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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After confirming hypercalcemia by 3 successive measurements of the total plasma calcium corrected for a plasma protein concentration of 72 g/l, which excludes spurious hypercalcemia due to dehydration, the physician orientates the aetiological diagnosis bearing in mind that primary hyperparathyroidism PHPT is the cause of 85 p. 100 of all asymptomatic forms of hypercalcaemia whilst overt or occult malignancy is the main cause (60 p. 100) of symptomatic forms of hypercalcaemia with PHPT responsible for 20 p. 100 of cases. Other causes, including drug toxicity with Vit D, calcium, Vit A, lithium, thiazide and aluminium hydroxide, sarcoidosis, hyperthyroidism, Addison's disease, pheochromocytoma and familial endocrine disorders are much rarer. Nevertheless, these rarer causes must be excluded on the clinical history and examination followed by radiological (chest X ray, plain abdomen X ray, bone X rays) and simple biological tests. The latter and/or scans tests should also help in a rapid diagnosis of metastatic carcinoma and multiple myeloma, so that the major diagnostic problem is to distinguish primary HPT from occult malignancy. This problem is greatly facilitated by reliable assays of C terminal or medium PTH rather than renal CAMP which is increased in 80 p. 100 of occult malignancies. When PTH assays is unavailable or unreliable Dent's hydrocortisone suppression test may be useful as a fall in'serum calcium is associated with occult malignancy in 70 p. 100 of cases and non-suppression is associated with PHPT in 91 p. 100 of cases. Discriminant analysis of the usual biochemical parameters may be helpful in this differential diagnosis and is accurate in about 90 p. 100 of cases. However, the association of PHPT and malignancy is also possible and not fortuitous.
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PMID:[Stages of the etiological diagnosis of hypercalcemia]. 389 Jun 61

Parathyroid carcinoma is an uncommon endocrine tumor. Its usual clinical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is very rare. There are 12 reported cases in the literature. This paper is a case report of a nonfunctioning parathyroid carcinoma and a review of the literature.
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PMID:Nonfunctioning parathyroid carcinoma: a case history. 394 79

Since 1974, a concerted effort has been made to identify and biopsy all parathyroid glands in patients presenting with primary hyperparathyroidism. From 1974 until July 1982, 247 patients had initial cervical exploration for primary hyperparathyroidism. The percentage of patients in whom four or more glands were identified rose from 53 per cent in 1974 to as high as 88 per cent, with a mean of 80 per cent during the 8.5-year period. Ectopic location, prior thyroid surgery, and detrimental effects of prolonging surgery in some patients are reasons precluding localization of all glands in every patient. The percentage of biopsies positive for parathyroid tissue rose from 78 per cent in 1974 to 94 per cent in 1982. Routine biopsy of all glands provided the following results of classification in the 247 cases: adenoma, 56 per cent; diffuse hyperplasia, 18 per cent; nodular hyperplasia, 24 per cent; carcinoma, 0.8 per cent; and in three cases, four normal glands were identified. The one major complication was a case of temporary bilateral recurrent laryngeal nerve palsy. Mean follow-up period is 3 years. There was no case of permanent hypocalcemia and no operative deaths. Persistence and recurrence rates are 4.9 per cent and 0.4 per cent, respectively. Four of the patients with persistence and the one patient with recurrence have required reexploration. All but one of these was considered cured by reoperation. Eight of the 12 patients with initial persistent hypercalcemia postoperatively have been managed conservatively. These results suggest routine attempts to identify and biopsy all glands can be performed with minimal risk and complications and without permanent hypocalcemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of routine biopsy of all parathyroid glands in primary hyperparathyroidism. 396 25

Parathyroid carcinoma, although rare, represents 0.5-4.0 per cent of the cases of hyperparathyroidism. The authors have encountered five cases of parathyroid carcinoma in their experience treating 445 patients with primary hyperparathyroidism (1.1%) since 1965. All five patients were women, ranging in age fro 29 to 60 years, and had marked hypercalcemia at the time of presentation, with values up to 26 mg/dl in one case. All the tumors were locally adherent to surrounding structures at the time of parathyroidectomy. Pathologically they were characteristic with a dense sclerotic reaction and fibrous bands criss-crossing islands of parathyroid cells. Three patients with local as well as distant metastases have died as a result of recurrent parathyroid carcinoma (follow-up: 2, 3, and 6 years). The remaining two patients became normocalcemic following resection, and have been asymptomatic for 1 and 7 years, respectively. The overall survival and clinical course, in our limited experience with five parathyroid carcinoma cases demonstrates that the morbidity and mortality in these patients is mainly due to local recurrence with the resultant metabolic disturbances, as has been previously noted in the literature.
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PMID:Parathyroid carcinoma. A report of five cases. 401 80

Dual tracer parathyroid imaging (DTPI) using Tc-99m and TI-201 has a reported sensitivity of 92% for the detection of parathyroid adenomas. A patient with biopsy-proven parathyroid adenoma as well as papillary thyroid carcinoma is presented. To date, this is the first such case ever to be reported and implies that DTPI, although a sensitive diagnostic modality for parathyroid adenoma detection, is not specific. The diagnosis of primary hyperparathyroidism has recently been established more frequently than in the past due to detection of elevated serum calcium levels on routine blood samples, relatively sensitive parathormone (PTH) assays, and noninvasive imaging modalities such as nuclear medicine, CT scanning, and ultrasonography. At our institution, we have successfully detected the location of parathyroid adenomas in many cases, using the dual tracer method with TI-201 and Tc-99m, confirmed at surgery. We present a case of primary hyperparathyroidism in which two distinct lesions were detected by nuclear imaging: one lesion was proven at surgery to be a parathyroid adenoma, while the other represented thyroid carcinoma.
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PMID:Co-existent parathyroid adenoma and thyroid carcinoma. Nonspecificity of dual tracer parathyroid imaging for parathyroid lesions. 404 7

In our first 200 cases of primary hyperparathyroidism confirmed by operation 12 were also shown to have a long history either of a malabsorption syndrome or of chronic renal-glomerular failure. We consider that they first went through a phase of secondary hyperparathyroidism, during which one or more of the glands became autonomous adenamata. This then produced the biochemical changes of "primary" hyperparathyroidism, necessitating excision of the adenoma. This condition is best described as "tertiary" hyperparathyroidism. The transition from secondary to tertiary hyperparathyroidism occurred in four of the 12 patients while under our observation. We think the same process can be traced retrospectively in the other eight cases. The concept of tertiary hyperparathyroidism may help to explain the high incidence of other diseases in association with primary hyperparathyroidism.The behaviour of the parathyroid glands provides a valuable model for the investigation of tumour formation in man. All states occurred in our patients with primary hyperparathyroidism, from normal through hyperplasia to adenoma formation and finally to parathyroid carcinoma.
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PMID:Tertiary hyperparathyroidism. 569 Dec

We describe a patient with multiple endocrine adenomatosis Type I, characterized by pituitary-dependent Cushing's Syndrome, marked hyperprolactinaemia, primary hyperparathyroidism and hyperinsulinism leading to hypoglycaemia. The patient subsequently developed an exocrine pancreatic carcinoma at the age of 32 years from which she died. An additional finding was the demonstration by immunocytochemistry of nesidioblastosis in the pancreas.
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PMID:A case of multiple endocrine adenomatosis (Type 1) with nesidioblastosis, terminating with an exocrine pancreatic carcinoma. 613 20

The extent of surgery in the treatment of primary hyperparathyroidism should be based on the pathologic entity of the disease. In neoplasia (either the common adenoma or the rare carcinoma), excision of the diseases parathyroid will generally suffice to cure the disease, but in primary hyperplasia, the removal of all the diseased glands except for a small amount of glandular tissue is required. The pathologic diagnosis of primary hyperparathyroidism can usually be made by a macroscopic assessment of the parathyroid. It is further delineated by the density test and confirmed by Sudan fat-frozen section examination.
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PMID:Surgery of hyperparathyroidism: a conservative approach. 616 29

Dichloromethylene diphosphonate (Cl2MDP) a potent inhibitor of osteoclast-mediated bone resorption, lowers serum calcium in hypercalcemia associated wit malignancies and with primary hyperparathyroidism, and reduces excess calcium mobilization from bone in multiple myeloma and in Paget's disease. We have evaluated the effectiveness of intravenously administered Cl2MDP in five patients with parathyroid carcinoma, a disorder characterized by severe hypercalcemia, very high parathyroid hormone (PTH) levels, and marked osteoclast-mediated bone resorption. All patients had biopsy-proved metastatic parathyroid carcinoma and hypercalcemia which persisted after multiple surgical procedures and other attempts at management. During a three-day observation period, each patients continued to demonstrate stable or progressive hypercalcemia despite infusion with saline solution and furosemide. Cl2MDP was administered over 2 hours at 2.5 mg/kg on day 1 and 5 mg/kg on days 2 through 7. Response was noted in all five patients; there was a gradual decline in the average serum calcium from 16.0 +/- 1.1 mg/dl (SEM) to 11.1 +/- 0.9 mg/dl by the eighth day (p less than 0.01). There were concomitant reductions in urinary calcium excretion, from 798 +/- 153 mg/g creatinine to 350 +/- 96 mg/g creatinine (p less than 0.05) and in the urinary hydroxyproline excretion, from 155 +/- 38 mg/g creatinine to 94 +/- 29 mg/g creatinine (p less than 0.02). Serum PTH levels remained markedly elevated (460 +/- 141 micrograms eq/ml to 493 +/- 169 micrograms eq/ml). In three patients, all indices returned to pretreatment levels by 10 days after the last infusion. In two of these patients there was a response to retreatment with Cl2MDP with a fall in calcium from 16.9 +/- 0.5 mg/dl to 12.4 +/- 1.5 mg/dl. There was no response in one patient. No adverse reactions to Cl2MDP were observed. The decrease in serum calcium and concomitant declines in urinary calcium and hydroxyproline suggest that Cl2MDP can effectively inhibit the excessive bone resorption associated with parathyroid carcinoma.
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PMID:Therapy of hypercalcemia due to parathyroid carcinoma with intravenous dichloromethylene diphosphonate. 621 78

Carcinoma of parathyroid accounts for one to two percent of patients with primary hyperparathyroidism. A patient admitted to our medical center gave us the opportunity to follow the course of the clinical laboratory findings and the effect of treatment modalities on these laboratory measurements. The clinical course included hypercalcemia, hypophosphatemia, pancreatitis, consumptive coagulopathy, pancytopenia, and sepsis. As vitamin D3 plays and important role in calcium homeostasis, 1,25-(OH)2- vitamin D3 was measured at several points during the clinical course. These finding may serve to help understand some of the underlying control mechanisms involved in the hypercalcemic state.
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PMID:Case report: clinical pathological correlations in a case of primary parathyroid carcinoma. 623 88


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