Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of hormone secretion and hormone clearance in the differential control of circulating levels of intact (I-) and carboxy-terminal (C-) immunoreactive parathyroid hormone (iPTH) was evaluated in 18 pentobarbital-anesthetized dogs. Catheters were installed in the aorta, left renal, and hepatic veins for sampling. Hepatic and renal blood flows were calculated from sulfobromophtalein (BSP) and p-aminohippuric acid (PAH) extraction and clearance. I- and C-iPTH were measured during a 1 h of infusion of CaCl2 or Na2EDTA. High-performance liquid chromatography (HPLC) profiles of I- and C-iPTH in and out of the liver and kidney were also obtained. Data on two dogs (one CaCl2 and one Na2EDTA infusion) were pooled for the analysis of one parathyroid function using a four-parameter mathematical model. Results obtained in the basal state and during analysis of the parathyroid function were also compared with those of 24 awakened dogs. Results are means +/- SD. Anesthetized dogs had lower levels of Ca2+ (1.29 +/- 0.03 vs. 1.34 +/- 0.04 mmol/l; p < 0.001) and higher levels of I- (11.5 +/- 5.7 vs. 3.0 +/- 1.9 pmol/l, p < 0.001) and C-iPTH (52 +/- 20.9 vs. 22.8 +/- 10.5 pmol/l; p < 0.001) than awakened dogs. Their stimulated (S) and nonsuppressible (NS) I-iPTH levels were increased 2- and 4-fold, respectively, while similar C-iPTH levels rose only 1.35- and 1.75-fold; this caused their S (4.4 +/- 0.7 vs. 6.8 +/- 1.9; p < 0.001) and NS (24.6 +/- 11.8 vs. 49.8 +/- 27.5; p < 0.05) C-iPTH/I-iPTH ratios to decrease. This was not explained by different renal clearance rates of I- and C-iPTH since both were similar at approximately 10 ml/kg/minute and unaffected by Ca2+ concentration. Clearance of all I- and C-iPTH HPLC molecular forms by the kidney appeared equal. A 50% decrease in the hepatic clearance of I-iPTH to approximately 12 ml/kg/minute in pentobarbital-anesthetized dogs, related to a lower hepatic blood flow, explained the higher levels of S and NS I-iPTH in these animals. I-iPTH hepatic clearance was unaffected by Ca2+ concentration. C-iPTH hepatic clearance was much lower at approximately 5 ml/kg/minute, abolished by hypercalcemia, and reduced by the influence of anesthesia on hepatic blood flow. This also explained the higher S C-iPTH levels in anesthetized animals. I-PTH(1-84) detected by the C-iPTH assay explained only 37.6% of the hepatic C-iPTH clearance in hypocalcemia and 73.3% in hypercalcemia. Overall, our results indicate that total C-iPTH clearance is about 40.2% that of I-iPTH in hypocalcemia and 41.3% in hypercalcemia. This would only explain a 2.4- to 2.5-fold difference in circulating levels of I- and C-iPTH if secretion rates were equal; the larger difference observed in S and NS C-iPTH/I-iPTH ratio values is thus mainly explained by different production rates.
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PMID:Influence of Ca2+ concentration on the clearance and circulating levels of intact and carboxy-terminal iPTH in pentobarbital-anesthetized dogs. 885 43

Malignant hyperthermia is clinically an uncommon disorder characterized by acute hypercatabolic reactions in muscles in response to the triggering effects of certain drugs mainly used during anesthesia or to physical or emotional stress. We present a pediatric patient with multiple caries who was suspected to contract malignant hyperthermia while underwent the operative procedure of comprehensive restoration. Sinus tachycardia, hyperthermia, hypercapnia, metabolic acidosis, hyperkalemia and hypercalcemia developed unexpectedly during the operation. Fortunately, the patient survived the episode with early recognition and prompt management.
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PMID:A child of suspected malignant hyperthermia during general anesthesia for dental surgery. 908 42

Anesthesia for surgery of primary hyperparathyroidism (HPT) usually concerns asymptomatic elderly women with moderate hypercalcemia. Cardiovascular repercussions of the endocrine disorder are possible, but they are not frequent except for hypertension. Hyperparathyroid crisis is a life-threatening condition with severe hypercalcemia. Intravenous diphosphonates are very effective drugs to control hypercalcemia. The improvement is transient but allows curative parathyroidectomy to be performed with a minimal risk of cardiac arrhythmias. Anesthesia for surgery of secondary HPT concerns patients with chronic renal failure treated by hemodialysis. Cardiovascular disease is frequent and aggravated by the endocrine disorder. In patients with marked aortic stenosis or severe left ventricular dysfunction, parathyroidectomy should be performed by cervicotomy under local anesthesia. Hyperparathyroidism may persist after renal transplantation (tertiary HPT): in this case cardiovascular disease is minimal and the hypercalcemia is moderate. Parathyroidectomy is usually performed by cervicotomy under general anesthesia. Sternotomy is required in the case of an abnormal mediastinal location of a gland. An interaction between myorelaxants and hyperparathyroidism has been observed. Total blood calcium must be systematically assayed postoperatively because postoperative hypocalcemia is constant. Hypocalcemia is moderate in primary and tertiary HPT, due to transient functional hypoparathyroidism, with lowest observed the 2nd or 3rd postoperative day. Hypocalcemia should not be treated when asymptomatic because it resolutes on the 4th or 5th postoperative day. Intravenous calcium infusion may be necessary for 1 or 2 days, if serum calcium is below 1.9 mmol per liter with symptoms of tetany. Persistent hypocalcemia is due to an hungry bone syndrome or organic hypoparathyroidism that should be treated by oral vitamin D and calcium. In secondary HPT, hypocalcemia is early, marked and asymptomatic. Treatment must often be started on the 6th postoperative hour by intravenous calcium infusion, followed by oral vitamin D and calcium. The absence of postoperative hypocalcemia indicate incomplete removal of all abnormal parathyroid tissue. At the third postoperative day, a second cervicotomy may be performed to complete the neck exploration.
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PMID:[Anesthesia and postoperative recovery for parathyroid gland surgery]. 1008 69

This is a case report of a 23 year old female. She had earlier been diagnosed to have Cushing's syndrome due to macronodular adrenal hyperplasia, for which bilateral adrenalectomy was performed three years before. The initial full recovery was sustained for about one and a half years, following which there was progressive recurrence of obesity, hypertension and hypercalcaemia. Plasma cortisol concentrations were markedly elevated and a diagnosis of recurrent Cushing's syndrome was made. Pre-operative localisation of the source of hypercortisolism through intravenous urogram, abdominal ultrasonogram and computerised tomogram was unfruitful, thus an exploratory laparatomy was undertaken. At surgery, extensive and dense adhesions were seen which caused difficult dissection and accidental injury to the patient's liver and kidney, necessitating massive intra-operative blood transfusions. The patient died within two hours of recovery from anaesthesia of acute massive pulmonary embolism. We postulate that the recurrent Cushing's syndrome in this patient could have been due autografting of remnants of adrenal tissue within the abdominal cavity. A pre-operative localisation with radio-labelled cholesterol scanning may have made reoperation of the patient easier.
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PMID:A follow up report: recurrent Cushing's syndrome after bilateral adrenalectomy. 1150 90

Minimally invasive parathyroidectomy (MIP) is gaining popularity as an alternative to traditional bilateral exploration for patients with primary hyperparathyroidism. The success of MIP relies on the ability of preoperative and intraoperative localization studies to guide a directed exploration for resection of a diseased gland. We hypothesize that excellent results can be achieved with MIP when only technetium-99m sestamibi (MIBI) is used for localization. We conducted a prospective analysis of all patients presenting with a biochemical diagnosis of primary hyperparathyroidism between January 1997 and November 2000. Patients meeting inclusion criteria were given a choice of MIP and directed exploration versus traditional bilateral exploration. Fifty patients chose MIP. Three patients who chose MIP had a negative MIBI, which left 47 patients in the primary study group. The MIBI correctly identified a parathyroid adenoma in 42 patients (89.3%). In two other patients MIBI was inaccurate; however, directed exploration was successfully converted to a bilateral exploration. Overall 44 of 47 (93.6%) patients in the study group were rendered normocalcemic after the initial operation. Three patients experienced persistent hypercalcemia and subsequently underwent successful bilateral exploration. Including those patients choosing a bilateral exploration, a total of 59 positive MIBI scans were evaluated. There were 54 true positives (positive predictive value 91.5%), and if all patients had chosen a MIP 94.9 per cent would have been successfully treated at the initial operation. Mean operative time for MIP was 54.6 minutes, and in 32 patients (68.1%) MIP was performed with local anesthesia and sedation. Twenty-six patients (55.3%) were discharged the same day of the procedure. There were no significant complications in any group analyzed. We conclude that MIP can be successfully performed on the basis of a positive MIBI scan. The present study highlighting many of the advantages of MIP questions the necessity of additional adjuncts such as intraoperative parathyroid hormone measurement and gamma-probe localization.
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PMID:Minimally invasive parathyroidectomy without intraoperative localization. 1173 Feb 17

We thoracoscopically managed parathyroid adenoma of the upper anterior mediastinum in a 29-year-old man. He had a backache and was found to have bilateral ureteric stones, hypercalcemia, and extremely increased parathyroid hormone levels. 99mTc-methoxyisobutyl isonitrile scintigraphy showed an accumulation area projected onto the right thyroid lobe and the upper mediastinum. A diagnosis of primary hyperparathyroidism secondary to double adenomas was made. The patient then underwent surgical intervention. With the patient under general anesthesia with one-lung ventilation, a reddish brown adenoma of an upper mediastinum was removed thoracoscopically with three trocars, whereas the right superior parathyroid adenoma was excised by a standard open cervical procedure. Conventionally, the mediastinal parathyroid adenoma was removed by an open approach and was associated with perioperative distress to the patient. If the exact location of the mediastinal lesion is established, thoracoscopic excision of these lesions is feasible and is strongly recommended.
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PMID:Thoracoscopically managed parathyroid adenoma in the upper anterior mediastinum. 1182 66

Williams syndrome (WS) is a rare genetical disorder with an incidence of 20-50 000 live births. It is caused by a delation of 1 elastin allele located within chromosome subunit 7q11.23 (long arm). It is characterized by: supravalvular aortic stenosis, multiple peripheral pulmonary artery stenosis, a typical face (elfine face), mental and statural deficiency, characteristic dental malformation, transient hypercalcemia that occurs during the 1(st) year of life. We present the case of a 7-month-old infant affected with WS. In order to clarify the cardiac findings, the baby under-went a MRI investigation, requiring an anesthesiological assistance. In this case a deep sedation approach was carried out by giving chloral hydrate 10% per os (80 mg/kg). We did not perform a general anesthesia in order to avoid the risk related to it. No other drugs were used. During the procedure SpO(2), HR, RR, and ETCO(2) were in normal range; ST tract analysis did not reveal any pathological change The examination lasted 95 minutes; at the end the baby was kept under surveillance in the recovery room for 30 minutes, he could be precociously fed. All the procedure was uneventful.
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PMID:Sedation for Magnetic Resonance Imaging in a child affected with Williams syndrome. 1279 85

A 5-year-old boy with Williams syndrome received open reduction of fracture of the antebrachium twice. He had been diagnosed as having Williams syndrome with some characteristic symptoms, including elfin face, mental retardation and primary pulmonary hypertension. Williams syndrome has a tetrad of cardiovascular disease, elfin face, mental retardation and hypercalcemia. Operations were performed twice under general anesthesia. Airway management with mask technique was easily performed. Tracheal intubation was accomplished successfully. Anesthesia was induced with propofol, fentanyl, and vecuronium, and maintained with propofol, fentanyl and the inhalation of oxygen with nitrous oxide. Both anesthetic courses were uneventful and he was discharged without any complications. Special anesthetic considerations should be taken for difficulties of intubation, management of circulatory system, malignant hyperthermia, and hypercalcemia in this syndrome.
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PMID:[Two occasions of anesthetic management for a patient with Williams syndrome]. 1367 82

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thallium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.
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PMID:[Review of 26 patients operated on for primary hyperparathyroidism]. 1473 18

A 13-year-old dog was diagnosed with hypercalcemia of malignancy associated with adenocarcinoma of the anal sacs. Hypercalcemia was treated with intravenous (IV) 0.9% sodium chloride (NaCl), furosemide, calcitonin, and pamidronate. Hypomagnesemia was documented by 72 hours following a single, IV dose of pamidronate. The dog subsequently underwent surgery to remove the primary tumors, and multiple cardiac arrhythmias occurred during anesthesia. This case documents electrolyte abnormalities in a dog following treatment with pamidronate in conjunction with other therapies used to manage hypercalcemia. The authors postulate that hypomagnesemia may have contributed to the arrhythmias that occurred during anesthesia. Electrolyte abnormalities should be anticipated and corrected following pamidronate therapy in canine patients.
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PMID:Electrolyte disturbances and cardiac arrhythmias in a dog following pamidronate, calcitonin, and furosemide administration for hypercalcemia of malignancy. 1473 9


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