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

Coma ; diagnosis ; etiology ; Female ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; Male ; Middle Aged

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

BACKGROUND AND OBJECTIVES: With the recent introduction of a routine calcium screening, the incidence of parathyroid adenoma, a rare disease but also the most frequent cause of primary hyperparathyroidism, has increased. The increased incidence, however, has not been met readily by ENT surgeons since the clinical symptoms, diagnostic and operative techniques of the disease are not familiar to them. The purpose of this study was to assess the clinical characteristics, effectiveness of preoperative localization test and surgical outcomes of parathyroid adenoma with primary hyperparathyroidism. SUBJECTS AND METHOD: Ten consecutive cases of parathyroid adenoma with hyperparathyroidism surgically treated from Jun. 2001 through Jan. 2005 were included in this study. Preoperative localization test was performed with combinations of radionuclide parathyroid scan, ultrasonography and CT scan. Intact parathyroid hormone (iPTH), total calcium, phosphate, alkaline phosphatase were checked before and after surgery. RESULTS: The clinical manifestations were osteoporosis (90%), neuromuscular symptoms (70%), peptic ulcer (60%), ureter stone (60%) and renal stone (40%) in order of frequency. Diagnosis was delayed in most of the patients for 1 to 9 months because of their nonspecific symptoms. Sensitivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 80%, 85.7% and 80%, respectively. The most common postoperative complication was temporary hypocalcemia due to hungry bone syndrome. It was easily corrected by calcium and vitamin D supplements. CONCLUSION: We reconfirmed that parathyroid adenoma with hyperparathyroidism needed to be presented as a systemic disease with numerous clinical features, and therefore, a team approach involving an endocrionolgist would be essential. Surgical treatment via unilateral approach for preoperatively localized single parathyroid adenoma was successful without any complications, but a prospective randomized study is needed.
Alkaline Phosphatase ; Calcium ; Diagnosis ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hypocalcemia ; Incidence ; Mass Screening ; Neck ; Osteoporosis ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy ; Peptic Ulcer ; Postoperative Complications ; Rare Diseases ; Tomography, X-Ray Computed ; Ultrasonography ; Ureter ; Vitamin D

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

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

Multiple endocrine neoplasia type 1 (MEN1) syndrome includes varying combinations of endocrine and non-endocrine tumors. There are also a considerable number of atypical MEN1 syndrome. In this case, a 68-yr-old woman was referred to the Department of Endocrinology for hypercalcemia. Five years ago, she had diagnosed as primary hyperaldosteronism and now newly diagnosed as parathyroid hyperplasia with laboratory and pathologic findings. Hurthle-cell thyroid cancer was also resected during the parathyroid exploration and small meningioma was found on brain MRI. Her general condition has markedly improved and her adrenal mass and meningioma are being closely observed now. We could find the loss of heterozygosity of the MEN1 locus in parathyroid glands, suggesting a MEN1-related tumor, but not a germline mutation. Considering a variety of phenotypic expression and a limitation of current molecular analysis, periodic follow up will be needed in patients with a MEN1-like phenotype.
Aged ; Base Sequence ; Brain/radionuclide imaging ; Female ; Humans ; Hyperaldosteronism/complications/*diagnosis ; Hyperparathyroidism, Primary/*diagnosis/etiology/pathology ; Loss of Heterozygosity ; Magnetic Resonance Imaging ; Meningeal Neoplasms/complications/*diagnosis/radionuclide imaging ; Meningioma/complications/*diagnosis/radionuclide imaging ; Mutation ; Parathyroid Glands/pathology ; Proto-Oncogene Proteins/genetics/metabolism ; Sequence Analysis, DNA ; Thyroid Neoplasms/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

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