Primary hyperparathyroidism

Abstract

Primary hyperparathyroidism is a common endocrine disorder caused by overactivation of parathyroid glands resulting in excessive release of parathyroid hormone. The resultant hypercalcemia leads to a myriad of symptoms. Primary hyperparathyroidism may increase a patient's morbidity and even mortality if left untreated. During the last few decades, disease presentation has shifted from the classic presentation of severe bone and kidney manifestations to most patients now being diagnosed on routine labs. Although surgery is the only curative therapy, many advances have been made over the past decades in the diagnosis and the surgical management of primary hyperparathyroidism. The aim of this review is to summarize the characteristics of the disease, the work up, and the treatment options.

The forgotten electrolyte, when hypercalcaemia manifest as gait instability and altered mental status

“…Neuropsychiatric manifestations of PHPT present in up to 23% of patients 3. Our patient had gait difficulty, confusion and difficulty with memory recall, which are unusual for her level of hypercalcaemia.…”

Myocardial infarction at the patient with parathyroid adenoma

“…hypercalcemic crisis can develop, leading to dehydration, heart and renal function disorders, abdominal pain, ulcers, and nervous system functions disorder as well 9,15,16 .During admission our patient was disoriented, with an altered mental status, pale and dehydrated, which fits in with clinical pHPT signs, but she didn't have abdominal pain or ulcer. Due to a range of polymorphic neurological disorders and mental disturbances, sometimes these patients are characterized as psychiatric patients.…”

Effectiveness of Intraoperative Parathyroid Monitoring (IoPTH) During Minimally - Invasive Parathyroidectomy: A Decade Experience in a Single Center

“…In the past, parathyroidectomy involved an open procedure with a neck incision not unlike that used for a thyroidectomy, and it required the inspection of all 4 parathyroid glands, with removal of the offending gland or glands [1,2].…”

“…The valid operative standard for the pHPT has been bilateral neck exploration (BNE) and the visualization of all parathyroid glands [1]. However, the increasing sensitivity of pre-operative localization methods such as 99Tc-sestamibi scanning and ultrasound in combination with intra-operative parathyroid hormone monitoring (ioPTH) assay have led to the use of minimally invasive procedures in parathyroid surgery.…”

“…However, the increasing sensitivity of pre-operative localization methods such as 99Tc-sestamibi scanning and ultrasound in combination with intra-operative parathyroid hormone monitoring (ioPTH) assay have led to the use of minimally invasive procedures in parathyroid surgery. After first endoscopic parathyroidectomy, described by Gagner [1], in recent years, different minimally invasive techniques of parathyroidectomy have been described [2][3][4][5][6] and several authors have demonstrated that MIVAP is a safe procedure with additional advantages regarding cosmetic results and post-operative recovery [2][3][4][5][6][7][8][9][10].…”