Adult ; Female ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Male ; Middle Aged ; Thyroid Crisis ; diagnosis ; etiology ; surgery

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

OBJECTIVETo discuss the clinical characteristics of primary hyperparathyroidism (PHPT) with kidney stones.

METHODSThe clinical data of 23 cases undergoing diagnostic evaluation and surgery for PHPT combined with kidney stones between January 2004 and February 2012 was retrospectively analyzed. The 23 cases had undergone preoperative parathyroid neck color ultrasound, CT or (99)mTc-methoxy isobutyl isonitrile ((99)mTc-MIBI) diagnosis. The surgical treatment included parathyroid disease and kidney stones. The intravenous calcium, phosphorus and serum intact parathyroid hormone (iPTH) levels, 24 hours urinary calcium concentrations were measured 3 days before and 7 days after surgery.

RESULTSThere were 8 male and 15 female patients. The stone diameter were (3.2 ± 0.7) cm (range 2.1-4.0 cm). All patients did both parathyroid surgery and kidney surgery. The statistical discrepancy of serum calcium (there were (3.31 ± 0.39) mmol/L before surgery and (2.12 ± 0.18) mmol/L at 7 days after surgery, t = 11.26), serum phosphorus ((0.70 ± 0.09) and (1.21 ± 0.21) mmol/L in before and after surgery respectively, t = 10.53), iPTH (there were (28.8 ± 10.0) pmol/L before surgery and (3.6 ± 2.6) pmol/L after surgery, t = 12.83) and 24-hours urine calcium (there were (7.2 ± 3.1) mmol/d before surgery and (3.6 ± 2.5) mmol/d after surgery, t = 8.81) before and after the operation was significant (all P < 0.01). PTH concentration with serum calcium concentration correlation coefficient was r = 0.59 (P < 0.01). Eighteen patients (78.3%) had solitary parathyroid adenomas, two patients (8.7%) had multiple parathyroid adenomas, and three patients (13.0%) had multiglandular hyperplasia confirmed at surgery and histology. During follow-up, 8 patients had stone recurrence and 3 patients were did operation again to deal with renal stone within 2 years. Among them, 7 cases were normal, 1 case of parathyroid adenomas recurrence and reoperation.

CONCLUSIONSThe parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.

Adolescent ; Adult ; Aged ; Female ; Humans ; Hyperparathyroidism, Primary ; complications ; surgery ; Kidney Calculi ; complications ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

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.
Adult ; Bone Density ; Bone Neoplasms/*etiology/radiography/*surgery ; Female ; Humans ; Hyperparathyroidism, Primary/*complications/*surgery ; Parathyroidectomy ; Patella/*pathology/radiography ; Tomography, X-Ray Computed

This study was conducted to review the clinical characteristics of parathyroid carcinoma (PC) and to evaluate potential preoperative predictive factors for PC in patients with primary hyperparathyroidism (PHPT). We performed a retrospective review of electronic medical records of 194 patients with pathologically confirmed PHPT in affiliated teaching hospitals of Seoul National University from January 2000 to March 2011. Adenoma was diagnosed in 171 patients, hyperplasia in 12, and carcinoma in 11. Several biochemical measurements were higher in patients with PC than in patients with benign disease, including serum total calcium (P < 0.001), intact parathyroid hormone (P = 0.003), and alkaline phosphatase (ALP) (P < 0.001). Tumors were larger in PC than in benign disease (P < 0.001). Multivariate analysis revealed that serum ALP level (P < 0.001) and tumor size were associated with PC (P = 0.03). Tumor size and serum ALP level were evaluated as preoperative predictive factors for PC using ROC analyses: a tumor size of 3.0 cm (sensitivity 90.9%, specificity 92.1%) and serum ALP level of 285 IU/L (83.3%, 97.0%) had predictive value for the diagnosis of PC in patients with PHPT. In conclusion, elevated serum ALP and a large parathyroid mass at the time of diagnosis can be helpful to predict PC in patients with PHPT.
Adenoma/complications/diagnosis/surgery ; Adult ; Aged ; Alkaline Phosphatase/blood ; Calcium/blood ; Carcinoma/complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary/complications/*diagnosis ; Hyperplasia/complications/diagnosis ; Male ; Middle Aged ; Neoplasm Staging ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/complications/*diagnosis/surgery ; Predictive Value of Tests ; *Preoperative Care ; ROC Curve ; Retrospective Studies

No abstract available.
Adenocarcinoma, Follicular/complications/*radionuclide imaging/surgery ; Adenoma/complications/*radionuclide imaging/surgery ; Biomarkers/blood ; Calcium/blood ; Humans ; Hyperparathyroidism, Primary/blood/*etiology ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/complications/*radionuclide imaging/surgery ; Predictive Value of Tests ; *Radiopharmaceuticals ; Reproducibility of Results ; *Technetium Tc 99m Sestamibi ; Thyroid Neoplasms/complications/*radionuclide imaging/surgery ; Thyroidectomy

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.
Adenoma ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; diagnostic imaging ; etiology ; surgery ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Muscle Weakness ; diagnosis ; etiology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Parathyroidectomy ; methods ; Pseudarthrosis ; diagnostic imaging ; etiology ; physiopathology ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Vitamin D Deficiency ; complications ; diagnosis