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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare occurrence of the association of parathyroid adenoma in a case of thyroid papillary carcinoma is described. The patient was incidentally found to have parathyroid adenoma which was preoperatively diagnosed to be a metastatic lymph node. Analysis of her serum obtained before operation showed an elevation of serum parathyroid hormone (PTH) concentration without hypercalcemia. Since the association of hyperparathyroidism is high in patients with thyroid diseases, examination of not only serum levels of calcium and PTH but also careful interpretation of computed tomography (CT) and/or nuclear magnetic imaging (MRI) is necessary in the diagnosis of co-existing asymptomatic hyperparathyroidism.
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PMID:A case of papillary carcinoma of the thyroid associated with parathyroid adenoma without hyperparathyroidism. 163 47

In a 54-year-old patient who entered the hospital because of flank pain of the left side, a prevesicular urethral calculus was found. On further investigation hypercalcaemia and hypophosphataemia were detected, possibly indicating hyperparathyroidism. When an ultrasound of the abdomen was made to exclude hydronephrosis, a tumor in the pancreas was found. The result of the fine needle biopsy of this tumor showed a neuroendocrine tumor. The examination of neuroendocrine parameters was without any reference to an active secreting process. On suspicion of a multiple endocrine neoplasia, a MRI of the hypophysis was made which showed no adenomatous alterations. The examination of the neuroendocrine parameters were without any reference to an active secreting process of the hypophysis, too.
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PMID:[Pain in the side]. 197 93

Primary hyperparathyroidism is a common disorder and one that can usually (approximately 95%) be successfully treated by parathyroidectomy. PTH assays have become quite accurate for confirming the diagnosis. In patients with malignancy-associated hypercalcemia, parathyroid-like protein levels are usually increased, and radioimmunoassays being developed to quantitate serum levels of this protein will make the diagnosis easier. Treatment for a parathyroid adenoma is removal of the tumor and identification of the normal parathyroid glands. Treatment for primary or secondary hyperplasia is usually subtotal parathyroidectomy. Recurrent hyperparathyroidism is uncommon, except in patients with familial hyperparathyroidism, MEN-1 parathyroid carcinoma, or renal failure and secondary hyperparathyroidism. Persistent hyperparathyroidism is more common and is usually due to surgeon inexperience, but it is also caused by ectopically situated parathyroid glands, multiple abnormal parathyroid glands, or supranumerary parathyroid glands. Preoperative localization studies using ultrasound, thallium-technetium scanning, MRI, or CT scanning are reliable in patients with solitary parathyroid adenomas, but often fail to detect all of the abnormal parathyroid tissue in patients with multiple abnormal parathyroid glands. Intraoperative use of urinary cyclic AMP assays and rapid PTH assays have recently been used experimentally during parathyroid explorations to determine whether all hyperfunctioning parathyroid tissue has been removed, but these methods are not yet reliable or fast enough to be generally accepted. Most patients with primary hyperparathyroidism who are successfully treated by parathyroidectomy experience psychological, clinical, and metabolic benefits.
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PMID:Primary hyperparathyroidism. A surgical perspective. 267 68

Authors report a case of parathyroid adenoma as lateral palpable cervical mass, with serious hypercalcemia. MRI and ultrasound investigations were performed preoperatively. No other pathological parathyroid gland was found. Surgical treatment did not include the exploration of the four parathyroid glands. Long term follow-up is necessary.
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PMID:[Parathyroid adenoma as an ectopic carotid mass. Apropos of a case]. 757 48

Twenty-two patients aged 36-63 years were diagnosed as having Fahr's syndrome on the basis of the presence on CT of unexpected extensive calcification of the basal ganglia. Even when associated with calcification of other brain areas, the main diagnostic criterion remained basal ganglia calcification larger than 800 mm2. Normal values of parathormone, serum calcium and phosphorus excluded hypercalcaemia and hypoparathyroidism. Mitochondrial CNS disease was excluded clinically. MRI and repeated CT and neurological examination were performed in all of the patients. The patients were divided into two groups: neurologically asymptomatic (group 1) and neurologically symptomatic (group 2). T2-weighted sequences demonstrated hyperintense areas in all of the patients involving the white and the grey matter of the brain. In group 1 the hyperintense lesions were significantly smaller than in group 2. The neurological symptoms correlated better with the hyperintensities on T2-weighted MR images than with the calcification demonstrated on CT. Hyperintensities in T2-weighted MRI and the areas shown by CT to have calcification had different locations. In 15 patients with dementia, the white matter of the entire centrum semiovale was bilaterally hyperintense. In another 3 patients with hemiparesis, hyperintense areas in the internal capsule, contralateral to the side of hemiparesis, were demonstrated in the T2-weighted sequence. The hyperintense T2 signals may reflect a slowly progressive, metabolic or inflammatory process in the brain which subsequently calcifies and are probably responsible for the neurological deficit observed.
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PMID:MRI demonstration and CT correlation of the brain in patients with idiopathic intracerebral calcification. 793 33

For patients with previous thyroid or parathyroid surgery and for those with significant comorbid conditions, noninvasive and invasive modalities exist for the preoperative localization of pathologic parathyroid tissue. Formal localization at our institution involves obtaining two studies that are independently positive for the same location. The studies utilized have included ultrasound, CT scans, MRI, technetium-99m/thallium-201 (Tc-Tl) imaging, and more recently, (99m)Tc-sestamibi (20-25 mCi) (MIBI) scans. These were followed by arteriography and/or venous sampling if necessary. From January 1992 through October 1995, 25 patients underwent preoperative parathyroid localization (10 reoperation, 3 grave hypercalcemia, 2 concurrent goiter, 2 cerebral vascular accident, 1 bleeding disorder, and 1 malignant ventricular arrhythmia) and were evaluated prospectively during the changeover from Tc-Tl to MIBI scanning at our institution. A total of 92 studies were obtained. All 25 patients were operated on by a single surgeon, and in each case the parathyroid adenoma was successfully resected with minimal morbidity (1 permanent hypoparathyroid and 1 temporary recurrent laryngeal nerve injury). True positives interpreted preoperatively: MIBI, 14 of 19 (74%); CT scan, 13 of 19 (68%); Tc-Tl, 4 of 8 (50%), ultrasound, 9 of 20 (45%); MRI, 8 of 14 (57%); arteriography, 3 of 7 (43%); venous sampling, 3 of 4 (75%); and positron emission tomography, 0 of 1. There were no false-positive MIBI scans. These results suggest that when formal parathyroid localization is needed in reoperative/complicated patients, 1) MIBI appears to be the most sensitive and specific study, and 2) the MIBI scan should be the initial study in any situation in which preoperative localization is needed. Ultrasound can be useful for patients with significant comorbidities who have not been previously explored. CT or MRI should then be used if further evaluation is needed. If the use of these noninvasive modalities does not produce positive gland localization, selective venous sampling should be utilized as the definitive procedure.
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PMID:Sestamibi parathyroid scanning and preoperative localization studies for patients with recurrent/persistent hyperparathyroidism or significant comorbid conditions: development of an optimal localization strategy. 898 69

From March 1993 to October 1994, 12 patients operated for persistent hyperparathyroidism had preoperative catheterization of large cervical and mediastinal veins (CLCMV) with determination of serum concentration of intact parathyroid hormone. Other localization procedures included: ultrasonography (US, n = 9), computed tomography (CT, n = 8), magnetic resonance imaging (MRI, n = 5), and sestamibi radionuclide imaging (MIBI, n = 9). A (1-84 PTH) gradient of 1-84 PTH was demonstrated in all patients, localizing a lesion in the neck (n = 9) or in the mediastinum (n = 3). An adenoma was found in nine patients either in the neck (n = 6) or in the mediastinum (n = 3), and 2 patients had glandular hyperplasia. Two patients remained hypercalcemic despite the removal of parathyroid tissue during CLCMV-guided reexploration. An other patient underwent unsuccessful neck reexploration. The sensitivity of other procedures was lower: US: 22%, CT: 50%, MRI: 60%, and MIBI: 66.5%. After a median follow-up of 13 months, 9 patients were cured of their hyperparathyroidism (75%) and 3 had persistent hypercalcemia. Our results suggest that CLCMV with 1-84 PTH measurement is the most accurate localization procedure in persistent hyperparathyroidism.
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PMID:[Role of selective venous catheterization with assay of parathormone 1-84 in the treatment of persistent hyperparathyroidism]. 929 68

Renal Cell Carcinoma is the third most common malignoma in urology. Only little is known about the etiology and risk factors; the age peak lies at 60 and twice as many men than women are affected. The clinical picture presents with a wide spectrum. Over one third of all tumours are detected accidentally by ultrasound or computed tomography in asymptomatic patients. Most common symptoms are hematuria and flank pain, the classical trials including in addition a palpable mass is rare and by mo means an early symptom. Paraneoplastic syndromes include unspecific (increased blood sedimentation rate, weight loss, fever) and endocrine symptoms (hypertension, polyglobulia, hypercalcemia). Diagnosis is based on imaging procedures. By means of sonography renal cysts may be separated from solid, space-occupying tumors. For the latter CT plays a decisive role for staging, therapeutic planning and prognosis. Further radiologic investigations (angiography, MRI) are indicated only in special situations. Rarely a biopsy is necessary for the distinction between renal cell carcinoma and metastases of other primary tumors. The only curative treatment of localized carcinoma is radical nephrectomy. Partial resection is indicated in cases of a single kidney, bilateral tumors and possibly also for tumors smaller than 4 cm in diameter. Radiotherapy is only initiated for palliation of painful skeletal metastases. In case of distant metastases--mainly pulmonary--nephrectomy should only be performed if systemic treatment is planned or if local complaints (pain, hematuria leading to anemia) exist. Chemotherapeutic drugs have no influence on survival. The effect of gestagens on life quality is questionable. Adoptive immunotherapy with cytokines (Interferon-alpha, interleukin-2) appears most promising. These substances, however, not yet been introduced into routine therapy should only be used in prospective studies. Furthermore, renal cell carcinoma is a potential candidate for gene therapy. After tumor nephrectomy follow-up investigations should be performed twice a year, because of the possibility of curative surgical treatment of late solid metastases. Prognosis of tumors restricted to the organ is good. Five year survival after operation is about 90%. However, is distant metastases exist already at the time of diagnosis 5 year survival drops to less than 10%.
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PMID:[Renal cell carcinoma--a current review]. 931 11

A case of MEN type I in a 64-year-old man is reported. He had undergone partial duodenectomy because of gastric ulcer and multiple duodenal polyps (gastrin secreting carcinoid). Blood examination revealed hypercalcemia, hyperPTHemia, and hyperprolactinemia. Neck US and CT showed enlargement of 4 parathyroid glands. Brain MRI revealed the microadenoma in left pituitary gland. Total parathyroidectomy with auto-transplantation in the left forearm were performed. Histological examination showed the hyperplasia of the parathyroid. Three and a half year after parathyroidectomy, there was no evidence of recurrence of gastrin secreting tumor and hyperparathyroidism, and enlargement of pituitary microadenoma. This is the first MEN type I case in Japan which have detected 3 endocrine tumors clinically with gastrin secreting duodenal carcinoid.
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PMID:[A case of multiple endocrine neoplasia type I with primary hyperparathyroidism, prolactin secreting pituitary microadenoma and gastrin secreting duodenal carcinoid]. 946 4

Although hypercalcemia may cause drowsiness, lethargy, weakness, confusion and coma it rarely causes seizures or cerebral infarction. The patient presented had a clinical evolution from hallucinosis to a generalized tonic-clonic seizure, and subsequent cortical blindness with occipital cerebral ischemia as evidenced by SPECT and MRI scans. EEG revealed occipital PLEDs. With reversal of hypercalcemia, there was a return of vision, resolution of EEG epileptiform activity, although with some residual occipital infarction. This case, in concert with a literature review of hypercalcemia, reveals examples of occipital and watershed ischemia, blindness, seizures and hypertension, a pattern markedly similar to that of eclampsia. Furthermore, medications such as magnesium sulfate, believed to reverse cerebrovasospasm responsible for the eclamptic neurologic findings, may counter the effects of hypercalcemia at a cellular level, lending support to a calcium-mediated injury in eclampsia.
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PMID:Reversible hypercalcemic cerebral vasoconstriction with seizures and blindness: a paradigm for eclampsia? 966 11


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