Diagnosis of Primary Hyperparathyroidism and Indications for Parathyroidectomy

Lal, Geeta; Clark, Orlo H.

doi:10.1016/b978-0-7216-0139-7.50044-2

Cited by 6 publications

(3 citation statements)

References 48 publications

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“…It is seen in 0.1-0.3% of population, more often in women (1/500) than men (1/2,000) [7]. While the cause is a single adenoma in parathyroid gland in 75-85% of cases, both adenomas in more than one gland and PC, rarely, may lead to PHPT [6].…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

Baser

2013

J Med Cases

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Atypical parathyroid adenoma is among the tumors diagnosed difficultly and including some histological features of parathyroid carcinoma. In literature, no definite criteria have been considered to be present to distinguish atypical parathyroid adenoma preoperatively from parathyroid carcinoma. A 65-year-old woman was admitted to our clinic with complaints of arthralgia, myalgia, fatigue and loss of appetite. She had severe hypercalcemia (serum calcium 17.2 mg/dL) and hypophosphatemia (serum phosphate 1.9 mg/dL) along with an elevated intact parathyroid hormone level of 879 pg/mL. Renal functions were within normal limits. The patient was administered with intravenous hydration and diuretic treatments because of severe hypercalcemia. Six sessions of hemodialysis were performed. In neck ultrasonography, multinodular goitre was detected. Tc-99m sestamibi scintigraphy revealed a focal involvement at the middle-inferior region of left thyroid lobe. Neck magnetic resonance imagination revealed a nodular lesion in size of 22 × 14 mm at the posterior region of left thyroid lobe. Parathyroidectomy guided by intraoperative gamma probe was performed. The lesion was histopathologically consistent with atypical parathyroid adenoma. In the postoperative period, serum calcium and intact parathyroid hormone levels were decreased as levels of 7 mg/dL and 42.6 pg/mL, respectively. We reported an atypical parathyroid adenoma accompanied by severe hypercalcemia and hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

Baser

2013

J Med Cases

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“…Primary hyperparathyroidism (PHPT) is a common entity characterized by elevated production of parathyroid hormone (PTH) and hypercalcemia [1]. This is the third most common endocrine disorder and the first cause of hypercalcemia in outpatients with an incidence of 20/100,000 habitants/year and a prevalence of more than 100,000 new cases in United State [2]. A single adenoma is observed in approximately in the 80% of the cases of this pathology [3].…”

Section: Introductionmentioning

confidence: 99%

Primary Hyperparathyroidism in a Twin Pregnancy: A Case Report

Sánchez¹,

Balanza²,

Pacheco³

et al. 2016

OJEMD

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The primary hyperparathyroidism during pregnancy is an infrequent disorder but it is rarer in a twin gestation. Often it is not suspected because the symptomatology is overlapped with the normal course of pregnancy and it is usually discovered after a routine blood test. Ultrasound is the best option to identify the adenoma, while the gold-standard is technetium-99 m sestamibi but is contraindicated in this situation. The treatment is controversial and depends of the time of the gestation: the medical therapy is accepted in the first and third trimester, and the surgery is reserved for the second trimester, where the side effects are low. We present a case of primary hyperparathyroidism in a twin pregnancy treated by a minimally invasive parathyroidectomy in the second trimester without consequences for both, mother and newborns.

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“…RIMARY HYPERPARATHYROIDism (pHPT) is a common disease affecting approximately 1 in every 500 women and 1 in every 2000 men older than 40 years. 1 Several prior studies have investigated the impact of ethnicity and geography on the clinical presentation of pHPT. [2][3][4][5] In 2000, Bilezikian et al 3 investigated the presentation of pHPT among women in China.…”

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confidence: 99%

Impact of Race on Intraoperative Parathyroid Hormone Kinetics

Cisco¹,

Kuo²,

Ogawa³

et al. 2012

Arch Surg

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Hypothesis: African American patients exhibit different intraoperative parathyroid hormone (IOPTH) profiles than non-African American patients. Design: Retrospective review. Setting: University medical center. Patients: Nine hundred ten patients who underwent parathyroidectomy for primary hyperparathyroidism between July 2005 and August 2010. Interventions: All patients underwent preoperative imaging with ultrasonography and sestamibi; operative exploration; and IOPTH measurement at 2 points preexcision and 5 and 10 minutes postexcision. Main Outcome Measures: Preexcision and postexcision IOPTH measurements. Results: Of the 910 patients, 734 self-reported their race as white (81%); 91, Latino/other (10%); 56, Asian (6%); and 28, African American (3%). African American patients had significantly higher initial preexcision IOPTH levels compared with white patients (348 vs 202 pg/mL; P = .048) and significantly higher 5-minute postexcision IOPTH levels (151 vs 80 pg/mL; P = .01). The 10-minute postexcision IOPTH levels were similar between the 2 groups (52 vs 50 pg/mL). A similar percentage of white and African American patients had a 50% drop in IOPTH level at 10 minutes postexcision. No differences in IOPTH kinetics were observed in the other racial groups examined. Conclusions: African American patients with primary hyperparathyroidism exhibit significantly higher preincision and 5-minute postexcision IOPTH values when compared with white patients. The 10-minute postexcision IOPTH values did not differ between races. The altered IOPTH kinetics identified in African American patients may reflect the severity of biochemical disease but may also be related to genetically predetermined differences in parathyroid hormone metabolism.

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Diagnosis of Primary Hyperparathyroidism and Indications for Parathyroidectomy

Cited by 6 publications

References 48 publications

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

Differential Diagnosis of Atypical Parathyroid Adenoma and Parathyroid Carcinoma in a Case With Severe Hypercalcemia

Primary Hyperparathyroidism in a Twin Pregnancy: A Case Report

Impact of Race on Intraoperative Parathyroid Hormone Kinetics

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