increased PTH level can have deleterious effects, including soft tissue mineralization, fibrous osteodystrophy, bone marrow suppression, urolithiasis, and neuropathy. Dietary phosphorus restriction, intestinal phosphate binders, and calcitriol supplementation may slow the progression of renal disease and decrease PTH concentrations in animals with secondary hyperparathyroidism; however, the prognosis for these animals is guarded to poor.

  4. ERYTHEMA NODOSUM AND PROLONGED FEVER ASSOCIATED TO SECONDARY HYPERPARATHYROIDISM

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    Galimberti R

    2005-08-01

    Full Text Available SUMMARYSecondary hyperparathyroidism is one of the main deragements caused by chronic renal failure, and parathyroid hormone is considered one of the toxins of the uremic syndrome. Prolonged fever due to primary hyperparathyroidism have already been described in the literature but not yet as induced by secondary hyperparathyroidism. In this case report a patient suffering from an erythema nodosum and prolonged fever associated to secondary hyperparathyroidism that disappeared through subtotal parathyroidectomy is presented.RESUMENEl hiperparatiroidismo secundario es uno de los principales disturbios causados por la insuficiencia renal crónica, y la paratohormona es considerada una de las toxinas del sindrome urémico. El sindrome febril prolongado secundario a hiperparatiroidismo primario ya ha sido descripto en la literatura, aunque no lo ha sido aun el inducido por hiperparatiroidismo secundario. En el presente reporte se presenta un caso de eritema nodoso y sindrome febril prolongado asociado a hiperparatiroidismo secundario y que resolvió luego de efectuada una paratiroidectomía subtotal.

  5. 以泌尿系结石首发的原发性甲状旁腺功能亢进症的诊治分析%Diagnosis and treatment of primary hyperparathyroidism initially with urinary calculus

    Institute of Scientific and Technical Information of China (English)

    常俊锴; 傅侃达; 谢青南; 徐卫波; 徐文超; 侯俊清; 刘辉; 杜信毅

    2014-01-01

    目的:探讨以泌尿系结石首发的原发性甲状旁腺功能亢进症( primary hyperparathyroidism , PHPT)的临床诊断及治疗。方法回顾性分析河南大学淮河医院近10年来收治的26例以泌尿系结石首发的PHPT的临床资料。结果本组病例中双侧上尿路结石22例,单侧4例,术前均有泌尿系统症状。彩超、CT及放射性核素检查有助于定位诊断。24例行经皮肾镜或输尿管镜气压弹道碎石术,2例输尿管结石自行排出。所有患者均行手术治疗PHPT,均经术中冰冻病理及术后常规病理检查证实诊断。术后临床症状明显改善。术前血钙、尿钙、甲状旁腺激素明显升高,术后下降,差异有统计学意义( P<0.05);术前血磷明显降低,术后升高,差异有统计学意义( P<0.05)。结论以泌尿系结石首发的PHPT的诊断应重视实验室检测及影像学检查,手术治疗可明显降低结石复发率和改善肾功能。%Objective To investigate the diagnosis and treatment of primary hyperparathyroidism ( PHPT) initially with urinary calculus .Methods The clinical data of 26 patients who diagnosed as PHPT ini-tially with urinary calculus were retrospectively reviewed .Results There were 22 cases with bilateral urinary calculus and 4 cases with unilateral relapsed urinary calculus .Ultrasonography , CT and radionuclide were helpful to determine the location of the neoplasia .24 cases underwent percutaneous nephroscope or ureteroscopy pneu-matic ballistic lithotripsy , 2 cases discharged ureteral calculi by themselves .All patients were performed surgical treatment of PHPT , which was confirmed by intraoperative frozen pathology and postoperative pathological exami -nation.There was great improvement of clinical symptoms after surgical procedures .The preoperative serum calci-um, urine calcium and parathyroid hormone elevated , while serum phosphate decreased .The postoperative indi-cators were just

  6. Effects on bone geometry, density, and microarchitecture in the distal radius but not the tibia in women with primary hyperparathyroidism: A case-control study using HR-pQCT.

    Science.gov (United States)

    Hansen, Stinus; Beck Jensen, Jens-Erik; Rasmussen, Lars; Hauge, Ellen M; Brixen, Kim

    2010-09-01

    Patients with primary hyperparathyroidism (PHPT) have continuously elevated parathyroid hormone (PTH) and consequently increased bone turnover with negative effects on cortical (Ct) bone with preservation of trabecular (Tb) bone. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new technique for in vivo assessment of geometry, volumetric density, and microarchitecture at the radius and tibia. In this study we aimed to evaluate bone status in women with PHPT compared with controls using HR-pQCT. The distal radius and tibia of 54 women--27 patients with PHPT (median age 60, range 44-75 years) and 27 randomly recruited age-matched healthy controls (median age 60, range 44-76 years)--were imaged using HR-pQCT along with areal bone mineral density (aBMD) by dual-energy X-ray absorptiomentry (DXA) of the ultradistal forearm, femoral neck, and spine (L1-L4). Groups were comparable regarding age, height, and weight. In the radius, patients had reduced Ct area (Ct.Ar) (p = .008), Ct thickness (Ct.th) (p = .01) along with reduced total (p = .002), Ct (p = .02), and Tb (p = .02) volumetric density and reduced Tb number (Tb.N) (p = .04) and increased Tb spacing (Tb.sp) (p = .05). Ct porosity did not differ. In the tibia, no differences in HR-pQCT parameters were found. Moreover, patients had lower ultradistal forearm (p = .005), spine (p = .04), and femoral neck (p = 0.04) aBMD compared with controls. In conclusion, a negative bone effect of continuously elevated PTH with alteration of HR-pQCT assessed geometry, volumetric density, and both trabecular and cortical microarchitecture in radius but not tibia was found along with reduced aBMD by DXA at all sites in female patients with PHPT. © 2010 American Society for Bone and Mineral Research.

  7. Genetics Home Reference: hyperparathyroidism-jaw tumor syndrome

    Science.gov (United States)

    ... Genetics Home Health Conditions hyperparathyroidism-jaw tumor syndrome hyperparathyroidism-jaw tumor syndrome Enable Javascript to view the ... boxes. Download PDF Open All Close All Description Hyperparathyroidism-jaw tumor syndrome is a condition characterized by ...

  8. Hyperparathyroidism revisited - Old wine in new bottles!

    Directory of Open Access Journals (Sweden)

    Rekha Arcot

    2011-01-01

    Full Text Available Aim: Hyperparathyroidism (HPT is a condition that occurs due to exacerbated activity of the parathyroid glands. According to the etiology it may be primary, secondary or tertiary hyperparathyroidism (pHPT, sHPT, tHPT. This is a study done to document and evaluate the presentations of primary and secondary HPT, with the associated complications and the approach to management in these patients, at our hospital. Materials and Methods: Twenty-one patients with HPT were encountered at Sri Ramachandra Medical College and Research Institute between January 2000 and January 2010. Operative notes, histopathology files, and medical records were used for the retrospective analysis of the patients with HPT. Parathormone, calcium, and phosphate levels were estimated on all the patients, to determine the primary or secondary etiology of this endocrine abnormality. Furthermore, these patients were subjected to ultrasonography (USG of the neck and Technetium (99 mTc scan of the neck to identify the parathyroid gland. Results: This study revealed that about 76, 19, and 5% of the patients suffered from pHPT, sHPT, and tHPT, respectively, with a female preponderance (62%.The neoplasm in all patients with pHPT was parathyroid adenoma. The patients presented with renal, bony, and menstrual abnormalities. Cases with sHPT had a 15 - 20 year history of chronic kidney disease and they subsequently developed bony abnormalities. Even as all the patients with pHPT were managed with parathyroidectomy, individuals with sHPT were treated conservatively. Postoperative features of hypocalcemia were noted in only one patient. Conclusion: This study re-emphasizes that pHPT is more common and is often due to an adenoma. Recent advances in parathormone sampling operatively and minimal access surgery, along with accurate and prompt clinical diagnosis, is necessary for the cure of these patients presenting with obscure abdominal, bony, and renal ailments.

  9. Asymptomatic bacteriuria among pregnant women

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    Paul Erhunmwunse Imade

    2010-06-01

    Full Text Available Background: Asymptomatic bacteriuria is the significant presence of bacteria in the urine of an individual without symptoms. In pregnancy, the apparent reduction in immunity of pregnant women tends to encourage the growth of pathogens. Aim: This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a primary health centre in Benin City, Nigeria. Materials and Methods: A total of 1,228 pregnant women were recruited for this study. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into sterile universal container. The urine samples were examined microscopically and by cultural method. Identification of isolates was by standard microbiological technique. Result: A total of 556 (45.3% were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P < 0.0001. Trimester did not show any significant difference (P = 0.2006 in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Staphylococcus aureus. Ciprofloxacin, Ceftriaxone and Augmentin were found to be the most effective antibiotics against the urinary isolates. Conclusion: Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

  10. Asymptomatic bacteriuria among pregnant women

    Directory of Open Access Journals (Sweden)

    Paul Erhunmwunse Imade

    2010-01-01

    Full Text Available Background: Asymptomatic bacteriuria is the significant presence of bacteria in the urine of an individual without symptoms. In pregnancy, the apparent reduction in immunity of pregnant women tends to encourage the growth of pathogens. Aim : This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a primary health centre in Benin City, Nigeria. Materials and Methods: A total of 1,228 pregnant women were recruited for this study. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into sterile universal container. The urine samples were examined microscopically and by cultural method. Identification of isolates was by standard microbiological technique. Result: A total of 556 (45.3% were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P < 0.0001. Trimester did not show any significant difference (P = 0.2006 in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Staphylococcus aureus. Ciprofloxacin, Ceftriaxone and Augmentin were found to be the most effective antibiotics against the urinary isolates. Conclusion : Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

  11. Primary hyperparathyroidism, adrenal tumors and neuroendocrine tumors of the pancreas - clinical diagnosis and imaging requirements; Primaerer Hyperparathyreoidismus, Tumoren der Nebenniere und neuroendokrine Tumoren des Pankreas. Klinische Diagnostik und Anforderungen an die Bildgebung

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    Auernhammer, C.J.; Engelhardt, D.; Goeke, B. [Medizinische Klinik II, Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Grosshadern (Germany)

    2003-04-01

    Diseases of the parathyroids, the adrenals and of neuroendocrine tumors of the pancreas are primarily diagnosed by clinical and endocrinological evaluation.The requirements concerning various imaging techniques and their relative importance in localization strategies of the different tumors are complex. Current literature search, using PubMed. Evaluation of primary hyperparathyroidism requires bone densitometry by DXA and search for nephrolithiasis by ultrasound or native CT examination.While ultrasound of the thyroid and parathyroids seems useful before any parathyroid surgery,more extensive preoperative localization strategies (sestamibi scintigraphy, MRI) should be restricted to minimal invasive parathyroid surgery or reoperations.For adrenal tumors CT and MRI are of similar diagnostic value. Imaging of pheochromocytomas should be completed by MIBG scintigraphy. Each adrenal incidentaloma requires an endocrinological work-up.A fine-needle aspiration or core needle biopsy of an adrenal tumor is rarely indicated.Before adrenal biopsy a pheochromocytoma has to be excluded.Successful localization strategies for neuroendocrine tumors of the pancreas include somatostatin receptor scintigraphy, endoscopic ultrasound and MRI.Discussion Specific localization strategies have been established for the aforementioned tumors.The continuous progress of different imaging techniques requires a regular reevaluation of these localization strategies. (orig.) [German] Die Diagnostik von Erkrankungen der Nebenschilddruese, der Nebenniere und von neuroendokrinen Tumoren des Pankreas erfolgt primaer klinisch-endokrinologisch.Die Anforderungen an die Bildgebung bei der nachfolgenden Lokalisationsdiagnostik sind komplex, und die verschiedenen bildgebenden Verfahren bei den jeweiligen Tumorentitaeten von unterschiedlichem Stellenwert.Material und Methodik Aktuelle Literaturrecherche mittels PubMed.Ergebnisse Beim primaeren Hyperparathyreoidismus sind die Bestimmung der Knochendichte

  12. Enabling minimal invasive parathyroidectomy for patients with primary hyperparathyroidism using Tc-99m-sestamibi SPECT–CT, ultrasound and first results of {sup 18}F-fluorocholine PET–CT

    Energy Technology Data Exchange (ETDEWEB)

    Kluijfhout, Wouter P., E-mail: WPKluijfhout@gmail.com [Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht (Netherlands); Vorselaars, Wessel M.C.M., E-mail: W.M.Vorselaars@umcutrecht.nl [Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht (Netherlands); Vriens, Menno R., E-mail: mvriens@umcutrecht.nl [Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht (Netherlands); Borel Rinkes, Inne H.M., E-mail: I.H.M.BorelRinkes@umcutrecht.nl [Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht (Netherlands); Valk, Gerlof D., E-mail: G.D.Valk@umcutrecht.nl [Department of Endocrinology, University Medical Center Utrecht, Utrecht (Netherlands); Keizer, Bart de, E-mail: B.deKeizer@umcutrecht.nl [Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Utrecht (Netherlands)

    2015-09-15

    Highlights: • We examined an optimal pre-operative imaging strategy. • Goal was to perform minimal invasive parathyroidectomy. • Ultrasound significantly decreased the PPV when added to SPECT–CT. • {sup 18}F-fluorocholine was positive in 4/5 cases with negative conventional imaging. - Abstract: Objective: Assessment of the diagnostic value of ultrasound (US), single photon-emission computed tomography–computed tomography (SPECT–CT) and {sup 18}F-fluorocholine (FCH) PET–CT for preoperative localization of hyper-functioning parathyroid(s) in order to create a more efficient diagnostic pathway and enable minimal invasive parathyroidectomy (MIP) in patients with biochemical proven non-familial primary hyperparathyroidism (pHPT). Methods: A single-institution retrospective study of 63 consecutive patients with a biochemical diagnosis of non-familial pHPT who received a Tc-99m-sestamibi SPECT–CT and neck ultrasound. Surgical findings were used in calculating the sensitivity and the positive predictive value (PPV) of both imaging modalities. Furthermore we present 5 cases who received additional FCH PET–CT. Results: A total of 42 (66.7%) patients underwent MIP. The PPV and sensitivity of SPECT–CT, 93.0% and 80.3%, were significantly higher than those of US with 78.3% and 63.2%, respectively. Adding US to SPECT–CT for initial pre-operative localization did not significantly increase sensitivity but did significantly decrease PPV. Performance of US was significantly better when performed after SPECT–CT. {sup 18}F-fluorocholine PET–CT localized the hyper-functioning parathyroid gland in 4/5 cases with discordant conventional imaging, enabling MIP. Conclusion: SPECT–CT is the imaging modality of choice for initial pre-operative localization of hyper-functioning parathyroid gland(s) in patients with biochemical pHPT. Ultrasound should be performed after SPECT–CT for confirmation of positive SPECT–CT findings and for pre-operative marking

  13. Diagnosis and treatment of primary hyperparathyroidism%原发性甲状旁腺机能亢进的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    龚龙; 薛新波; 易春华; 童彦初; 陈文奎

    2009-01-01

    目的 探讨原发性甲状旁腺机能亢进症(primary lhyperparathyroidism,PHPT)的早期诊断与合理治疗.方法 对近10年来两院收治的23例PHPT患者的临床资料进行回顾性分析.结果 女15例,男8例;年龄16~64岁,患者临床表现多样,病程迁延,术前均采用颈部彩超+颈部增强CT或MRI检查+血钙+血PTH检查的综合分析诊断模式.21例行单侧甲状旁腺探查术,2例行双侧甲状旁腺探查术,22例术后确诊为PHPT并治愈,1例永久性甲状旁腺机能减退.结论 对可疑PHPT患者可采用颈部彩超+颈部增强CT或MRI检查+血钙+血PTH检查的综合分析诊断模式可帮助早期诊断.单侧甲状旁腺探查术是PHPT有效的治疗方法.

  14. [Oral calcimimetics on secondary hyperparathyroidism of uremia.

    Science.gov (United States)

    Imanishi, Yasuo

    2017-01-01

    Secondary hyperparathyroidism of uremia is associated with poor health outcomes, including all-cause mortality, cardiovascular mortality, and fractures. Standard therapy for secondary hyperparathyroidism includes vitamin D receptor activators, and phosphate binders. Persistently elevated parathyroid hormone(PTH)levels may require the addition of calcimimetics which sensitizes calcium-sensing receptors on the parathyroid glands.

  15. Hyperparathyroidism Two Years after Radioactive Iodine Therapy in an Adolescent Male

    Directory of Open Access Journals (Sweden)

    Danielle L. Gomez

    2014-01-01

    Full Text Available Primary hyperparathyroidism is a very rare complication following radioactive iodine therapy. There is typically a latency period of more than a decade following radiation exposure and, therefore, it is observed almost exclusively in adults. Consequently, pediatricians are not aware of the association. We present a case of primary hyperparathyroidism due to a solitary parathyroid adenoma occurring in an adolescent male two years following radioactive iodine treatment for papillary thyroid carcinoma. Periodic screening of serum calcium following ablative doses of radioactive iodine for thyroid cancer may be justified even in adolescents.

  16. Self-diagnosis of hyperparathyroidism during pregnancy resulting in parathyroidectomy and uncomplicated delivery.

    Science.gov (United States)

    Medza, Aleksandra; Obolonczyk, Lukasz; Lewalska, Anna; Buss, Tomasz; Peksa, Rafal; Siekierska-Hellmann, Malgorzata; Berendt-Obolonczyk, Monika; Wisniewski, Piotr; Sworczak, Krzysztof

    2017-03-06

    Primary hyperparathyroidism is a condition with hypercalcemia and elevated parathyroid hormone (PTH). Typically, treating patients with such disease does not pose a problem for doctors, unless the patient is pregnant. Firstly, pregnancy may mask signs of hypercalcemia. Secondly, treatment should be applied with special care for immature fetus. If undiagnosed and untreated, it is life-threatening for the mother and the baby. The main cause of primary hyperparathyroidism is parathyroid adenoma, which should be removed surgically in second trimester. If the patient is monitored by a multidisciplinary team, the risk of mortality and pregnancy loss is reduced.

  17. Craniofacial brown tumor as a result of secondary hyperparathyroidism in chronic renal disease patient: A rare entity

    Science.gov (United States)

    Verma, Pradhuman; Verma, Kanika Gupta; Verma, Dinesh; Patwardhan, Nitin

    2014-01-01

    Brown tumors are erosive bony lesions caused by rapid osteoclastic activity and peritrabecular fibrosis due to primary or secondary hyperparathyroidism resulting in a local destructive phenomenon. The differential diagnosis based on histological examination is only presumptive. Clinical, radiological and laboratory data are necessary for definitive diagnosis. Here, we report a very rare case of brown tumor involving maxilla and mandible, which is the result of secondary hyperparathyroidism in 30-year-old female patient with chronic renal disease. PMID:25328310

  18. Analysis of 7 Misdiagnosed Cases of Primary Hyperparathyroidism and the Related Literature Review%原发性甲状旁腺功能亢进症七例误诊分析及文献复习

    Institute of Scientific and Technical Information of China (English)

    邱平; 唐明薇; 梅希; 兰天; 廖戮缪; 黎瑶

    2015-01-01

    Objective To investigate clinical features, misdiagnosed causes and preventive measures of primary hy-perparathyroidism ( PHPT) . Methods The clinical data of seven misdiagnosed cases of PHPT during January 2010 and Jan-uary 2014 in the first affiliated hospital of Chengdu Medical College were analyzed retrospectively. The relevant literature was reviewed. Results All the cases had apparent increased intact parathyroid hormone ( iPTH) complicated with severe osteopo-rosis and were misdiagnosed at the first visit. Four patients were misdiagnosed with lumbar disc herniation, bone cysts, meta-static tumors, or fibrocartilaginous dysplasia respectively in orthopedics department. 1 case was misdiagnosed as coronary heart disease and hypertension in cardiovascular department. 1 case had pure renal calculus and chronic obstructive nephropathy for a long period of time in urinary surgery department. 1 case was mistaken for renal tubular diseases because of normocalcemic PHPT at the first visit in other tertiary hospitals. The misdiagnosed time was from 2 months to 10 years ( average time was 4. 74 ± 2. 94 years). 6 patients underwent surgery, and postoperative pathological diagnosis confirmed 4 cases of parathyroid adenoma;1 case of multiple parathyroid adenomas and 1 case of parathyroid carcinoma. After surgery, 5 patients were fol-lowed up from 1 to 11 months and the blood calcium and iPTH level decreased to normal limit;1 patient died of sepsis and systemic failure with elevated iPTH level. 1 patient died of hypercalcaemia crisis, complicated with acute kidney injures myo-cardial infarction and consciousness disturbance 2 days after diagnosis was confirmed. Conclusion The major cause for mis-diagnosis of PHPT is lack of clinical specificity and insufficient awareness of the disease by clinicians. Serum calcium, serum parathyroid hormone and bone density should be screened for suspected patients in order to make early diagnosis and rational treatment of PHPT patients.%

  19. 原发性甲状旁腺机能亢进性骨病影像学表现%Skeletal disease in primary hyperparathyroidism: X-ray, CT and MR imaging foundings

    Institute of Scientific and Technical Information of China (English)

    钱占华; 白荣杰; 闫东; 李新民; 程晓光; 顾翔; 屈辉

    2013-01-01

    目的 分析原发性甲状旁腺机能亢进(PHPT)性骨病的X线、CT和MR表现,探讨相关临床影像特点和鉴别诊断.方法 收集1999年3月至2012年1月北京积水潭医院30例甲状旁腺机能亢进性骨病患者,均经手术及病理证实,其中股骨病变15例、胫骨干15例、腓骨干12例、髂骨14例、椎体3例、肱骨3例、肋骨5例和指骨12例.所有病例均行局部骨X线、CT和MR检查,对其影像学表现与病理结果进行对照,并由双盲法分析确认.结果 30例中均表现有不同程度的全身性骨质疏松.骨吸收20(66.7%)例,其中骨膜下骨吸收12例(40.0%)、皮质内骨吸收11例(36.7%),软骨下骨吸收10例(33.3%).纤维囊性骨炎/棕色瘤19例(63.3%).病理性骨折5例(16.7%).结论 X线、CT和MRI从不同方面反映PHPT骨病的影像病理特点,髂骨是常见的好发部位,可侵犯骶髂关节.PHPT骨病应与溶骨性转移性骨肿瘤、骨纤维异常增殖症、骨巨细胞瘤和动脉瘤样骨囊肿相鉴别.%Objective To analyze the X-ray,CT and MR imaging findings in skeletal disease with primary hyperparathyroidism(PHPT),so as to discuss the clinic feature and differential diagnosis.Methods Thirty patients with PHPT were confirmed by surgery and pathological examination.In 15 patients the lesion were found in femur.There were 15 tibia,12 fibula,and 14 iliac lesions.In three patients lesions were found in vertebrae.Three patients had lesions in humeri.In five patients lesions were found in rib.Twelve patients had lesions in phalanges.Thirty patients were studied preoperatively with radiographs,CT and MR imaging.The imaging findings were compared with the pathologic diagnosis and confirmed by double blind method.Results Radiographs of the bone in 30 patients showed generalised osteopaenia.There were 20 (66.7%) cases with bone resorption,which include 12 (40.0%) cases with subperiosteal resorption,11 (36.7%) cases with cortical bone resorption,and 10

  20. Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol

    DEFF Research Database (Denmark)

    Hansen, Ditte; Brandi, Lisbet; Rasmussen, Knud

    2009-01-01

    BACKGROUND: Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.Reduced synthesis of active...... vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.In Denmark alfacalcidol is the primary choice of vitamin D analog.A new vitamin D analog, paricalcitol...... hyperparathyroidism and the tendency towards hyperphosphatemia and hypercalcemia. METHODS/DESIGN: This is an investigator-initiated cross-over study. Nine Danish haemodialysis units will recruit 117 patients with end stage renal failure on maintenance haemodialysis therapy.Patients are randomised into two treatment...

  1. Nutritional secondary hyperparathyroidism in two cats

    DEFF Research Database (Denmark)

    Dimopoulou, Maria; Kirpensteijn, Jolle; Nielsen, Dorte Hald

    2010-01-01

    severely affected cat, postmortem examination revealed changes consistent with nutritional secondary hyperparathyroidism and fibrous osteodystrophy, such as cortical thinning, massive connective tissue invasion in the diaphysis of long bones, and hypertrophy of the chief cells in both parathyroid glands...

  2. Consequences of long-term hyperparathyroidism.

    Science.gov (United States)

    Graal, M B; Wolffenbuttel, B H

    1998-07-01

    We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin D deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, severe and long-standing hypocalcaemia ('hungry bone syndrome') developed after parathyroidectomy. We discuss the consequences of hyperparathyroidism, especially the effects on bone, the complications of parathyroidectomy and the possibilities of preoperative treatment with bisphosphonates.

  3. Asymptomatic infection with Borrelia burgdorferi.

    Science.gov (United States)

    Steere, Allen C; Sikand, Vijay K; Schoen, Robert T; Nowakowski, John

    2003-08-15

    The natural history of asymptomatic seroconversion to Borrelia burgdorferi has been unclear. We report here, on the basis of a post hoc assessment, the frequency and outcome of asymptomatic seroconversion to B. burgdorferi in participants of a large Lyme disease vaccine trial. We show that infection with B. burgdorferi may be asymptomatic but that asymptomatic infection is unusual in the United States.

  4. Asymptomatic Borrelia burgdorferi infection.

    Science.gov (United States)

    Wormser, G P; Nadelman, R B; Nowakowski, J; Schwartz, I

    2001-10-01

    Little is known about the natural history of asymptomatic Borrelia burgdorferi infection. Our analysis of the asymptomatic infections diagnosed serologically in a recent OspA vaccine trial conducted in the United States (N Engl J Med 1998;339: 209-215), suggests that the natural history of this event is more benign than that reported for untreated patients with erythema migrans (Ann Intern Med 1987;107: 725-731). We hypothesize that this is due either to incorrect diagnosis since the specificity of the serologic criteria used to diagnose asymptomatic infection in the vaccine study is unknown, or to infection with non-pathogenic strains of B. burgdorferi. Increasing evidence indicates that the invasive potential of strains of B. burgdorferi varies according to the specific subtype. Theoretically, a serologic testing method could be devised which would distinguish infection with invasive versus non-invasive strains of B. burgdorferi, and allow testing of the second hypothesis.

  5. Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort

    Science.gov (United States)

    Isakova, Tamara; Anderson, Cheryl A. M.; Leonard, Mary B.; Xie, Dawei; Gutiérrez, Orlando M.; Rosen, Leigh K.; Theurer, Jacquie; Bellovich, Keith; Steigerwalt, Susan P.; Tang, Ignatius; Anderson, Amanda Hyre; Townsend, Raymond R.; He, Jiang; Feldman, Harold I.; Wolf, Myles

    2011-01-01

    Background. Secondary hyperparathyroidism is a common complication of chronic kidney disease (CKD) that is associated with bone disease, cardiovascular disease and death. Pathophysiological factors that maintain secondary hyperparathyroidism in advanced CKD are well-known, but early mechanisms of the disease that can be targeted for its primary prevention are poorly understood. Diuretics are widely used to control volume status and blood pressure in CKD patients but are also known to have important effects on renal calcium handling, which we hypothesized could alter the risk of secondary hyperparathyroidism. Methods. We examined the relationship of diuretic treatment with urinary calcium excretion, parathyroid hormone (PTH) levels and prevalence of secondary hyperparathyroidism (PTH ≥ 65 pg/mL) in a cross-sectional study of 3616 CKD patients in the Chronic Renal Insufficiency Cohort. Results. Compared with no diuretics, treatment with loop diuretics was independently associated with higher adjusted urinary calcium (55.0 versus 39.6 mg/day; P < 0.001), higher adjusted PTH [67.9, 95% confidence interval (CI) 65.2–70.7 pg/mL, versus 52.8, 95% CI 51.1–54.6 pg/mL, P < 0.001] and greater odds of secondary hyperparathyroidism (odds ratio 2.1; 95% CI 1.7–2.6). Thiazide monotherapy was associated with lower calciuria (25.5 versus 39.6 mg/day; P < 0.001) but only modestly lower PTH levels (50.0, 95% CI 47.8–52.3, versus 520.8, 95% CI 51.1–54.6 pg/mL, P = 0.04) compared with no diuretics. However, coadministration of thiazide and loop diuretics was associated with blunted urinary calcium (30.3 versus 55.0 mg/day; P <0.001) and odds of hyperparathyroidism (odds ratio 1.3 versus 2.1; P for interaction = 0.05) compared with loop diuretics alone. Conclusions. Loop diuretic use was associated with greater calciuria, PTH levels and odds of secondary hyperparathyroidism compared to no treatment. These associations were attenuated in patients who were coadministered

  6. Asymptomatic ocular sarcoidosis

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Azevedo de Freitas

    2013-04-01

    Full Text Available Sarcoidosis is an idiopathic systemic granulomatous disease. It commonly affects the skin, lungs, kidneys, and central nervous system. In the eyes it primarily affects the uveal tract, conjunctiva, lacrimal glands and optic nerve. Here in we describe the case of a patient with systemic sarcoidosis and asymptomatic eye inflammation.

  7. 117例原发性甲状旁腺功能亢进症的核素骨显像分析%Clinical study of bone imaging in 117 cases with primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    朱瑞森; 罗琼; 陆汉魁; 陈立波; 罗全勇

    2010-01-01

    目的 为提高骨显像对骨性原发性甲状旁腺功能亢进症(PHPT)的诊断效率,对117例PHPT患者骨显像特点进行分析.方法 117例PHPT患者,男50例,女67例,其中116例为甲状旁腺腺瘤,1例为甲状旁腺腺癌,平均年龄61.1(12~86)岁.所有患者均行~(99)Tc~m-亚甲基二膦酸盐(MDP)显像,骨显像图分为4种类型:Ⅰ型骨显像阴性;Ⅱ型骨显像局部骨异常,即局灶型,又再分为2个亚型:ⅡA型颅骨和下颌骨放射性浓聚,Ⅱ B型表现为除有ⅡA型特点外,还存在其他局部骨代谢异常;Ⅲ型全身骨放射性摄取增加;Ⅳ型表现为全身+局部骨代谢异常.用X2检验和独立样本t检验进行统计学处理.结果 117例骨显像表现为Ⅰ型者47例,占40.17%;Ⅱ型35例,占29.91%,其中ⅡA 21例,ⅡB 14例;Ⅲ型30例,占25.64%;Ⅳ型5例,占4.27%.70例Ⅱ、Ⅲ、Ⅳ型异常骨显像PHPT患者有骨折史、结石史、骨折+结石史、骨质疏松史和骨痛史,分别占55.71%(39例)、11.43%(8例)、10.00%(7例)、72.86%(51例)和37.14%(26例);而47例骨显像Ⅰ型者上述病史分别为2.13%(1例),0,0,21.28%(10例)和21.28%(10例).两者各种病史发生率相比差异有统计学意义(X~2=11.152,P=0.01).Ⅱ、Ⅲ、Ⅳ型(骨显像异常)与Ⅰ型患者的肿瘤体积、甲状旁腺激素(PTH)、血钙、血磷分别为(14.52±13.72)cm~3和(0.78±1.33)cm~3、(731.67±618.40)ng/L和(112.04±62.98)ng/L、(3.05±0.29)mmol/L和(2.56±0.42)mmol/L、(0.71±0.14)mmol/L和(1.03±0.36)mmol/L,两者相比t=-5.724,-5.741,-7.274和-6.451,P均<0.01,差异也有统计学意义.结论 (1)约40%PHPT患者骨显像正常;(2)PHPT患者4种骨显像结果 反映了骨损害的情况;(3)PHPT的骨显像特点有助于该病的鉴别诊断.%Objective To analyze the characteristics of bone scintigraphy in 117 cases with primary hyperparathyroidism (PHPT).Methods Of these 117 cases (50 males and 67 females),there were 116 parathyroid adenomas and 1 parathyroid cancer.Mean age was

  8. Ultrasound in clinical setting of secondary hyperparathyroidism.

    Science.gov (United States)

    Meola, Mario; Petrucci, Ilaria; Cupisti, Adamasco

    2013-01-01

    Secondary hyperparathyroidism (sHPT) is one of the most common and serious complications of chronic kidney disease (CKD) and maintenance hemodialysis (MHD). In sHPT, the biology of parathyroid cells changes significantly toward diffuse and nodular hyperplasia. Diagnosis and treatment of sHPT are based on intact parathyroid hormone (i-PTH) serum levels and on the parameters of mineral metabolism. The morphological diagnosis of sHPT relies on 2 complementary imaging techniques: high-resolution ultrasonography with color Doppler imaging (US/CD) and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy. The main objective of this review is to stimulate nephrologists to use US/CD of the parathyroid glands during the progression of CKD in order to aid clinical, pharmacological and surgical strategies. The primary role of US/CD in sHPT should be to integrate the clinical diagnosis by defining the number and volume of hyperplastic glands, although the international guidelines do not state when and why to perform US/CD. This review also evaluates the role of US/CD in clinical follow-up and assessment of therapeutic response of sHPT, and it highlights how US/CD can evaluate the effect of therapy with phosphate binders, vitamin D or its analogues and calcimimetics, which are changing the natural history of sHPT and the frequency of parathyroidectomy. Evaluation of the morphological and vascular changes of hyperplastic parathyroids is useful to guide percutaneous ethanol injection therapy and to support clinical, pharmacological and surgical strategies. Epidemiological studies are needed to establish how US/CD could change the management of sHPT and why it should be repeated in patients with high levels of serum i-PTH.

  9. Pathology of the parathyroid glands in hyperparathyroidism.

    Science.gov (United States)

    Baloch, Zubair W; LiVolsi, Virginia A

    2013-08-01

    This paper reviews the embryology, histology and pathology of the human parathyroid glands. It emphasizes those pathologic lesions which are found in the setting of clinical hyperparathyroidism. Also discussed are certain molecular features of hyperfunctioning parathyroid glands. The difficulties encountered in parathyroid FNA are reviewed and illustrated.

  10. Consequences of long-term hyperparathyroidism

    NARCIS (Netherlands)

    Graal, M B; Wolffenbuttel, B H

    1998-01-01

    We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin D deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, se

  11. Oesophageal carcinoma presenting with a synchronous asymptomatic colon carcinoma

    OpenAIRE

    Alok Gupta; Bharat Chauhan; V Rangarajan; Saral Desai; Vanita Noronha; Kumar Prabhash

    2013-01-01

    The advancement in diagnostic techniques has resulted in increased incidence of occult second primary in cancer patients. Here, we report a case of symptomatic oesophageal carcinoma and synchronous asymptomatic colon carcinoma diagnosed through Positron Emission Tomography-Computed Tomography imaging.

  12. Double-phase Tc-99m tetrofosmin parathyroid scan in hyperparathyroidism: comparison with ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, In Soo; Kim, Sang Yoon [Daegu Fatima Hospital, Daegu (Korea, Republic of); Zeon, Seok Kil; Won, Kyoung Sook [School of Medicine, Keimyung University, Daegu (Korea, Republic of)

    2004-07-01

    This study was performed to evaluate the utility of double-phase Tc-99m Tetrofosmin(TF) parathyroid scan in the detection of pathologic lesions of primary hyperparathyroidism, and comparison with the ultrasonography(US). The double phase TF parathyroid scan of the anterior neck including upper mediastinum with 800 MBq TF were acquired at ten minutes (early phase) and at two hours (delayed phase) after radiopharmaceutical injection, in 24 consecutive patients under the clinical impression of primary hyperparathyroidism and hypercalcaemia. The images were evaluated for abnormal focal areas of increased tracer localization in the anterior neck and superior mediastinum in early phase, and visualization of parathyroid gland radioactivity after wash-out of the thyroid gland radioactivity in delayed phase. US of the anterior neck including upper mediastinum was performed by a diagnostic radiologist in 24 consecutive patients, within one week before or after the scan. The findings of double phase TF parathyroid scan and US were compared with the pathologic results. Ten of 24 patients were surgically explored and pathologic results showed eight adenomas and two hyperplasia. The double phase TF parathyroid scan showed positive findings in seven patients of eight adenomas and one patient of two hyperplasia patients. US image showed positive findings in six patients of eight adenomas and no positive findings of two hyperplasia. The sensitivity of the double phase TF scan for detection of the causes of the primary hyperparathyroidism was 80% and US was 60%. The double phase Tc-99m Tetrofosmin parathyroid scan showed higher sensitivity in detection of the pathologic lesions of primary hyperparathyroidism than ultrasonography.

  13. [Usefulness of computed tomography and magnetic resonance in the preoperative diagnosis for hyperparathyroidism].

    Science.gov (United States)

    Pino Rivero, V; Pantoja Hernández, C G; González Palomino, A; Trinidad Ruíz, G; Marcos García, M; Keituqwa Yáñez, T; Pardo Romero, G; Blasco Huelva, A

    2005-01-01

    Sonnography and Tc-99m sestamibi scintigraphy are the most requested preoperative imaging tests nowdays in the surgery of hyperparathyroidism. The aim of our article is to know if Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are useful as a location study and in which cases it would be more justified to ask these radiologic techniques. For that we report our results with 29 patients at all diagnosed as hyperparathyroidism (26 primary forms and 3 secondary ones) and operated by our E.N.T. Department later. On 20 of them a cervical CT was asked before the parathyroidectomy and on the rest 9, a MRI with sensitivities of 65% and 88.9% respectively. We think both complementary explorations must not be solicited by routine but they can represent a help in the cases in that sonnography and scintigraphy are not able to show the possible adenoma or hiperplasia, particularly in recurrent hyperparathyroidisms, reinterventions or suspect of parathyroid glands in an atypical location.

  14. Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

    Directory of Open Access Journals (Sweden)

    Fabio Luiz de Menezes Montenegro

    2012-01-01

    Full Text Available Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1 is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

  15. Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

    Science.gov (United States)

    de Menezes Montenegro, Fabio Luiz; Lourenço, Delmar Muniz; Tavares, Marcos Roberto; Arap, Sergio Samir; Nascimento, Climerio Pereira; Neto, Ledo Mazzei Massoni; D'Alessandro, André; Toledo, Rodrigo Almeida; Coutinho, Flávia Lima; Brandão, Lenine Garcia; de Britto e Silva Filho, Gilberto; Cordeiro, Anói Castro; Toledo, Sergio Pereira Almeida

    2012-01-01

    Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. PMID:22584718

  16. Review of cinacalcet hydrochloride in the management of secondary hyperparathyroidism.

    Science.gov (United States)

    Yousaf, Farhanah; Charytan, Chaim

    2014-02-01

    Cinacalcet is the first Food and Drug Administration-approved calcimimetic for the treatment of secondary hyperparathyroidism in dialysis patients. It is effective in improving control of parathyroid hormone, serum calcium, phosphorus, and calcium-phosphorus product. The calcium-lowering effect of cinacalcet overcomes the limitations of standard therapy associated hypercalcemia. There is evidence to suggest that cinacalcet has important clinical implications, which extend beyond its relevance in the treatment of secondary hyperparathyroidism. This review summarizes the evidence regarding the role of cinacalcet in the treatment of secondary hyperparathyroidism, disrupted bone mineral metabolism, cardiovascular disease, and mortality. In addition, the cost implications of cinacalcet are briefly explored.

  17. [Parenteral calcimimetics for the treatment of secondary hyperparathyroidism.

    Science.gov (United States)

    Hamano, Naoto; Fukagawa, Masafumi

    2017-01-01

    The oral calcimimetics, cinacalcet, is reported to be effective on secondary hyperparathyroidism resistant to classical treatment like phosphate binders or vitamin D receptor activator. The problem that gastrointestinal adverse events cause poor adherence, drug discontinuation, and insufficient dose escalation remains unsolved. The novel injectable calcimimetic, etelcalcetide, is recently developed and is expected to reduce such adverse events and improve the therapeutic effects on moderate to severe secondary hyperparathyroidism. Further studies are needed to demonstrate the potential benefits of etelcalcetide compared to cinacalcet.

  18. Persistent renal hyperparathyroidism caused by intrathyroidal parathyroid glands.

    Science.gov (United States)

    Chen, Chin-Li; Lin, Shih-Hua; Yu, Jyh-Cherng; Shih, Ming-Lang

    2014-09-01

    Renal hyperparathyroidism usually occurs in chronic renal failure patients on regular dialysis. However, renal hyperparathyroidism resulting from intrathyroidal parathyroid glands is an uncommon condition. We herein present the case of a 35-year-old woman who has been on hemodialysis for 20 years. She had renal hyperparathyroidism with generalized weakness and bone pain for 2 years. The patient initially underwent parathyroidectomy at a local institution, during which two large parathyroid glands were resected from the right side (no parathyroid glands were found on the left side); however, the surgical procedure was unsuccessful, and the patient had persistent renal hyperparathyroidism after the operation. She was then transferred to our hospital and ectopic intrathyroidal parathyroid glands were localized by neck ultrasonography and technetium-99m sestamibi scans with single-photon emission computed tomography imaging preoperatively. A left thyroid lobectomy was performed and two intrathyroidal parathyroid glands were found. The patient recovered uneventfully and her symptoms resolved. Therefore, clinicians should be aware of the possibility of renal hyperparathyroidism resulting from intrathyroidal parathyroid glands in cases where the renal hyperparathyroidism persists after parathyroidectomy.

  19. Surgical management of primary hyperparathyroidism guided by double-phase Tc-99m-MIBI scintigraphy%Tc-99m-MIBI双时相显像在原发性甲状旁腺功能亢进症手术治疗中的价值

    Institute of Scientific and Technical Information of China (English)

    Abdel Hamid Hussein Ezzat; Tarek El. Baradie; Amr Attia; Magdy Kotb; Ahmad Zaher; Iman Gouda

    2012-01-01

    Objective: The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to study the role of nuclear medicine techniques in the initial diagnosis and preoperative localization directing surgical management of these cases. Methods: This study included 27 patients with PHPT properly diagnosed and treated in the NCI, Cairo University from January 2005 to December 2010. Preoperative neck U/S and Tc-99m-MIBI scintigraphy were done in all cases. If preoperative localization detected a single lesion, unilateral exploration was done. Bilateral exploration was done if multiple foci of active parathyroid glands or no lesions were detected. Results: This study included 27 patients (8 males and 19 females). The median age was 43 years (range from 19 to 68 years). All cases presented with bone disease in the form of bony pain in 23 patients, bony swellings in 15 patients and pathological fractures in 6 cases. Twenty one patients (77.8%) had single adenoma, 5 cases (18.5%) had parathyroid hyperplasia, and only one case had double adenomas. The sensitivity of neck U/S in detecting single adenoma was 61.9% (13/21), with 81% positive predictive value (PPV) while the sensitivity of Tc-99m- MIBI scintigraphy was 90.5% (19/21) with 100% PPV. Based on preoperative localization tests, unilateral exploration was done in 19 patients with solitary adenomas. All cases in this group were cured with no reported case of persistent or recurrent hypercalcemia. Conclusion: Presentation of PHPT may mimic malignant bone tumors but fortunately these patients were correctly diagnosed with bone scan which confirm the presence of metabolic bone disease rather than bone metastases. This was followed by estimation of serum calcium and parathormone levels for confirmation. Unilateral exploration based on the combination of ultrasound and preoperative localization

  20. New options for the management of hyperparathyroidism after renal transplantation.

    Science.gov (United States)

    Douthat, Walter Guillermo; Chiurchiu, Carlos Raul; Massari, Pablo Ulises

    2012-06-24

    The persistence and severity of hyperparathyroidism (HPT) post-renal transplantation is relatively frequent and primarily associated with the timing and its magnitude in the pre-transplant period and with the presence of parathyroid adenomas. HPT after renal transplantation is clinically manifested with hypercalcemia, hypophosphatemia, bone pain, fractures, and in more serious cases with cardiovascular calcifications that affect the survival. The primary clinical objective for patients with secondary HPT after renal transplantation is to obtain a level of parathyroid hormone (PTH) adequate to the renal transplanted function and to normalize levels of calcium, phosphorus and vitamin D. In many cases during this period, the development of hypercalcemia and/or hypophosphatemia makes it necessary to take different therapeutic measures. The use of vitamin D or its analogues has been extrapolated from the management of pre-transplant HPT obtaining variable outcomes, although its use is limited by its capacity to produce hypercalcemia. Calcimimetics are drugs that have proven be effective in reducing PTH levels in patients with HPT on dialysis and has been effective in reducing up to 50% PTH levels in moderate to severe HPT in post-renal transplantation.When HPT persists after renal transplantation and does not respond to medical treatment, invasive management by percutaneous ethanol injection therapy of parathyroid glands or parathyroidectomy should be considered. The emergence of new methods for the management of HPT expands the availability of therapeutic tools for transplant patients.

  1. Clinical role of {sup 99m}TcO{sub 4}/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Casara, D.; Rubello, D. [Dept. of Radiotherapy, Regional Hospital of Padova (Italy); Pelizzo, M.R. [Dept. of Surgery, University of Padova, Padova (Italy); Shapiro, B. [Dept. of Radiology, University of Michigan Medical Center, Ann Arbor (United States)

    2001-09-01

    One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified {sup 99m}TcO{sub 4}/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid {sup 99m}TcO{sub 4} washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46

  2. Palpation thyroiditis following subtotal parathyroidectomy for hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Elizabeth M Madill

    2016-07-01

    Full Text Available Thyrotoxicosis is an under-recognised but clinically important complication of parathyroidectomy. We report a case of a 37-year-old man with tertiary hyperparathyroidism who initially developed unexplained anxiety, diaphoresis, tachycardia, tremor and hyperreflexia one day after subtotal parathyroidectomy. Thyroid biochemistry revealed suppressed thyroid stimulating hormone and elevated serum free T4 and free T3 levels. Technetium-99m scintigraphy scan confirmed diffusely decreased radiotracer uptake consistent with thyroiditis. The patient was diagnosed with thyrotoxicosis resulting from palpation thyroiditis. Administration of oral beta-adrenergic antagonists alleviated his symptoms and there was biochemical evidence of resolution fourteen days later. This case illustrates the need to counsel patients about thyroiditis as one of the potential risks of parathyroid surgery. It also emphasises the need for biochemical surveillance in patients with unexplained symptoms in the post-operative period and may help to minimise further invasive investigations for diagnostic clarification.

  3. Fibrous dysplasia of the jaws associated with secondary hyperparathyroidism: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Whi, Jung Hyun; Kim, Young Joo; Chun, Kyung Ah; Kim, Ki Tae; Chang, Eun Deok; Kim, Young Ok; Lee, Won [The Catholic University of Korea, Uijongbu (Korea, Republic of)

    2007-06-15

    There have been few reports on fibrous dyplasia associated with secondary hyperparathyroidism. We report a case of a hemodialysis patient with secondary hyperparathyroidism concomitant with fibrous dysplasia of the jaws causing an abnormal deformity.

  4. Asymptomatic bacteriuria Escherichia coli strains

    DEFF Research Database (Denmark)

    Hancock, Viktoria; Nielsen, E.M.; Klemm, Per

    2006-01-01

    Urinary tract infections (UTIs) affect millions of people each year. Escherichia coli is the most common organism associated with asymptomatic bacteriuria (ABU) in humans. Persons affected by ABU may carry a particular E. coli strain for extended periods of time without any symptoms. In contrast...

  5. Asymptomatic bacteriuria among pregnant women

    Directory of Open Access Journals (Sweden)

    Sudha Biradar Kerure

    2013-04-01

    Full Text Available Background: Urinary tract infections (UTIs are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens. Methods: A total of 500 pregnant women were studied over a period of one year. Clean catch midstream urine sample was collected into a sterile container & then subjected to culture method. Results: Significant bacteriuria was noted in 45 patients (9%. 3% patients had insignificant bacteriuria. Growth of contaminants was noted in 8%. 80% samples were sterile with no growth. E. coli was the most common etiological agent, followed by Staphylococcus aureus. Conclusions: Asymptomatic bacteriuria is not uncommon in antenatal patients. All pregnant women should be screened by urine culture to detect asymptomatic bacteriuria at their first visit to prevent overt UTI & other complications in both mother & fetus. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 213-216

  6. Prevalence and outcome of asymptomatic bacteriuria in early pregnancy

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    Sreekumary Radha

    2016-12-01

    Full Text Available Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of the urinary tract. The primary objective was to find out the prevalence of asymptomatic bacteriuria in pregnancies less than 28 weeks gestation in our hospital and to study the various adverse pregnancy outcomes in the study group. Methods: This was a cross sectional study done over a period of 12 months at this tertiary care centre in Government sector in Trivandrum, Kerala. A sample size was calculated statistically and 400 women with gestational age less than 28 weeks attending the outpatient department were included in this study. A structured proforma, urine microscopy and urine culture and sensitivity were the study tools. Results: Prevalence of asymptomatic bacteriuria in our study population was 8.25%. Commonest pathogen isolated was E.coli in 57.14% cases. Maternal morbidity was higher in women with asymptomatic bacteriuria (24.2% than those without (12.5%. Fetal morbidity in women with asymptomatic bacteriuria was 24% whereas it was 12.5% in those without it. Preterm labour, preeclampsia and prematurity were the common morbidities noted. Conclusions: Since pregnant women with asymptomatic bacteriuria were at an increased risk of adverse maternal and fetal outcome, routine screening for asymptomatic bacteriuria preferably in the first trimester is highly recommended.

  7. A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism.

    Science.gov (United States)

    Cruzado, Josep M; Moreno, Pablo; Torregrosa, José V; Taco, Omar; Mast, Richard; Gómez-Vaquero, Carmen; Polo, Carolina; Revuelta, Ignacio; Francos, José; Torras, Joan; García-Barrasa, Arantxa; Bestard, Oriol; Grinyó, Josep M

    2016-08-01

    Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant ≥6 months before the study and had an eGFR>30 ml/min per 1.73 m(2) The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism.

  8. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Pons, F.; Vidal-Sicart, S.; Fuster, D.; Herranz, R. [Department of Nuclear Medicine, Hospital Clinic, University of Barcelona (Spain); Torregrosa, J.V. [Unit of Renal Transplant, Hospital Clinic, Barcelona (Spain); Sabater, L.; Fernandez-Cruz, L. [Department of Surgery, Hospital Clinic, Barcelona (Spain)

    1997-12-01

    Technetium-99m sestamibi scintigraphy has become a valuable tool in locating parathyroid glands in patients with primary hyperparathyroidism. The aim of this study was to evaluate its usefulness in secondary hyperparathyroidism. Twenty patients were injected intravenously with 740 MBq of {sup 99m}Tc-sestamibi and images were obtained at 15 min and 2 h post injection. All patients underwent parathyroid ultrasonography (US) as well as bilateral surgical neck exploration and 64 parathyroid glands were removed. US revealed at least one enlarged gland in 15/20 patients (75%), while {sup 99m}Tc-sestamibi scintigraphy showed focal areas of increased uptake in at least one gland in 17/20 patients (85%). When imaging results for all glands were evaluated according to surgical results, sensitivity was 54% for parathyroid scintigraphy and 41% for US, and specificity was 89% for both imaging techniques. There was a discrepancy between the two imaging modalities in 28 glands (35%). The mean surgical weight of US-positive glands (1492{+-}1436 mg) was significantly higher than that of US-negative glands (775{+-}703 mg) (P<0.05). However, there were no significant differences in weight between sestamibi-positive and sestamibi-negative glands. When only sestamibi-positive glands were considered, a positive correlation between uptake and weight was found (r=0.4, P<0.05). In conclusion, parathyroid US and {sup 99m}Tc-sestamibi scintigraphy are complementary imaging techniques in the preoperative localization of abnormal parathyroid glands in patients with secondary hyperparathyroidism. The limited sensitivity of the techniques means that patients will still require bilateral neck exploration; therefore routine preoperative parathyroid scanning in renal patients is not justified. (orig.) With 3 figs., 2 tabs., 22 refs.

  9. Intraoperative nuclear guidance in benign hyperparathyroidism and parathyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bonjer, H.J. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Bruining, H.A. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Pols, H.A.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Internal Medicine 3; Herder, W.W. de [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Internal Medicine 3; Eijck, C.H.J. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Breeman, W.A.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Nuclear Medicine; Krenning, E.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Nuclear Medicine

    1997-03-01

    The success of parathyroid surgery is determined by the identification and removal of all hyperactive parathyroid tissue. Ectopic location of parathyroid tumours and fibrosis due to previous operations can cause failure of parathyroidectomy. Parathyroid tumours accumulate and retain 2-methoxyisobutylisonitrile (MIBI) labelled with technetium-99m. This study assesses the value of intra-operative localization of parathyroid tumours using a hand-held gamma detector in patients with hyperparathyroidism and parathyroid cancer. Twenty patients undergoing their first operations for hyperparathyroidism, 15 patients undergoing reoperations for either persistent or recurrent hyperparathyroidism and two patients with parathyroid cancer were studied. Radioactivity in the neck and the mediastinum was recorded by a gamma detector after administration of 370 MBq {sup 99m}Tc-MIBI. Surgical findings and postoperative serum levels of calcium were documented. The sensitivity of the gamma detector in identifying parathyroid tumours was 90.5% in first parathyroidectomies, 88.9% in reoperations for either persistent or recurrent hyperparathyroidism and 100% in parathyroid cancer. One false-positive result was due to a thyroid nodule. Hypercalcaemia ceased in all but one patient postoperatively. It is concluded that employment of the gamma detector is to be advocated in first parathyroidectomies when a parathyroid tumour cannot be discovered, in reoperations for either persistent or recurrent hyperparathyroidism and in surgery for parathyroid cancer. (orig.)

  10. [Bisalbuminemia disclosing primary hyperparathyroidism with fistulized pancreatic false cyst].

    Science.gov (United States)

    Galezowski, N; Jouanique-Bayrod, C; Dazza, F; Gehrig, D; Trivin, F; Herreman, G

    1997-01-01

    Discovery on a protein electrophoregram of a bisalbuminemia can orientate according to its migration fast or slow to an hereditary mutation of an amino acid, or an acquired form by excess of beta lactamines due to renal insufficiency or by the rupture of a pancreatic pseudocyst in the peritoneum. This is this late mechanism that we report in this case of bisalbuminemia related to an opened pancreatic pseudocyst secondary to an adenoma of the parathyroid gland.

  11. A Rare Electrocardiographic Manifestation of A Rare form of Multiple Electrolyte Disturbances: Hyperparathyroid Crisis

    Directory of Open Access Journals (Sweden)

    Mitra Chitsazan

    2011-12-01

    Full Text Available The surface electrocardiogram (ECG has been used as a useful method for detection of metabolic disturbances for a long time. However, it may be difficult to distinguish the exact disturbance when more than one metabolic abnormality exists in a patient simultaneously. Although, "classic" ECG characterizations of common electrolyte disturbances are well described, multiple concurrent electrolyte disturbances may lead to ECG abnormalities that may not be easily detectable. This ECG concerns a 60-year-old male presented with general fatigue, weakness, epigastric pain, anorexia, nausea and extreme hypercalcemia (serum total and ionized calcium levels 20.5 mg/dL and 12.02 mg/dl, respectively, hypokalemia and hypomagnesemia associated with elevated parathyroid hormone (1160 pg/ml and normal serum vitamin D level (97 ng/ml . This rare manifestation of primary hyperparathyroidism has been named hyperparathyroid crisis in the literature. Hyperparathyroid crisis is an emergency form of multiple electrolyte abnormalities that manifest as a life-threatening hypercalcemia and simultaneous hypokalemia and hypomagnesemia; these two later are believed to be caused by diuretic effect of calcium on the renal tubules. The unique pattern of ECG in our patient first was misdiagnosed as prominent T waves with prolongation of the QT corrected (QTc interval, which has been reported several times in patients with hyperparathyroidism crisis, compatible with our patient. But more investigation revealed that, the QTc interval not only is not prolonged, it is shortened as it is expected from the effect of hypercalcemia on electrocardiogram. The exact pattern of the patient`s ECG (figure 1 can be interpreted as it follows: (1 Flattening of the T wave, (2 a prominent U wave, (3 prolongation of the descending limb of the T wave such that it overlapped with the next U wave (4 virtual absence of ST segment and (5 shortening of the QT corrected interval. In conclusion, it should

  12. A novel SLC12A1 gene mutation associated with hyperparathyroidism, hypercalcemia, nephrogenic diabetes insipidus, and nephrocalcinosis in four patients.

    Science.gov (United States)

    Wongsaengsak, Sariya; Vidmar, Alaina P; Addala, Ananta; Kamil, Elaine S; Sequeira, Paola; Fass, Benjamin; Pitukcheewanont, Pisit

    2017-04-01

    Solute Carrier Family 12 member 1 (SLC12A1) gene encodes the sodium-potassium-chloride co-transporter (NKCC2) at the apical membrane of the thick ascending loop of Henle (TAL). Bartter's syndrome (BS) type I is a rare, autosomal recessive, renal tubular disorder associated with mutation of the SLC12A1 gene. Presenting features include: hypokalemic metabolic alkalosis, hypercalciuria and nephrocalcinosis. The many allelic variants reported present with a spectrum of phenotypes, biochemical abnormalities and clinical severities. However, to date, only two reports have described hyperparathyroidism and hypercalcemia in patients with SLC12A1 gene mutations. We describe 4 patients with 4 novel mutation variants in the SLC12A1 gene (c.735C>G, c.1137del, c.2498-2499del, and c.1833delT) presenting with variable degrees of hyperparathyroidism, hypercalcemia, hypokalemic metabolic alkalosis, nephrocalcinosis, and nephrogenic diabetes insipidus. The link between calcium and parathyroid hormone abnormalities in patients with SLC12A1 mutations is unclear; the cases described suggest an association between primary hyperparathyroidism and loss of function mutation of SLC12A1, which may result in an aberrant threshold of the calcium sensing receptor at the level of the kidney.

  13. Secondary hyperparathyroidism disease stabilization following calcimimetic therapy.

    Science.gov (United States)

    Frazão, João; Rodriguez, Mariano

    2008-01-01

    Standard therapy for secondary hyperparathyroidism (SHPT) includes dietary calcium supplementation, active vitamin D, and phosphate binders; however, these are often insufficient to allow patients to achieve their serum parathyroid hormone (PTH), calcium and calcium-phosphorus product (Ca × P) targets. Recent preclinical studies have demonstrated that treatment with type II calcimimetics that increase the sensitivity of the calcium-sensing receptor (CaR) to calcium can reverse the alterations in CaR and vitamin D receptor expression and parathyroid cell proliferation that are associated with SHPT. These data suggest that calcimimetic treatment could stabilize disease progression and improve maintenance of treatment goals. In clinical trials involving SHPT patients, the calcimimetic cinacalcet has been shown to decrease PTH, calcium, phosphorus and Ca × P. Significant improvements were seen regardless of initial disease severity, and benefits were maintained over the course of long-term therapy (up to 4 years), indicating effective disease stabilization. In conclusion, preclinical and clinical data provide both theoretical and empirical support for the use of calcimimetics in moderate and advanced SHPT to effectively stabilize disease.

  14. Management of secondary hyperparathyroidism: how and why?

    Science.gov (United States)

    Komaba, Hirotaka; Kakuta, Takatoshi; Fukagawa, Masafumi

    2017-03-01

    Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease. Currently, various treatment options are available, including vitamin D receptor activators, cinacalcet hydrochloride, and parathyroidectomy. These treatment options have contributed to the successful control of SHPT, and recent clinical studies have provided evidence suggesting that effective treatment of SHPT leads to improved survival. Although bone disease is the most widely recognized consequence of SHPT and remains a major target for treatment of SHPT, there is increasing evidence that parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23), both of which are markedly elevated in SHPT, have multiple adverse effects on extraskeletal tissues. These actions may lead to the pathological development of left ventricular hypertrophy, renal anemia, immune dysfunction, inflammation, wasting, muscle atrophy, and urate accumulation. Given that treatment of SHPT leads to decreases in both PTH and FGF23, these data provide an additional rationale for treating SHPT. However, definitive evidence is still lacking, and future research should focus on whether treatment of SHPT prevents the adverse effects of PTH and FGF23.

  15. Diagnosis of hyperparathyroidism; Diagnostik des Hyperparathyreoidismus

    Energy Technology Data Exchange (ETDEWEB)

    Delorme, S. [Abteilung fuer Onkologische Diagnostik und Therapie, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Hoffner, S. [Abteilung Nuklearmedizin, Universitaetsklinik Heidelberg (Germany)

    2003-04-01

    To preoperatively localize enlarged parathyroid glands in patients with hyperparathyroidism (HPT). Besides clinical and biochemical workup, high-resolution ultrasonography (US) is the most commonly used imaging method.Additionally,Tc-99m-MIBI scintigraphy in subtraction or biphasic technique, computed tomography (CT) and magnetic resonance imaging (MRI) are used. US fails to detect a minimum of 10% of enlarged parathyroid glands,most commonly due to ectopic location, or difficult examination conditions, such as nodular goiter or previous surgery. If attempted US localization is unsuccessful, multiphase scintigraphy, using Tc-99m-sestamibi, can help to locate ectopic adenomas in the mediastinum. With SPECT, ademomas can be found which escape detection on planar scans due to their small size.With combined use of US and scintigraphy, a correct localization of parathyroid adenomas is possible in up to 90%. CT and MRI are of limited value due to their low specificity. For newly diagnosed hyperparathyroidism, high-resolution US is the method of choice for localizing parathyroid adenomas.If ultrasound fails to detect a lesion, Tc-99m-MIBI scintigraphy is recommended. In patients scheduled for re-operation for recurrent or persistant HPT, a preoperative detection of a parathyroid adenoma should be attempted whenever possible, in order to minimize the extent of surgery. The role of CT or MRI is mainly to help to better anatomically localize a suspected adenoma previously detected with scintigraphy. (orig.) [German] Praeoperative Lokalisation vergroesserter Epithelkoerperchen bei Patienten mit primaerem Hyperparathyreoidismus (HPT).Methoden Neben klinischem Befund und laborchemischer Abklaerung ist der hochaufloesende Ultraschall die am haeufigsten eingesetzte Methode.Zusaetzliche Methoden sind Tc-99m-MIBI-Szintigraphie in Subtraktions- oder Zweiphasentechnik,Computertomographie (CT) oder Magnetresonanztomographie (MRT).Ergebnisse Mit der Sonographie gelingt eine

  16. Hyperparathyroidism caused by distant pulmonary lesions and parathyromatosis after ethanol injection/parathyroidectomy for secondary hyperparathyroidism.

    Science.gov (United States)

    Nakamura, Michio; Tanaka, Kiho; Fujii, Takeshi

    2017-01-11

    Secondary hyperparathyroidism (SHPT) treatment includes parathyroidectomy and percutaneous ethanol injection therapy (PEIT), which are invasive procedures. The condition in which benign hyperfunctioning parathyroid tissue is distributed throughout the neck and mediastinum is termed parathyromatosis. Here, we present the case of a 51-year-old woman who began hemodialysis in 1986 due to chronic kidney disease of unknown etiology and developed SHPT in 1999. She underwent 6 rounds of PEIT followed by total a parathyroidectomy with partial forearm autotransplantation. Between 2011 and 2013, surgeons removed several nodules from her pulmonary and cervical regions and the transplanted masses from her forearm; all showed hyperplasia but exhibited no histological evidence of malignancy. Damage to the parathyroid capsule after repeated PEITs may cause local cervical recurrence and pulmonary lesions, although distant lesions are extremely rare in SHPT. This case is of interest due to the possible association between PEIT and parathyromatosis and distal lesions.

  17. Evaluation of secondary hyperparathyroidism in patients undergoing hemodialysis.

    Science.gov (United States)

    Rahimian, Mohammad; Sami, Ramin; Behzad, Fariba

    2008-01-01

    Renal osteodystrophy is a complication of chronic kidney disease (CKD) that present in low and high turnover patterns. This disorder has a key role in the disability of CKD patients in whom early diagnosis and treatment can result in better outcome. We studied hyperparathyroidism prevalence and its relationship with renal osteodystrophy in our advanced CKD population. We included 80 patients (of whom 44 (55%) were diabetic) during 6 months period. The patients answered a questionnaire about symptoms related to bone disease and blood levels of parathormone (PTH), calcium, phosphorus, and alkaline phosphatase were obtained, in addition to hand and skull radiographs in all the study patients. Prevalence of clinically evident hyperparathyroidism in our patients was 45%. Hyperparathyroidism had significant relationship with alkaline phosphatase and radiological findings, but did not have a significant relationship with dialysis duration, age, sex, familial history, diabetes mellitus, or hypertension. We conclude that secondary hyperparathyroidism is prevalent in our dialysis population and has high correlation with serum alkaline phosphatase levels and radiological changes.

  18. [Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy].

    Science.gov (United States)

    Las Heras Alonso, M M; Pérez Ruiz, L; Guajardo Guajardo, J; Bordalba Gómez, J R; Puig Giró, R; Gómez Agudo, M; Flavian Domenech, L M; Berbegal, C

    2005-03-01

    We documented the frequency of nephritic colic in patients with primary hyperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism.

  19. Avaliação da hipercalcemia assintomática em pacientes ambulatoriais Assessment of asymptomatic hypercalcemia in outpatients

    Directory of Open Access Journals (Sweden)

    Mônica Barros Costa

    2008-10-01

    Full Text Available INTRODUÇÃO: Dosagens indiscriminadas de cálcio sérico podem levar à detecção de pacientes assintomáticos, com hipercalcemia, em que o hiperparatireoidismo primário é a causa mais comum. OBJETIVO: Discutir a forma de avaliação da hipercalcemia detectada em população atendida em regime ambulatorial, avaliando a sua freqüência, com ênfase na pesquisa de hiperparatireoidismo primário. MATERIAL E MÉTODOS: Foi realizado estudo prospectivo envolvendo 1.049 indivíduos, de 40 a 60 anos, com dosagens séricas de cálcio e albumina, e calculado o valor de cálcio corrigido. Na presença de elevação do cálcio corrigido, foram dosados cálcio iônico, fósforo, paratormônio (PTH e calciúria. RESULTADOS: A idade foi 49,7 ± 13,7 anos e 188 (17,9% indivíduos apresentaram valores elevados de cálcio corrigido. Desses, 90 pacientes compareceram à segunda avaliação e 19 (2% mantiveram quadro de hipercalcemia. Os níveis de cálcio iônico (média: 1,2 ± 0,01 mmol/l foram normais em todos os indivíduos. A calciúria foi 185,8 ± 111,8 mg/24 horas. Os níveis de PTH (média: 46 ± 11,8 pg/ml foram elevados em três casos, com cintilografia de paratireóides normal. DISCUSSÃO: A queda na freqüência de hipercalcemia com base no valor do cálcio corrigido e, sobretudo, após dosagem de cálcio ionizável sugere que a dosagem de cálcio livre seja preferida como triagem. Na população estudada não foi diagnosticado hiperparatireoidismo, sugerindo distribuição variável da doença em diferentes populações. CONCLUSÃO: Deve ser questionada a dosagem rotineira de cálcio sérico em indivíduos sem quadro clínico que indique a necessidade da realização desse exame. Quando realizada, a dosagem de cálcio iônico deverá ser preferida.INTRODUCTION: Indiscriminate serum calcium measurement may lead to the identification of asymptomatic patients with hypercalcaemia, which is caused mostly by primary hyperparathyroidism. OBJECTIVE: To

  20. A cluster randomised controlled trial in primary dental care based intervention to improve professional performance on routine oral examinations and the management of asymptomatic impacted third molars: study protocol

    Directory of Open Access Journals (Sweden)

    Grol Richard PTM

    2007-04-01

    Full Text Available Abstract Background Routine oral examination (ROE refers to periodic monitoring of the general and oral health status of patients. In most developed Western countries a decreasing prevalence of oral diseases underpins the need for a more individualised approach in assigning individualised recall intervals for regular attendees instead of systematic fixed intervals. From a quality-of-care perspective, the effectiveness of the widespread prophylactic removal of mandibular impacted asymptomatic third molars (MIM in adolescents and adults is also questionable. Data on the effectiveness of appropriate interventions to tackle such problems, and for promoting continuing professional development in oral health care are rare. Methods/design This study is a cluster randomised controlled trial with groups of GDPs as the unit of randomisation. The aim is to determine the effectiveness and efficiency of small group quality improvement on professional decision-making of general dental practitioners (GDPs in daily practice. Six peer groups ('IQual-groups' shall be randomised either to the intervention arm I or arm II. Groups of GDPs allocated to either of these arms act as each other's control group. An IQual peer group consists of eight to ten GDPs who meet in monthly structured sessions scheduled for discussion on practice-related topics. GDPs in both trial arms receive recently developed evidence-based clinical practice guidelines (CPG on ROE or MIM. The implementation strategy consists of one interactive IQual group meeting of two to three hours. In addition, both groups of GDPs receive feedback on personal and group characteristics, and are invited to make use of web-based patient risk vignettes for further individual training on risk assessment policy. Reminders (flow charts will be sent by mail several weeks after the meeting. The main outcome measure for the ROE intervention arm is the use and appropriateness of individualised risk assessment in

  1. Value of 99mTc-MIBI SPECT/CT on preoperative localization diagnosis of primary hyperparathyroidism%99mTc-MIBI SPECT/CT对原发性甲状旁腺功能亢进症的术前定位诊断价值

    Institute of Scientific and Technical Information of China (English)

    韩军; 韩星敏; 程兵; 谢新立

    2014-01-01

    目的 探讨99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)双时相显像对原发性甲状旁腺功能亢进症(pHPT)的术前定位诊断价值,并与超声检查比较.方法 58例经病理证实的pHPT患者术前均行99mTc-MIBI SPECT/CT双时相甲状旁腺显像及颈部超声检查,将检查结果与手术及病理结果比较,同时伴随的甲状腺病理结果也被记录.采用配对x2检验,比较两种检查方法对甲状旁腺病灶的检出率.结果 术后病理证实58例pHPT患者共有78枚甲状旁腺病灶,其中腺瘤47枚(包括2枚异位腺瘤),增生28枚,腺癌3枚.99mTc-MIBI SPECT/CT对pHPT病灶的总的检出率为79.5%,明显高于超声的检出率(62.8%),x2 =7.579,P<0.05.伴有甲状腺疾病的17例患者中,99mTc-MIBI SPECT/CT和超声对甲状旁腺病灶的检出率分别为71.4%和46.4%,二者比较差异有统计学意义(x2=4.000,P<0.05).而对于不伴有甲状腺疾病的41例pHPT患者MIBI和超声对甲状旁腺病灶的检出率分别为92.0%,78.0%,二者比较差异无统计学意义(x2=3.273,P>0.05).结论 99mTc-MIBI SPECT/CT是定位pHPT病灶的有效方法,对于伴有甲状腺疾病的pHPT及异位的甲状旁腺病灶,其定位价值高于超声.%Objective To evaluate the preoperative localization value of 99mTc-sestamibi (99mTc-MIBI) single photon emission computed tomography/computerized tomography (SPECT/CT) dual-phase imaging on patients with primary hyperparathyroidism (pHPT),and was compare with neck ultrasound (US).Methods 99mTc-MIBI SPECT/CT dual-phase imaging and neck ultrasound were performed preoperatively in 58 patients with pHPT confirmed by pathology.The imaging findings were compared with the operative and pathological results.Concomitant thyroid pathology was also recorded.The paired chisquare test was used to compare the detection rate between the two imaging techniques.Results Fiftyeight patients were

  2. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism.

    Science.gov (United States)

    Signori, Carina; Zalesin, Kerstyn C; Franklin, Barry; Miller, Wendy L; McCullough, Peter A

    2010-07-01

    Obesity as well as bariatric surgery may increase the risk for vitamin D deficiency. We retrospectively compared vitamin D levels in obese patients (n = 123) prior to bariatric surgery and 1 year postoperatively. We also evaluated parathyroid hormone levels (PTH) 1 year after surgery. A higher percentage of patients had baseline vitamin D deficiency (86%), defined as 25-hydroxy vitamin D vitamin D deficiency at baseline (r = -0.3, p = 0.06) and at the postoperative follow-up (r = -0.2, p = 0.013). One third of the postoperative population had secondary hyperparathyroidism, defined by a serum PTH level >62 pg/mL; however, postoperative PTH and vitamin D levels were unrelated (r = -0.001, p = 0.994). Pre- and postoperative vitamin D levels were inversely correlated with BMI. Secondary hyperparathyroidism was observed in 33% of patients postoperatively; however, this did not correlate with vitamin D.

  3. Performances of scintigraphy in the primitive hyperparathyroidism and the associated thyroid pathologies; Performances de la scintigraphie dans les hyperparathyroidies primitives et les pathologies thyroidiennes associees

    Energy Technology Data Exchange (ETDEWEB)

    Monteil, J. [Service de Medecine Nucleaire, CHRU de Limoges (France); Mathonnet, M. [Service de Chirurgie Endocrinienne, CHRU de Limoges (France); Chianea, T. [Service de Medecine Nucleaire, CHRU de Limoges (France); Cubertafond, P. [Service de Chirurgie Endocrinienne, CHRU de Limoges (France); Piquet, L.; Rince, C.; Bournaud, E.; Verbeke, S.; Perdrisot, R.; Vandroux, J.C. [Service de Medecine Nucleaire, CHRU de Limoges (France)

    1997-12-31

    The data from scintigraphic and echographic exploration were compared to the surgery results in 32 patients (29 F and 3 M) presenting a primitive hyperparathyroidism, biologically proved, associated to a thyroid pathology. The scintigraphies were achieved with a collimator placed anteriorly and oblique-anteriorly, 4 h after injection by iodine 123 (7 MBq) and 30 min and 2 h after injection of {sup 99m}Tc-MIBI (555 MBq). The cervical echography and scintigraphy are independently interpreted. The results are given in a table containing the sensitivity, specificity, V.P.P. and V.P.N. for scintigraphy and echography, respectively. The association of a primary hyperparathyroidism and of a thyroid pathology (with a prevalence of 70% in our region) appears to affect less the performances of scintigraphy imaging than those of morphologic imaging

  4. Brown tumor of the maxilla in patient with secondary hyperparathyroidism

    OpenAIRE

    2004-01-01

    Brown tumor or parathyroid osteopathy is a kind of bony lesion caused by hyperparathyroidism. It appears as an expansive osteolytic lesion mostly in mandible, ribs, pelvis and femur, but rarely in the upper jaw. Bone resorption is the result of osteoclastic activity due to an increased activity of parathyroid hormone. A 25-years-old male patient was operated on due to clinicaly and radiographicaly obvious maxillary tumor and increased values of parathyroid hormon (PTH - 1 050 ng/l). The level...

  5. Tumoral calcinosis, calciphylaxis, hyperparathyroidism and tuberculosis in a dialysis patient

    Directory of Open Access Journals (Sweden)

    Khawla Kammoun

    2011-01-01

    Full Text Available Tumoral calcinosis and calciphylaxis are uncommon but severe complications in ure-mic patients. They occur generally after long-term hemodialysis (HD treatment explained by ad-vanced secondary hyperparathyroidism and longstanding high calcium phosphorus product (Ca × P. Other factors such granulomatous diseases may worsen the calcium phosphate homeostasis alterations. We report a young male patient treated by HD for 6 years who developed tuberculosis in addition to tumoral calcinosis and calciphylaxis.

  6. Asymptomatic bacteriuria in antenatal women

    Directory of Open Access Journals (Sweden)

    Lavanya S

    2002-01-01

    Full Text Available A total of 500 antenatal women in their first or second trimesters were screened over a period of 2 years for asymptomatic bacteriuria. Out of them, 8.4% (42 were culture positive. A control group of 100 non-pregnant women, both married and unmarried, was also simultaneously screened. The control group yielded an overall culture positivity of 3% (4% in the married non-pregnant women and 2% in the unmarried women. Primigravida had highest percent culture positivity of 66.6%. The incidence was higher in less than 20 years age group i.e. 71.42%. Of the screening tests, Gram stained smear when compared with the standard loop method, showed the highest sensitivity of 95.2%. The specificity of the screening tests was high [Gram stained smear (98.6%, catalase test (97.1% and pus cell count(96.5%]. Escherichia coli was the most common organism isolated in the test and control groups. The organisms were sensitive to cephalexin, nitrofurantoin, amoxycillin and norfloxacin in decreasing order. Incidence of prematurity was 75% and that of low birth weight was 50% in untreated patients.

  7. Bilateral simultaneous quadriceps tendon rupture in a patient with secondary hyperparathyroidism: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Son, Sang Beom; Han, Chang Whan; Kang, Si Won [Taejon St. Mary' s Hospital, The Catholic Univ. of Korea, Taejon (Korea, Republic of)

    2001-11-01

    Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

  8. Incidental finding of a giant asymptomatic right atrial tumor

    Science.gov (United States)

    Strecker, Thomas; Agaimy, Abbas; Zelzer, Peter; Weyand, Michael; Wachter, David Lukas

    2014-01-01

    Primary cardiac tumors are very rare, atrial myxoma being the most common benign tumor of the heart. They may present with a great variety of incidental asymptomatic masses to severe life-threatening cardiovascular complications necessitating emergency surgery. Here we report the diagnostic evaluation and successful surgical resection of such a giant cardiac tumor which was found on a routine medical check-up in a 62-year-old patient. Histology confirmed diagnosis of unusually huge myxoma. This article demonstrates it’s necessary to include cardiac tumors in the differential diagnosis of subtle and non-specific cardiothoracic symptoms. PMID:25120848

  9. Cestrum diurnum intoxication in normal and hyperparathyroid pigs.

    Science.gov (United States)

    Kasali, O B; Krook, L; Pond, W G; Wasserman, R H

    1977-04-01

    The effect of ingestion of dried leaves of Cestrum diurnum, a plant shown to contain a 1,25-dihydroxycholecalciferol-like principle, was tested in normal pigs fed 1.2% calcium and 1.0% phosphorus for 10 weeks from weaning and in hyperparathyroid pigs fed 0.8% calcium and 1.6% phosphorus for the same periods of time. Addition of 3% Cestrum diurnum leaf meal rapidly resulted in decreased feed consumption and weight gain, hypercalcemia and hypophosphatasemia. In normal pigs, plasma calcium rose to 16 mg/100 ml within one week and remained high for the 4 week experimental period. In hyperparathyroid pigs with hypocalcemia, plasma calcium rose to 12.75 mg/100 ml within one week and later approached 15 mg/100 ml. Ingestion of Cestrum diurnum retarded cell differentiation of growth cartilages. Arrested osteocytic osteolysis was observed within one week with osteopetrosis of epiphyses and metaphyses. The negative effect on the resorbing osteocytes then caused osteonecrosis which, in combination with lack of bone formation because of atrophy of osteoblasts, resulted in osteopenia within 4 weeks. Dystrophic calcinosis occurred within 2 weeks and was widespread after 4 weeks in lungs, kidneys, heart and vessels. Atrophy of parathyroid cells was severe after one week. Hyperparathyroid pigs responded with skeletal lesions, dystrophic calcinosis and parathyroid atrophy more rapidly and severely than normal pigs. The biochemical and anatomical changes in Cestrum diurnum ingestion are closely similar to those in vitamin D3 intoxication in pigs. Whereas pigs can tolerate large amounts of vitamin D3 because of feed-back control of 1 alpha-hydroxylation in the kidney, this control point is by-passed in Cestrum diurnum ingestion and intoxication occurs promptly.

  10. [Hyperparathyroidism disclosed by forward sagging of the head].

    Science.gov (United States)

    Berenbaum, F; Rajzbaum, G; Bonnichon, P; Amor, B

    1993-06-01

    An unusual clinical presentation of hyperparathyroidism is reported. The 73-year-old patient was unable to maintain her head upright after ten minutes of walking or standing. Parathyroid adenoma was diagnosed on the basis of ultrasound and pathological findings and parathyroid hormone assays. Following surgery the forward sagging of the head no longer occurred and serum levels of calcium and phosphorus returned to normal. Pathophysiological hypotheses are discussed. No similar cases with isolated weakness of the cervical and dorsal paravertebral muscles has been reported to date.

  11. [Severe macrocytic anaemia and secondary hyperparathyroidism in a vegan].

    Science.gov (United States)

    Førland, Elizabeth Siren Bjerga; Lindberg, Mats Jacob Hermansson

    2015-08-10

    Nutritional deficiency anaemia in vegans is common and usually due to lack of vitamin B12, as this vitamin is found almost exclusively in animal-based food products. In this case report we present a 39-year-old male vegan with severe macrocytic anaemia due to vitamin B12 deficiency as well as secondary hyperparathyroidism due to severe vitamin D deficiency. We want to emphasize the importance of a detailed nutritional history for patients with anaemia, and the need for vitamin B12 and vitamin D supplements for people who comply with a vegan diet.

  12. Asymptomatic carotid stenosis: What we can learn from the next generation of randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Mark N Rubin

    2014-04-01

    Full Text Available Stroke remains an exceedingly incident and prevalent public health burden across the globe, with an estimated 16 million new strokes per annum and prevalence over 60 million, and extracranial internal carotid artery atherosclerotic disease is an important risk factor for stroke. Randomized trials of surgical treatment were conducted (North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial and demonstrated efficacy of carotid endarterectomy for secondary prevention of stroke in patients with cerebrovascular events (e.g. ipsilateral stroke, transient ischemic attack, and/or amaurosis fugax attributable to a diseased artery with 50–99% stenosis. Therapeutic clarity, however, proved elusive with asymptomatic carotid artery disease. Asymptomatic Carotid Atherosclerosis Study (ACAS, Asymptomatic Carotid Surgery Trial, and Veterans Affairs Cooperative Study (VACS suggested only modest benefit from surgical intervention for primary stroke prevention and the best medical therapy at the time of these trials is not comparable to modern medical therapy. ACT-1, Asymptomatic Carotid Surgery Trial-2, Stent-Protected Angioplasty in asymptomatic Carotid artery stenosis versus Endarterectomy Trial-2, European Carotid Surgery Trial-2, Carotid Revascularization Endarterectomy Versus Stenting Trial-2 are trials that are recent, ongoing, or in development that include diverse populations across Europe and North America, complementary trial designs, and a collaborative spirit that should provide clinicians with evidence that informs best clinical practice for asymptomatic carotid artery disease.

  13. Mineralization defect but no effect on hypercalcemia during clodronate treatment in secondary hyperparathyroidism.

    Science.gov (United States)

    Ring, T; Sodemann, B; Nielsen, C; Melsen, F; Kornerup, H J

    1995-09-01

    In four patients with severe secondary hyperparathyroidism, treatment with clodronate caused no decrease in serum calcium. In one of the patients treatment for seven months was associated with a severe mineralization defect which was not caused by aluminium. This lesion was reversible upon termination of clodronate treatment. In a single patient without hyperparathyroidism, a precipitous decrease in serum calcium was observed due to clodronate. However, long-term treatment with clodronate did not ameliorate ectopic calcification in this patient. It is concluded that in severe secondary hyperparathyroidism, clodronate does not always decrease serum calcium. Our experience suggest that clodronate like other bisphosphonates may inhibit bone mineralization.

  14. Contribution of {sup 99m}Tc-sestamibi scintigraphy by double phase in the exploration of hyperparathyroidism. Report of 20 cases; Apport de la scintigraphie parathyroidienne au {sup 99m}Tc-MIBI en double phase dans l'exploration des hyperparathyroidies. A propos de 20 cas

    Energy Technology Data Exchange (ETDEWEB)

    Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire de Rabat (Morocco)

    2008-11-15

    Introduction {sup 99m}Tc-sestamibi parathyroid scintigraphy is a means of functional imaging allowing the exploration of hyperparathyroidism. The aim of our study is to demonstrate the utility of double-phase {sup 99m}Tc-sestamibi scintigraphy in the exploration of the secreting abnormal parathyroid gland. Materials and methods We report, through this work, the observation of 20 patients followed for a biologically ascertained hyperparathyroidism and explored, for the majority of them, by ultrasonography and/or computed tomography. All our patients benefited from a double-phase {sup 99m}Tc-sestamibi scintigraphy. Results On the 20 studied cases, the sex-ratio was equal to 1, two patients exhibited three high uptake foci at the {sup 99m}Tc-sestamibi scintigraphy, six exhibited two foci, twelve exhibited one parathyroid focus. In our series, 80% of patients exhibited secondary hyperparathyroidism and 20% exhibited a primary hyperparathyroidism. The pathologic exam revealed four cases of parathyroid adenoma and 16 parathyroid cases of hyperplasia. Discussion The double-phase {sup 99m}Tc-sestamibi scintigraphy contributes to the orientation and the improvement of the surgical attitude of the hyperparathyroidism, insofar as it could affirm the multiplicity of some adenomas, the diffuse form of some hyperplasia, and especially ectopic localization of the abnormal parathyroid gland.

  15. ASYMPTOMATIC BACTERIURIA AND PYURIA IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    M Rahimkhani

    2008-11-01

    Full Text Available "nPregnant women are at increased risk for urinary tract infection (UTI but in many cases infection is asymptomatic. This study was performed to determine the incidence of asymptomatic bacteriuria and pyuria in pregnant women. A total of 86 pregnant women during first trimester and 56 nonpregnant women were evaluated. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine samples were collected for both groups. Urine samples were examined microscopically and were cultured. Bacteriological examination revealed asymptomatic bacteriuria in 25 (29.1% and 3 (5.4% of the study group and controls, respectively (P < 0.05. Microscopic analysis of urine revealed pyuria in 18 (20.9% and 3 (5.4% of the study group and controls, respectively (P < 0.05. In study group, Escherichia coli were found in 20%, Staphylococcus epidermidis in 36%, Staphylococcus haemolyticus in 12%, streptococcus group D in 12%, Staphylococcus saprophyticus in 12% and Proteus mirabilis in 8%. In control group, E. coli were found in 33.3% and S. epidermidis in 66.7%. Our results show that the incidence of asymptomatic bacteriuria is significantly higher in pregnant women than nonpregnant women. The main finding in the present study was that 29.1% of the pregnant women who were in first trimester had asymptomatic bacteriuria which is much higher than figures reported from other countries. The use of microscopic urinanalysis was not an effective method of detecting asymptomatic bacteriuria and urine culture is necessary for screening these pregnant women.

  16. CINACALCET IMPROVES BONE DENSITY IN POST KIDNEY TRANSPLANT HYPERPARATHYROIDISM

    Science.gov (United States)

    Cho, ME; Duan, Z; Chamberlain, CE; Reynolds, JC; Ring, MS; Wright, EC; Mannon, RB

    2010-01-01

    The recent availability of cinacalcet has provided a possible alternative to parathyroidectomy in kidney transplant patients with persistent hyperparathyroidism, but its effect on bone mass density (BMD) is unknown. From our database containing 163 kidney transplants performed at our center from 1999-2007, we compared recipients who received cinacalcet for persistent hypercalcemia and hyperparathyroidism following renal tx (n=8; CIN) with up to 2 other post tx patients matched for age, sex, race, and graft function (n=15; CON). The outcome of the study was BMD changes from baseline to 12, 24, and 36 months post renal tx. Repeated Measures Mixed model was used to assess the difference of BMD change between two groups. Cinacalcet therapy was started at a median of 9 months (range; 1, 24 months) post tx with a mean dose 56±29 mg/d (mean duration; 1.6 years, range; 1, 2.1). Cinacalcet therapy was associated with significant reduction of serum calcium compared to control. Cinacalcet therapy was associated with greater BMD increase at the hip over the 36-month post transplant period. Cinacalcet was well tolerated. Our results suggest that cinacalcet may have a small but favorable effect on bone density following kidney transplantation. PMID:21094814

  17. Brown tumor of the maxilla in patient with secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Jović Nebojša

    2004-01-01

    Full Text Available Brown tumor or parathyroid osteopathy is a kind of bony lesion caused by hyperparathyroidism. It appears as an expansive osteolytic lesion mostly in mandible, ribs, pelvis and femur, but rarely in the upper jaw. Bone resorption is the result of osteoclastic activity due to an increased activity of parathyroid hormone. A 25-years-old male patient was operated on due to clinicaly and radiographicaly obvious maxillary tumor and increased values of parathyroid hormon (PTH - 1 050 ng/l. The level of calcium in blood was normal (Ca 2.34 mEq/L. The patient was dialyzed for years because of the chronic renal failure. Histopathologic analysis confirmed brown tumor, that appeared as bony lesion of secondary hyperparathyroidism due to the chronic renal failure. The operation of the upper jaw had been performed before parathyroidectomy, due to an excessive growth of tumor followed by heavy epistaxes. The subsequent parathyroidectomy was followed by the regression of remaining bony lesions.

  18. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

    Directory of Open Access Journals (Sweden)

    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  19. Petechiae and vasculitis in asymptomatic primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Diederichsen, H; Sørensen, P G; Mickley, H;

    1985-01-01

    vasculitis in all three patients. Direct immunofluorescent studies showed deposits of IgM, C3 and fibrinogen in and around the walls of the small vessels of the skin of two and C3 as well as fibrinogen in one patient. It is suggested that leukocytoclastic vasculitis may be a microscopic feature...

  20. Asymptomatic spontaneous cerebral emboli and mood in a cohort of older people: a prospective study.

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Purandare, N.; Hardicre, J.; McCollum, C.N.; Burns, A.

    2007-01-01

    OBJECTIVE: To examine whether asymptomatic spontaneous cerebral emboli (SCE) predicts subsequent depression in older people. METHODS: Prospective cohort study with 2.5 years of follow-up including 96 nondepressed older subjects in primary care. Presence of SCE was measured at baseline by transcrania

  1. Role of pre-operative imaging using {sup 99m}Tc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy

    Energy Technology Data Exchange (ETDEWEB)

    Fuster, David; Ortin, Jaime; Setoain, Xavier; Paredes, Pilar; Duch, Joan; Pons, Francesca [Hospital Clinic, Nuclear Medicine Department, Barcelona (Spain); Ybarra, Juan; Torregrosa, Jose-Vicente [Hospital Clinic, Renal Transplant Unit, Barcelona (Spain); Gilabert, Rosa [Hospital Clinic, Radiology Department, Barcelona (Spain)

    2006-04-15

    The purpose of this study was to assess whether pre-operative {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism. Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent ''blinded'' subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase {sup 99m}Tc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed {sup 99m}Tc-MIBI uptake or an abnormal size on US, it was considered that ''{sup 99m}Tc-MIBI advice'' and ''US advice'', respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis. Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120{+-}900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when {sup 99m}Tc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for {sup 99m}Tc-MIBI, and 55%, 67%, 87% and 28% for US. {sup 99m}Tc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with {sup 99m}Tc-MIBI alone. (orig.)

  2. "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances.

    LENUS (Irish Health Repository)

    Freeman, James

    2010-11-01

    We report the radiographic, echocardiographic and cardiac CT appearances of \\'porcelain heart\\' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.

  3. Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review.

    Science.gov (United States)

    Davis, Eric M

    2015-01-01

    Recent epidemiological studies have demonstrated that significant associations exist between oral disease and diseases involving non-oral tissues. Occasionally, the roles may be reversed and the oral cavity can be severely affected by systemic disease originating in another part of the body. Renal secondary hyperparathyroidism is a common endocrinopathy that occurs as a consequence of chronic azotemic kidney disease. Renal osteodystrophy, the most dramatic clinical consequence of renal secondary hyperparathyroidism is uncommon, but can result in demineralization of maxillofacial bones, loosening of teeth, and pathological jaw fractures. The purpose of this report is to update the current understanding of the pathophysiology of this endocrine disease and to compare the oral manifestations of renal secondary hyperparathyroidism in humans and companion animals. A 50-year review of the veterinary literature was undertaken to examine the clinical presentation of renal osteodystrophy in dogs, and to determine what clinical consequences of renal secondary hyperparathyroidism have been reported in domestic cats.

  4. A randomized study evaluating cinacalcet to treat hypercalcemia in renal transplant recipients with persistent hyperparathyroidism

    DEFF Research Database (Denmark)

    Evenepoel, P.; Cooper, K.; Holdaas, H.

    2014-01-01

    Persistent hyperparathyroidism (HPT) after kidney transplantation (KTx) is associated with hypercalcemia, hypophosphatemia and abnormally high levels of parathyroid hormone (PTH). In this randomized trial, cinacalcet was compared to placebo for the treatment of hypercalcemia in adult patients...

  5. "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances.

    LENUS (Irish Health Repository)

    Freeman, James

    2012-02-01

    We report the radiographic, echocardiographic and cardiac CT appearances of \\'porcelain heart\\' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.

  6. Asymptomatic body packers should be treated conservatively

    DEFF Research Database (Denmark)

    Glovinski, Peter V; Lauritsen, Morten L; Bay-Nielsen, Morten

    2013-01-01

    Body packing takes advantage of the human storage capacity within the alimentary tract. Body packing is used for the smuggling of drugs such as heroin, cocaine, amphetamine, hashish and ecstasy. Most body packers are asymptomatic. However, packets may rupture or obstruct the alimentary tract...

  7. ASYMPTOMATIC ABSENT EPIGLOTTIS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Vaibhav Shahi

    2015-03-01

    Full Text Available Absence or hypoplasia of the epiglottis is a rare anomaly. Most patients, with absent or hypoplastic epiglottis, have presented, life-threatening symptoms of respiratory distress and severe aspiration in infancy or early childhood. We report a case of completely asymptomatic 30 year old female with absent epiglottis posted for modified radical mastoidectomy for chronic suppurative otitis media (CSOM.

  8. Asymptomatic Bacteriuria in Clinical Urological Practice

    DEFF Research Database (Denmark)

    Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo;

    2016-01-01

    Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two i...... a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis) has been isolated....

  9. Multiseptate Gallbladder in an Asymptomatic Child

    Directory of Open Access Journals (Sweden)

    Dylan Wanaguru

    2011-01-01

    Full Text Available A one-year-old child being investigated for urinary tract infection was diagnosed with a multiseptate gallbladder. The patient remains asymptomatic, and investigations demonstrate no associated anomalies. Forty-three cases, including 13 cases in children were identified in the literature. Their presentation and management were reviewed.

  10. ASYMPTOMATIC ABSENT EPIGLOTTIS: A CASE REPORT

    OpenAIRE

    2015-01-01

    Absence or hypoplasia of the epiglottis is a rare anomaly. Most patients, with absent or hypoplastic epiglottis, have presented, life-threatening symptoms of respiratory distress and severe aspiration in infancy or early childhood. We report a case of completely asymptomatic 30 year old female with absent epiglottis posted for modified radical mastoidectomy for chronic suppurative otitis media (CSOM).

  11. Amelioration of Sickle Cell Pain after Parathyroidectomy in Two Patients with Concurrent Hyperparathyroidism: An Interesting Finding

    Directory of Open Access Journals (Sweden)

    John Muthu

    2016-01-01

    Full Text Available Patients with sickle cell disease have high morbidity and healthcare utilization due to repeated painful crises. Some coexisting conditions which cause pain similar to sickle cell disease may go undiagnosed in these patients. We report two adults with concurrent hyperparathyroidism who experienced significant improvement in sickle cell pain following parathyroidectomy thereby pointing to hyperparathyroidism as the principal causative factor for their pain. Meticulous evaluation for parathyroid disorders can be rewarding in sickle cell disease.

  12. Tentorial and dural calcification with tertiary hyperparathyroidism: a rare entity in chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Dorenbeck, U.; Bretschneider, T.; Feuerbach, S. [Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg (Germany); Leingaertner, T.; Kraemer, B.K. [Department of Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg (Germany)

    2002-07-01

    A case of rare calcification of the tentorium cerebelli, the thoracal dura mater of the spine, and the sclera in an adult male patient with tertiary hyperparathyroidism is presented. The often reported feature in the skull is that of a combination of osteopenia and osteosclerosis giving a granular bone texture. Extensive dura calcification with this condition has very rarely been reported. It is the aim of this paper to document the latter in a patient with chronic renal failure and tertiary hyperparathyroidism. (orig.)

  13. Partial response to cinacalcet treatment in a patient with secondary hyperparathyroidism undergoing hemodialysis: a case report

    Science.gov (United States)

    2012-01-01

    Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions. PMID:23232027

  14. Partial response to cinacalcet treatment in a patient with secondary hyperparathyroidism undergoing hemodialysis: a case report

    Directory of Open Access Journals (Sweden)

    Conzo Giovanni

    2012-12-01

    Full Text Available Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions.

  15. Hiperparatiroidismo secundario a adenoma paratiroideo mediastinal Hyperparathyroidism due to mediastinal parathyroid adenoma

    Directory of Open Access Journals (Sweden)

    C Agostinis

    2012-03-01

    Full Text Available Las glándulas paratiroides se localizan en el cuello, en la cara posterior de la glándula tiroides. Tienen como función secretar PTH, la cual está regulada por la concentración extracelular de calcio. Se define como hiperparatiroidismo a la producción excesiva de PTH por las glándulas paratiroideas, siendo el 85 % aproximadamente de los casos producto de un adenoma; un 12 % debido a hiperplasia y menos del 1 % por carcinomas. El hiperparatiroidismo primario ectápico se presenta en el 10 % de los pacientes, de los cuales del 1 al 2 % corresponde a la localización mediastinal(1. Presentamos una paciente de 38 años, internada en nuestra institución por hipercalcemia sintomática, comprobándose niveles plasmáticos elevados de PTH. Se le realizá una gammagrafía con tecnecio 99 MIBI que evidenció una imagen hipercaptante a nivel de mediastino anterior. Fue intervenida quirúrgicamente, obteniendo como resultado de la anatomía patolágica un adenoma paratiroideo.The parathyroid glands are located in the neck, on the back of the thyroid gland. Their function is to secrete PTH, which is regulated by extracellular calcium concentration. Hyperparathyroidism is defined as the excessive production of PTH by the parathyroid glands; approximately 85 % of the cases are caused by an adenoma, 12 % due to hyperplasia and less than 1 % by carcinomas. Ectopic Primary hyperparathyroidism occurs in 10 % of the patients, of which from 1 to 2 % are of mediastinal location(1. We report the case of a 38-year-old patient hospitalized in our institution for symptomatic hypercalcemia. During her hospitalization elevated plasma levéis of PTH were found with image MIBI technetium 99 high uptake in the anterior mediastinum. She underwent surgery, and the pathology report showed parathyroid adenoma.

  16. Efficacy of microwave ablation for severe secondary hyperparathyroidism in subjects undergoing hemodialysis.

    Science.gov (United States)

    Diao, Zongli; Wang, Liyan; Li, Dishan; Liu, Wenhu

    2017-11-01

    Severe secondary hyperparathyroidism (SHPT) is a serious problem in patients undergoing hemodialysis. The efficacy and safety of microwave ablation (MWA), a minimally invasive treatment, for severe SHPT are as yet unclear. To clarify the role of MWA, we administered it to patients with severe SHPT and assessed its efficacy and safety. This was a prospective, single-center, single-arm, clinical trial. We enrolled patients with severe SHPT attending our hemodialysis center who met the inclusion and exclusion criteria. We then assessed primary outcome measures (serum concentrations of intact parathyroid hormone) and secondary outcome measures (serum concentrations of calcium and phosphorus). Twenty-six patients were enrolled in this study, 10 of whom (38.46%) were responsive to MWA and 16 (61.54%) of whom were not. The main complication was hypocalcemia (10 cases, 38.46%), which had occurred in all cases by one week after administration of MWA. Responding patients with hypocalcemia all achieved normal serum calcium concentrations within seven months and non-responding patients within three months. There were no changes in serum phosphorus concentrations after MWA in either responders or non-responders. Microwave ablation is relatively ineffective in patients with severe SHPT undergoing maintaining hemodialysis and should not be the initial therapy in such cases.

  17. Hyperparathyroid crisis: clinical and pathologic studies of 14 patients.

    Science.gov (United States)

    Wang, C A; Guyton, S W

    1979-01-01

    A study is presented of 14 patients with hyperparathyroid crisis treated at the Massachusetts General Hospital between 1964 and 1978. These patients showed diverse clinical manifestations that were indistinguishable from those in patients with pseudohyperparathyroidism. Their symptoms varied from progressive fatigue, malaise, and weakness to those related to the gastrointestinal and urinary tracts. The one biochemical alteration commonly found among these patients was the rapid increase in the serum calcium. There was a concomitant rise in the BUN in 50% of the patients and in the creatinine in 80%. The diagnosis was established by an elevated immunoreactive parathyroid hormone (PTH) level in all eight patients (100%) who had the radioimmunoassay; by the presence of subperiosteal resorption of the phalanges in six of the eight patients (75%); and in three of four patients (75%) by the loss of the lamina dura of the teeth. The 12 patients who had surgery all survived; the two who did not died. Thirteen patients (93%) had a neoplasm--an adenoma in 12 and a carcinoma in one. One patient had hyperplasia (7%). Nine patients (64%) received hypocalcemic drug therapy. The serum calcium temporarily fell to 12 mg/100 ml in five patients (56%) but failed to budge in four (44%). Simultaneous treatment with saline infusion, furosemide and with hypocalcemic drugs over a prolonged period compounded the difficulty at operation by increasing interstitial edema. Our findings from this study show prompt surgical intervention as the ideal treatment for hyperparathyroid crisis, preferably, within 72 hours of the acute onset of symptoms. PMID:518179

  18. Hyperparathyroidism and vitamin D deficiency after laparoscopic gastric bypass.

    Science.gov (United States)

    Clements, Ronald H; Yellumahanthi, Kishore; Wesley, Mary; Ballem, Naveen; Bland, Kirby I

    2008-06-01

    Hyperparathyroidism (HPT) can occur after gastric bypass because of the alteration in vitamin D and calcium absorption. Adequate serum vitamin D concentrations have not been clearly defined in this patient population. Vitamin D (Vit D) and parathyroid hormone (PTH) were assessed 1 year after laparoscopic gastric bypass (LGB). The prevalence of HPT and Vit D deficiency were determined and their association was evaluated using Fisher's exact test. Ninety-three patients (aged 44 +/- 1.1 years, 49.6 +/- 0.67 Kg/m2 body mass index, 79.6% female, 69.6% white) were evaluated. The prevalence of Vit D deficiency (less than 20 ng/mL) and HPT (greater than 65 pg/mL) was 23.6 per cent (n = 22) and 25.7 per cent (n = 28), respectively. Among patients with HPT, only eight of 28 (28.6%) had Vit D deficiency, and of those with Vit D deficiency, only eight of 22 (36.4%) had HPT. There was a weak inverse correlation (r = -0.37) between PTH and Vit D. Blacks are at higher risk for Vit D deficiency. There was no significant association between Vit D deficiency and HPT, Vit D deficiency and Roux limb length, or HPT and Roux limb length. After LGB, Vit D deficiency and hyperparathyroidism occur commonly. Body mass index and Roux limb length are not associated with these two conditions, but racial differences do exist. There is a weak inverse correlation between Vit D and PTH. Further research is needed to elucidate the causes, treatments, and significance of HPT after LGB.

  19. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs

    OpenAIRE

    Wynn, Susan G.; Angela L. Witzel; Joseph W. Bartges; Tamberlyn S. Moyers; Claudia A. Kirk

    2016-01-01

    Background. Obesity has reached epidemic proportions in dogs and, as in humans, cost of care has increased due to associated comorbidities. In humans, asymptomatic urinary tract infections (UTI) may be more prevalent in the obese. Asymptomatic bacteriuria (AB) is the term used when UTI are asymptomatic. We hypothesized that morbidly obese dogs are similarly more likely to have asymptomatic bacteriuria than lean, overweight, and moderately obese dogs. Methods. A retrospective study was underta...

  20. Efficacy and safety of Cinacalcet on secondary hyperparathyroidism in Chinese chronic kidney disease patients receiving hemodialysis.

    Science.gov (United States)

    Mei, Changlin; Chen, Nan; Ding, Xiaoqiang; Yu, Xueqing; Wang, Li; Qian, Jiaqi; Wang, Mei; Jiang, Gengru; Li, Xuemei; Hou, Fanfan; Zuo, Li; Wang, Niansong; Liu, Hong

    2016-10-01

    Introduction Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. Cinacalcet hydrochloride has been used successfully in U.S., Europe, and Japan in the treatment of SHPT, while maintaining serum levels of calcium and phosphorus. The efficacy and safety profile of Cinacalcet treatment vs. conventional treatments has been of great interest in clinical practice. In this recent phase III study conducted in China, efficacy and safety of a calcimimetic agent, Cinacalcet (Kyowa Hakko Kirin Co., Ltd.), were assessed for SHPT treatment in stable chronic renal disease patients on hemodialysis. Methods In this double-blind, multicenter, placebo-controlled, randomized phase III study, 238 subjects were enrolled in 12 centers and randomly divided into a Cinacalcet group and a placebo group. The percentage of patients achieving a serum parathyroid hormone (PTH) level ≤250 pg/mL was the primary efficacy end point. Serum calcium and phosphorus levels were measured. Adverse events and serious adverse events were recorded, and causal analysis performed. Findings In primary analysis, 25.4% of the Cinacalcet group and 3.5% of the placebo group achieved the primary end point (PTH ≤250 pg/mL). Calcium and phosphorus levels and calcium-phosphorus product were lower in the Cinacalcet group compared with the placebo group. Eleven serious adverse events were reported and considered to be not related to study drugs. Mild to moderate hypocalcemia and reduced calcium levels were reported and considered to be Cinacalcet related. Discussion This phase III study demonstrated that Cinacalcet is effective and well tolerated in treating SHPT in Chinese chronic kidney disease patients on hemodialysis, and in a patient population with much higher baseline PTH levels.

  1. Endothelial dysfunction and inflammation in asymptomatic proteinuria

    OpenAIRE

    Paisley, K.E.; Beaman, M; Tooke, J. E.; Mohamed-Ali, V; Lowe, G. D. O.; Shore, A C

    2003-01-01

    Background. Proteinuria is associated with vascular risk and a systemic increase in vascular permeability. Endothelial dysfunction occurs early in atherosclerosis and modulates vascular permeability. Vascular risk and chronic inflammation are associated. This study investigates whether the increased vascular permeability in proteinuria reflects systemic endothelial dysfunction and chronic inflammation. Methods. Twenty-one patients with asymptomatic proteinuria (1.29 g/24 h; range 0.18 to 3.17...

  2. Asymptomatic atlantoaxial subluxation in rheumatoid arthritis.

    Directory of Open Access Journals (Sweden)

    Mohammadali Nazarinia

    2014-06-01

    Full Text Available This cross-sectional study is conducted to determine the prevalence of asymptomatic cervical spine subluxation in rheumatoid arthritis patients by plain radiographs and its relation to demographic and clinical characteristics, disease activity measures and medications. 100 rheumatoid arthritis patients (18 male and 82 female were selected randomly, according to the American college of Rheumatology Criteria, who were under follow up in the rheumatology clinic. A complete history was taken, and physical examination has been done with focus on the cervical spine to determine their demographic data, disease duration, age of disease onset, drug history, swollen and tender joint counts, and ESR, Hb, CRP, RF levels. The disease activity of patients with rheumatoid arthritis was measured using the disease activity score 28. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck and anterioposterior and odontoid projection view. Asymptomatic cervical spine subluxation was found in 17 of the 100 patients (17%. The prevalence of, anterior atlantoaxial subluxation, atlantoaxial impaction and subaxial subluxation was 10(10%, 5(5% and 6(6%, respectively. Posterior subluxation was not detected. The only characteristic that showed meaningful relationship with cervical spine subluxation was CRP (P=0.036. Our results showed that patients with RA, who have cervical spine subluxation cannot be distinguished on the basis of symptoms. Cervical spine involvement is common and may be asymptomatic, indicating routine cervical spine imaging is needed in patients with RA.

  3. Papillary thyroid carcinoma presenting as an asymptomatic pelvic bone metastases

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    Siddiq S

    2010-05-01

    Full Text Available Thyroid carcinoma is rare comprising 1% of all malignancies and commonly presents as a neck lump. Papillary thyroid carcinoma unlike follicular thyroid carcinoma tends not to metastasise to distant sites.We present a case of papillary thyroid carcinoma presenting as a solitary asymptomatic pelvic bone metastases and highlight current management of bone metastases. A 59-year old female was found on abdominal computerised tomography to have an incidental finding of a 4.5 cm soft tissue mass in the right iliac bone. Biopsy of the lesion confirmed metastatic thyroid carcinoma. There was no history of a neck lump, head and neck examination was normal. Further imaging confirmed focal activity in the right lobe of the thyroid. A total thyroidectomy and level VI neck dissection was performed and histology confirmed follicular variant of papillary carcinoma.Early detection of bone metastases have been shown to improve prognosis and thyroid carcinoma should be considered as a potential primary malignancy.

  4. A randomized study evaluating cinacalcet to treat hypercalcemia in renal transplant recipients with persistent hyperparathyroidism.

    Science.gov (United States)

    Evenepoel, P; Cooper, K; Holdaas, H; Messa, P; Mourad, G; Olgaard, K; Rutkowski, B; Schaefer, H; Deng, H; Torregrosa, J V; Wuthrich, R P; Yue, S

    2014-11-01

    Persistent hyperparathyroidism (HPT) after kidney transplantation (KTx) is associated with hypercalcemia, hypophosphatemia and abnormally high levels of parathyroid hormone (PTH). In this randomized trial, cinacalcet was compared to placebo for the treatment of hypercalcemia in adult patients with persistent HPT after KTx. Subjects were randomized 1:1 to cinacalcet or placebo with randomization stratified by baseline corrected total serum calcium levels (≤11.2 mg/dL [2.80 mmol/L] or >11.2 mg/dL [2.80 mmol/L]). The primary end point was achievement of a mean corrected total serum calcium value<10.2 mg/dL (2.55 mmol/L) during the efficacy period. The two key secondary end points were percent change in bone mineral density (BMD) at the femoral neck and absolute change in phosphorus; 78.9% cinacalcet- versus 3.5% placebo-treated subjects achieved the primary end point with a difference of 75.4% (95% confidence interval [CI]: 63.8, 87.1), p<0.001. There was no statistical difference in the percent change in BMD at the femoral neck between cinacalcet and placebo groups, p=0.266. The difference in the change in phosphorus between the two arms was 0.45 mg/dL (95% CI: 0.26, 0.64), p<0.001 (nominal). No new safety signals were detected. In conclusion, hypercalcemia and hypophosphatemia were effectively corrected after treatment with cinacalcet in patients with persistent HPT after KTx.

  5. Percutaneous ethanol injection therapy for advanced renal hyperparathyroidism in Japan: 2004 survey by the Japanese Society for Parathyroid Intervention.

    Science.gov (United States)

    Kakuta, Takatoshi; Fukagawa, Masafumi; Kitaoka, Masafumi; Koiwa, Fumihiko; Onoda, Noritaka; Tominaga, Yasuhiro; Akizawa, Tadao; Kurokawa, Kiyoshi

    2008-08-01

    Background. Marked hyperplasia of the parathyroid gland (PTG) is a characteristic feature of severe hyperparathyroidism in patients under chronic haemodialysis treatment. Percutaneous ethanol injection therapy (PEIT) is now becoming popular in Japan as a treatment option for secondary hyperparathyroidism (SHPT) and its cost is covered by the National Health Insurance (NHI) System. The Japanese Society for Parathyroid Intervention surveyed its membership in 2004 to revise the guidelines for the use of PEIT. Methods. The project was approved by the Executive Committee of the Society, and the primary questionnaire was addressed to 3268 centres (departments) affiliated with the Japanese Society for Dialysis Therapy. A follow-up questionnaire was sent to all the centres that responded. Results. Although the number of centres to which the questionnaire was sent in 2004 was 3268, compared with 2653 in 1998, the number of responses decreased from 1425 (53.7%) in 1998 to 962 (29.4%) in 2004. To the question of whether the centre performed PEIT, 114 (11.9%) answered 'Yes' and 848 (88.1%) answered 'No' in 2004. It was an increase from 1998 when only 83 (5.8%) of 1425 centres answered 'Yes'. In the 1998 survey, 612 patients underwent PEIT at 74 centres, and in 2004, 2098 patients underwent PEIT at 111 centres. Conclusions. PEIT may become the frequently performed treatment for SHPT patients who become resistant to medical therapy. However, the same problems as in 1998 remain unsolved; that is, recurrent nerve paralysis, difficulty of post-PEIT PTx and lack of evidence showing the long-term effectiveness of PEIT.

  6. An LRP5 receptor with internal deletion in hyperparathyroid tumors with implications for deregulated WNT/beta-catenin signaling.

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    Peyman Björklund

    2007-11-01

    Full Text Available BACKGROUND: Hyperparathyroidism (HPT is a common endocrine disorder with incompletely understood etiology, characterized by enlarged hyperactive parathyroid glands and increased serum concentrations of parathyroid hormone and ionized calcium. We have recently reported activation of the Wnt signaling pathway by accumulation of beta-catenin in all analyzed parathyroid tumors from patients with primary HPT (pHPT and in hyperplastic parathyroid glands from patients with uremia secondary to HPT (sHPT. Mechanisms that may account for this activation have not been identified, except for a few cases of beta-catenin (CTNNB1 stabilizing mutation in pHPT tumors. METHODS AND FINDINGS: Reverse transcription PCR and Western blot analysis showed expression of an aberrantly spliced internally truncated WNT coreceptor low-density lipoprotein receptor-related protein 5 (LRP5 in 32 out of 37 pHPT tumors (86% and 20 out of 20 sHPT tumors (100%. Stabilizing mutation of CTNNB1 and expression of the internally truncated LRP5 receptor was mutually exclusive. Expression of the truncated LRP5 receptor was required to maintain the nonphosphorylated active beta-catenin level, transcription activity of beta-catenin, MYC expression, parathyroid cell growth in vitro, and parathyroid tumor growth in a xenograft severe combined immunodeficiency (SCID mouse model. WNT3 ligand and the internally truncated LRP5 receptor strongly activated transcription, and the internally truncated LRP5 receptor was insensitive to inhibition by DKK1. CONCLUSIONS: The internally truncated LRP5 receptor is strongly implicated in deregulated activation of the WNT/beta-catenin signaling pathway in hyperparathyroid tumors, and presents a potential target for therapeutic intervention.

  7. No difference between alfacalcidol and paricalcitol in the treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized crossover trial

    DEFF Research Database (Denmark)

    Hansen, Ditte; Rasmussen, Knud; Danielsen, Henning

    2011-01-01

    Alfacalcidol and paricalcitol are vitamin D analogs used for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease, but have known dose-dependent side effects that cause hypercalcemia and hyperphosphatemia. In this investigator-initiated multicenter randomized...... were equally effective in the suppression of secondary hyperparathyroidism in hemodialysis patients while calcium and phosphorus were kept in the desired range...

  8. Increased technetium-99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism: correlation with hyperphosphataemia.

    Science.gov (United States)

    Enevoldsen, Lotte Hahn; Heaf, James; Højgaard, Liselotte; Zerahn, Bo; Hasbak, Philip

    2017-03-01

    In bone scan patients with dialysis-treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium-99 m hydroxy/methylene diphosphonate (Tc-99 m-HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and/or hyperphosphataemia. As human vascular smooth muscle cells produce hydroxyapatite during cell culture with increased phosphate levels and as Tc-99 m-HDP/MDP primarily binds to hydroxyapatite, we hypothesized that soft tissue accumulation would be found in patients with hyperphosphataemia. We identified 63 CKD patients diagnosed with secondary hyperparathyroidism admitted for Tc-99 m-HDP bone scan. Baseline characteristics and mean concentrations of biochemical markers (including P-calcium and P-phosphate) taken 0-3 months prior to the bone scans were collected. Soft tissue uptake was detected on bone scans in 37 of 63 (59%) patients. Primary locations were in the heart (27/37 = 73%), muscles (12/37 = 32%), lung (9/37 = 24%) and gastrointestinal tract (6/37 = 16%), and 13 of 37 (35%) patients had simultaneous uptake in more than one location. Regarding biochemical markers, patients with soft tissue uptake only differed from patients without in terms of plasma phosphate levels (1·95 ± 0·15 (n = 37) versus 1·27 ± 0·08 (n = 26), P = 0·0012). All patients with myocardial uptake (n = 27) had a coronary arteriography-verified history of coronary artery disease (CAD), whereas CAD was only present in six of the 36 patients without myocardial uptake. In conclusion, dialysis-treated CKD patients with secondary hyperparathyroidism have a high incidence of soft tissue uptake, and this finding is strongly correlated with elevated phosphate, but not calcium values.

  9. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    Yuan Fei; Yu Weijia; Waqas Ahmad; Yang Zhixue; Cao Hua; Li Juncheng; Jiang Guoqin

    2014-01-01

    Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients (group Ⅰ) underwent conventional neck exploration and open parathyroidectomy.Thirteen patients (group Ⅱ) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone (PTH),calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy (89.74%) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25%).However,the accuracy of 99TcmMIBI scintigraphy (66.67%) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86%).The operation time was significantly longer in group Ⅰ ((120±25) minutes) than in group Ⅱ ((90±30) minutes).The accuracy of parathyroid identification was significantly higher in group Ⅱ (92.59%) than in group Ⅰ (80.39%).On average,significantly fewer parathyroid specimens were obtained in group Ⅰ (2.5±0.5) than in group Ⅱ (3.5±0.5).Compared with group Ⅰ,group Ⅱ showed a significant increase (15.4%) in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intraoperative gamma probe

  10. Prevalence of asymptomatic urinary abnormalities among adolescents

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    Mohamed Fouad

    2016-01-01

    Full Text Available To determine the prevalence of asymptomatic urinary abnormalities in adolescents, first morning clean mid-stream urine specimens were obtained from 2500 individuals and examined by dipstick and light microscopy. Adolescents with abnormal screening results were reexamined after two weeks and those who had abnormal results twice were subjected to systemic clinical examination and further clinical and laboratory investigations. Eight hundred and three (32.1% individuals had urinary abnormalities at the first screening, which significantly decreased to 345 (13.8% at the second screening, (P <0.001. Hematuria was the most common urinary abnormalities detected in 245 (9.8% adolescents who had persistent urine abnormalities; 228 (9.1% individuals had non glomerular hematuria. The hematuria was isolated in 150 (6% individuals, combined with leukocyturia in 83 (3.3% individuals, and combined with proteinuria in 12 (0.5% individuals. Leukocyturia was detected in 150 (6% of all studied adolescents; it was isolated in 39 (1.6% individuals and combined with proteinuria in 28 (1.1% of them. Asymp- tomatic bacteriuria was detected in 23 (0.9% of all studied adolescents; all the cases were females. Proteinuria was detected in 65 (2.6% of all the studied adolescents; 45 (1.8% indivi- duals had <0.5 g/day and twenty (0.8% individuals had 0.5-3 g/day. Asymptomatic urinary abnormalities were more common in males than females and adolescents from rural than urban areas (P <0.01 and (P <0.001, respectively. The present study found a high prevalence of asymptomatic urinary abnormalities among adolescents in our population.

  11. Secondary hyperparathyroidism to chronic renal disease in dialysis patients in Para– Brazil

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    Georgia Miranda Tomich

    2015-12-01

    Full Text Available Objective: to establish the frequency of secondary hyperparathyroidism on renal replacement therapy patients on the nephrology service of southeast Para (Brazil.Methods: retrospective cross-sectional survey based on available electronic medical records data referring to the first semester of 2014.Results: data from 108 patients with an average age of 47.8 ± 12.0 years (20-65 were analyzed, 64 patients (59.3% were male. The frequency of secondary hyperparathyroidism was 57.4%, corresponding to a total of 62 patients with parathyroid hormone above 300 pg/ml. Parathyroid hormone levels greater than 1000 pg/ml were found in 12.0% (n=13 of the sample.Conclusion: the occurrence of secondary hyperparathyroidism was similar to other retrospective studies published. This data collection can contribute to improve the assistance program for dialysis patients.

  12. SECONDARY HYPERPARATHYROIDISM AFTER BARIATRIC SURGERY: TREATMENT IS WITH CALCIUM CARBONATE OR CALCIUM CITRATE?

    Science.gov (United States)

    BARETTA, Giorgio Alfredo Pedroso; CAMBI, Maria Paula Carlini; RODRIGUES, Arieli Luz; MENDES, Silvana Aparecida

    2015-01-01

    Background : Bariatric surgery, especially Roux-en-Y gastric bypass, can cause serious nutritional complications arising from poor absorption of essential nutrients. Secondary hyperparathyroidism is one such complications that leads to increased parathyroid hormone levels due to a decrease in calcium and vitamin D, which may compromise bone health. Aim : To compare calcium carbonate and calcium citrate in the treatment of secondary hyperparathyroidism. Method : Patients were selected on the basis of their abnormal biochemical test and treatment was randomly done with citrate or calcium carbonate. Results : After 60 days of supplementation, biochemical tests were repeated, showing improvement in both groups. Conclusion : Supplementation with calcium (citrate or carbonate) and vitamin D is recommended after surgery for prevention of secondary hyperparathyroidism. PMID:26537273

  13. An analysis of preoperative localization of parathyroid glands in hyperparathyroidism associated with thyroid diseases

    Energy Technology Data Exchange (ETDEWEB)

    Komatsu, Makoto; Inoue, Kazuaki [Fujimi-kogen Hospital, Nagano (Japan); Itoh, Atsuko

    1996-05-01

    Recently hyperparathyroidism associated with some thyroid diseases, especially nonmedually thyroid carcinoma has been payed attention to. In this study we analyzed 12 cases of hyperparathyroidism (6 cases independent of thyroid diseases and 6 cases associated with thyroid diseases) and estimated the affect of association with thyroid diseases on the preoperative localization of the parathyroid glands. The results of preoperative localization of the parathyroid glands in cases independent of thyroid diseases were relatively satisfactory. On the other hand, the preoperative localization in cases associated with thyroid diseases came to false result in about half of them. It was far from satisfactory. Association of thyroid diseases strongly affected the preoperative localization of the parathyroid glands in hyperparathyroidism. Conventional imaging such as ultrasonography, CT, MRI and {sup 201}Tl-{sup 99m}TC subtraction scintigraphy alone were not satisfactory. Now {sup 99m}Tc-MIBI scintigraphy is expected to be one of reliable imaging methods for progress in the preoperative localization. (author)

  14. Biochemical and Clinical Variables of Normal Parathyroid and Hyperparathyroid Diabetic Chronic Kidney Disease Patients

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    Syed Abdul Kader

    2016-09-01

    Full Text Available Background: In chronic kidney disease (CKD intact parathyroid hormone (iPTH level is often increased before clinical hyperphosphatemia occurs. Despite its importance very few studies evaluated parathyroid status in CKD. Objective: The study was undertaken to estimate level of parathormone in diabetic CKD patients at a tertiary level hospital and assessing its relationship with different parameters like hemoglobin, calcium etc. and comparing biochemical and clinical variables between normal parathyroid and hyperparathyroid groups. Materials and Methods: It was a hospital based cross-sectional study involving purposively selected chronic kidney disease patients attending nephrology and endocrinology outdoor and indoor services of BIRDEM hospital, Dhaka, Bangladesh. Study was conducted during the period of April to October 2010. All the subjects were divided into two groups based on serum parathormone level and different parameters were compared between groups. Results: The mean duration of chronic kidney disease was significantly higher in hyperparathyroid group than that in the normal group (<0.001. Retinopathy and hypertension were more common in hyperparathyroid group than that in patients with normal serum parathormone (p<0.001 and p=0.012. Neuropathy was solely present in hyperparathyroid group (p<0.001. Mean fasting blood glucose, serum creatinine and serum phosphate were significantly higher in the hyperparathyroid group compared to normal group (p<0.001 in all cases while the mean serum calcium and haemoglobin were lower in hyperparathyroid group than those in the normal group (p<0.001 in both cases. Serum creatinine and serum parathormone bears a significantly linear relationship (r=0.986, p<0.001, while serum parathormone and serum calcium bears a significantly negative relationship (r=−0.892 and p<0.001. Conclusion: Earlier intervention on the basis of iPTH in addition to other biochemical parameters of chronic kidney disease is

  15. Let-7 and MicroRNA-148 Regulate Parathyroid Hormone Levels in Secondary Hyperparathyroidism.

    Science.gov (United States)

    Shilo, Vitali; Mor-Yosef Levi, Irit; Abel, Roy; Mihailović, Aleksandra; Wasserman, Gilad; Naveh-Many, Tally; Ben-Dov, Iddo Z

    2017-03-15

    Secondary hyperparathyroidism commonly complicates CKD and associates with morbidity and mortality. We profiled microRNA (miRNA) in parathyroid glands from experimental hyperparathyroidism models and patients receiving dialysis and studied the function of specific miRNAs. miRNA deep-sequencing showed that human and rodent parathyroids share similar profiles. Parathyroids from uremic and normal rats segregated on the basis of their miRNA expression profiles, and a similar finding was observed in humans. We identified parathyroid miRNAs that were dysregulated in experimental hyperparathyroidism, including miR-29, miR-21, miR-148, miR-30, and miR-141 (upregulated); and miR-10, miR-125, and miR-25 (downregulated). Inhibition of the abundant let-7 family increased parathyroid hormone (PTH) secretion in normal and uremic rats, as well as in mouse parathyroid organ cultures. Conversely, inhibition of the upregulated miR-148 family prevented the increase in serum PTH level in uremic rats and decreased levels of secreted PTH in parathyroid cultures. The evolutionary conservation of abundant miRNAs in normal parathyroid glands and the regulation of these miRNAs in secondary hyperparathyroidism indicates their importance for parathyroid function and the development of hyperparathyroidism. Specifically, let-7 and miR-148 antagonism modified PTH secretion in vivo and in vitro, implying roles for these specific miRNAs. These findings may be utilized for therapeutic interventions aimed at altering PTH expression in diseases such as osteoporosis and secondary hyperparathyroidism.

  16. Prevalence of asymptomatic urinary abnormalities among adolescents.

    Science.gov (United States)

    Fouad, Mohamed; Boraie, Maher

    2016-05-01

    To determine the prevalence of asymptomatic urinary abnormalities in adolescents, first morning clean mid-stream urine specimens were obtained from 2500 individuals and examined by dipstick and light microscopy. Adolescents with abnormal screening results were reexamined after two weeks and those who had abnormal results twice were subjected to systemic clinical examination and further clinical and laboratory investigations. Eight hundred and three (32.1%) individuals had urinary abnormalities at the first screening, which significantly decreased to 345 (13.8%) at the second screening, (P adolescents who had persistent urine abnormalities; 228 (9.1%) individuals had non glomerular hematuria. The hematuria was isolated in 150 (6%) individuals, combined with leukocyturia in 83 (3.3%) individuals, and combined with proteinuria in 12 (0.5%) individuals. Leukocyturia was detected in 150 (6%) of all studied adolescents; it was isolated in 39 (1.6%) individuals and combined with proteinuria in 28 (1.1%) of them. Asymptomatic bacteriuria was detected in 23 (0.9%) of all studied adolescents; all the cases were females. Proteinuria was detected in 65 (2.6%) of all the studied adolescents; 45 (1.8%) individuals had adolescents from rural than urban areas (P adolescents in our population.

  17. Five cases of asymptomatic spontaneous pneumothorax.

    Science.gov (United States)

    Kadokura, M; Nonaka, M; Yamamoto, S; Kataoka, D; Tanio, N; Iyano, K; Oki, A; Kawada, T; Takaba, T

    1999-06-01

    Asymptomatic spontaneous pneumothorax (ASPT) is an uncommon condition. Between January 1, 1989 and December 31, 1997, 269 patients were admitted to our department with spontaneous pneumothorax. Of the 269 patients, 5 had no symptoms at the time of discovery. Their ages ranged from 15 to 61 years (mean, 37.8 years), and all of them were male. Of the 5 patients with no complaints, 2 had bilateral metachronous pneumothoraces and 3 had hemilateral pneumothorax. All of these ASPTs were revealed by chest roentgenographs taken during medical examinations or follow-up studies relating to other diseases. The mean value of body mass index (BMI) was 19.96 +/- 1.4 (range 18.7 - 22.1). Two of the 5 patients underwent bilateral partial lung resection. Histopathological examination of the resected specimens showed elastofibrosis, scar formation, and an interruption of the elastic fiber of the pleura. In these 5 cases, clinical courses were uneventful, and relapse of the pneumothorax did not occur. Clinical physicians should be aware of the possibility of asymptomatic pneumothorax, as well as the optimal radiographic techniques for revealing small pneumothoraces.

  18. Asymptomatic Urolithiasis Complicated by Nephrocutaneous Fistula

    Science.gov (United States)

    Hamard, Marion; Amzalag, Gaël; Becker, Christoph D; Poletti, Pierre-Alexandre

    2017-01-01

    Asymptomatic spontaneous nephrocutaneous fistula is a rare and severe complication of chronic urolithiasis. We report a case of 56-year-old woman with a nephrocutaneous fistula (NFC) which developed from a superinfected urinoma following calyceal rupture due to an obstructing calculus in the left ureter. The patient was clinically asymptomatic and came to the emergency department for a painless left flank fluctuating mass. This urinoma was superinfected, with a delayed development of renal abscesses and perirenal phlegmon found on contrast-enhanced uro-computed tomography (CT), responsible for left renal vein thrombophlebitis and left psoas abscess. Thereafter, a 99 mTc dimercaptosuccinic acid (DMSA) scintigraphy revealed a nonfunctional left kidney, leading to the decision of left nephrectomy. Chronic urolithiasis complications are rare and only few cases are reported in medical literature. A systematic medical approach helped selecting the best imaging modality to help diagnosis and treatment. Indeed, uro-CT scan and renal scintigraphy with 99 mTc-DMSA are the most sensitive imaging modalities to investigate morphological and functional urinary tract consequences of NFC, secondary to chronic urolithiasis. PMID:28299237

  19. Conservative management of a left ventricle cardiac fibroma in an asymptomatic child patient.

    Science.gov (United States)

    Ünsal, Handan; Ekici, Enver

    2015-07-01

    Primary cardiac tumors in infancy and childhood are rare and usually benign. Fibroma is the second most common bening cardiac tumor after rhabdomyoma. Surgery is required when fibromas cause ventricular outflow tract obstruction, ventricular dysfunction and life-threatening arrhythmia. This case report describes a 9-year-old asymptomatic male presenting with a giant left ventricular cardiac fibroma who was followed up using conservative treatment.

  20. Brown tumor: clinical findings of secondary hyperparathyroidism in patients with renal osteodystrophy.

    Science.gov (United States)

    Silva, Mairaira Teles Leão E; Cedraz, Juliana Silva Barros; Pontes, Caetano Guilherme Carvalho; Trento, Cleverson Luciano; Brasileiro, Bernardo Ferreira; Piva, Marta Rabello; Pereira, Fabiano Alvim

    2017-01-01

    A brown tumor, or osteoclastoma, is a nonneoplastic bony lesion associated with hyperparathyroidism and directly related to increased levels of parathyroid hormone. These tumors result from excessive osteoclastic activity. This article presents 3 cases of brown tumor localized in facial bones. The lesions were the result of secondary hyperparathyroidism associated with chronic renal failure. The patients were two 42-year-old men and a 39-year-old woman. All patients had been treated systemically by hemodialysis for more than 10 years. This article highlights the importance of proper diagnosis and management of dental patients presenting with a brown tumor.

  1. The OPTIMA Study: Assessing a New Cinacalcet (Sensipar/Mimpara) Treatment Algorithm for Secondary Hyperparathyroidism

    Science.gov (United States)

    Messa, Piergiorgio; Macário, Fernando; Yaqoob, Magdi; Bouman, Koen; Braun, Johann; von Albertini, Beat; Brink, Hans; Maduell, Francisco; Graf, Helmut; Frazão, João M.; Bos, Willem Jan; Torregrosa, Vicente; Saha, Heikki; Reichel, Helmut; Wilkie, Martin; Zani, Valter J.; Molemans, Bart; Carter, Dave; Locatelli, Francesco

    2008-01-01

    Background and objectives: Cinacalcet, a novel calcimimetic, targets the calcium-sensing receptor to lower parathyroid hormone (PTH), calcium, and phosphorus levels in dialysis patients with secondary hyperparathyroidism (SHPT). This study compared the efficacy of a cinacalcet-based regimen with unrestricted conventional care (vitamin D and phosphate binders) for achieving the stringent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) targets for dialysis patients. Study design: In this multicenter, open-label study, hemodialysis patients with poorly controlled SHPT were randomized to receive conventional care (n = 184) or a cinacalcet-based regimen (n = 368). Doses of cinacalcet, vitamin D sterols, and phosphate binders were adjusted during a 16-wk dose-optimization phase with the use of algorithms that allowed cinacalcet to be used with adjusted doses of vitamin D. The primary end point was the proportion of patients with mean intact PTH ≤300 pg/ml during a 7-wk efficacy assessment phase. Results: A higher proportion of patients receiving the cinacalcet-based regimen versus conventional care achieved the targets for PTH (71% versus 22%, respectively; P < 0.001), Ca × P (77% versus 58%, respectively; P < 0.001), calcium (76% versus 33%, respectively; P < 0.001), phosphorus (63% versus 50%, respectively; P = 0.002), and PTH and Ca × P (59% versus 16%, respectively, P < 0.001), and allowed a 22% reduction in vitamin D dosage in patients receiving vitamin D at baseline. Achievement of targets was greatest in patients with less severe disease (intact PTH range, 300 to 500 pg/ml) and the cinacalcet dose required was lower in these patients (median = 30 mg/d). Conclusions: Compared with conventional therapy, a cinacalcet-based treatment algorithm increased achievement of KDOQI treatment targets in dialysis patients in whom conventional therapy was no longer effective in controlling this disease. PMID:18178780

  2. PREVALENCE OF ASYMPTOMATIC BACTERIURIA IN PREGNANCY AT A TEACHING HOSPITAL

    OpenAIRE

    2016-01-01

    BACKGROUND UTI is the most frequent medical complication. It may be asymptomatic or symptomatic. Asymptomatic bacteriuria if left untreated might result in symptomatic UTI and adverse pregnancy outcomes. AIM This prospective study was aimed to determine the prevalence of Asymptomatic bacteriuria of pregnancy among antenatal women attending the antenatal clinic in the Department of Obstetrics and Gynaecology, Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianag...

  3. Asymptomatic brucellosis infection in humans: implications for diagnosis and prevention.

    Science.gov (United States)

    Zhen, Q; Lu, Y; Yuan, X; Qiu, Y; Xu, J; Li, W; Ke, Y; Yu, Y; Huang, L; Wang, Y; Chen, Z

    2013-09-01

    Human brucellosis is mainly caused by contact with Brucella-infected animals and their secretions and carcasses. Individuals who are continuously in contact with animals are considered to be at a high risk but only some show symptoms and are diagnosed as cases of brucellosis. Here, we showed that asymptomatic brucellosis infections occur among humans. Asymptomatic infections mainly result from less frequent contact with Brucella and/or contact with low-virulence Brucella. In our study, patients with asymptomatic infection had low antibody titres and different contact patterns. Awareness of asymptomatic infection is important for early diagnosis of brucellosis and prevention of chronic infection.

  4. Recurrent Parotid Carcinosarcoma in an Asymptomatic Patient

    Directory of Open Access Journals (Sweden)

    Joshua Mansour MD

    2016-10-01

    Full Text Available In this article, we present the case of a 52-year-old male with a history of parotid carcinosarcoma with initial diagnosis being 18 months prior. Initial treatment included a combination of gamma knife surgery coupled with high dosage chemotherapy and X-ray radiation therapy. At the time of follow-up, the patient presented with no complaints and had a nearly normal physical exam with the exception of some facial nerve weakness on the same side as the initial surgery. Despite being asymptomatic, the patient had a significant progression of disease that was manifested with intracranial lesions, multiple pathologic fractures, and a dramatic increase in overall tumor burden. Ultimately, the patient decided to pursue comfort measures only and succumbed to the disease peacefully soon thereafter.

  5. Are the Intracranial Lipomas Always Asymptomatic?

    Directory of Open Access Journals (Sweden)

    Mustafa Yilmaz

    2014-02-01

    Full Text Available Intracranial lipomas are rarely observed, and accepted as the congenital lesion of central nervous system. Intracranial lipomas are usually based centrally and have benign character. In the brain, it is mostly localized in pericallosal region, quadrigeminal system, and suprasellar region and cerebellopontine angles. As being mostly asymptomatic, the patients occasionally constitute clinical symptoms according to localization area. These symptoms are systemic symptoms such as cephalalgia, drowsiness, crisis and ataxy. In this article, we aimed to present the intracranial lipomas phenomenon which was diagnosed to have caused ptosis and upper lateral sight problem, namely causing localized neurological symptom, situated in mesencephalon and having pressure effect, regarding a 57-year old male patient brought to the emergency service with the nausea, throwing up and cephalalgia ailments.

  6. Asymptomatic young man with Danon disease.

    Science.gov (United States)

    Kim, Jiwon; Parikh, Parag; Mahboob, Mohammad; Arrighi, James A; Atalay, Michael K; Rowin, Ethan J; Maron, Martin S

    2014-06-01

    Danon disease is a rare, codominant X-linked genetic disorder characterized by the triad of left ventricular hypertrophy, mental retardation, and peripheral myopathy. This disease is caused by mutations in the gene that encodes lysosomal associated membrane protein 2 (LAMP2), a deficiency of which results in the accumulation of autophagic granular débris within the vacuoles of muscle cells. This is a report of an asymptomatic 19-year-old man with Danon disease in the absence of mental retardation or clinically significant skeletal myopathy. This case underscores the importance of accurate diagnosis of unexplained left ventricular hypertrophy, in order to establish an appropriate treatment plan and to advise genetic counseling.

  7. Asymptomatic humans transmit dengue virus to mosquitoes.

    Science.gov (United States)

    Duong, Veasna; Lambrechts, Louis; Paul, Richard E; Ly, Sowath; Lay, Rath Srey; Long, Kanya C; Huy, Rekol; Tarantola, Arnaud; Scott, Thomas W; Sakuntabhai, Anavaj; Buchy, Philippe

    2015-11-24

    Three-quarters of the estimated 390 million dengue virus (DENV) infections each year are clinically inapparent. People with inapparent dengue virus infections are generally considered dead-end hosts for transmission because they do not reach sufficiently high viremia levels to infect mosquitoes. Here, we show that, despite their lower average level of viremia, asymptomatic people can be infectious to mosquitoes. Moreover, at a given level of viremia, DENV-infected people with no detectable symptoms or before the onset of symptoms are significantly more infectious to mosquitoes than people with symptomatic infections. Because DENV viremic people without clinical symptoms may be exposed to more mosquitoes through their undisrupted daily routines than sick people and represent the bulk of DENV infections, our data indicate that they have the potential to contribute significantly more to virus transmission to mosquitoes than previously recognized.

  8. Asymptomatic post-rheumatic giant left atrium.

    Science.gov (United States)

    Özkartal, Tardu; Tanner, Felix C; Niemann, Markus

    2016-06-26

    A 78-year-old asymptomatic woman was referred to our clinic for a second opinion regarding indication for mitral valve surgery. An echocardiogram showed a moderate mitral stenosis with a concomitant severe regurgitation. The most striking feature, however, was a giant left atrium with a parasternal anteroposterior diameter of 79 mm and a left atrial volume index of 364 mL/m². There are various echocardiographic definitions of a giant left atrium, which are mainly based on measurements of the anteroposterior diameter of the left atrium using M-mode in the parasternal long axis view. Since the commonly accepted method for echocardiographic evaluation of left atrial size is left atrial volume index, we propose a cut-off value of 140 mL/m(2) for the definition of a "giant left atrium".

  9. Asymptomatic cardiopulmonary changes caused by adenoid hypertrophy.

    Science.gov (United States)

    Abdel-Aziz, Mosaad

    2011-07-01

    Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.

  10. Educational paper: Primary antibody deficiencies

    NARCIS (Netherlands)

    G.J.A. Driessen (Gertjan); M. van der Burg (Mirjam)

    2011-01-01

    textabstractPrimary antibody deficiencies (PADs) are the most common primary immunodeficiencies and are characterized by a defect in the production of normal amounts of antigen-specific antibodies. PADs represent a heterogeneous spectrum of conditions, ranging from often asymptomatic selective IgA a

  11. Pharmacogenetic analysis of cinacalcet response in secondary hyperparathyroidism patients

    Directory of Open Access Journals (Sweden)

    Jeong S

    2016-07-01

    Full Text Available Sohyun Jeong,1 In-Wha Kim,1 Kook-Hwan Oh,2 Nayoung Han,1 Kwon Wook Joo,2 Hyo Jin Kim,2 Jung Mi Oh1 1College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, 2Department of Internal Medicine, Division of Nephrology, Seoul National University Hospital, Seoul, Korea Background: Secondary hyperparathyroidism (SHPT is one of the major risk factors of morbidity and mortality in end-stage renal disease. Cinacalcet effectively controls SHPT without causing hypercalcemia and hyperphosphatemia. However, there is significant inter-individual response variance to cinacalcet treatment. Therefore, we aimed to evaluate the genetic effects related with parathyroid hormone regulation as factors for cinacalcet response variance. Methods: Patients with a diagnosis of SHPT based on intact parathyroid hormone (iPTH >300 pg/mL on dialysis were included in this study. They were over 18 years and have been treated by cinacalcet for more than 3 months. Responders and nonresponders were grouped by the serum iPTH changes. Twenty-four single nucleotide polymorphisms of CASR, VDR, FGFR1, KL, ALPL, RGS14, NR4A2, and PTHLH genes were selected for the pharmacogenetic analysis. Results: After adjusting for age, sex, and calcium level, CASR rs1042636 (odds ratio [OR]: 0.066, P=0.027 and rs1802757 (OR: 10.532, P=0.042 were associated with cinacalcet response. The association of haplotypes of CASR rs1042636, rs10190, and rs1802757; GCC (OR: 0.355, P=0.015; and ATT (OR: 2.769, P=0.014 with cinacalcet response was also significant. Conclusion: We obtained supporting information of the associations between cinacalcet response and CASR polymorphisms. CASR single nucleotide polymorphisms (SNPs rs1802757, rs1042636, and haplotypes of rs1042636, rs10190, and rs1802757 were significantly associated with cinacalcet response variance. Keywords: CASR, calcium sensing receptor, SHPT, genetic polymorphisms, haplotype, single nucleotide polymorphisms

  12. CINACALCET IN TREATMENT OF HYPERPARATHYROIDISM IN RECIPIENTS OF RENAL GRAFT

    Directory of Open Access Journals (Sweden)

    O. N. Vetchinnikova

    2014-01-01

    Full Text Available Aim. Evaluate the efficacy and safety of cinacalcet in the treatment of hyperparathyroidism (HPT in renal transplant recipients. Materials and methods. During the year, three patients with satisfactory functioning kid- ney transplant (glomerular filtration rate − GFR 44–80 ml/min and HPT (parathyroid hormone − PTH 320– 348 pg/ml, resistant to treatment with active forms of vitamin D and hypercalcemia (2,6–3,1 mmol/l were treated with cinacalcet (initial dose of 30 mg/day, supporting − 60–15 mg/day with the added in 2–3 months alfacalcidol (0,25–0,75 μg/day. Investigated the serum concentrations and renal excretion of calcium and phos- phorus, PTH, renal transplant function (blood creatinine, GFR, plasma concentrations of tacrolimus, bone mine- ral density (BMD in different parts of the skeleton (dual energy X-ray absorptiometry. Results. A month later, the level of calcium in the blood to normal, PTH levels decreased by 1,2–3,2 times. A year later, in two patients, blood levels of PTH was back to normal, one − up − 142 pg/ml. Renal excretion of calcium varied differently − in two patients increased gradually, without exceeding the physiological norm, and in one − remained stable. Gene- ral pattern in the dynamics of serum concentration and urinary excretion of phosphorus was not observed. Renal graft function remained stable − GFR 46–76 ml/min. BMD of the distal forearm, femoral neck and lumbar spine in two patients remained the same, in one − increased by 14, 6 and 7%. Adverse events were absent. Conclusion. Application of cinacalcet is promising for the correction of HPT in renal transplant recipients. 

  13. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Sampaio Lacativa

    Full Text Available CONTEXT AND OBJECTIVE: Patients with end stage renal disease (ESRD and secondary hyperparathyroidism (HPT2 are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING: This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF, in Rio de Janeiro, Brazil. METHODS: Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS: The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each. "Rugger jersey spine" sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%, abdominal aorta and lower limb arteries (35% each. Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each. CONCLUSION: The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.

  14. Three-Year Successful Cinacalcet Treatment of Secondary Hyperparathyroidism in a Patient with X-Linked Dominant Hypophosphatemic Rickets: A Case Report

    Science.gov (United States)

    Rejnmark, Lars

    2014-01-01

    Hypophosphatemic rickets (HR) is a rare inherited disorder characterized by a classic rickets phenotype with low plasma phosphate levels and resistance to treatment with vitamin D. Development of secondary hyperparathyroidism (SHPT) as a direct consequence of treatment is a frequent complication and a major clinical challenge, as this may increase risk of further comorbidity. Cinacalcet, a calcimimetic agent that reduces the secretion of PTH from the parathyroid glands, has been suggested as adjuvant treatment to SHPT in patients with HR. However, only two papers have previously been published and no data are available on effects of treatment for more than six months. We now report a case of 3-year treatment with cinacalcet in a patient with HR complicated by SHPT. A 53-year-old woman with genetically confirmed X-linked dominant hypophosphatemic rickets developed SHPT after 25 years of conventional treatment with alfacalcidol and phosphate supplements. Cinacalcet was added to her treatment, causing a sustained normalization of PTH. Ionized calcium decreased, requiring reduction of cinacalcet, though asymptomatical. Level of phosphate was unchanged, but alkaline phosphatase increased in response to treatment. Cinacalcet appeared to be efficient, safe, and well tolerated. We recommend close control of plasma calcium to avoid hypocalcemia. PMID:24660072

  15. Three-Year Successful Cinacalcet Treatment of Secondary Hyperparathyroidism in a Patient with X-Linked Dominant Hypophosphatemic Rickets: A Case Report

    Directory of Open Access Journals (Sweden)

    Diana Grove-Laugesen

    2014-01-01

    Full Text Available Hypophosphatemic rickets (HR is a rare inherited disorder characterized by a classic rickets phenotype with low plasma phosphate levels and resistance to treatment with vitamin D. Development of secondary hyperparathyroidism (SHPT as a direct consequence of treatment is a frequent complication and a major clinical challenge, as this may increase risk of further comorbidity. Cinacalcet, a calcimimetic agent that reduces the secretion of PTH from the parathyroid glands, has been suggested as adjuvant treatment to SHPT in patients with HR. However, only two papers have previously been published and no data are available on effects of treatment for more than six months. We now report a case of 3-year treatment with cinacalcet in a patient with HR complicated by SHPT. A 53-year-old woman with genetically confirmed X-linked dominant hypophosphatemic rickets developed SHPT after 25 years of conventional treatment with alfacalcidol and phosphate supplements. Cinacalcet was added to her treatment, causing a sustained normalization of PTH. Ionized calcium decreased, requiring reduction of cinacalcet, though asymptomatical. Level of phosphate was unchanged, but alkaline phosphatase increased in response to treatment. Cinacalcet appeared to be efficient, safe, and well tolerated. We recommend close control of plasma calcium to avoid hypocalcemia.

  16. Cinacalcet versus Parathyroidectomy in the Treatment of Secondary Hyperparathyroidism Post Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Soliman Amin R.

    2016-09-01

    Full Text Available Background. Persistent hyperparathyroidism (HPT with hypercalcemia is prevalent after transplant and is considered a risk factor for progressive bone loss and fractures and vascular calcification, as well as the development of tubulointerstitial calcifications of renal allografts and graft dysfunction. The subtotal parathyroidectomy is the standard treatment, although currently it has been replaced by the calcimimetic cinacalcet.

  17. Renal Tubular Acidosis after Jejunoileal Bypass for Morbid Obesity: role of secondary hyperparathyroidism

    DEFF Research Database (Denmark)

    Andersen, NN; Ladefoged, NN

    1991-01-01

    The effect of calcium infusion was studied in patients with renal tubular acidosis (RTA) and secondary hyperparathyroidism. Both developed after jejunoileal bypass operation (JIB) for morbid obesity. In three of four cases the acidification defect was abolished, probably due to a decrease of seru...

  18. Involvement of the MEN1 gene locus in familial isolated hyperparathyroidism

    DEFF Research Database (Denmark)

    Villablanca, Andrea; Wassif, Wassif S; Birket-Smith, Niels Thomas

    2002-01-01

    Familial isolated hyperparathyroidism (FIHP) is a hereditary disorder characterised by uni- or multiglandular parathyroid disease. A subset of families are likely to be genetic variants of other familial tumour syndromes in which PHPT is the main feature, for example multiple endocrine neoplasia...

  19. Smoking and hyperparathyroidism in patients with end-stage renal disease (ESRD)

    NARCIS (Netherlands)

    G.L. Tripepi (Giovanni); F.U.S. Mattace Raso (Francesco); P. Pizzini (Patrizia); S. Cutrupi (Sebastiano); J.C.M. Witteman (Jacqueline); C. Zoccali (Carmine); F. Mallamaci (Francesca)

    2012-01-01

    textabstractBackground and methods: Smoking is associated with hyperparathyroidism in the elderly general population and nicotine, the main component of tobacco smoke, stimulates PTH release in experimental models. Although smoking is a persisting problem in patients with endstage renal disease (ESR

  20. Secondary hyperparathyroidism and mortality in hip fracture patients compared to a control group from general practice

    DEFF Research Database (Denmark)

    Madsen, Christian Medom; Jørgensen, Henrik Løvendahl; Lind, Bent

    2012-01-01

    INTRODUCTION: Previously, little attention has been paid as to how disturbances in the parathyroid hormone (PTH)-calcium-vitamin D-axis, such as secondary hyperparathyroidism (SHPT), relate to mortality amongst hip fracture patients. This study aimed to (1) determine if SHPT is associated...

  1. Leontiasis ossea in a patient with hyperparathyroidism secondary to chronic renal failure

    Energy Technology Data Exchange (ETDEWEB)

    Aggunlu, Levent; Akpek, Sergin; Coskun, Bilgen [Department of Radiology, School of Medicine, Gazi University, Besevler, Ankara (Turkey)

    2004-08-01

    Osteitis fibrosa describes the bone changes seen in renal osteodystrophy secondary to longstanding hyperparathyroidism. We report a 19-year-old man with longstanding chronic renal failure with a severe form of osteitis fibrosa affecting the jaws and other maxillofacial bones causing bizarre facial and dental deformity in a patient-uraemic leontiasis ossea. (orig.)

  2. Human rhinovirus infections in symptomatic and asymptomatic subjects

    Directory of Open Access Journals (Sweden)

    C.N. Camargo

    2012-12-01

    Full Text Available The role of rhinovirus asymptomatic infections in the transmission among close contacts subjects is unknown. We tested health care workers, a pair of one child and a family member and immunocompromised patients (n =191. HRV were detected on 22.9% symptomatic and 3.6% asymptomatic cases suggesting lower transmission among contacts.

  3. Asymptomatic moyamoya disease: literature review and ongoing AMORE study.

    Science.gov (United States)

    Kuroda, Satoshi

    2015-01-01

    Recent development of a non-invasive magnetic resonance examination has increased the opportunity to identify asymptomatic patients with moyamoya disease who have experienced no cerebrovascular events. However, their clinical features, prognosis, and treatment strategy are still unclear because of small number of subjects and short follow-up periods. Therefore, we have designed Asymptomatic Moyamoya Registry (AMORE) study in Japan. The objectives of this nation-wide, multi-center prospective study are to clarify long-term prognosis of asymptomatic patients with moyamoya disease and to determine the risk factors that cause ischemic and hemorrhagic stroke in them. In this article, we review the published data on asymptomatic moyamoya disease and report the on-going multi-center prospective cohort study, AMORE study. We would like to emphasize the importance to determine the clinical features, prognosis, and treatment strategies of asymptomatic moyamoya disease in very near future.

  4. The asymptomatic bacteriuria Escherichia coli strain 83972 outcompetes uropathogenic E. coli strains in human urine

    DEFF Research Database (Denmark)

    Hancock, Viktoria; Ulett, G.C.; Schembri, M.A.

    2006-01-01

    Escherichia coli is the most common organism associated with asymptomatic bacteriuria (ABU). In contrast to uropathogenic E. coli (UPEC), which causes symptomatic urinary tract infections (UTI), very little is known about the mechanisms by which these strains colonize the human urinary tract....... The prototype ABU E. coli strain 83972 was originally isolated from a girl who had carried it asymptomatically for 3 years. Deliberate colonization of UTI-susceptible individuals with E. coli 83972 has been used successfully as an alternative approach for the treatment of patients who are refractory...... to conventional therapy. Colonization with strain 83972 appears to prevent infection with UPEC strains in such patients despite the fact that this strain is unable to express the primary adhesins involved in UTI, viz. P and type 1 fimbriae. Here we investigated the growth characteristics of E. coli 83972 in human...

  5. Management of Asymptomatic Renal Stones in Astronauts

    Science.gov (United States)

    Reyes, David; Locke, James

    2016-01-01

    Introduction: Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The risks for renal stone formation in astronauts due to bone loss and hypercalcuria are unknown. Astronauts have a stone risk which is about the same as commercial aviation pilots, which is about half that of the general population. However, proper management of this condition is still crucial to mitigate health and mission risks in the spaceflight environment. Methods: An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. Using this work, a screening and management algorithm was created that takes into consideration the unique operational environment of spaceflight. Results: Renal stone screening and management guidelines for astronauts were created based on accepted standards of care, with consideration to the environment of spaceflight. In the proposed algorithm, all astronauts will receive a yearly screening ultrasound for renal calcifications, or mineralized renal material (MRM). Any areas of MRM, 3 millimeters or larger, are considered a positive finding. Three millimeters approaches the detection limit of standard ultrasound, and several studies have shown that any stone that is 3 millimeters or less has an approximately 95 percent chance of spontaneous passage. For mission-assigned astronauts, any positive ultrasound study is followed by low-dose renal computed tomography (CT) scan, and flexible ureteroscopy if CT is positive. Other specific guidelines were also created. Discussion: The term "MRM" is used to account for small areas of calcification that may be outside the renal collecting system, and allows objectivity without otherwise constraining the diagnostic and treatment process for potentially very small calcifications of uncertain

  6. Cinacalcet reduces plasma intact parathyroid hormone, serum phosphate and calcium levels in patients with secondary hyperparathyroidism irrespective of its severity.

    LENUS (Irish Health Repository)

    2011-09-01

    To evaluate the relationship between the severity of secondary hyperparathyroidism (SHPT) - defined in terms of baseline plasma intact parathyroid hormone (iPTH) level - and the magnitude of response to cinacalcet.

  7. Calcification of all four parathyroid glands in a hemodialysis patient with secondary hyperparathyroidism revealed by computerized tomography.

    Science.gov (United States)

    Peces, R; Rodríguez, M; González, F; Ablanedo, P

    2001-09-01

    This report describes the parathyroid scan, computerized tomography and histologic findings in a young female hemodialysis patient with severe secondary hyperparathyroidism. These findings included hyperplasia and calcification of all four parathyroid glands.

  8. Serum phosphorus reduction in dialysis patients treated with cinacalcet for secondary hyperparathyroidism results mainly from parathyroid hormone reduction

    DEFF Research Database (Denmark)

    Zitt, Emanuel; Fouque, Denis; Jacobson, Stefan H

    2013-01-01

    The calcimimetic cinacalcet lowers parathyroid hormone (PTH), calcium (Ca) and phosphorus (P) in dialysis patients with secondary hyperparathyroidism (SHPT). We explored serum P changes in dialysis patients treated with cinacalcet, while controlling for vitamin D sterol and phosphate binder (PB...

  9. Outcome of total parathyroidectomy and autotransplantation as treatment of secondary and tertiary hyperparathyroidism in children and adults.

    NARCIS (Netherlands)

    Kievit, A.J.; Tinnemans, J.G.; Idu, M.M.; Groothoff, J.W.; Surachno, S.; Aronson, D.C.

    2010-01-01

    BACKGROUND: Treatment safety and effectiveness of total parathyroidectomy and autotransplantation for secondary and tertiary hyperparathyroidism have been extensively proven in adults; the evidence for children, however, is scarce. Children and adolescents cannot simply be seen as young adults in th

  10. Effectiveness of cinacalcet in patients with recurrent/persistent secondary hyperparathyroidism following parathyroidectomy: results of the ECHO study

    DEFF Research Database (Denmark)

    Zitt, Emanuel; Rix, Marianne; Ureña Torres, Pablo

    2011-01-01

    Progressive secondary hyperparathyroidism (sHPT) is characterized by parathyroid gland hyperplasia which may ultimately require parathyroidectomy (PTX). Although PTX is generally a successful treatment for those patients subjected to surgery, a significant proportion develops recurrent sHPT follo......Progressive secondary hyperparathyroidism (sHPT) is characterized by parathyroid gland hyperplasia which may ultimately require parathyroidectomy (PTX). Although PTX is generally a successful treatment for those patients subjected to surgery, a significant proportion develops recurrent s...

  11. Treatment of asymptomatic catecholaminergic polymorphic ventricular tachycardia.

    Science.gov (United States)

    Obeyesekere, Manoj N; Sy, Raymond W; Leong-Sit, Peter; Gula, Lorne J; Yee, Raymond; Skanes, Allan C; Klein, George J; Krahn, Andrew D

    2012-05-01

    Catecholaminergic polymorphic ventricular tachycardia is a rare genetic disorder caused by mutations in genes involved in the intracellular calcium homeostasis of cardiac cells. Affected patients typically present with life-threatening ventricular arrhythmias precipitated by emotional/physical stress. The diagnosis is based on the demonstration of polymorphic or bidirectional ventricular tachycardia associated with adrenergic stress. Genetic testing can be confirmatory in some patients. Treatment for catecholaminergic polymorphic ventricular tachycardia includes medical and surgical efforts to suppress the effects of epinephrine at the myocardial level and/or modulation of calcium homeostasis. Mortality is high when untreated and sudden cardiac death may be the first manifestation of the disease. First-degree relatives of a proband should be offered genetic testing if the causal mutation is known. If the family mutation is not known, relatives should be clinically evaluated with provocative testing. In the absence of rigorous trials, prophylactic treatment of the asymptomatic catecholaminergic polymorphic ventricular tachycardia patient appears to reduce morbidity and mortality.

  12. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs

    Science.gov (United States)

    Witzel, Angela L.; Bartges, Joseph W.; Moyers, Tamberlyn S.; Kirk, Claudia A.

    2016-01-01

    Background. Obesity has reached epidemic proportions in dogs and, as in humans, cost of care has increased due to associated comorbidities. In humans, asymptomatic urinary tract infections (UTI) may be more prevalent in the obese. Asymptomatic bacteriuria (AB) is the term used when UTI are asymptomatic. We hypothesized that morbidly obese dogs are similarly more likely to have asymptomatic bacteriuria than lean, overweight, and moderately obese dogs. Methods. A retrospective study was undertaken to explore a possible association between obesity and asymptomatic bacteriuria. Records from lean, overweight, and obese dogs receiving both a dual energy absorptiometry (DXA) scan and urine culture were included. Results. Six positive urine cultures were identified among 46 dogs fulfilling search criteria. All six positive cultures were found in dogs with body fat percentage of >45%. In dogs with body fat percentage of <45%, there were no positive urine cultures. Discussion. There was an increased prevalence of asymptomatic bacteriuria in the morbidly obese dogs in this study compared to those that were lean, overweight, or moderately obese. Whether antibiotic therapy is necessary in such cases is still being debated, but because asymptomatic bacteriuria may be associated with ascending infections, uroliths, or other complications, the data reported herein support the screening of obese patients for bacteriuria. PMID:26989606

  13. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs

    Directory of Open Access Journals (Sweden)

    Susan G. Wynn

    2016-03-01

    Full Text Available Background. Obesity has reached epidemic proportions in dogs and, as in humans, cost of care has increased due to associated comorbidities. In humans, asymptomatic urinary tract infections (UTI may be more prevalent in the obese. Asymptomatic bacteriuria (AB is the term used when UTI are asymptomatic. We hypothesized that morbidly obese dogs are similarly more likely to have asymptomatic bacteriuria than lean, overweight, and moderately obese dogs. Methods. A retrospective study was undertaken to explore a possible association between obesity and asymptomatic bacteriuria. Records from lean, overweight, and obese dogs receiving both a dual energy absorptiometry (DXA scan and urine culture were included. Results. Six positive urine cultures were identified among 46 dogs fulfilling search criteria. All six positive cultures were found in dogs with body fat percentage of >45%. In dogs with body fat percentage of <45%, there were no positive urine cultures. Discussion. There was an increased prevalence of asymptomatic bacteriuria in the morbidly obese dogs in this study compared to those that were lean, overweight, or moderately obese. Whether antibiotic therapy is necessary in such cases is still being debated, but because asymptomatic bacteriuria may be associated with ascending infections, uroliths, or other complications, the data reported herein support the screening of obese patients for bacteriuria.

  14. Asymptomatic patients of chronic obstructive pulmonary disease in China

    Institute of Scientific and Technical Information of China (English)

    LU Ming; WANG Chang-zheng; NI Dian-tao; WANG Xiao-ping; WANG Da-li; LIU Sheng-ming; L(U) Jia-chun; SHEN Ning; DING Yan-ling; RAN Pi-xin; YAO Wan-zhen; ZHONG Nan-shan; ZHOU Yu-min; WANG Chen; CHEN Ping; KANG Jian; HUANG Shao-guang; CHEN Bao-yuan

    2010-01-01

    Background Chronic obstructive pulmonary disease (COPD) has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents (over 40 years old) were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 (35.3%)were asymptomatic. The age, sex, body mass index (BMI),rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 (73.1% vs. 61.0%), FVC (91.9% vs. 82.0%), and a higher ratio of FEV1/FVC (62.9% vs.58.7%) (all P <0.001) than symptomatic group. More asymptomatic patients were underdiagnosed (91.9% vs.54.3%, P<0.001) than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.

  15. Ultrasonography in the diagnosis of asymptomatic hyperuricemia and gout.

    Science.gov (United States)

    Puig, J G; Beltrán, L M; Mejía-Chew, C; Tevar, D; Torres, R J

    2016-12-01

    Sonography has detected urate deposits in 34%-42% of the patients with asymptomatic hyperuricemia. This may prompt reclassification of asymptomatic hyperuricemia into "asymptomatic gout" and consideration of urate lowering therapy (ULT) to resolve urate deposits. In patients with gout and no visible tophi, sonography has detected urate deposits in half of the patients. This may allow diagnosing "tophaceous gout" and influencing the serum urate target level, prophylaxis to avoid acute gout flares during ULT, and clinical follow-up. Current accessibility to sonography may better classify patients with hyperuricemia and gout and contribute to delineate therapeutic objectives and clinical guidance.

  16. Prognostic value of asymptomatic skin sensitization to aeroallergens

    DEFF Research Database (Denmark)

    Bødtger, Uffe

    2004-01-01

    immunological mechanisms in asymptomatic skin sensitization might provide new insights into the natural history and treatment of respiratory allergy. RECENT FINDINGS: Research on asymptomatic skin sensitization is rare, and the present review unites previous studies with recent findings. It is a common...... positive skin test must be ruled out before allergen avoidance measures are initiated. SUMMARY: Surprisingly few papers exist on asymptomatic skin sensitization epidemiology and immunology, despite the intriguing question as to why symptoms do not develop in IgE-sensitized patients. It is a common...

  17. Patología hiperparatiroidea atendida en tres hospitales costarricenses Hyperparathyroid pathology treated in three Costa Rican hospitals

    Directory of Open Access Journals (Sweden)

    Manuel F Jiménez-Navarrete

    2012-12-01

    , whose sample was patients treated between January 2007 and December 2009. Determination of frequencies and proportions for the qualitative variables was made by means of the Chi-Square test. The quantitative variables were determined by the estimate of Student’s t-test. Results: Out of 199 patients studied, 9 were excluded. Women prevailed (68.9 %, the most frequent age group was 60 years and over (33.1 %. Primary hyperparathyroidism was the most frequent disease (n=46, 24.2 %; 73.9 % women, 69.5% older than 50, then hypovitaminosis D and chronic renal failure. The majority lived in San José (59.4 % and were assisted at the Mexico Hospital (65.8%. There is no clear concept among some doctors, thus normocalcemic hyperparathyroidism is underestimated. The majority do not request determinations of vitamin D in these patients. Discussion: Patients with raised PTH by diverse reasons are exposed to many diseases that can compromise their survival and quality of life. Hypovitaminosis D would probably be more frequent if measurement was requested more often. The request for calciphediol must be emphasized in any parathyroid disease.

  18. A Giant-Cell Lesion with Cellular Cannibalism in the Mandible: Case Report and Review of Brown Tumors in Hyperparathyroidism.

    Science.gov (United States)

    Azzi, Lorenzo; Cimetti, Laura; Annoni, Matteo; Anselmi, Diego; Tettamanti, Lucia; Tagliabue, Angelo

    2017-01-01

    A small radiolucent area in the mandible was discovered in a 58-year-old woman with no oral complaints. The patient's history included only hypertension. The lesion was considered as an inflammatory cyst and was enucleated. Three months later, a CT revealed the presence of a cyst-like lesion in the mandible with thin expanded buccal cortical plate, localized erosion, and a polylobate appearance on the lingual aspect of the cortical plate. The histological diagnosis of the lesion was central giant-cell granuloma (CGCG). The lesion was thoroughly enucleated. Nevertheless, another X-ray carried out six months later revealed multiple bilateral osteolytic areas throughout the jaw. In addition, widespread cortical plate erosion was observed, as well as signs of root resorption and periodontal enlargement. There was no sign of neurological involvement, although the nerves appeared to be dislocated. After full blood chemistry analysis and detailed collection of radiographs, the final diagnosis was brown tumors in primary hyperparathyroidism. This case report demonstrates how dental clinicians may be the first-line specialists who identify a complex systemic disease before other clinicians. Finally, it highlights the role of cellular cannibalism in predicting the clinical aggressiveness of brown tumors as well as in other giant-cell lesions.

  19. Nutritional profile of asymptomatic alcoholic patients

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Sobral-Oliveira

    2011-06-01

    Full Text Available CONTEXT: Alcoholism may interfere with nutritional status, but reports are often troubled by uncertainties about ingested diet and organ function, as well as by ongoing abuse and associated conditions. OBJECTIVE: To identify nutritional and body compartment changes in stable alcoholics without confounding clinical and dietetic variables, a prospective observational pilot study was designed. Three well-matched populations were considered: subjects with chronic alcoholic pancreatitis, alcoholics without visceral disease, and healthy never-drinking adults (controls. METHODS: Subjects (n = 60 were asymptomatic males with adequate diet, no superimposed disease or complication, and alcohol-free for at least 6 months. After exclusions, 48 patients were compared. Variables encompassed dietary recall, bioimpedance analysis, biochemical profile and inflammatory markers. Main outcome measures were body fat, lean body mass, serum lipids, C-reactive protein, and selected minerals and vitamins. RESULTS: Both alcoholic populations suffered from reduced lean body mass (P = 0.001, with well-maintained body fat.Magnesium was depleted, and values of vitamin D and B12 correlated with alcohol abuse. LDL and total cholesterol was increased in alcoholics without pancreatitis (P = 0.04, but not in those with visceral damage. C-reactive protein and serum amyloid A correlated with duration of excessive drinking (P = 0.01. CONCLUSIONS: Undernutrition (diminished lean body mass, risk of magnesium and vitamin deficiencies contrasted with dyslipidemia and increased cardiovascular risk. This second danger was masked during chronic pancreatitis but not in alcoholics without visceral disease. Further studies should focus special requirements of this population.

  20. Factors prompting PSA-testing of asymptomatic men in a country with no guidelines: a national survey of general practitioners.

    LENUS (Irish Health Repository)

    Drummond, Frances J

    2009-01-01

    of asymptomatic men in primary care is primarily due to a combination of clinical experience, poor knowledge and the support of doctors for PSA testing, as evidenced by the willingness of male doctors to have a PSA test. There is an urgent need for education and support for GPs concerning prostate cancer screening, starting with the implementation of national guidelines.

  1. Urinary tract infections and asymptomatic bacteriuria in older adults.

    Science.gov (United States)

    Nelson, Joan M; Good, Elliot

    2015-08-15

    Overuse of urinalysis in older adults to investigate vague changes in condition such as confusion, lethargy, and anorexia, has led to overtreatment of asymptomatic bacteriuria and associated antibiotic resistance.

  2. Cognitive Deficits in Symptomatic and Asymptomatic Carotid Endarterectomy Surgical Candidates

    Science.gov (United States)

    Jackson, Daren C.; Sandoval-Garcia, Carolina; Rocque, Brandon G.; Wilbrand, Stephanie M.; Mitchell, Carol C.; Hermann, Bruce P.; Dempsey, Robert J.

    2016-01-01

    The role played by vessel disease in stroke-related cognition dysfunction is unclear. We assessed the impact of significant atherosclerotic disease on cognition—even in patients asymptomatic for stroke. We hypothesized that patients would perform poorly relative to controls, but that symptomatic/asymptomatic status (history of stroke/transient ischemic attack) would have no effect. Fifty-two carotid endarterectomy candidates with >60% carotid stenosis and 17 controls underwent a 60-min neuropsychological test protocol. Symptomatic and asymptomatic patients showed deficits in executive function, delayed verbal recall, and general knowledge. Patients symptomatic for stroke also performed worse on tests of language and motor/visuomotor ability. Symptomatic and asymptomatic patients differed in working memory and language task performance. Although all patients showed deficits in executive function and memory, only symptomatic patients showed additional deficits in language and motor function. Cognitive abnormalities in patients viewed as “asymptomatic” for stroke underscore the need for early identification and treatment. PMID:26663810

  3. [Asymptomatic myxoma of the tricuspid valve septal leaflet].

    Science.gov (United States)

    Jedliński, Ireneusz; Jamrozek-Jedlińska, Maria; Bugajski, Paweł; Kalawski, Ryszard; Poprawski, Kajetan; Słomczyński, Marek

    2012-01-01

    We presented a case of asymptomatic myxoma of the tricuspid valve septal leaflet. The tumour was diagnosed accidentally during rutine transthoracic echocardiography and confirmed by transesophageal echocardiography. It was resected and the septal leaflet repaired during surgery.

  4. Clinical and angiographic comparison of asymptomatic occlusive cerebrovascular disease.

    Science.gov (United States)

    Gorelick, P B; Caplan, L R; Langenberg, P; Hier, D B; Pessin, M; Patel, D; Taber, J

    1988-06-01

    We compared clinical and arteriographic features in 106 patients with symptomatic unilateral carotid territory occlusive disease to determine the frequency and distribution of occlusive arterial lesions in asymptomatic vessels. Among black patients who were predominantly from Chicago, young, and female, there were fewer transient ischemic attacks and myocardial infarcts, less claudication, and more asymptomatic lesions of the supraclinoid internal carotid artery, anterior cerebral artery stem, and the middle cerebral artery stem. Among white patients predominantly from New England, elderly, and male, there was more frequent and severe occlusive asymptomatic disease at extracranial carotid and vertebral artery sites. Knowledge of the distribution of asymptomatic lesions will help guide evaluation and treatment strategies for patients with occlusive cerebrovascular disease.

  5. Asymptomatic infection with American cutaneous leishmaniasis: epidemiological and immunological studies

    Science.gov (United States)

    Andrade-Narvaez, Fernando J; Loría-Cervera, Elsy Nalleli; Sosa-Bibiano, Erika I; Van Wynsberghe, Nicole R

    2016-01-01

    American cutaneous leishmaniasis (ACL) is a major public health problem caused by vector-borne protozoan intracellular parasites from the genus Leishmania, subgenera Viannia and Leishmania. Asymptomatic infection is the most common outcome after Leishmania inoculation. There is incomplete knowledge of the biological processes explaining the absence of signs or symptoms in most cases while other cases present a variety of clinical findings. Most studies of asymptomatic infection have been conducted in areas of endemic visceral leishmaniasis. In contrast, asymptomatic ACL infection has been neglected. This review is focused on the following: (1) epidemiological studies supporting the existence of asymptomatic ACL infection and (2) immunological studies conducted to understand the mechanisms responsible for controlling the parasite and avoiding tissue damage. PMID:27759762

  6. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  7. Asymptomatic spontaneous rupture of suprasellar dermoid cyst : a case report.

    Directory of Open Access Journals (Sweden)

    Venkatesh S

    2002-10-01

    Full Text Available Suprasellar dermoid cysts are uncommon intracranial lesions. CT and MRI findings in a rare case of asymptomatic rupture of suprasellar dermoid cyst with subarachnoid dissemination is described.

  8. A novel CLCN5 mutation in a boy with asymptomatic proteinuria and focal global glomerulosclerosis.

    Science.gov (United States)

    Valina, Mary Rose; Larsen, Christopher P; Kanosky, Sherry; Suchy, Sharon F; Nield, Linda S; Onder, Ali Mirza

    2013-11-01

    Dent disease is an X-linked proximal tubulopathy that typically presents with hypercalciuria, low-molecular-weight proteinuria and slow progression to endstage renal disease. We report the case of a 5-year-old boy who presented with asymptomatic nephrotic range proteinuria and was later diagnosed with Dent disease. Absence of specific glomerular pathology in the first kidney biopsy led to erroneous treatment for presumably unsampled primary focal segmental glomerulosclerosis. Aggressive angiotensin blockade and immunosuppression resulted in significant side effects with marginal benefit. The continued nonspecific findings after a second kidney biopsy 2 years later led to the suspicion of a congenital tubulopathy. We detected a novel CLCN5 gene mutation, c.1396G > C, that creates a G466R missense change in the ClC-5 protein. Dent disease should be considered in the differential diagnosis of asymptomatic proteinuria for male patients. Profiling proteinuria in these patients by spot urine albumin/creatinine ratio may give the first clue to a tubulopathy. Determining the extent to which the clinical work-up should proceed for females with Dent phenotype or asymptomatic proteinuria remains to be a challenging clinical dilemma.

  9. Abnormal muscle and hematopoietic gene expression may be important for clinical morbidity in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Reppe, Sjur; Stilgren, Lis; Abrahamsen, Bo;

    2007-01-01

    , kidney stones and metabolic bone disease. Our objective was to characterize changes in muscle and hematopoietic gene expression in patients with reversible mild PHPT after parathyroidectomy and possibly link molecular pathology to symptoms. Global mRNA profiling using Affymetrix gene chips was carried...... of several tissue characteristic groups of mRNAs as well as those belonging to common cell signaling and major metabolic pathways. PTHR1 and PTHR2 mRNAs were more abundantly expressed in muscle and brain than in hematopoietic cells. We suggest that sustained stimulation of PTH receptors present in brain......, muscle, and hematopoietic cells have to be considered as one independent, important cause of molecular disease in PHPT leading to profound alterations in gene expression that may help explain symptoms like muscle fatigue, cardiovascular pathology, and precipitation of psychiatric illness....

  10. Gene expression profiles give insight into the molecular pathology of bone in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Reppe, Sjur; Stilgren, Lis; Olstad, Ole K;

    2006-01-01

    Global gene expression profiling has been used to study the molecular mechanisms of increased bone remodeling caused by PHPT. This disease is a model for chronic over-stimulation of target organs by PTH due to an inappropriate overproduction of the hormone. Hyperactivity of osteoblasts and osteoc......Global gene expression profiling has been used to study the molecular mechanisms of increased bone remodeling caused by PHPT. This disease is a model for chronic over-stimulation of target organs by PTH due to an inappropriate overproduction of the hormone. Hyperactivity of osteoblasts...... and osteoclasts lead to increased calcium and phosphate mobilization from the skeleton and hypercalcaemia. The ensemble of genes that alter expression and thus is responsible for the effects of chronic PTH stimulation is today largely unknown. The differentiated gene expression profiles revealed characteristic...

  11. Neck ultrasonography as preoperative localization of primary hyperparathyroidism with an additional role of detecting thyroid malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Joon Ho; Kim, Eun-Kyung [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of); Lee, Hye Sun [Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of); Moon, Hee Jung [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of); Kwak, Jin Young, E-mail: docjin@yuhs.ac [Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of)

    2013-01-15

    Objective: To evaluate and compare the diagnostic performances of high-resolution ultrasonography and {sup 99m}Tc-sestamibi scintigraphy for the preoperative localization of abnormal parathyroid glands and to evaluate the ability of US for additional diagnostic roles in detecting thyroid malignancy in patients with pHPT. Materials and methods: Preoperative localization images of 115 parathyroid adenomas from high-resolution ultrasonography (US) and {sup 99m}Tc-sestamibi scintigraphy (SS) were studied from 105 patients, who had undergone parathyroidectomy. Sensitivity, accuracy, and positive predictive value were calculated for the identification of adenomas in lesions and patients for both US and SS, respectively, and US and SS diagnostic performances were compared using generalized estimating equation. Results: Preoperative imaging by both modalities localized 105 (93.8%) of the 112 parathyroid lesions confirmed at surgery and histology. Sensitivity, accuracy, and positive predictive value were 93.1% and 92.2%, 90.4% and 89.5%, and 96.9% and 96.9% by US and SS, respectively, without any statistically significant differences (P = 0.796, 0.796, 0.879). US found incidental thyroid nodules in 47 patients (47/107, 43.9%), and 7 patients (7/107, 6.5%) were confirmed to have malignancy based on pathology results (all had papillary thyroid carcinoma). Conclusion: Neck ultrasonography and {sup 99m}Tc-sestamibi scintigraphy are complementary methods of the preoperative localization of parathyroid adenomas. Neck ultrasounds add an additional thyroid gland evaluation, and can be useful in the detection of incidental thyroid gland lesions, especially malignant nodules.

  12. Recurrence of Hyperparathyroid Hypercalcemia in a Patient With the HRPT-2 Mutation and a Previous Parathyroid Carcinoma in Hyperparathyroidism-Jaw Tumor Syndrome

    Directory of Open Access Journals (Sweden)

    Mele

    2016-04-01

    Full Text Available Introduction Cancer in the parathyroid gland is rare, but parathyroid cancer is occasionally seen in relation to genetic abnormalities. Due to a limited amount of evidence, the optimal handling of these cases is not clear. Furthermore, the presence of a malignant parathyroid tumor is rarely known at the time of the initial operation; therefore, re-operations are often necessary. The aim of this study was to present the case of a patient with a previously diagnosed jaw tumor and parathyroid carcinoma that presents as a recurrence of hyperparathyroid hypercalcemia. Case Presentation A 41-year-old patient who was already diagnosed with a parathyroid carcinoma and a jaw tumor caused by a CDC73 mutation, presented with biochemical evidence of increasing parathyroid hormone (PTH and calcium levels after a previous total parathyroidectomy. The patient’s ionized calcium increased to 1.55 mmol/L and PTH increased to 16.0 pmol/L. A previous genetic analysis revealed a mutation in the CDC73 gene. There was no family history of hyperparathyroidism. We performed a sestamibi scintigraphy and an 11-C methionine (MET positron emission tomography (PET scan that showed a recurrence on the left side of the trachea. The patient underwent a third neck operation for the removal of a tumor on the left side of the trachea. The pathology report revealed that the tumor was a lymph node metastasis from the previous parathyroid carcinoma. The patient is currently enrolled in our follow-up regime. Hyperparathyroidism-jaw tumor (HPT-JT syndrome is a rare autosomal dominant disorder characterized by a parathyroid adenoma or carcinoma, fibro-osseous lesions (ossifying fibroma of the mandible and maxilla, and renal cysts and tumors. This autosomal dominant familial cancer syndrome has been reported with a variable and incomplete penetrance, and up to 10% of gene carriers do not show any clinical manifestations. Here we present a patient’s case and discuss the literature

  13. Transthoracic Repair of Asymptomatic Morgagni Hernia in an Adult

    OpenAIRE

    2011-01-01

    Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfac...

  14. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos;

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis.......The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  15. Expression of the calcium receptor CaR in the parathyroid of secondary hyperparathyroidism patients

    Institute of Scientific and Technical Information of China (English)

    王宁宁; 王笑云; 彭韬; 吴宏飞; 胡建明; 赵卫红; 俞香宝

    2004-01-01

    @@ The effects of calcium on parathyroid hormone (PTH) has further discovered in recent years. It has been known that calcium ion concentration in the extracellular fluid is a major determinant of PTH secretion. The relationship between serum intact PTH (iPTH) and calcium ion levels is described by a sigmoidal curve. The calcium concentration that produces half-maximal change in PTH release (the midpoint between maximal and minimal change in PTH release) represents the sensitivity of parathyroid cells to serum calcium. In secondary hyperparathyroidism (SHPT) patients, higher calcium concentrations are needed to suppress PTH secretion, as demonstrated by the PTH-calcium sigmoidal curve. The loss of physiological control over the secretory function and growth of parathyroid tissue in hyperparathyroid disease is still incompletely understood.

  16. Síndrome de hiperparatiroidismo por tumor maxilar Hyperparathyroidism-jaw tumour syndrome

    Directory of Open Access Journals (Sweden)

    L. Barroso

    2008-08-01

    Full Text Available El hiperparatiroidismo tiene con frecuencia manifestaciones óseas, de predomínio facial en algunos pacientes. Los autores describen las manifestaciones en una família de la región central de Portugal, como punto de partida para una revisión de los conocimientos sobre esta entidade clínica todavía poco divulgada y que puede tener como primera manifestación la presentación de tumores faciales.Hyperparathyroidism frequently has bone effects. In one subset of patients, these effects involve mainly facial bones (hyperparathyroidism-jaw tumour syndrome. The authors describe an affected family from central Portugal and discuss the features of this still poorly known disease, which can present initially as a facial tumour.

  17. [Is there a role for asymptomatic carotid artery stenosis screening?].

    Science.gov (United States)

    Heldenberg, Eitan; Bass, Arie

    2014-08-01

    Screening for asymptomatic carotid artery stenosis (CAS) is highly controversial Many surgeons routinely screen their patients for carotid disease prior to major operations, yet the benefit of such practice was never demonstrated. The treatment of symptomatic patients has not changed much during the last twenty years, since the publication of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). However, in contrast, the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST) failed to get the same acceptance among the multidisciplinary group treating CAS.The prevalence of asymptomatic 60-99% carotid artery stenosis among the general population is about 1%. Neither ACAS nor ACST showed that stenosis severity was associated with increasing stroke risk. The 'realpolitik' is that mass interventions in asymptomatic patients will probably only ever prevent about 1% of all strokes. This is even truer regarding patients scheduLed for major operation, in which the incidence of stroke is less than 1%. Moreover the current evidence in the literature suggests that the best medicaL treatment (BMT) results in 0.5% strokes per year, better than resuLts which can be offered by surgery. According to the current evidence, it seems that asymptomatic carotid artery screening should be discontinued, since it is a major waste of resources.

  18. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs.

    Science.gov (United States)

    Wynn, Susan G; Witzel, Angela L; Bartges, Joseph W; Moyers, Tamberlyn S; Kirk, Claudia A

    2016-01-01

    Background. Obesity has reached epidemic proportions in dogs and, as in humans, cost of care has increased due to associated comorbidities. In humans, asymptomatic urinary tract infections (UTI) may be more prevalent in the obese. Asymptomatic bacteriuria (AB) is the term used when UTI are asymptomatic. We hypothesized that morbidly obese dogs are similarly more likely to have asymptomatic bacteriuria than lean, overweight, and moderately obese dogs. Methods. A retrospective study was undertaken to explore a possible association between obesity and asymptomatic bacteriuria. Records from lean, overweight, and obese dogs receiving both a dual energy absorptiometry (DXA) scan and urine culture were included. Results. Six positive urine cultures were identified among 46 dogs fulfilling search criteria. All six positive cultures were found in dogs with body fat percentage of >45%. In dogs with body fat percentage of obese dogs in this study compared to those that were lean, overweight, or moderately obese. Whether antibiotic therapy is necessary in such cases is still being debated, but because asymptomatic bacteriuria may be associated with ascending infections, uroliths, or other complications, the data reported herein support the screening of obese patients for bacteriuria.

  19. Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    ZOU Qiang; ZHANG Yan-ling; WANG Hong-ying; ZHOU Jian; LAO Zheng-yin; XUE Jun; LI Ming-xin; LI Hai-ming; JIN Yi-ting; GU Yong

    2007-01-01

    Background Drug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism.Methods From September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively,intraoperatively, and postoperatively.Results A total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90±67.42) ng/L, (433.80±243.72) ng/L, (48.80±42.69) ng/L, (229.04±172.68) ng/L and (232.39±224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients.Conclusions The total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.

  20. The localization of 10% of the pathologic glands in secondary hyperparathyroidism depends on the surgeon experience

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    José Luis D’Addino

    2015-07-01

    Full Text Available Methods for preoperative localization of parathyroidin secondary hyperparathyroidism are controversial in the literature and have different and dissimilar sensitivity. With the objective to determine the correlation between preoperative ultrasound, scintigraphy MIBI and intraoperative findings in secondary hyperparathyroidism we review our 10 years statistic.Between2004-2014, 100 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Data obtained from medical records included: preoperative serum parathormona, ultrasound, scintigraphy. Positive predictive value and negative predictive value were analyzed in correlation with intraoperative findings.The method of calculation of ROC curves and area under the curve and other screening values (confidence index, index of validity and likelihood ratio were used. 68% were women; mean age was 52,7 years. Mean PTH value was 1486 pg/ml. The specificity and sensitivity of preoperative ultrasound were 94,44% and 30,14%, respectively. PPV was 93,62% and NPV was 33,33%. For scintigraphy, the sensitivity was 25,34%, specificity 98,15%, PPV was 97,37% and NPV was 32,72%. The ultrasound diagnosed 94 glands among a possibility of 400, the scintigraphy showed 76 and the surgery founded 292. Recurrence, 22%. Ultrasound and scintigraphy allow the localization of pathological parathyroid; however, in 10% of cases,glands could not be detected preoperatively, making surgeons experience fundamental in gland localization

  1. Hyperphosphatemia-induced hyperparathyroidism in 5/6 nephrectomized rats: development of a new animal model

    Institute of Scientific and Technical Information of China (English)

    JIANG Ying; WANG Mei

    2008-01-01

    Background We require a stable model to understand the molecular mechanism by which isolated hyperphosphatemia induces hyperparathyroidism secondary to chronic renal failure.The present study established a rat model of hyperphosphatemia-induced secondary hyperparathyroidism in chronic renal failure.Methods Twenty-nine rats with 5/6 nephrectomy (Nx) were divided into three groups and were fed for 10 weeks on a high phosphate diet (1.2% phosphate) starting from three different post-Nx time points.Parathyroid hormone mRNA in parathyroid gland was measured by real-time PCR and parathyroid cell hyperplasia was tested by proliferating cell nuclear antigen (PCNA) assay.Results The 10 rats fed a high phosphate diet starting from the fourth week post-Nx had isolated hyperphosphatemia and excess synthesis/secretion of parathyroid hormone,and hyperplasia of the parathyroid glands were induced (r=0.86-0.97,P<0.001),but the levels of serum calcium and 1,25(OH)2D3 did not change.Conclusion A rat model of hyperphosphatemia-induced secondary hyperparathyroidism in chronic renal failure was established by 5/6 Nx and 10 weeks-high phosphate diet starting from the fourth week post-Nx.

  2. Relative hyperphosphaturia in diabetic chronic renal failure: a protective factor of hyperparathyroidism.

    Science.gov (United States)

    Aubia, J; Bosch, J; Lloveras, J; Chine, M; Hojman, L; Masramon, J

    1987-01-01

    Relative low serum levels of parathormone (PTH) and low incidence of secondary hyperparathyroidism have been reported in diabetic uremic patients. The pathogenesis of this reported resistance to uremic secondary hyperparathyroidism in diabetes remains controversial. We have measured the serum C-terminal parathormone (C-PTH) renal phosphorus threshold (TmPO4) and nephrogenous cyclic AMP (N-cCAMP), in 2-hour urine collection in 22 patients with diabetic nephropathy with moderate chronic renal failure and in 27 controls with similar creatinine clearance values (18.16 +/- 9.14 and and 19.1 +/- 8.47 ml/min). In spite of the lower levels of serum C-PTH (1.07 +/- 0.43 ng/ml) diabetic patients exhibited an increased phosphaturia (TmPO4: 1.97 +/- 0.9 mg/100 ml GFR) when compared with the control group (C-PTH: 2.01 +/- 1.17 mg/ml, and TmPO4: 2.5 +/- 0.7 ml GFR). When the C-PTH values were plotted against the logarithm of creatinine clearance values, both groups showed a significant linear relationship reflecting the progressive increase in PTH when GFR fell. This progressive parathyroid stimulus was also present in diabetic patients but in a lower intensity. We believe that increased phosphaturia in diabetics with moderate chronic renal failure may be a major factor in precluding the appearance of secondary hyperparathyroidism in these patients once they reach the dialysis and transplantation programs.

  3. Massive gastrointestinal bleeding:An unusual case of asymptomatic extrarenal,visceral,fibromuscular dysplasia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Extrarenal fibromuscular dysplasia causing gastrointestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic appearance and the treatment is controversial. To our knowledge only seven cases of visceral fibromuscular dysplasia as a primary manifestation of the disease have been described, symptoms range from abdominal pain to gangrene. This is the first case of visceral fibromuscular dysplasia presenting with otherwise asymptomatic gastrointestinal bleeding, without bowel necrosis or ischemic changes. We provide a review of the literature.

  4. Multimicronutrient supplementation and asymptomatic urinary tract infections in the elderly

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    Paul Boekitwetan

    2016-02-01

    Full Text Available As human life expectancy continues to increase, developing countries are reporting higher percentages of elderly in their respective populations. The defense mechanisms of the elderly are reduced due to several factors, such as increased susceptibility to infection, specifically urinary tract infection (UTI. A randomised, placebo-controlled, double-blind trial was conducted to assess whether multimicronutrient supplementation is effective in reducing UTIs in older people in the community. A total of 261 elderly who lived in Mampang Prapatan district, South Jakarta, were randomised to daily multimicronutrient supplementation or control groups. The primary outcomes were the incidence of asymptomatic UTI, the organisms responsible for UTIs and the results of sensitivity tests on UTI microorganisms. UTI was defined as culture-positive urine yielding a single species of organisms in numbers greater than 104 cfu/mL urine specimen. At base-line 19.5% of the elderly had UTI, namely 23.7% patients in the MMN group and 16.7% in the control group, but the difference was not statistically significant (p=0.158. Escherichia coli was the most common microorganism, isolated in 20.7% of the MMN group and 17.5% of the control group. After six months of supplementation, UTI in the MMN group decreased by 40.6% compared with only 14.4% in the control group. The numbers of E. coli also declined by 64.3% in the MMN group compared to 37.8% in the control group. This study has confirmed the beneficial effect of multimicronutrient supplementation on UTI in the elderly.

  5. Treatment of secondary hyperparathyroidism in kidney disease: what we know and do not know about use of calcimimetics and vitamin D analogs

    Directory of Open Access Journals (Sweden)

    James B Wetmore

    2008-11-01

    Full Text Available James B Wetmore1, L Darryl Quarles1,21Department of Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS, USA; 2The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USAAbstract: There is a growing understanding of the pathophysiology of secondary hyperparathyroidism (SHPT and a recent emergence of new agents for SHPT treatment in patients with advanced kidney disease. At the same time, appreciation that mineral metabolic derangements promote vascular calcification and contribute to excess mortality, along with recognition of potentially important “non-classical” actions of vitamin D, have prompted the nephrology community to reexamine the use of various SHPT treatments, such as activated vitamin D sterols, phosphate binders, and calcimimetics. In this review, the evidence for treatment of SHPT with calcimimetics and vitamin D analogs is evaluated, with particular consideration given to recent clinical trials that have reported encouraging findings with cinacalcet use. Additionally, several controversies in the pathogenesis and treatment of SHPT are explored. The proposition that calcitriol deficiency is a true pathological state is challenged, the relative importance of the vitamin D receptor and the calcium sensing receptor in parathyroid gland function is summarized, and the potential relevance of non-classical actions of vitamin D for patients with advanced renal disease is examined. Taken collectively, the balance of evidence now supports a treatment paradigm in which calcimimetics are the most appropriate primary treatment for SHPT in the majority of end stage renal disease patients, but which nevertheless acknowledges an important role for modest doses of activated vitamin D sterols.Keywords: secondary hyperparathyroidism, vitamin D, vitamin D receptor, calcium sensing receptor, calcimimetics, kidney disease

  6. 甲状旁腺功能亢进手术方式分析%Analysis of Operation Mode of Hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    黄清丰; 吕晶; 翟雪雁; 杨迎旭; 付倩; 张兰

    2014-01-01

    目的:总结甲状旁腺功能亢进症的外科治疗经验。方法回顾性的分析2000年1月~2014年3月在我科行外科手术治疗的60例甲状旁腺功能亢进症的临床资料。40例原发性甲状旁腺功能亢进,20例继发性甲状旁腺功能亢进。结果根据患者术前影像学检查,分别实施不同的手术方式,术后临床症状均有不同程度的改善,甲状旁腺素和血清钙离子水平均较术前降低(P<0.05)。结论外科手术治疗可以明显改善甲状旁腺功能亢进患者的临床症状,提高其生活质量。%Objective To evaluate the feasibility and efficacy treatment for patient with hyperparathroidism.Methods The studies were analyzed for 60 patient with hyperparathroidism who underwent parathyroidectomy in our hospital from 2000 to 2014.40 cases of primary hyperparathyroidism and 20 cases of secondary hyperparathyroidism were observed. Results Dif erent surgical approaches were implementd,according to the preoperative imaging.Clinical symptoms were improved in varying degrees of postoperative.The levels of serum calcium and PTH are lowoer than before surgery ( <0.05). Conclusion Parathyoidectomy is an ef ective approach and can improve the quality of life to patients with hyperparathroidism.

  7. Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT?

    Energy Technology Data Exchange (ETDEWEB)

    Awengen, R.; Hirschmann, M.T. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Rasch, H. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Institute of Radiology and Nuclear Medicine, Bruderholz (Switzerland); Amsler, F. [Amsler Consulting, Basel (Switzerland)

    2016-04-15

    The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05). Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position

  8. Association between Asymptomatic Bacteriuria and Pre-Eclampsia.

    Science.gov (United States)

    Rezavand, Negin; Veisi, Firooze; Zangane, Mrayam; Amini, Roghaye; Almasi, Afshin

    2015-12-18

    Asymptomatic bacteriuria is one of the most common and important bacterial infections during pregnancy and can result in progressive infections and endanger maternal as well as fetal health. In this study, we assessed the relationship between asymptomatic bacteriuria and pre-eclampsia. In this case-control study, pregnant women who presented to Imam Reza Hospital in Kermanshah in 2013-14 were studied. The minimum sample size was calculated as 125 pregnant women in each group with a total of 250 subjects. There were 125 women with pre-eclampsia and 125 women without pre-eclampsia (control group). Matching was done for age, gestational age, and parity between case and control groups. Matching was verified by a P value of 0.061 for maternal age and gestational age and 0.77 for parity. The statistical analyses were done by applying the chi-squared test and determining odds ratio (OR) for having bacteriuria in univariate logistic regression as well as multivariate regression with adjusting the effect of maternal age, gestational age, and parity. Pyuria and bacteriuria were significantly more common in pre-eclampsia group than in control group. The results showed that a significant association existed between asymptomatic bacteriuria and pre-eclampsia. The rate of asymptomatic bacteriuria was 6.8 times higher in women with pre-eclampsia compared to those without pre-eclampsia. Further studies are required for better clarification of association between asymptomatic bacteriuria and pre-eclampsia.

  9. Risk of thyroid cancer in euthyroid asymptomatic patients with thyroid nodules with an emphasis on family history of thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    JHwang, Shin Hye; Kim, Eun Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young [Dept. of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-04-15

    To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules. This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors- such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels - were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics. Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041–0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values. Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients.

  10. Dynamics of collateral circulation in progressive asymptomatic carotid disease.

    Science.gov (United States)

    Moll, F L; Eikelboom, B C; Vermeulen, F E; van Lier, H J; Schulte, B P

    1986-03-01

    Inadequacy of collateral arterial flow is the major risk factor for hemispheric infarction in association with spontaneous occlusion of the ipsilateral carotid artery. This prospective study was designed to measure the adaptation of collateral cerebral circulation through the circle of Willis in patients in whom a unilateral carotid stenosis of hemodynamic consequence develops asymptomatically. The collateral cerebral potential is assessed by ocular pneumoplethysmography (OPG) during proximal common carotid artery compression, measuring the collateral ophthalmic artery pressure (COAP). During an average follow-up of almost 3 years (maximum more than 7 years), 45 patients showed asymptomatic development of a unilateral hemodynamically significant carotid stenosis according to OPG evidence. In these patients the mean index COAP/brachial artery pressure did not change on the side of stenosis progression (p greater than 0.05). The developed carotid stenosis had only reduced collateral circulation to the contralateral hemisphere. The risk of inadequate collateral cerebral circulation remained during progression of asymptomatic extracranial arterial obstructive disease.

  11. Prevalence and risk factors of asymptomatic bacteriuria in pregnancy

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    Ghafarnezhad M

    2001-07-01

    Full Text Available Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptomatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan Hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were obtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%. Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection, preterm delivery and pyuria pvalue <0.05. We suggest routine urine culture in first visit of high risk and 16th week of low risk pregnancies.

  12. Urinary tract infections and asymptomatic bacteriuria in renal transplant recipients

    Directory of Open Access Journals (Sweden)

    Rabi Yacoub

    2011-01-01

    Full Text Available Asymptomatic bacteriuria and urinary tract infection are common complications after kidney transplantation. In this population, if urinary tract infection occurred in the first six months post procedure, it carries a grave impact on both graft and patient survival. Renal transplant recipients with urinary tract infection are often clinically asymptomatic as a consequence of immunosuppression. Urinary tract infection, however, may progress to acute pyelonephritis, bacteremia and the full blown picture of urosepsis. PubMed and Cochrane databases were searched. The purpose of this review is to discuss the screening and treatment of urinary tract infection and asymptomatic bacteriuria in renal transplant recipients and to evaluate the guidelines on the basis of a review of published evidence.

  13. Asymptomatic bacteriuria in postmenopausal women with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    George Kasyan

    2013-05-01

    Full Text Available Introduction. An evaluation of efficacy of the management of urinary tract infections by using local forms of Estriol in postmenopausal women with type II diabetes and asymptomatic bacteriuria.Material and methods. The study was conducted in two stages. The first stage: a prospective cross–sectional study to identify patients with asymptomatic bacteriuria. During this stage, 414 postmenopausal women with type II diabetes, but without clinical symptoms of urinary tract infection, were investigated. In the second stage, women with asymptomatic bacteriuria (87 women were randomized to two groups: the first group was the main group receiving 0.5 mg of Estriol as a vaginal cream, the second group was the control group. The study lasted 12 months.Results. After 12 months of the study, asymptomatic bacteriuria was revealed in 19.4% of women in the group 1 and 68.4% of women in the group 2 (р <0.001, and symptomatic urinary tract infection in 8.3% of women in the group 1 and 18.4% of women in the group 2 (р <0.001. There was no connection revealed between asymptomatic bacteriuria and НвА1с. Using Estriol in group 1 led to an increase in VHI, the appearance of lactobacilli in the vaginal smear, and the decrease of symptom frequency in atrophic vaginitis. In group 2, there were no significant changes revealed.Conclusions. Usage of local forms of Estriol effectively prevents and decreases the frequency of asymptomatic bacteriuria and urinary tract infection in postmenopausal women suffering with diabetesmellitus.

  14. Transthoracic repair of asymptomatic morgagni hernia in an adult.

    Science.gov (United States)

    Pousios, Dimitrios; Panagiotopoulos, Nikolaos; Piyis, Anastasios; Gourgiotis, Stavros

    2012-10-01

    Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfactory result after the repair by a transthoracic approach.

  15. Spatial working memory in asymptomatic HIV-infected subjects.

    Science.gov (United States)

    Grassi, B; Garghentini, G; Campana, A; Grassi, E; Bertelli, S; Cinque, P; Epifani, M; Lazzarin, A; Scarone, S

    1999-01-01

    Many clinical and research findings converge to indicate that frontal lobe, basal ganglia, and related neuronal connections are primarily involved in human immunodeficiency virus (HIV) infection; frontal lobe, mainly the prefrontal cortex, has a specialized role in working memory processes. This study focused on neuropsychological evaluation of the spatial component of working memory in a sample of 34 asymptomatic HIV-infected subjects as compared with 34 age- and sex-matched seronegative control subjects. A computer-administered test assessing spatial working memory was used for the neuropsychological evaluation. The findings did not show any spatial working memory impairment during the asymptomatic phase of HIV infection.

  16. Asymptomatic Wolff-Parkinson-White Syndrome: Who Should Be Treated?

    Science.gov (United States)

    Obeyesekere, Manoj N; Leong-Sit, Peter; Krahn, Andrew D; Gula, Lorne J; Yee, Raymond; Skanes, Allan C; Klein, George J

    2012-09-01

    This article discusses the merits of electrophysiology study (EPS) and/or ablation for asymptomatic preexcitation Wolff-Parkinson-White (WPW) ECG pattern. Sudden deaths in asymptomatic patients are too few to merit broad screening and aggressive intervention. It also discusses the risks of ablation and the low predictive accuracy of EPS. When WPW is an incidental finding, the decision to proceed with investigation and ablation can be made considering patients' situations and preferences. An invasive strategy is targeted at patients concerned about the low risk of life-threatening arrhythmia as a first presentation after a discussion of the risks and benefits.

  17. Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders; Gerdts, Eva; Boman, Kurt

    2013-01-01

    BACKGROUND: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. METHODS: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild......-to-moderate AS and preserved left ventricular (LV) systolic function, randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. At inclusion, AF was categorized as episodic or longstanding. Rhythm change was assessed on annual in-study electrocardiograms...

  18. Diagnosis and management of patients with asymptomatic severe aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Minako Katayama; Hari P Chaliki

    2016-01-01

    Aortic stenosis(AS) is a disease that progresses slowly for years without symptoms, so patients need to be carefully managed with appropriate follow up and referred for aortic valve replacement in a timely manner. Development of symptoms is a clear indication for aortic valve intervention in patients with severe AS. The decision for early surgery in patients with asymptomatic severe AS is more complex. In this review, we discuss how to identify high-risk patients with asymptomatic severe AS who may benefit from early surgery.

  19. Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

    2011-01-01

    Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS). Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe...... in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...

  20. Peripheral artery disease (PAD) screening in the asymptomatic population

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Falk, Erling

    2011-01-01

    and feet (lower limb), which in the Western world is caused by atherosclerosis if not previous trauma. Whereas severity of intermittent claudication is only poorly related to ABI, cardiovascular outcomes are as follows: the lower the ABI the higher the incidence of cardiovascular events and death....... Measuring ABI identifies asymptomatic persons at increased risk of cardiovascular morbidity and mortality: an ABI 25% in people between 80 and 90 years of age. The majority of persons with reduced ABI are asymptomatic and therefore unaware of the increased risk they are living with, thus, screening...

  1. Quantitative bone scanning after asymptomatic Charnley arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Mullaji, A.B. (University Department of Orthopedic and Accident Surgery, Royal Liverpool University Hospital, Lierpool (United Kingdom)); Tood, R.C. (Department of Orthopedics, Black Notley Hospital, Braintree (United Kingdom)); Robinson, S. (Department of MedicaL Physics, Colchester General Hospital, Colchester (United Kingdom)); Critchley, M. (Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool (United Kingdom))

    1994-06-01

    To establish the normal pattern of postoperative tracer uptake we performed 73 [sup 99m]technetium methylene disphosphonate scans following primary Charnley hip replacements for arthrosis in 68 patients without clinical, hematological and radiographic complications. The patients were divided into 7 subgroups according to the period, 6-24 months, between surgery and scan. There were 10-12 patients in each subgroup. A high-resolution gamma camera with a large filed of view was used. Ratios of uptake in each of 10 peri-prosthetic zones to normal bone were calculated. Femoral uptake was found to decrease in linear fashion from 6 to 12 months after surgery. Thereafter the uptake remained unaltered at levels nearly twice the normal ones in the greater trochanter and nearly 1.5 times in the lesser trochanter, returning to almost normal levels in other zones. Acetabular uptake remained elevated throughout. (au) (20 refs.).

  2. Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Latus J

    2013-07-01

    Full Text Available Joerg Latus,1 Meike Roesel,1 Peter Fritz,2 Niko Braun,1 Christoph Ulmer,3 Wolfgang Steurer,3 Dagmar Biegger,4 M Dominik Alscher,1 Martin Kimmel1 1Department of Internal Medicine, Division of Nephrology, Robert Bosch Hospital, Stuttgart, Germany; 2Department of Diagnostic Medicine, Robert Bosch Hospital, Stuttgart, Germany; 3Department of Surgery, Robert Bosch Hospital, Stuttgart, Germany; 4Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tuebingen, Stuttgart, Germany Introduction: Secondary hyperparathyroidism develops in nearly all patients with end-stage renal disease. Parathyroidectomy is often performed when medical therapy fails. The most common postoperative complication, hungry bone syndrome (HBS, requires early recognition and treatment. Materials and methods: A total of 84 patients who underwent parathyroidectomy because of secondary hyperparathyroidism were investigated. Detailed analysis of laboratory parameters (calcium, phosphate, parathyroid hormone, hemoglobin, and urea levels and baseline characteristics (age at time of surgery, duration of renal replacement therapy, and medication was performed to detect preoperative predictors for the development of HBS. Results: Average overall follow-up of the cohort was 4.7 years. Within this time frame, 13 of 84 patients had to undergo a second surgery because of recurrent disease, and HBS occurred in 51.2%. Only decreased preoperative calcium levels and younger age at time of surgery were significant predictors of HBS. Minimal levels of calcium were detected 3 weeks after surgery. Preoperative vitamin D therapy could not prevent HBS and could not shorten the duration of intravenous calcium supplementation. Conclusion: HBS is a very common complication after parathyroidectomy. Younger patients and patients with low preoperative calcium levels were at higher risk for the development of HBS. Remarkably, preoperative vitamin D therapy could not prevent HBS and had no

  3. Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report

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    Tešić-Rajković Snežana

    2016-01-01

    Full Text Available Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP is hypercalcemia. Hyperparathyroidism (HPT, as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program, systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid. During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with

  4. Lesion localization in patients with hyperparathyroidism using double-phase Tc-99m MIBI parathyroid scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jung Woo; Ryu, Jin Sook; Kim, Jae Seung; Moon, Dae Hyuk; Hong, Seung Mo; Gong, Gyung Yub; Hong, Suk Joon; Lee, Hee Kyung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    1999-02-01

    This study was performed to evaluate the diagnostic usefulness of double-phase Tc-99m MIBI parathyroid scintigraphy with single photon emission computed tomography (SPECT) in patients with hyperparathyroidism. We also evaluated the relationship between Tc-99m MIBI uptake and oxyphil cell contents in parathyroid glands. The subjects were 28 parathyroid glands of 10 patients who underwent Tc-99m MIBI parathyroid scintigraphy and parathyroidectomy for clinically suspected hyperparathyroidism. Early and delayed pinhole images were obtained at 15 minutes and 2 hours after injection of Tc-99m MIBI, and SPECT images were followed. The weight and oxyphil cell contents of parathyroid tissue were obtained from pathologic specimen, and the scintigraphic findings were compared with histopathology. In surgical histopathology, 6 parathyroid adenomas and 9 parathyroid hyperplasias were confirmed. The sensitivity, specificity, and positive predictive value of early and delayed images were 46.7% (7/15), 76.9% (10/13), 70% (7/10) and 66.7% (10/15), 92.3% (12/13), 90.9% (10/11), respectively. SPECT image detected an additional small hyperplasia. The sensitivity, specificity, and positive predictive value of combined interpretation of early and delayed images with SPECT were 73.3% (11/15), 100% (13/13), 100% (11/11). The sensitivity was 100% (6/6) for adenoma, whereas that was 55.5% (5/9) for hyperplasia. Both adenomas and hyperplasias showed significantly increased oxyphil cell contents compared with normal parathyroid glands (p<0.0001), but the oxyphil cell content and weight were not significantly different between adenomas and hyperplasias. Double-phase Tc-99m MIBI parathyroid scintigraphy with SPECT is useful for lesion localization in patients with hyperparathyroidism. Although both adenoma and hyperplasia have increased oxyphil cell content, the sensitivity is high in adenoma, but low in hyperplasia.

  5. [Multiple brown tumors in a female hemodialyzed patient with severe secondary hyperparathyroidism].

    Science.gov (United States)

    Peces, R; Gil, F; González, F; Ablanedo, P

    2002-01-01

    Skeletal brown tumours are relatively uncommon, and brown tumours that involve multiple bones are considered very rare. We describe a 29-year-old woman with chronic renal failure (CRF) who had undergone hemodialysis for 21 years and developed multiple brown tumours associated with severe secondary hyperparathyroidism. Computed tomography (CT) revealed multiple brown tumours involving scapula, ribs, spine and sacroiliac bone. Microscopic analysis of the brown tumour showed dense infiltration of the marrow space by reactive fibroblastic tissue with irregularly distributed multinucleated osteoclastic giants cells and marked increase in hematopoietic elements.

  6. NaF18-PET/CT imaging of second hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Win, Aung Zaw; Aparici, Carina Mari [San Francisco VA Medical Center, San Franciso (United States)

    2015-12-15

    The patient was a 59-year-old man with a history of hypertension and end-stage renal disease for 14 years. An NaF-18 positron emission tomography/CT bone scan was ordered to rule out osteosarcoma or other possible bone malignancies. A lesion representing a brown tumor was observed on the left femoral shaft. The incidence of ESRD is about 400 cases per million in the United States and it has risen fastest in older individuals. This is the second paper to report the use of NaF18-PET/CT to image secondary hyperparathyroidism, osteomalacia, mixed renal ostedystrophy and adyanmic bone disease.

  7. Consequences of asymptomatic bacteriuria in women with diabetes mellitus

    NARCIS (Netherlands)

    Geerlings, SE; Stolk, RP; Camps, MJL; Netten, PM; Collet, JT; Schneeberger, PM; Hoepelman, AIM

    2001-01-01

    Background: Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than women without DM. It is unknown, however, what the consequences of ASB are in these women. Objectives: To compare women with DM with and without ASB for the development of symptomatic urinary tract infe

  8. Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient

    Directory of Open Access Journals (Sweden)

    Eisha Wali

    2015-01-01

    Full Text Available Acute obstructive suppurative pancreatic ductitis (AOSPD, defined as suppuration from the pancreatic duct without associated pseudocyst, abscess, or necrosis, is a rare complication of chronic pancreatitis. We present the first case of AOSPD in an asymptomatic patient with a polymicrobial infection and review the literature on this rare clinical entity.

  9. Asymptomatic malaria infections: detectability, transmissibility and public health relevance

    NARCIS (Netherlands)

    Bousema, T.; Okell, L.; Felger, I.; Drakeley, C.

    2014-01-01

    Most Plasmodium falciparum infections that are detected in community surveys are characterized by low-density parasitaemia and the absence of clinical symptoms. Molecular diagnostics have shown that this asymptomatic parasitic reservoir is more widespread than previously thought, even in low-endemic

  10. Vulvovaginal Candida: a study of (a)symptomatic women

    NARCIS (Netherlands)

    Engberts, M.K.

    2007-01-01

    The research described in this thesis concerns presence of asymptomatic vaginal Candida and vulvovaginal candidiasis. Vulvovaginal candidiasis (VVC) is an infection caused by abnormal growth of yeasts in the mucosa of the female genital tract. Acute vulvar pruritus and vaginal discharge are the usua

  11. [Screening of parasitic diseases in the asymptomatic immigrant population].

    Science.gov (United States)

    Goterris, Lidia; Bocanegra, Cristina; Serre-Delcor, Núria; Moure, Zaira; Treviño, Begoña; Zarzuela, Francesc; Espasa, Mateu; Sulleiro, Elena

    2016-07-01

    Parasitic diseases suppose an important health problem in people from high endemic areas, so these must be discarded properly. Usually, these infections develop asymptomatically but, in propitious situations, are likely to reactivate themselves and can cause clinical symptoms and/or complications in the receiving country. Moreover, in some cases it is possible local transmission. Early diagnosis of these parasitic diseases made by appropriate parasitological techniques and its specific treatment will benefit both, the individual and the community. These techniques must be selected according to geoepidemiological criteria, patient's origin, migration route or time spent outside the endemic area; but other factors must also be considered as its sensitivity and specificity, implementation experience and availability. Given the high prevalence of intestinal parasites on asymptomatic immigrants, it is recommended to conduct a study by coproparasitological techniques. Because of its potential severity, the screening of asymptomatic malaria with sensitive techniques such as PCR (polymerase chain reaction) is also advisable. Serological screening for Chagas disease should be performed on all Latin American immigrants, except for people from the Caribbean islands. Other important parasites, which should be excluded, are filariasis and urinary schistosomiasis, by using microscopic examination. The aim of this paper is to review the different techniques for the screening of parasitic diseases and its advices within the care protocols for asymptomatic immigrants.

  12. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma

    DEFF Research Database (Denmark)

    Zukauskaite, Ruta; Schmidt, Henrik; Asmussen, Jon T

    2013-01-01

    The aim of the study was to identify the frequency of asymptomatic brain metastases detected by computed tomography (CT) scans in patients with metastatic cutaneous melanoma referred to first-line systemic treatment. Between 1995 and 2009, 697 Danish patients were screened with a contrast...

  13. Histopathologic assessment of the entire endometrium in asymptomatic women

    NARCIS (Netherlands)

    Mingels, M.J.J.M.; Geels, Y.P.; Pijnenborg, J.M.A.; Wurff, A.A. van der; Tilborg, A.A. Van; Ham, M.A.P.C. van; Massuger, L.F.A.G.; Bulten, J.

    2013-01-01

    Knowledge on the nature of the endometrium in women without symptoms of endometrial disease is poor. Therefore, the aim of this prospective study was to describe the endometrium of a cohort of asymptomatic women. The entire endometrium of premenopausal and postmenopausal women was embedded for histo

  14. Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis

    Directory of Open Access Journals (Sweden)

    Evangelos Falidas

    2012-01-01

    Full Text Available Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature.

  15. Aortic coarctation, aneurysm, and ventricular dysfunction in an asymptomatic infant.

    Science.gov (United States)

    García, Ana I; Aguilar, Juan M; García, Enrique

    2016-06-01

    Aortic arch coarctation with post-coarctation aneurysm is rare in infants. We present the case of an asymptomatic 3-month-old infant with severe left ventricular dysfunction in this setting. The patient underwent surgical repair, and the left ventricular ejection fraction improved to recovery the 4th post-operative month.

  16. Asymptomatic Malaria among Blood Donors in Benin City Nigeria.

    Directory of Open Access Journals (Sweden)

    Bankole Henry Oladeinde

    2014-09-01

    Full Text Available This study aimed at determining the prevalence and associated risk factors for asymptomatic malaria parasitaemia and anemia among blood donors in a private medical laboratory in Benin City, Nigeria.Venous blood was collected from a total of 247 blood donors. Malaria status, ABO, Rhesus blood groups and hemoglobin concentration of all participants were determined using standard methods.The prevalence of asymptomatic malaria infection was higher among commercial blood donors than volunteer group (commercial vs volunteer donor: 27.5 %vs. 13.8%; OR = 2.373, 95% CI = 0.793, 7.107, P = 0.174. Asymptomatic malaria was not significantly affected by gender (P = 0.733, age (P = 0.581, ABO (P = 0.433 and rhesus blood groups (P = 0.806 of blood donors. Age was observed to significantly (P = 0.015 affect malaria parasite density with donors within the age group of 21-26 years having the highest risk. The prevalence of anemia was significantly higher among commercial donors (commercial vs volunteer donors: 23.4% vs 3.4%: OR = 8.551, 95% CI = 1.135, 64.437, P = 0.013 and donors of blood group O type (P = < 0.0001.Asymptomatic malaria parasitaemia and anemia was higher among commercial donors than voluntary donors. Mandatory screening of blood donors for malaria parasite is advocated to curb transfusion transmitted malaria and associated sequelae.

  17. Asymptomatic free-floating vitreous cyst masquerading as cysticercosis.

    Science.gov (United States)

    Ganger, Anita; Agarwal, Rinki; Kumar, Vinod

    2016-11-02

    A male patient aged 37 years, referred with the diagnosis of right eye intravitreal cysticercosis, was diagnosed as asymptomatic free-floating vitreous cyst after thorough evaluation. The patient was kept under observation, since baseline visual acuity was unaffected. No change was noted over the period of 6 months.

  18. Asymptomatic carriers contribute to nosocomial Clostridium difficile infection

    DEFF Research Database (Denmark)

    Blixt, Thomas; Gradel, Kim Oren; Homann, Christian;

    2017-01-01

    BACKGROUND & AIMS: Nosocomial infection with Clostridium difficile pose a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile might spread their infection to other patients. We investigated the effects of of as...

  19. Picornavirus-Induced Airway Mucosa Immune Profile in Asymptomatic Neonates

    DEFF Research Database (Denmark)

    Wolsk, Helene M.; Følsgaard, Nilofar V.; Birch, Sune;

    2016-01-01

    Bacterial airway colonization is known to alter the airway mucosa immune response in neonates whereas the impact of viruses is unknown. The objective was therefore to examine the effect of respiratory viruses on the immune signature in the airways of asymptomatic neonates. Nasal aspirates from 571...

  20. Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

    DEFF Research Database (Denmark)

    Greve, Anders M; Boman, Kurt; Gohlke-Baerwolf, Christa

    2012-01-01

    BACKGROUND: The prognostic impact of electrocardiographic left ventricular (LV) strain and hypertrophy (LVH) in asymptomatic aortic stenosis (AS) is not well described. METHODS AND RESULTS: Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination vs. placebo...... in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary endpoint was the first of myocardial infarction, non-hemorrhagic stroke, heart failure, aortic valve replacement (AVR) or cardiovascular death. Predictive value of electrocardiographic LV strain (defined as T-wave inversion in leads V(4...

  1. Effectiveness of cinacalcet in patients with recurrent/persistent secondary hyperparathyroidism following parathyroidectomy: results of the ECHO study

    DEFF Research Database (Denmark)

    Zitt, Emanuel; Rix, Marianne; Ureña Torres, Pablo

    2010-01-01

    Background. Progressive secondary hyperparathyroidism (sHPT) is characterized by parathyroid gland hyperplasia which may ultimately require parathyroidectomy (PTX). Although PTX is generally a successful treatment for those patients subjected to surgery, a significant proportion develops recurrent......(TM) target ranges. Conclusions. Our data support the successful use of cinacalcet in patients with recurrent/persistent sHPT after PTX....

  2. The role of 99mTc-MIBI SPECT-CT in reoperation therapy of persistent hyperparathyroidism patients

    Science.gov (United States)

    Yin, Lijie; Guo, Dandan; Liu, Jie; Yan, Jue

    2015-01-01

    To compare the role of 99mTc-MIBI SPECT-CT image and US in reoperation of persistent secondary hyperparathyroidism patients. A total of 8 persistent secondary hyperparathyroidism patients underwent parathyroidectomy. The sensitivity and accuracy of US and 99mTc-MIBI images before operation were determined. 9 of 14 surgical resection tissues from 8 persistent secondary hyperparathyroidism patients were confirmed to parathyroid hyperplasia. The results showed that the sensitivities were 77.8% and 100%, respectively, for US and 99mTc-MIBI SPECT-CT images. And the accuracies of US and 99mTc-MIBI dual time planar image and SPECT-CT were 50%, 78.6%, respectively. There was significantly difference between two procedures (P=0.021). The superior and inferior localization of glands were both detected by the ultrasound and scintigraphy. Two ectopic parathyroidism nodules were found by 99mTc-MIBI SPECT-CT imaging, while US provided no consistent findings. There was no significantly difference between two procedures (P=0.3). Although two cases of them were not confirmed by pathology, the iPTH of them (800 and 1429 respectively) were much higher than other four cases (<400) pg/ml. PTX is a safe and effective treatment for the patients with persistent SHPT. 99mTc-MIBI planar and SPECT-CT imaging may provide more helps for clinician’s localization the hyperparathyroidism glands accurately.

  3. Outcome of Total Parathyroidectomy and Autotransplantation as Treatment of Secondary and Tertiary Hyperparathyroidism in Children and Adults

    NARCIS (Netherlands)

    Kievit, A.J.; Tinnemans, J.G.M.; Idu, M.M.; Groothoff, J.W.; Surachno, S.; Aronson, D.C.

    2010-01-01

    Treatment safety and effectiveness of total parathyroidectomy and autotransplantation for secondary and tertiary hyperparathyroidism have been extensively proven in adults; the evidence for children, however, is scarce. Children and adolescents cannot simply be seen as young adults in the case of ch

  4. Asymptomatic skin sensitization to birch predicts later development of birch pollen allergy in adults

    DEFF Research Database (Denmark)

    Bodtger, Uffe; Poulsen, Lars K.; Malling, Hans-Jørgen

    2003-01-01

    The skin prick test is the allergologic test of choice, but asymptomatic skin sensitization to aeroallergens is common. However, no data in the literature describe the clinical phenotype of asymptomatic sensitized adults....

  5. Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure.

    Science.gov (United States)

    Pugliese, Nicola Riccardo; Fabiani, Iacopo; La Carrubba, Salvatore; Conte, Lorenzo; Antonini-Canterin, Francesco; Colonna, Paolo; Caso, Pio; Benedetto, Frank; Santini, Veronica; Carerj, Scipione; Romano, Maria Francesca; Citro, Rodolfo; Di Bello, Vitantonio

    2017-01-01

    Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13 years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29 mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p = 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.

  6. Usefulness of {sup 67}Ga scintigraphy in deciding surgical indication in secondary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Otsuka, Nobuaki; Mimura, Hiroaki; Sone, Teruki; Tamada, Tsutomu; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao [Kawasaki Medical School, Kurashiki, Okayama (Japan); Katagiri, Makoto

    1999-07-01

    In order to evaluate the usefulness in deciding surgical indication in secondary hyperparathyroidism (SHP), {sup 67}Ga scintigraphy was performed in 37 patients of SHP before parathyroidectomy (PTx). The radionuclide accumulation in skull and submandible was classified into 4 patterns (skull-submandibular pattern, skull pattern, submandibular pattern and normal pattern). Serum alkaline phosphatase levels were significantly elevated in patients of skull-submandibular pattern (13 cases) compared with skull pattern (6 cases), submandibular pattern (6 cases) and normal pattern (12 cases). Serum intact parathyroid hormone levels were significantly elevated in patients of skull-submandibular and skull patterns compared with normal pattern. No significant difference was observed among the weight of resected parathyroid glands. In 4 of 6 patients of normal pattern on {sup 67}Ga scintigram, bone scintigraphy showed a characteristic pattern of SHP including an increased accumulation in the skull and submandible. Bone mineral density (BMD) in the distal radius was increased within six to twelve months after PTx in 10 of 11 patients of skull-submandibular pattern on {sup 67}Ga scintigram, whereas only one patient showed an increase in BMD in 9 patients of normal pattern. In summary, it was concluded that {sup 67}Ga scintigraphy could provide a useful information in deciding the indication for PTx in secondary hyperparathyroidism. (author)

  7. Bilateral synchronous parathyroids cancer and femoral neck fracture as the complications of tertiary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    A F Romanchishen

    2013-12-01

    Full Text Available In the paper has presented the first in Russia observation of bilateral synchronous parathyroids cancer in patient with urolithiasis complicated by chronic pyelonephritis, renal insufficiency with tertiary hyperparathyroidism and femoral neck fracture. During observation of the patient in our hospital were found hyperparathyroid osteodystrophy, medial right femoral neck fracture, very high level of parathormone (1969,0 pg/ml, tumorous of right (16,0 × 17,0 mm and left (23,0 × 17,0 mm parathyroid glands located behind of inferior thyroid poles during ultrasound research. Surgical exploration has found bilateral whitish parathyroid tumorous with invasion to right recurrent laryngeal nerve. Were performed right hemithyroidectomy, left thyroid lobe resection and central neck dissections. Parathormone level has decreased to 3.5 times (up to 582 pg/ml. 20 minutes later after bilateral inferior parathyroidectomies. The regular hemodialysis was restore and six months later was successfully undertaken the hip prosthetics. Two year later after the surgery signs of parathyroid cancer relapses were no found.

  8. Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study

    Directory of Open Access Journals (Sweden)

    Gojaseni P

    2017-02-01

    Full Text Available Pongsathorn Gojaseni, Dolnapa Pattarathitinan, Anutra Chittinandana Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH in patients with secondary hyperparathyroidism (HPT. This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT.Materials and methods: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group. Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested.Results: A total of 30 patients (16 low doses and 14 controls took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413. The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0. Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957. There was no difference in the adverse events between both groups.Conclusion: Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials. Keywords

  9. Surgery in asymptomatic patients with colorectal cancer and unresectable liver metastases: the authors' experience

    Directory of Open Access Journals (Sweden)

    Boselli C

    2013-03-01

    Full Text Available Carlo Boselli,1 Claudio Renzi,2 Alessandro Gemini,1 Elisa Castellani,1 Stefano Trastulli,2 Jacopo Desiderio,2 Alessia Corsi,2 Francesco Barberini,1 Roberto Cirocchi,2 Alberto Santoro,3 Amilcare Parisi,4 Adriano Redler,3 Giuseppe Noya1 1Department of General and Oncologic Surgery, University of Perugia, Perugia, 2Department of General Surgery, University of Perugia, St Maria Hospital, Terni, 3Department of Surgical Sciences, Sapienza University of Rome, Rome, 4Department of Digestive Surgery, St Maria Hospital, Terni, Italy Purpose: In asymptomatic patients with Stage IV colorectal cancer, the debate continues over the efficacy of primary resection compared to chemotherapy alone. The aim of this study was to define the optimal management for asymptomatic patients with colorectal cancer and unresectable liver metastases. Patients and methods: Patients receiving elective surgery (n = 17 were compared to patients receiving chemotherapy only (n = 31. Data concerning patients' demographics, location of primary tumor, comorbidities, performance status, Child–Pugh score, extension of liver metastases, size of primary, and other secondary locations were collected. Results: Thirty-day mortality after chemotherapy was lower than that after surgical resection (19.3% versus 29.4%; not significant. In patients with >75% hepatic involvement, mortality at 1 month was higher after receiving surgical treatment than after chemotherapy alone (50% versus 25%. In patients with <75% hepatic involvement, 30-day mortality was similar in both groups (not significant. Thirty-day mortality in patients with Stage T3 was lower in those receiving chemotherapy (16.7% versus 30%; not significant. Overall survival was similar in both groups. The risk of all-cause death after elective surgery (2.1 was significantly higher than in patients receiving chemotherapy only (P = 0.035. Conclusion: This study demonstrated that in palliative treatment of asymptomatic unresectable Stage

  10. Ileal ulcer in asymptomatic individuals. Is this Crohn?

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Marques dos Santos

    2012-06-01

    Full Text Available The endoscopic finding of ileal ulcers, alone or in small number, is not usual, but when it occurs in asymptomatic patients, an impasse may be generated regarding the action to be taken, since the medical literature is unclear as to how to proceed in this situation. OBJECTIVE: Evaluate patients with ileal ulcers, single or in a small number, asymptomatic, and their follow-up. METHODS: The author reports a series of asymptomatic cases (23 patients of ulcers - single or in small number - found in colonoscopy exams performed for other reasons than typical clinical manifestations of Crohn's disease. RESULTS: Most patients were not treated and remained asymptomatic during the follow-up period. CONCLUSIONS: The patients remained asymptomatic and without treatment in most cases, and, considering the small number of cases and the short observation time, this study does not allow to conclude that this is the best practice in case of asymptomatic patients with ileal ulcer.O achado endoscópico de úlceras ileais, isoladas ou em pequeno número, não é frequente, mas quando ocorre em pacientes assintomáticos pode gerar um impasse quanto à conduta a ser tomada, já que a literatura médica não é clara quanto a como se proceder nessa situação. OBJETIVO: Avaliar pacientes que apresentaram úlceras ileais solitárias ou em pequena quantidade, assintomáticos e a evolução clínica dos mesmos. MÉTODOS: O autor relata uma série de casos (23 pacientes assintomáticos que apresentaram úlceras ileais únicas ou em pequeno número em colonoscopias realizadas por outros motivos que não manifestações clínicas típicas de doença de Crohn. RESULTADOS: A maioria dos pacientes não foi tratada e permaneceu assintomática pelo período de acompanhamento. CONCLUSÕES: Os pacientes permaneceram assintomáticos e sem tratamento em sua maioria, salientando-se o reduzido número de casos e o curto tempo de observação, de modo a não permitirem a este estudo

  11. Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-09-01

    The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.

  12. Isolated Asymptomatic Short Sternum in a Healthy Young Girl

    Directory of Open Access Journals (Sweden)

    Francesco Turturro

    2014-01-01

    Full Text Available Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature.

  13. Advanced Asymptomatic Carotid Disease and Cognitive Impairment: An Understated Link?

    Directory of Open Access Journals (Sweden)

    Irena Martinić-Popović

    2012-01-01

    Full Text Available Advanced carotid disease is known to be associated with symptomatic cerebrovascular diseases, such as stroke or transient ischemic attack (TIA, as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced carotid disease and possible mechanisms involved in the causal relationship between asymptomatic advanced carotid disease and cognitive decline.

  14. A Case of Aortopulmonary Window: Asymptomatic until the First Pregnancy

    Directory of Open Access Journals (Sweden)

    Murat Kose

    2015-01-01

    Full Text Available The aortopulmonary window (APW is an abnormal communication between the ascending aorta and the pulmonary trunk in the presence of two separate semilunar valves. It is a rare congenital malformation which represents 0.1% of all congenital cardiac diseases. Herein, we report a very rare case of 27-year-old patient with unrepaired APW causing Eisenmenger syndrome and pulmonary hypertension who was asymptomatic until her first pregnancy. The median survival of uncorrected APW is 33 years. Aortopulmonary window is a very rare congenital anomaly. To our knowledge, asymptomatic adult case has not been reported until now. APW should be considered in the differential diagnosis of the severe pulmonary hypertension also in adult patients.

  15. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

    Science.gov (United States)

    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated.

  16. Insurability for asymptomatic hematuria or proteinuria during childhood.

    Science.gov (United States)

    Feld, L G; Stapleton, F B

    1993-08-01

    The objective of this survey was to describe life insurance underwriting practices concerning children with asymptomatic hematuria and proteinuria. A questionnaire was sent to 200 companies licensed to issue life insurance policies in the state of New York. The medical director of each company was asked to respond to the insurability of children with asymptomatic hematuria and proteinuria. Two case summaries were provided with the questionnaire. Of 97 companies, 66 would offer insurance to the patient with hematuria, although 38 (58%) would charge additional premiums. In response to the problem of proteinuria, 61 companies would offer life insurance, although 50 (82%) would require higher premium charges (P life insurance, although often at higher cost. Invasive diagnostic tests are not necessary for insurers to offer insurance.

  17. A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst

    Science.gov (United States)

    Torun, Mümtaz Taner; Seçkin, Ender; Tuncel, Ümit; Kılıç, Caner; Özkan, Özalkan

    2015-01-01

    Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst. PMID:26688767

  18. A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst

    Directory of Open Access Journals (Sweden)

    Mümtaz Taner Torun

    2015-01-01

    Full Text Available Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI, a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst.

  19. First metatarsophalangeal joint- MRI findings in asymptomatic volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Dietrich, Tobias Johannes; Pfirrmann, Christian W.A. [University of Zurich, Radiology, Orthopedic University Hospital Balgrist, Zurich (Switzerland); Figueira da Silva, Flora Luciana [University of Zurich, Radiology, Orthopedic University Hospital Balgrist, Zurich (Switzerland); Radiology, Hospital Mae de Deus and Mae de Deus Center, Porto Alegre, RS (Brazil); Abreu, Marcelo Rodrigues de [Radiology, Hospital Mae de Deus and Mae de Deus Center, Porto Alegre, RS (Brazil); Klammer, Georg [University of Zurich, Orthopedic Surgery, Orthopedic University Hospital Balgrist, Zurich (Switzerland)

    2015-04-01

    To evaluate the spectrum and frequency of MR findings of the first metatarsophalangeal joint (MTPJ) in asymptomatic volunteers. MR imaging of 30 asymptomatic forefeet was performed with a dedicated extremity 1.5-Tesla system. Participants were between 20 and 49 years of age (mean ± SD: 35.5 ± 8.4 years). Two radiologists assessed cartilage, bone, capsuloligamentous structures, and tendons of first MTPJs on MR images. Cartilage defects were observed in 27 % (n = 8) of first MTPJs, most frequently located at the base of the proximal phalanx (23 %, n = 7), whereas cartilage defects of the metatarsal head (13 %, n = 4) and the metatarsosesamoid compartment were rare (0 %-3 %, n = 0-1). Bone marrow oedema-like signal changes were present in 37 % (n = 11) and subchondral cysts in 20 % (n = 6) of first MTPJs. Hyperintense areas on intermediate-weighted sequences (range: 30-43 %, n = 9-13) and on fluid-sensitive sequences with fat suppression (range: 33-60 %, n = 10-18) within the medial and lateral collateral ligament complex were common. Plantar recesses (77 %, n = 23) and distal dorsal recesses (87 %, n = 26) were frequently observed. Cartilage defects, bone marrow oedema-like signal changes, subchondral cysts, plantar recesses, and distal dorsal recesses were common findings on MRI of first MTPJs in asymptomatic volunteers. The collateral ligaments were often heterogeneous in structure and showed increased signal intensity. (orig.)

  20. Asymptomatic pancreatic lesions: New insights and clinical implications

    Institute of Scientific and Technical Information of China (English)

    Martin Loos; Christoph W Michalski; J(o)rg Kleeff

    2012-01-01

    Despite great efforts in experimental and clinical research,the prognosis of pancreatic cancer (PC) has not changed significantly for decades.Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC.Therefore,screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC.In this regard,Canto et al recently contributed an important article comparing computed tomography,magnetic resonance imaging,and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI).Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%).The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary:First:which imaging test should be performed? Second and most importantly:what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?