Aged ; Bone Neoplasms ; diagnosis ; etiology ; Female ; Humans ; Hyperparathyroidism ; complications

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

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

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

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

OBJECTIVE: To investigate the clinical manifestation, diagnosis, treatment of parathyroid occupying lesions. METHOD: The clinical data of 26 patients with parathyroid occupying lesions between January 2003 and October 2012 at Dalian Central Hospital were retrospectively analyzed. RESULT: There were 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma, 13 cases of parathyroid cysts in this study. All the cases,except 13 cases of cysts, are accompanied by symptoms of hyperparathyroidism. The symptoms were as follows:26 cases of neck lump, 11 cases of osteoporosis/osteitis fibrosa cystica,9 cases of urinary symptom, 8 cases of digestive symptom. Serum calciumion level and serum parathyroid hormone(PTH) level were examined qualitatively before operation. Ultrasonography, CT, MRI were used in diagnosing and locating parathyroid occupying lesion before operation. 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts with preoperative and postoperative diagnosis coincidence rate was 0 (0/2), 91% (10/11), 69% (9/13). All patients were treated with operation. 2 cases of parathyroid cancer survived with out recurrence during follow up for 17 months and 27 months after operation. 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts were treated with operation,achieved complete remission and the outcome was no recurrence. CONCLUSION There lack of specific clinical symptoms of parathyroid occupying lesions,neck lump are common manifestations. Examination of serum calcium and PTH level together with ultrasonography, CT, MRI, 99mTc-MIBI is helpful to diagnose parathyroid occupying lesions. Parathyroid cancer preoperative diagnosis is difficult . Parathyroid occupying lesions determine the diagnosis depends on pathology. Surgery should be done as primary treatment.
Adenoma ; blood ; complications ; diagnosis ; surgery ; Adult ; Aged ; Biomarkers, Tumor ; Cysts ; blood ; diagnosis ; surgery ; Female ; Humans ; Hyperparathyroidism ; etiology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; blood ; complications ; diagnosis ; surgery ; Retrospective Studies

No abstract available.
Aged ; Biological Markers/blood ; Biopsy ; Calcium/blood ; Female ; Humans ; Hyperparathyroidism/blood/diagnosis/*etiology/surgery ; Hyperplasia ; Parathyroid Glands/metabolism/*pathology/radionuclide imaging/surgery/ultrasonography ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*complications/diagnosis/surgery ; Parathyroidectomy ; Treatment Outcome ; Up-Regulation

There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged < or = 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.
Absorptiometry, Photon ; Age Factors ; Aged ; *Bone Density ; Female ; Femur/anatomy & histology ; Humans ; Hyperparathyroidism/diagnosis/etiology ; Lumbosacral Region/anatomy & histology ; Male ; Middle Aged ; Parathyroid Hormone/*blood ; Postmenopause ; Republic of Korea ; Seasons ; Sex Factors ; Vitamin D/*analogs & derivatives/blood

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

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