Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020438 (hypercalciuria)
 2,502 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighty-four patients with recurrent kidney stones, serum calcium levels in the upper normal quartile, and most of whom with hypercalciuria had their parathyroids surgically explored. Parathyroid adenomata were found in 19 patients, hyperplasia in 39, and normal parathyroids in 26. Postoperatively there was a significant fall in serum calcium and urinary calcium excretion in all three groups. At clinical follow-up 2 to 5 years postoperatively there was no case of kidney stone recurrence among the adenoma patients. In the hyerplasia group there were recurrences tn 25 percent. The corresponding figure for the patients with normal parathyroids was 48 percent. The concept of normocalcemic primary hyperparathyroidism and the relationship between this syndrome and idiopathic hypercalciuria are discussed. Some prinicpal therapeutic measures are recommended.
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PMID:Normocalcemic hyperparathyroidism, kidney stones, and idiopathic hypercalciuria. 112 10

In a short-term prospective study 36 patients with absorptive hypercalciuria were initially treated with diet alone followed by either trichlormethiazide (4 mg. per day) or oral neutral phosphate (1,500 mg. of elemental phosphorus per day) for 6 weeks. Study subjects were then crossed over to the second drug for an additional 6 weeks. In response to dietary treatment urinary calcium decreased from a pre-treatment value of 346 +/- 63 mg. per 24 hours to 308 +/- 90 mg. per 24 hours. Oral phosphate therapy caused a further decrease in urinary calcium to 218 +/- 85 mg. per 24 hours, an over-all decrease of 37 per cent. Parathyroid function did not change significantly with phosphate administration but circulating levels of 1,25-dihydroxyvitamin D decreased by 22 per cent (73 +/- 12 to 57 +/- 16 pg. per ml., p less than 0.001). Pre-treatment renal phosphate threshold did not correlate with the response to oral phosphate administration. Trichlormethiazide treatment led to a 34 per cent decrease in urinary calcium with a mean value on treatment of 228 +/- 80 mg. per 24 hours. 1,25-Dihydroxyvitamin D levels decreased by 10 per cent. Pre-treatment fasting calcium excretion, parathyroid function and 1,25-dihydroxyvitamin D levels did not correlate with the response to trichlormethiazide. We conclude that both drugs by pharmacological means improve the biochemical abnormalities in absorptive hypercalciuria and should be efficacious in its treatment.
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PMID:Trichlormethiazide and oral phosphate therapy in patients with absorptive hypercalciuria. 291 43

Hyperparathyroidism was described initially in the mid 1920s in patients suffering from a rare and severe form of bone disease, osteitis fibrosa cystica. In the 1940s and 1950s renal stone disease was recognized as a far more frequent complication of primary hyperparathyroidism than bone disease, and approximately half of the patients with primary hyperparathyroidism in clinical series published through the 1970s presented with renal stones. The introduction of routine determination of serum calcium concentration in the mid 1970s has had a dramatic impact on the frequency with which primary hyperparathyroidism is diagnosed in the population, particularly in older individuals with predominantly nonspecific symptoms of the disease. Stone complications appear to occur in less than 10 per cent of such patients. Underlying primary hyperparathyroidism is diagnosed in approximately 1 to 5 per cent of the patients with calcium stone disease. The predominant risk factor for stone formation in primary hyperparathyroidism is hypercalciuria, and patients typically present with moderate to marked hypercalciuria but with only mild hypercalcemia, in the range of 11 mg. per dl. or less. Hypercalciuria in these patients is principally the result of 1,25-dihydroxyvitamin D-mediated hyperabsorption of calcium from the intestine. The pattern of hypercalciuria disproportionate to the degree of hypercalcemia that typifies patients with primary hyperparathyroidism and stone disease reaches an extreme degree in patients with so-called subtle or normocalcemic primary hyperparathyroidism, in whom diagnosis by routine techniques may be difficult. Parathyroid exploration remains the treatment of choice in patients with primary hyperparathyroidism and stone complications.
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PMID:Primary hyperparathyroidism. 291 15

The purpose of the present investigation was to study various aspects of phosphate metabolism in renal calcium stone patients with special reference to the renal handling of phosphate and its relationship to other renal tubular functions and calcium metabolism. Serum phosphate and the capacity for renal tubular reabsorption of phosphate were lower in stone patients than in controls and decreased with advancing age. Reduced tubular phosphate reabsorption was particularly evident in stone patients with other tubular dysfunctions. Absorptive hypercalciuria was common, but unrelated to the renal tubular reabsorption of phosphate. Parathyroid hyperfunction was not observed in stone formers. Various loads of dietary phosphate resulted in similar renal adaptive responses in controls and stone formers. Orthophosphate supplementation had metabolic consequences with potentially beneficial effects for stone prevention (increased urinary pyrophosphate, decreased urinary calcium). The altered renal handling of phosphate in calcium stone formers may reflect a primary (independent of parathyroid hormone) renal tubular dysfunction in phosphate reabsorption.
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PMID:Phosphate metabolism and renal calcium stone disease. 627 3

Primary hyperparathyroidism (PHP) during pregnancy is well known to confer an increased risk of complications to both the mother and the fetus. However, the risks and optimal management of patients with mild, asymptomatic disease during pregnancy are much less clear. We observed a patient with mild, asymptomatic PHP who was diagnosed before conception through pregnancy. The patient remained asymptomatic through the first 22 weeks of pregnancy, and her calcium levels remained under 11 mg/dL. This occurred despite a dramatic elevation in the level of 1,25-dihydroxyvitamin D and marked hypercalciuria. Parathyroid surgery was performed at 22 weeks of gestation and a parathyroid adenoma was removed. Postoperatively, the patient's calcium level normalized and the rest of the pregnancy was uncomplicated. The patient delivered a healthy baby at 40 weeks of gestation. The neonatal course was unremarkable. We conclude that mild, asymptomatic PHP during early pregnancy is compatible with normal fetal development and an uncomplicated pregnancy and that the serum calcium level in such patients can remain stable with medical management alone, despite the marked changes in maternal calcium metabolism that characterize normal pregnancy.
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PMID:Course and outcome of pregnancy in a patient with mild, asymptomatic, primary hyperparathyroidism diagnosed before conception. 1098 91

A 63-year-old man was admitted to our hospital for the evaluation of hypercalcemia and anterior neck mass. Laboratory findings revealed hypercalcemia, hypophosphatemia, and hypercalciuria, as well as elevated serum levels of parathyroid hormone (PTH) and alkaline phosphatase. Computerized tomography and magnetic resonance images showed that the mass contained a cystic area. Parathyroid scintigraphy using either 99mTc-sestamibi alone or 201Tl-chloride in conjunction with 99mTc-pertechnetate for thyroid image subtraction showed uptake of the radioactivity into the cyst wall, suggesting that the mass originated from the parathyroid. Fine needle aspiration biopsy revealed that the cyst fluid was serous and bloody with extremely high concentrations of both PTH and CA19-9. The patient was diagnosed as primary hyperparathyroidism caused by parathyroid cyst and cervical exploration was performed. The cyst was dissected away along with the right lobe of the thyroid gland. After tumor removal, serum calcium and PTH levels were normalized. Histological study showed that the tumor possessed malignant potential with capsular invasion as well as moderate cellular atypia with trabecular pattern in arrangement. Parathyroid cells in the wall of the cystic tumor were immunostained positively for CA19-9, suggesting that CA19-9 in the cyst fluid was produced from the cells.
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PMID:Functional giant parathyroid cyst with high concentration of CA19-9 in cystic fluid. 1280 42

Because no comparative studies exist, no clear pronouncements can be made about the potential differences in effectiveness and safety between PTH 1-34 and PTH 1-84. As regards the efficacy, a convincing reduction of vertebral fractures was shown in both cases [Neer, R.M., Arnaud, C.D., Zanchetta, J.R., Prince, R., Gaich, G.A., Reginster, J.Y., Hodsman, A.B., Eriksen, E.F., Ish-Shalom, S., Genant, H.K., Wang, O., Mitlak, B.H., 2001. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N. Engl. J. Med. 344, 1434-1441; Greenspan, S.L., Bone, H.G., Ettinger, M.P., Hanley, D.A., Lindsay, R., Zanchetta, J.R., Blosch, C.M., Mathisen, A.L., Morris, S.A., Marriott, T.B., Treatment of Osteoporosis with Parathyroid Hormone Study Group, 2007. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann. Intern. Med. 146, 326-339]. A reduction of non-vertebral fractures was shown in the case of PTH 1-34 only. Another significant resemblance is that both medicines have a strong anabolic action; this mechanism of action is essentially different from the bisphosphonates and strontium ranelate. Both medicines constitute a welcome addition to the therapeutic arsenal for patients with severe osteoporosis. More data from literature (including information on follow-up data and use in men) are available for PTH 1-34 because it has been available for longer. As regards the side effect profile, PTH 1-84 appears to have a higher incidence of hypercalcemia, hypercalciuria and nausea than teriparatide. Here, too, no comparative study exists: the differences may therefore be based on an actual difference in side effects, or it may be ascribed to differences in definitions and/or patient populations.
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PMID:PTH-analogs: comparable or different? 1912 66

Primary hyperparathyroidism is a relatively common problem encountered in clinical endocrine practice. In most cases the diagnosis is relatively straightforward, however, when imaging studies fail to localize the parathyroid adenoma or hyperplasia, management can be challenging. We describe here such a case where the diagnosis was made by a novel method of analysis of parathyroid hormone levels in the needle wash obtained during fine-needle aspiration of a suspected parathyroid adenoma. A 60 year old white male was first seen in the endocrinology clinic for evaluation of osteoporosis. He had history of multiple compression vertebral fractures involving thoracic and lumbar vertebrae and fracture of right femoral neck following minimal trauma. He had high normal serum calcium and elevated urinary calcium levels. His parathyroid hormone level was within normal limits. Work-up for secondary causes of osteoporosis was unremarkable. He was started on hydrochlorthiazide therapy for a presumptive diagnosis of idiopathic hypercalciuria. Subsequently his serum calcium level became elevated and he continued to have significant hypercalciuria. The elevation in serum calcium persisted despite cessation of hydrochlorthiazide therapy. Parathyroid hormone level remained in mid-normal range. A diagnosis of primary hyperparathyroidism was considered at this stage and imaging studies were carried out to localize the parathyroid pathology. Parathyroid-sestamibi scan did not reveal any abnormality. Ultrasound examination of the neck showed a hypoechoic nodule posterior to right thyroid lobe. A fine needle aspiration of the nodule was carried out with estimation of parathyroid hormone level in the needle wash to indicate the presence of parathyroid adenoma. This was surgically removed later successfully with subsequent normalization of serum and urinary calcium levels. The current management of hyperparathyroidism is primarily surgical. Minimally invasive parathyroid surgery is the treatment of choice but it requires the clear localization of a parathyroid lesion for successful removal. In cases where preoperative localization is evasive, novel techniques, such as the one described above, can provide useful diagnostic information which can aid in the successful management of hyperparathyroidism. Further studies are needed before this technique can be applied on a more widespread basis.
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PMID:Parathyroid FNA and hormone assay. 1980 69