Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes a case of primary hyperparathyroidism in a 68-year-old man. The endocrine disorder, while suspected before the commission of homicide and attempted murder, was proven biochemically and histologically a number of months after the commission of the crimes. The acts of homicide and attempted murder followed the development of paranoid delusions, which rapidly resolved upon successful removal of a single cystic parathyroid gland adenoma. The unusual events that immediately followed the acts of violence indicate that the delusions occurred in a clear sensorium (absence of delirium). Psychological measures taken before and after surgery document improvement in subtle organic functioning while intelligence was unchanged. This report discusses the neuropsychiatric manifestations of hypercalcemia and reviews the literature.
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PMID:Primary hyperparathyroidism, hypercalcemia, paranoid delusions, homicide, and attempted murder. 366 84

A 67-year-old woman who had primary hyperparathyroidism presented with delirium rather than dementia as the predominant psychologic manifestation. After surgical removal of a parathyroid adenoma, there was a dramatic improvement in mental status. Psychologic retesting at six weeks after discharge showed her to be well oriented to time, place, and person, with no impairment of cognitive capacity.
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PMID:Delirium as the predominant manifestation of hyperparathyroidism: reversal after parathyroidectomy. 647 Mar 89

Renal failure is relatively common, but except in association with spina bifida or paraplegia it is unlikely to occur as a result of disease of the CNS. Renal failure, however, commonly affects the nervous system. The effects of kidney failure on the nervous system are more pronounced when failure is acute. In addition to the important problems related to renal failure there are both acquired and genetically determined diseases which may affect the kidney and the brain. Those acquired diseases include the vasculitides, the paraproteinaemias, and various granulomatous conditions (considered in other chapters of Neurology and Medicine). In two of the most commonly encountered genetically determined diseases, Von Hippel-Lindau disease and polycystic kidney disease, location of pathogenic mutations will provide improved screening programmes and, possibly, allow therapeutic intervention. Uraemia may affect both the central and peripheral nervous systems. Whereas the clinical features of uraemia are well documented, the pathophysiology is less well understood and probably multifactorial. Uraemic encephalopathy, which classically fluctuates, is associated with problems in cognition and memory and may progress to delirium, convulsions, and coma. The encephalopathy may initially worsen with periods of dialysis and almost certainly relates to altered metabolic states in association with ionic changes and possibly impaired synaptic function. Renal failure may affect the peripheral nervous system, resulting in a neuropathy which shows a predilection for large diameter axons. This may be reversed by dialysis and transplantation. The myopathy seen in renal failure, often associated with bone pain and tenderness, is similar to that encountered in primary hyperparathyroidism and osteomalacia. Dialysis itself is associated with neurological syndromes including the dysequilibrium syndrome, subdural haematoma, and Wernicke's encephalopathy. Dialysis dementia, which was prevalent during the 1970s, has reduced in frequency with the use of aluminium free dialysate. With the introduction of transplantation and the concomitant use of powerful immunosuppressive drugs, the pattern of neurological problems encountered in renal replacement therapy has shifted. Five per cent of patients develop nerve injuries during renal transplantation, and up to 40% of patients experience neurological side effects from cyclosporine. Furthermore, CNS infections, often fungal in type, have been reported in up to 45% of transplant patients coming to postmortem. The nature of the involvement of neurologists with their nephrology colleagues is therefore evolving.
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PMID:Neurology and the kidney. 985 55

Hyperparathyroid crisis is an uncommon clinical state characterized by severe hypercalcemia which can produce an acute confusional syndrome (ACS) or delirium. We are reporting the case of a 58-year male with calcemias greater than 14 mg/dl, that were due to a parathyroid adenoma (primary hyperparathyroidism), and caused his admission in UCI with change in the conscience level, global afectation of the cognitive functions, letargia and disorentiation among other clinical symptoms. The patient was operated by our Service on lower left parathyroidectomy with PTH rapid or turbo assay and decreasing such hormone levels about 75%. After the surgery his evolution was satisfactory obtaining the normocalcemia.
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PMID:[Acute confusional syndrome as first manifestation of primary hyperparathyroidism]. 1556 60

Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness.
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PMID:Lithium-associated primary hyperparathyroidism complicated by nephrogenic diabetes insipidus. 2650 22

This is the case of a 76-year-old man admitted to hospital in a delirium state, previously diagnosed with a major depressive disorder at an age of 50 years, treated for years for chronic tension headache. The computed tomography of the head resulted negative. Inpatient laboratory tests revealed a mild hypercalcemia. Due to the progression of the disease (delirium state, dementia, tension headache, and depression), he was again admitted to hospital. The patient showed dysarthria, postural tremors, mirror movements and palmar hyperhidrosis, mild ataxia when walking, and rigidity. Sleep disturbances were also observed. He underwent several clinical diagnostic tests, which resulted negative. After more than 2 years, the ultrasound of the neck identified enlarged parathyroid glands. The patient was surgically treated, and three parathyroid glands were removed. Parathyroidectomy and lithium treatment resulted in improvement of cognitive functions. In elderly patients, concomitant presence of cognitive dysfunction may mask the underlying primary hyperparathyroidism.
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PMID:Dementia Improvement after Primary Hyperparathyroidism Surgery. 3267 Mar 75