scholarly journals CLINICAL MANIFESTATIONS OF PARATHYROID CANCER IN 29 YEARS OLD MAN

2019 ◽  
Vol 21 (1) ◽  
pp. 98-101
Author(s):  
A F Romanchishen ◽  
A V Gostimsky ◽  
Z S Matveeva ◽  
I V Karpatsky
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Endocrine Surgery ◽  
Rapid Progression ◽  
Parathyroid Tumor ◽  
Parathyroid Cancer ◽  
Electrolyte Disorders ◽  
Blood Calcium

Parathyroid cancer is an extremely rare cause of primary hyperparathyroidism, accounting less than 1% of cases. The neoplasm is detected in people 40-50 years old. Ratio of men and women is 1: 1, in contrast to hyperparathyroidism caused by adenoma of epithelial bodies, when there are 3-4 times more women than men among the patients. Due to the rarity of this disease, surgeons and morphologists may have difficulties in verification of the tumor. Distinctive features of the course of the disease include the extremely rapid progression of bone changes, the development of hypercalcemic crises with a high level of blood calcium and serum parathyroid hormone. Radical surgery involves the removal of malignant parathyroid tumor in a single block with the ipsilateral thyroid gland, as well as paratracheal lymph nodes. The aim of investigation is to show a rare observation of bone manifestations of parathyroid cancer. Material and methods. Parathyroid cancer was diagnosed in 2 (0.7%) of 283 patients with primary hyperparathyroidism, operated in the Center of Endocrine Surgery. Male 29 years old was operated on in January 2016. Disease duration was about 2 years. The clinical picture was characterized by multiple bone fractures, generalized cystic osteodistorofy, renal failure, severe electrolyte disorders, cachexia. The diagnosis was confirmed by high values of total calcium and blood parathyroid hormone. The patient underwent removal of the parathyroid tumor, during the histological and immunohistochemical study of which parathyroid cancer was verified. The patient was able to sit on his own after 3 months, get up with support after 6 months and walk with the help 10 months later after the operation. In May 2017 an increase of parathyroid hormone to 1900 pg / ml was detected with a normal value of blood calcium, which indicates recurrence of parathyroid cancer. Findings. The high grade of the disease is due to both the aggressive course of parathyroid cancer and the late diagnosis.

scholarly journals Primary Hyperparathyroidism with a Predominant Lesion of the Gastrointestinal Tract

2021 ◽  
Vol 11 (1) ◽  
pp. 51-59
Author(s):  
E. Yu. Kudashkina ◽  
E. G. Gavrilenko ◽  
A. A. Yakushev ◽  
G. G. Totolyan ◽  
N. N. Petrenko ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Gastrointestinal Tract ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Complete Relief ◽  
Electrolyte Disorders ◽  
Terminal Ileitis ◽  
Surgical Department

Primary hyperparathyroidism is a common pathology, but it is fact that doctors of various specialties run against difficulties in diagnosinging. The variety of clinical manifestations causes a long period of diagnosis and, late start of treatment. The main symptoms of this pathology are described taking into account the pathogenesis. The most common laboratory markers of hyperparathyroidism are incrising level of parathyroid hormone and hypercalcemia. Imaging examination methods are used to establish primary hyperparathyroidism. Targeted ultrasound examination of the parathyroid glands should be performed in all patients with suspected calcium metabolism disorders.This article presents a clinical case of primary hyperparathyroidism with predominant gastrointestinal symptoms. The patient was twice admitted to the hospital with various clinical manifestations of damage to the gastrointestinal tract. Erosive gastritis, terminal ileitis, chronic pancreatitis, and cholelithiasis were identified. A differential diagnosis was made with small intestine lymphoma and Crohn’s disease. In addition, there were General cerebral symptoms in the form of lethargy, rapid exhaustion. Due to severe electrolyte disorders, the patient was observed in the intensive care unit. Due to the development of mechanical jaundice, endoscopic retrograde cholangiopancreatography with papillosphincterotomy was performed. Based on hypercalcemia, elevated parathyroid hormone levels, and visualization of parathyroid gland formation, the diagnosis of primary hyperparathyroidism was established based on ultrasound data. An adenomectomy of the left lower parathyroid gland was performed. in the surgical department. The patient was discharged with positive dynamics in the form of improvement in General health, cessation of pain, regress of vomiting, expansion of motor activity. Betimes diagnosis and treatment of primary hyperparathyroidism, on the example of the described case, leads to complete relief of symptoms and improvement of the quality of life of patients.

scholarly journals Advances in the diagnosis and the management of primary hyperparathyroidism

2021 ◽  
Vol 12 ◽  
pp. 204062232110159
Author(s):  
Ana Kashfia Islam
Keyword(s):  
Renal Function ◽  
Parathyroid Hormone ◽  
Bone Loss ◽  
Primary Hyperparathyroidism ◽  
Kidney Stones ◽  
Parathyroid Glands ◽  
Definitive Treatment ◽  
Indications For Surgery ◽  
Musculoskeletal Complaints ◽  
Parathyroid Cancer

The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

scholarly journals Effectiveness of surgical treatment of primary hyperparathyroidism with urolithiasis: correction of symptoms, laboratory parameters and stone-forming risk

2018 ◽  
Vol 11 (4) ◽  
pp. 191-200
Author(s):  
Sergey V. Sergiyko ◽  
Dmitriy S. Rogozin
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Symptoms ◽  
Stone Formation ◽  
Urinary Calculi ◽  
Urine Excretion ◽  
Blood Calcium ◽  
Laboratory Parameters ◽  
Risk Of Stone Formation

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

scholarly journals Primary Hyperparathyroidism: Modern Conception and Clinical Observation

2020 ◽  
Vol 10 (2) ◽  
pp. 94-101
Author(s):  
L. M. Farkhutdinova
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Developed Countries ◽  
Severe Form ◽  
Mineral Density ◽  
Target Organs ◽  
Increased Risk

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

scholarly journals SAT-353 Familial Hyperparathyroidism - Due to a Rare Genetic Mutation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Adeyinka Taiwo ◽  
Joseph Stephen Dillon ◽  
Jennifer Stinson
Keyword(s):  
Family History ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Gene Mutation ◽  
Parathyroid Tissue ◽  
Clinical Manifestations ◽  
Young Age ◽  
Parathyroid Cancer ◽  
History Of ◽  
Familial Hyperparathyroidism

Abstract Introduction: Hyperparathyroidism occurs most commonly in middle age patients, predominantly in women. It can be caused by parathyroid adenoma, hyperplasia or parathyroid carcinoma. Genetic predisposition can be found in about 10% of primary hyperparathyroidism due to certain gene mutations. This case emphasizes the importance of taking a detailed family history when patients present with hyperparathyroidism at a young age, so that familial hyperparathyroidism, if present, can be detected and relatives screened. Clinical case: A 26 y.o. male presented with symptoms of fatigue and polydipsia for several years. He was noted to have a serum calcium of 12.4 mg/dL(8.5–10.5), with parathyroid hormone of 213 pg/ml (15–65). He denied any history of kidney stones, fractures and no palpable neck masses. The patient’s family history was significant for his paternal half-sister who had parathyroidectomy for hyperparathyroidism at 20yrs old and paternal grandmother died of parathyroid cancer in her 50s. The patient’s father died of pancreatic cancer at 41yrs old. A neck ultrasound revealed a mass posterior to the left inferior thyroid. A Sestamibi parathyroid scan revealed a parathyroid adenoma at the posteroinferior aspect of the left hemithyroid. Labs for free metanephrines and normetanephrine, prolactin and gastrin levels were all normal. Due to his young age and the possibility of having familial hyperparathyroidism, he underwent bilateral neck exploration and parathyroidectomy, with removal of his left inferior, right superior, left superior parathyroid glands and left upper thymus. Surgical pathology revealed, hypercellular parathyroid tissue. Post operatively, his calcium and vitamin D remained within the normal range. Genetic studies revealed a mutation in the parafibromin gene - CDC73 (also called HRPT2), a tumor suppressor gene, which is on chromosome 1q25. The patient currently has 6 children ranging from age 5 months to 6 years. He was advised to have his children tested any time from age 7 years for the gene mutation. The patient has remained stable 4yrs post operatively, with normal calcium and PTH levels. He does not have any history of jaw tumor. He never had an ultrasound kidney done. He is being monitored with yearly lab tests. Conclusion: CDC73 gene mutation-associated disorders are inherited as an autosomal dominant fashion, with variable penetrance. This gene mutation can be found in conditions such as hyperparathyroidism jaw tumor, familial hyperparathyroidism and parathyroid cancer. Reference: 1. CDC73-Related Disorders: Clinical Manifestations and Case Detection in Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2017 Dec 1;102(12):4534–4540.

scholarly journals The clinical practice guidelines for primary hyperparathyroidism, short version

2021 ◽  
Vol 67 (4) ◽  
pp. 94-124
Author(s):  
N. G. Mokrysheva ◽  
A. K. Eremkina ◽  
S. S. Mirnaya ◽  
J. A. Krupinova ◽  
I. A. Voronkova ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Western Europe ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Short Version ◽  
Blood Calcium ◽  
Special Groups ◽  
Increased Risk ◽  
Excessive Secretion ◽  
System Disorder

Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.

scholarly journals Primary Hyperparathyroidism: Modern Conception and Clinical Observation

2020 ◽  
Vol 10 (2) ◽  
pp. 94-101
Author(s):  
L. M. Farkhutdinova
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Developed Countries ◽  
Severe Form ◽  
Mineral Density ◽  
Target Organs ◽  
Increased Risk

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

scholarly journals Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ding Na ◽  
Guo Tao ◽  
Liu Shu-Ying ◽  
Wang Qin-Yi ◽  
Qu Xiao-Li ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Retrospective Study ◽  
Primary Hyperparathyroidism ◽  
Clinical Evidence ◽  
Clinical Manifestations ◽  
Tertiary Hospital ◽  
Laboratory Findings ◽  
Hypercalcemic Crisis ◽  
Males And Females ◽  
Prevalence Of Osteoporosis

Abstract Background The occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT. Methods This was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group. Results Among the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged. Conclusion Biochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

Association between Myotonic Dystrophy and Primary Hyperparathyroidism

1994 ◽  
Vol 22 (5) ◽  
pp. 296-298 ◽  
Author(s):  
E Bell ◽  
A R Lorimer ◽  
J Hinnie
Keyword(s):  
Urinary Tract Infection ◽  
Renal Function ◽  
Parathyroid Hormone ◽  
Urinary Tract ◽  
Tract Infection ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Myotonic Dystrophy ◽  
Muscle Atrophy ◽  
Blood Calcium

A case of primary hyperparathyroidism in a patient with myotonic dystrophy is reported. A 56-year old female with myotonic dystrophy, admitted to hospital with a urinary tract infection, had widespread muscle atrophy and myotonia with bilateral cataracts. Biochemical findings of normal renal function but raised blood calcium, depressed blood phosphate and increased parathyroid hormone, were consistent with a diagnosis of primary hyperparathyroidism. Thallium scanning of the parathyroids showed an area of discordant thallium suggesting a parathyroid adenoma. When the left lower parathyroid was later excised, histology was consistent with the diagnosis of parathyroid adenoma. As far as the authors are aware this is the first report of myotonic dystrophy and primary hyperparathyroidism in the same patient.

scholarly journals Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units

2018 ◽  
Vol 100 (2) ◽  
pp. 140-145 ◽  
Author(s):  
O Edafe ◽  
EE Collins ◽  
CS Ubhi ◽  
SP Balasubramanian
Keyword(s):  
Cohort Study ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Positive Predictive Value ◽  
Predictive Models ◽  
Predictive Value ◽  
Endocrine Surgery ◽  
Preoperative Imaging ◽  
Original Report ◽  
Cure Rates

Background Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is dependent upon accurate prediction of single-gland disease on the basis of preoperative imaging and biochemistry. The aims of this study were to validate currently available predictive models of single-gland disease in two UK cohorts and to determine if these models can facilitate MIP. Methods This is a retrospectively cohort study of 624 patients who underwent parathyroidectomy for primary hyperparathyroidism in two centres between July 2008 and December 2013. Two recognised models: CaPTHUS (preoperative calcium, parathyroid hormone, ultrasound, sestamibi, concordance imaging) and Wisconsin Index (preoperative calcium, parathyroid hormone) were validated for their ability to predict single-gland disease. Results The rates of single- and multi-gland disease were 491 (79.6%) and 126 (20.2%), respectively. Cure rates in centres 1 and 2 were 93.2% and 93.8%, respectively (P = 0.789). The positive predictive value (PPV) of CaPTHUS score . 3 in predicting single-gland disease was 84.6%, compared with 100% in the original report. CaPTHUS . 4 and 5 had a PPV of 85.1 and 87.1, respectively. There were no differences in Wisconsin Index (WIN) between patients with single- and multi-gland (P = 0.573). A WIN greater than 1600 and weight of excised gland greater than 1 g had a positive predictive value of 86.7% for single-gland disease. Conclusions The use of CaPTHUS and WIN indices without intraoperative adjuncts (such as IOPTH) had the potential to result in failure to cure in up to 15% (CaPTHUS) and 13% (WIN) of patients treated by MIP targeting a single enlarged gland.

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