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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present 3 cases of melanoma associated with a parathyroid adenoma discovered by routine measurement of blood calcium levels. The melanomas were differently located and had different histological degrees. Hypercalcaemia is an infrequent complication of melanoma. According to data found in the literature, it is most often consecutive to bone metastases. The other causes of hypercalcaemia are metastatic extension of melanoma to the parathyroid glands, secretion of parathormone-related peptide (PTH-RP) and the actions of prostaglandins, vitamin D and the osteoclast-activating factor (OAF). Primary hyperparathyroidism due to adenoma has seldom been described associated with melanoma.
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PMID:[Melanoma and primary hyperparathyroidism]. 823 59

Cryopreserved parathyroid glands from patients operated on for hyperparathyroidism were stored for further auto- or allografting. In an attempt to better use cryopreserved parathyroid glands in humans, we designed a study whose goal was to compare human parathormone (hPTH) secretion from cryopreserved parathyroid glands with regard to tissue histology (adenoma or hyperplasia), mass, and time of storage in hypocalcemic Nude mice and to be able to better use them in humans. A new hypocalcemic experimental model, using parathyroidectomized Nude mice was set up. Hypocalcemic mice received calibrated grafts from human parathyroid glands cryopreserved between 1982 and 1992 originating from 30 patients (15 adenomas, 15 hyperplasias). Each parathyroid was grafted into two mice under the ratio of one mass-unit (12 mg) and three mass-units (36 mg). The hPTH concentration was assessed by an immunoradiometric method 21 days after grafting. The mean cryopreservation time was 677 days (54-3187 days). The time of cryopreservation was identical in the two kinds of tissue (p = 0.88). The hPTH concentration in 59 living mice was 72.2 +/- 271.4 (SD) ng/ml (3-1936 ng/ml). This concentration was 7.1 +/- 4.3 ng/L for adenomas versus 139.4 +/- 378.6 ng/L for hyperplasias (p = 0.003) and 87.1 +/- 352.6 ng/L for one-unit-mass grafts versus 56.7 +/- 152.5 ng/L for three unit-mass grafts (p = 0.824). Hyperplastic glands showed more secretion, which was confirmed in both mass related groups (p = 0.02, p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transplantation of human cryopreserved adenomatous and hyperplastic parathyroid tissue to the hypocalcemic nude mouse. 767 18

The value of magnetic resonance imaging (MRI) in the preoperative localization of parathyroid glands was assessed through a comparison of the findings with those obtained by ultrasonography and isotope scanning. The localization findings in 37 patients with primary hyperparathyroidism were compared with the operative findings. The sensitivities of the three modalities as defined by the ability to detect a parathyroid adenoma were 67% (isotope scanning), 44% (ultrasonography) and 36% (MRI). The differences were not significant. The sensitivities as defined by the ability to predict the correct side of the lesion were 48% (isotope scanning) 33% (ultrasonography) and 36% (MRI). No correlation was found between the sensitivity of a given localization test and factors such as the presence of thyroid abnormalities, size of the lesion, type of lesion and preoperative calcium and parathormone levels. The low sensitivity and high cost of all three preoperative localization studies render them unnecessary in the management of uncomplicated parathyroid disease. However, if preoperative imaging is necessary, ultrasonography and isotope scanning are recommended, since MRI was not found to be superior.
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PMID:Magnetic resonance imaging in preoperative localization of diseased parathyroid glands: a comparison with isotope scanning and ultrasonography. 832 59

The authors describes a case of tertiary hyperparathyroidism (HPTH) in a uremic patient on intermittent dialysis treatment: the term refers to an adenoma with ensuing uncontrolled parathormone (PTH) secretion rate arising on the ground of hyperstimulated hypertrophied parathyroid glands. The syndrome was heralded clinically by bone pain, psychiatric disorder and biochemically by increased levels of calcium and alkaline phosphatase (AP), while parathormone (PTH), did not change from basal very high levels as commonly found in uraemic patients. As hypercalcemia in the hemodialyzed is an infrequent finding the only alternative explanation could have been hypercalcemic secondary HPTH related to hyperplastic autonomous parathyroids. For no clinical and laboratory findings as well as US findings and double scintigraphy (99mTc and 201mTl) may suggest differential diagnosis the patient underwent total parathyroidectomy which actually revealed an adenoma of the left superior parathyroid gland. Bone pain and psychiatric disturbances disappeared and now get well on chronic dialysis treatment and 1.25-OH Vit D3 supplement.
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PMID:[Tertiary hyperparathyroidism during chronic kidney failure under dialysis treatment. Apropos a clinical case]. 841 36

The distribution and expression of parathyroid hormone (PTH) were investigated in normal and abnormal parathyroid tissue. PTH was detected using a monoclonal antibody with specificity for the 44-68 region of the PTH molecule. Prominent reactivity for PTH was seen in normal parathyroid with a granular pattern of staining. Active parathyroid tissue (adenoma and hyperplasia) showed much less reactivity for PTH, although there was prominent reactivity in the normal tissue around adenomas. Comparison of expression of PTH with that of parathormone mRNA showed a reciprocal pattern in normal tissue and, to a less marked extent, in abnormal tissue. Parathyroid carcinoma in particular had coinciding areas of PTH and PTH mRNA expression. Oxyphil cells had little or no PTH expression, except in the associated 'colloid' in some cases. The findings indicate an inverse relationship between storage and cellular synthesis of PTH, this being more marked in physiological than in pathological conditions of the parathyroid.
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PMID:In situ correlation of synthesis and storage of parathormone in parathyroid gland disease. 843 15

The classical presentation of primary hyperparathyroidism, "moans, bones, groans," is no longer commonly seen since the diagnosis of hypercalcemia is now made much earlier with the routine use of the SMA 12. In the past 8 1/2 years, 85 patients underwent cervical exploration in our institution for primary hyperparathyroidism. There were 34 male and 51 female patients, ranging in age from 18-84 years. The specific symptoms included hypertension in 40 patients, generalized weakness in 25, renal stones in 14, psychiatric problems in 2, and bone changes on X-ray in 4. Forty-one patients were totally asymptomatic. The diagnosis was made mainly on the basis of history, serum calcium and phosphorous levels, parathormone assay, and 24-hour urinary calcium studies. Preoperative localization studies were performed in 38 patients. Thallium technetium subtraction scans, when positive, were very helpful. The surgical approach involved stepwise exploration of both sides of the neck with identification of all four parathyroid glands. In patients with uniglandular pathology (87%), the adenoma was removed with biopsy of at least one normal gland. In multiglandular disease, the abnormal glands were removed. Frozen section was routinely performed to confirm the presence of parathyroid tissue and no attempt was made to pathologically distinguish adenoma from hyperplasia. Two patients had parathyroid carcinoma. In three patients, serum calcium levels did not fall, resulting in an operative success rate of 96%. One patient treated by subtotal parathyroidectomy developed permanent hypoparathyroidism and one other patient developed temporary hypocalcemia. Only a single patient developed vocal cord palsy. Early exploration in patients with primary hyperparathyroidism is indicated. The basic diagnostic workup is sufficient for initial exploration. It is important to distinguish uniglandular from multiglandular pathology after careful bilateral exploration and identification of all four parathyroid glands.
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PMID:Cervical exploration for primary hyperparathyroidism. 844 Dec 55

This report describes a rare case of parathyroid carcinoma associated with an adenoma. Nuclear imaging provided the most specific information about localization of the primary carcinoma and cervical metastasis, but failed to demonstrate evidence of a parathyroid adenoma. This could be explained by a partial inhibition of hormonal biosynthesis due to the high level of circulating parathormone produced by the carcinoma.
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PMID:Nuclear medicine imaging in a case of hyperfunctioning parathyroid carcinoma associated with a parathyroid adenoma. 852 61

The blood supply of pathologic parathyroid glands and the relation between parathyroid hormone secretion and parathyroid blood perfusion was studied during surgery for hyperparathyroidism. Blood flow in 39 single adenomas and 20 glands classified as primary or secondary hyperplasia were studied intraoperatively with laser Doppler flowmetry. The ipsilateral inferior thyroid artery was occluded during continuous flowmetry recording, which resulted in a 40% reduction of parathyroid blood flow in both groups. In 12 patients with single adenomas, intact parathormone (iPTH) was measured intraoperatively before and during occlusion of the ipsilateral inferior thyroid artery and after extirpation of the adenoma. During occlusion the iPTH levels were mainly unchanged despite blood flow reduction of up to 80%. After removal of the adenoma the iPTH normalized within 15 minutes. In a control group of eight single adenomas, iPTH was measured similarly without vascular occlusion, demonstrating comparable iPTH levels. This study demonstrates similar routes of vascularization for single adenomas and hyperplastic glands, as was earlier seen for normal parathyroid glands. The increased parathyroid hormone secretion from single adenomas appears to remain mainly unchanged during significant blood flow reduction.
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PMID:Blood supply and parathyroid hormone secretion in pathological parathyroid glands. 866 37

The authors report their 3-year experience with the diagnosis of parathyroid lesions in primary hyperparathyroidism patients in a geographic area where the occurrence of endemic goiter is medium. Our study was aimed at prospectively assessing preoperative imaging results in these patients. The following imaging methods were used: high-definition and color-Doppler ultrasonography (US), double-tracer 201Thallium-99mTechnetium (T1/Tc) subtraction scintigraphy, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and US-guided fine-needle aspiration of the suspected parathyroid lesions. Preoperative US and scintigraphy were performed in 50 patients with primary hyperparathyroidism; in addition, color-Doppler US studies were performed in 33 patients for vascular characterization of the lesions. In 19 patients, the suspected lesions were punctured under US guidance to measure parathormone (PTHa) and thyroglobulin (TGa) levels in the aspirated material. CT and MRI were performed in 9 patients, to identify a possible ectopic parathyroid gland. Surgery demonstrated 48 solitary parathyroid lesions and one double parathyroid adenoma. In one patient no abnormal parathyroid gland was found. Overall sensitivity rates of US and scintigraphy were 85.7% and 61.2%, respectively. In multinodular goiter patients, the sensitivity rates of US and scintigraphy were 71.4% and 47.6%, respectively. At color-Doppler US the presence of parenchymal vascularization was specific of parathyroid nodules and the method helped differentiate parathyroid lesions from thyroid nodules in 14 multinodular goiter patients. Overall PTHa sensitivity was 72.2% and its specificity 100%. Overall TGa sensitivity was 100% and specificity 94.7%. CT and MRI allowed the detection of 8 ectopic parathyroid lesions. In conclusion, in our personal experience, US should be preferred to double-tracer T1/Tc subtraction scintigraphy in the early examination of primary hyperparathyroidism patients. When US detects a suspected parathyroid lesion, color-Doppler US and PTH and TG sampling can make useful diagnostic tools for reducing false-positive results, especially when thyroid disease is associated.
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PMID:[Preoperative imaging in the detection of parathyroid tumefaction in patients with primary hyperparathyroidism. The authors' own experience]. 868 59

A simple method for intra-operative lateralization of parathyroid adenomas by venous sampling for intact parathormone (PTH [1-84] is described. After induction of anaesthesia, percutaneous right and left internal jugular and arm vein PTH [1-84] was estimated within 30 minutes by a modification of the Allegro PTH [1-84] assay. Twenty-three patients with primary hyperparathyroidism due to adenoma were explored, 21 with one adenoma and two with two adenomas. Intraoperative jugular PTH [1-84] correctly lateralized 16 (76%) of the single adenomas (P < 0.006), and the side of the neck with the greater weight of parathyroid adenoma in 18 (78%) patients (P < 0.004). Two patients with previous failed neck explorations were correctly lateralized. Thallium/technetium scanning lateralized 41%, significantly less then jugular PTH [1-84] (P < 0.02). Adenomas of 1 g or less were more likely to be lateralized by PTH [1-84] than thallium/technetium scanning (P < 0.05). Intraoperative jugular PTH [1-84] was superior to thallium/technetium scanning for parathyroid adenoma lateralization.
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PMID:Lateralization of parathyroid adenomas by intra-operative parathormone estimation. 876 81


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