To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.
Male ; Humans ; Adult ; Hypercalcemia/diagnosis* ; Hyperparathyroidism, Primary/surgery* ; Parathyroid Hormone ; Hypocalcemia/complications* ; Thyroid Gland ; Calcium

Acute Disease ; Bone Neoplasms ; diagnosis ; secondary ; Carcinoma, Squamous Cell ; classification ; diagnosis ; Humans ; Hypercalcemia ; complications ; Lung Neoplasms ; complications ; diagnosis ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; etiology

Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs, occasionally mimicking malignancy. We herein report a 50-yr-old woman of muscular sarcoidosis of chronic myopathic type, manifested by hypercalcemia and muscle wasting. Besides insignificant hilar lymphadenopathy, her sarcoidosis was confined to generalized atrophic muscles and therefore, F-18 FDG PET/CT alone among conventional imaging studies provided diagnostic clues for the non-parathyroid-related hypercalcemia. On follow-up PET/CT during low-dose steroid treatment, FDG uptake in the muscles disappeared whereas that in the hilar lymph nodes remained. PET/CT may be useful in the evaluation of unexpected disease extent and monitoring treatment response in suspected or known sarcoidosis patients.
Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Hypercalcemia/complications/*diagnosis ; Kidney Calculi/complications/diagnosis ; Lymph Nodes/radionuclide imaging ; Middle Aged ; Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Sarcoidosis/complications/drug therapy/*radionuclide imaging ; Steroids/therapeutic use ; Tomography, X-Ray Computed

Cachexia ; etiology ; Cough ; Delayed Diagnosis ; Fever ; Humans ; Hypercalcemia ; etiology ; Male ; Middle Aged ; Radiography ; Renal Dialysis ; Renal Insufficiency ; etiology ; therapy ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

BACKGROUND/AIMS: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. METHODS: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). RESULTS: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized beta was -0.4389 (p < 0.001) and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods (kappa, 0.279; p < 0.001). CONCLUSIONS: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.
Aged ; Biological Markers/blood ; Calcium/*blood ; Female ; Humans ; Hypercalcemia/blood/*diagnosis/etiology ; Hypocalcemia/blood/*diagnosis/etiology ; Kidney Diseases/blood/complications/diagnosis/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; *Renal Dialysis/adverse effects ; Reproducibility of Results ; Specimen Handling/*methods

OBJECTIVETo investigate the diagnosis and surgical treatment of parathyroid carcinoma.

METHODSThe clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures.

RESULTSParathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism.

CONCLUSIONSThe diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia ; diagnosis ; etiology ; Hyperparathyroidism, Primary ; diagnosis ; etiology ; Lymph Node Excision ; Male ; Middle Aged ; Parathyroid Neoplasms ; complications ; diagnosis ; pathology ; therapy ; Parathyroidectomy ; methods ; Retrospective Studies ; Technetium Tc 99m Sestamibi

No abstract available.
Acute Kidney Injury/diagnosis/*etiology/therapy ; Biopsy ; Fluid Therapy ; Glucocorticoids ; Humans ; Hypercalcemia/diagnosis/*etiology/therapy ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Renal Dialysis ; Sarcoidosis/*complications/diagnosis/therapy ; Subcutaneous Tissue/pathology ; Tomography, X-Ray Computed ; Treatment Outcome

Lysinuric protein intolerance (LPI) is a rare inherited metabolic disease, caused by defective transport of dibasic amino acids. Failure to thrive, hepatosplenomegaly, hematological abnormalities, and hyperammonemic crisis are major clinical features. However, there has been no reported Korean patient with LPI as of yet. We recently encountered a 3.7-yr-old Korean girl with LPI and the diagnosis was confirmed by amino acid analyses and the SLC7A7 gene analysis. Her initial chief complaint was short stature below the 3rd percentile and increased somnolence for several months. Hepatosplenomegaly was noted, as were anemia, leukopenia, elevated levels of ferritin and lactate dehydrogenase, and hyperammonemia. Lysine, arginine, and ornithine levels were low in plasma and high in urine. The patient was a homozygote with a splicing site mutation of IVS4+1G > A in the SLC7A7. With the implementation of a low protein diet, sodium benzoate, citrulline and L-carnitine supplementation, anemia, hyperferritinemia, and hyperammonemia were improved, and normal growth velocity was observed.
Amino Acid Metabolism, Inborn Errors/complications/diet therapy/*genetics ; Antifungal Agents/therapeutic use ; Antigens, CD98 Light Chains/genetics ; Asian Continental Ancestry Group/*genetics ; Carnitine/therapeutic use ; Child, Preschool ; Citrulline/therapeutic use ; Diet, Protein-Restricted ; Disorders of Excessive Somnolence/complications/*diagnosis/drug therapy ; Female ; Growth Disorders/complications/*diagnosis ; Homozygote ; Humans ; Hypercalcemia/complications/*diagnosis ; Metabolic Diseases/complications/*diagnosis ; Mutation ; Nephrocalcinosis/complications/*diagnosis ; Republic of Korea ; Sequence Analysis, DNA ; Sodium Benzoate/therapeutic use ; Vitamin B Complex/therapeutic use

Primary hyperparathyroidism due to ectopic parathyroid adenomas can pose diagnostic and management challenges, especially when imaging studies have localised the lesions to different sites. We report a case of symptomatic hypercalcaemia due to a mediastinal parathyroid adenoma. Ultrasonography identified a nodule posterior to the right thyroid gland. However, computed tomography and technetium-99m sestamibi scintigraphy revealed an ectopic parathyroid adenoma located in the anterior mediastinum. The adenoma was successfully removed through a median sternotomy. However, postoperatively, the patient developed prolonged symptomatic hypocalcaemia, possibly due to suppression of the normal parathyroid gland function, although the presence of concomitant hungry bone syndrome was possible. The histopathology of the mediastinal mass was consistent with a parathyroid adenoma.
Calcium ; blood ; Female ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; diagnosis ; Hypocalcemia ; drug therapy ; etiology ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Middle Aged ; Parathyroid Glands ; pathology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Postoperative Complications ; Technetium Tc 99m Sestamibi ; pharmacology ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Biological Markers/blood ; Biopsy, Fine-Needle ; Calcium/blood ; Humans ; Hypercalcemia/etiology ; Hyperparathyroidism/blood/diagnosis/*etiology/therapy ; Immunohistochemistry ; Male ; Middle Aged ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*complications/diagnosis/therapy ; Parathyroidectomy ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy, Adjuvant ; Renal Insufficiency/etiology ; Treatment Outcome