Pierwotna nadczynność przytarczyc w przebiegu raka przytarczyc — wyzwanie diagnostyczne i terapeutyczne

Dabrowska, Anna; Tarach, Jerzy S.; Zwolak, Agnieszka

doi:10.5603/ep.2015.0023

Cited by 3 publications

(4 citation statements)

References 57 publications

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“…Both our own observations and the experience of other authors point to the effectiveness of surgery in the treatment of hypercalcaemia, which is a pre-breakthrough state, and a rapid post-operative improvement in the general condition of patients [2,6,[16][17][18]. Continuous monitoring of patients plays an extremely important role in postoperative management.…”

Section: Discussionmentioning

confidence: 54%

“…These activities should include the preparation of the patient for surgery as soon as possible, with the aim of removing the diseased parathyroid gland as a factor generating hypercalcaemia and the sequence of metabolic disorders resulting from it [16]. A proper preparation of the patient for surgery, safety of anaesthesia, and the effectiveness of the surgical treatment often require interdisciplinary cooperation and combined efforts of an internist, nephrologist, endocrinologist, anaesthesiologist, and surgeon [5,6,15,17,18]. A clinical analysis of our patients indicates that it is not always possible to perform a MIBI parathyroid scintigraphy test, either because of the lack of technical capabilities or, above all, the rapidly worsening condition of the patient with a systematically increasing serum iCa2 + concentration.…”

Section: Discussionmentioning

confidence: 99%

“…It also allows the avoidance of emergency surgery and instead an urgent elective procedure, which, in the absence of previous diagnostic and localisation tests, also gives time to perform them and increases the effectiveness of the surgical treatment. This is all the more important because, as a rule, the patient's serious condition and the resulting loads representing a high risk of perioperative complications, including death, require that the surgical treatment be effective [6,10,11]. According to our own observations, giant parathyroid adenomas are a common cause of critically high hypercalcaemia, which is a threat of breakthrough, although the literature data do not indicate a simple relationship between the size and activity of the diseased parathyroid glands.…”

Section: Discussionmentioning

confidence: 99%

“…This condition affects the function of many organs and systems, including kidneys, as well as central nervous, circulatory, and digestive systems. The main symptoms of a developing hypercalcaemic crisis include progressive polydipsia, polyuria, progressive signs of dehydration with confusion and anxiety, and excessive sleepiness and coma [4][5][6]. The exacerbation of bone pains as well as gastrointestinal complaints in the form of a peptic ulcer disease or pancreatitis, cardiac arrhythmia, or other cardiac problems are observed [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Buła

Kowalski

Koziołek

et al. 2020

Endokrynologia Polska

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Introduction: The objective of the work was to evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcaemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery. Material and methods and Results: Between 2010 and 2019, 627 patients underwent surgery due to PHPT. Sixty-two patients (9.9%) (47 women and 15 men, aged 28-79 years, average 53.7 years) faced the threat of a parathyroid crisis. In these patients, the average parathyroid hormone (PTH) levels were 774.02 pg/mL (95% CI: 203-1246 pg/mL) and ionised calcium (iCa2+) 1.91 mmol/L (95% CI: 1.70-2.2 mmol/L). The PTH postoperative concentration averaged at 37.86 pg/mL (95% CI: 9.91-42.7 pg/mL) and iCa2 + 1.11 mmol/L (95% CI: 1.07-1.21 mmol/L). Bilateral neck exploration was performed in all patients with the removal of the affected parathyroid gland and biopsies of other parts. Histopathological examination revealed adenoma in 42 cases (67.7%), hyperplasia in 16 (25.7%), and parathyroid cancer in four of the patients (6.6%). Comparison of tests before and after surgery showed a statistically significant decrease in PTH (p < 0.001) and iCa (p < 0.001) in blood serum. Conclusions: A developing hypercalcaemic crisis in the course of hyperparathyroidism is an indication for preoperative intensive medical therapy, along with urgent surgical intervention and removal of diseased parathyroid glands. This type of surgery should be performed as soon as possible, even if there are no imaging tests, only based on an assessment of the general condition of the patient and their serum calcium levels.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Buła

Kowalski

Koziołek

et al. 2020

Endokrynologia Polska

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Clinicopathological correlates of hyperparathyroidism

2015

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Hyperparathyroidism is a common endocrine disorder with potential complications on the skeletal, renal, neurocognitive and cardiovascular systems. While most cases (95%) occur sporadically, about 5% are associated with a hereditary syndrome: multiple endocrine neoplasia syndromes (MEN-1, MEN-2A, MEN-4), hyperparathyroidism-jaw tumour syndrome (HPT-JT), familial hypocalciuric hypercalcaemia (FHH-1, FHH-2, FHH-3), familial hypercalciuric hypercalcaemia, neonatal severe hyperparathyroidism and isolated familial hyperparathyroidism. Recently, molecular mechanisms underlying possible tumour suppressor genes (MEN1, CDC73/HRPT2, CDKIs, APC, SFRPs, GSK3β, RASSF1A, HIC1, RIZ1, WT1, CaSR, GNA11, AP2S1) and proto-oncogenes (CCND1/PRAD1, RET, ZFX, CTNNB1, EZH2) have been uncovered in the pathogenesis of hyperparathyroidism. While bi-allelic inactivation of CDC73/HRPT2 seems unique to parathyroid malignancy, aberrant activation of cyclin D1 and Wnt/β-catenin signalling has been reported in benign and malignant parathyroid tumours. Clinicopathological correlates of primary hyperparathyroidism include parathyroid adenoma (80–85%), hyperplasia (10–15%) and carcinoma (<1–5%). Secondary hyperparathyroidism generally presents with diffuse parathyroid hyperplasia, whereas tertiary hyperparathyroidism reflects the emergence of autonomous parathyroid hormone (PTH)-producing neoplasm(s) from secondary parathyroid hyperplasia. Surgical resection of abnormal parathyroid tissue remains the only curative treatment in primary hyperparathyroidism, and parathyroidectomy specimens are frequently encountered in this setting. Clinical and biochemical features, including intraoperative PTH levels, number, weight and size of the affected parathyroid gland(s), are crucial parameters to consider when rendering an accurate diagnosis of parathyroid proliferations. This review provides an update on the expanding knowledge of hyperparathyroidism and highlights the clinicopathological correlations of this prevalent disease.

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Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234?cases

et al. 2017

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Parathyroid carcinoma (PC) is one of the rarest known types of cancer and has a moderate prognosis, with estimated 5- and 10-year overall survival rates between 78–85% and between 49–70%, respectively. To raise awareness of this disease, and to optimize its diagnosis, clinical management and prognosis, the present study retrospectively reviewed 234 cases of PC. A total of 226 cases of PC, which were archived between 1984 and 2015 in the three major databases of the Chinese population, were retrieved and pooled with the 8 cases diagnosed and treated at the Department of Thyroid Surgery of The First Hospital of Jilin University (Changchun, China) between June 2008 and December 2015. The clinicopathological features, diagnosis, surgical procedures and outcomes of these cases of PC were investigated. The review revealed that misdiagnosis has been a considerable issue, with >80% of the patients misdiagnosed prior to surgery, and the accuracy of intraoperative diagnosis based on frozen sections was only 15.04%. The use of radical resection as first-line therapy significantly improved the disease-free survival by ~8 years (log-rank, 20.956; P<0.001); and, at relapse, reoperation prolonged patient survival by ~7 years (log-rank, 35.322; P<0.001). Consistently, a Cox proportional hazards analysis indicated that radical resection as a first-line therapy reduced the risk of postoperative recurrence (P=0.030), and that reoperation following recurrence significantly improved patient survival (P=0.030). The 5- and 10-year cumulative disease-specific survival rates of the cases of PC were 83 and 67%, respectively. Notably, an increased mortality rate was observed among males with PC compared with female patients with PC. In summary, in the past 32 years (1984–2015), the majority of patients with PC have been misdiagnosed. Performing radical resection as the first-line therapy significantly reduces recurrence and improves patient survival time; and, following relapse, subsequent surgery has also been demonstrated to be an effective approach.

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Pierwotna nadczynność przytarczyc w przebiegu raka przytarczyc — wyzwanie diagnostyczne i terapeutyczne

Cited by 3 publications

References 57 publications

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Clinicopathological correlates of hyperparathyroidism

Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234?cases

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