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

With increasing awareness of cost-containment measures, early discharge after parathyroidectomy for primary hyperparathyroidism is to be evaluated. This report concerns the Cleveland Clinic experience with the last 70 consecutive patients treated for primary hyperparathyroidism from June 1981 to June 1983. The mean postoperative hospital stay was 1.4 days. Most patients were discharged on the morning of the second postoperative day receiving oral calcium supplements for 3 weeks. Three patients were discharged on the morning of the first postoperative day. The overall mortality rate was 0%. Morbidity included two patients (2.9%) who developed symptoms of mild tetany after discharge that responded to an increased dose of oral calcium. The usual practice of most surgeons of delaying hospital discharge after neck exploration for primary hyperparathyroidism for 5 to 7 days in fear of symptomatic hypocalcemia is unnecessary. Considerable cost containment can be achieved by sparing patients from 3 to 5 extra days of hospitalization.
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PMID:Parathyroidectomy for primary hyperparathyroidism: early discharge. 650 68

It is possible to assess bone resorption from a determination of urinary excretion of hydroxyproline, which is the specific amino-acid of collagen. As dietary collagen affects 24-hour urinary excretion of hydroxyproline, it has been stated that the urine should be collected under a gelatin-free diet. A new sampling method was described in the present paper for the determination of hydroxyproline in urine, which could eliminate the affection of dietary collagen by simple fasting. The method was useful for the evaluation of bone metabolism in patients with parathyroid disorders. 10 patients with primary hyperparathyroidism (3 skeletal types and 7 non-skeletal types), 3 patients with idiopathic hypoparathyroidism and 5 normal subjects were studied. It was found that the urinary excretion of hydroxyproline increased at night and diminished during the day in patients with primary hyperparathyroidism as well as in normal subjects, but this diurnal rhythm was not clear in a patient with idiopathic hypoparathyroidism. A pilot study revealed that 10 g gelatin administered orally did not affect the urinary excretion of hydroxyproline after a 12-hour fast. Therefore, 2-hour urine samples (700 h-900 h) were collected, and blood samples were drawn at 800 h after a 13-hour fasting from 1800 h on the previous day to 700 h in the morning studied. The urinary excretion of hydroxyproline was expressed as follows: HOP (microgram/ml)/Cr(mg/dl). The 2-hour urinary excretion of hydroxyproline thus determined was highly correlated with that determined in 24-hour urine collected under a gelatin-free diet (r = 0.995, p less than 0.001) and with the total serum alkaline phosphatase activity (r = 0.987, p less than 0.001). The levels of 2-hour urinary excretion of hydroxyproline in normal subjects were 0.18-0.28 in range, and those in patients with the skeletal type of primary hyperparathyroidism were high. However, the levels were not always higher than those in the patients with the non-skeletal type, in which cases the 2-hour excretion of hydroxyproline was higher than 0.50 except in one patient. The 9 patients with primary hyperparathyroidism who had elevated levels of the 2-hour urinary excretion of hydroxyproline showed tetany after parathyroidectomy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Urinary excretion of hydroxyproline in parathyroid disorders, with special reference to its changes before and after parathyroidectomy in primary hyperparathyroidism]. 668 63

Data on the management of primary hyperparathyroidism during pregnancy are sparse and relatively few parathyroidectomies have been performed during pregnancy. Provided the diagnosis can be established with reasonable certainty, removal of a parathyroid adenoma should be undertaken during the second or at the beginning of the third trimester. Parathyroidectomy in the hands of a surgeon familiar with this operation carries few risks. The complication rate of untreated cases may reach 80 per cent and include spontaneous abortion, fetal death and neonatal tetany. We present two cases of pregnant women who underwent successful parathyroidectomy during the course of gestation.
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PMID:The treatment of primary hyperparathyroidism during pregnancy. 669 28

The parathyroid response to an EDTA infusion was measured in 11 patients with hypoparathyroidism and 22 patients with normocalcaemic tetany, and compared to that of normal controls and of 23 patients with primary hyperparathyroidism. Despite comparable basal PTH values, the patients with hypoparathyroidism and the normocalcaemic patients, with tetany following thyroid surgery, responded less than normals to EDTA, while normocalcaemic patients with tetany due to psychogenic hyperventilation responded more than normals. In hypoparathyroidism, mainly three types of results were observed: no response (total hypoparathyroidism), diminished or delayed response (partial hypoparathyroidism), and discrepant results using different antisera in cases of idiopathic hypoparathyroidism, suggesting the secretion of immunologically abnormal PTH. In tetany due to psychogenic hyperventilation, parathyroid hyperreactivity might be explained by repeated stimulation through respiratory alkalosis. Although the EDTA test rarely improved the diagnostic accuracy of basal PTH measurements in primary hyperparathyroidism, it was useful for differentiating between latent hypoparathyroidism and tetany due to psychogenic hyperventilation, both presenting with normal plasma calcium.
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PMID:Parathyroid response to EDTA in hypoparathyroidism and in tetany. 677 88

Analysis of a series of 205 surgically treated cases of primary hyperparathyroidism was carried out to assess the long-term results of the conservative approach of selectively removing the adenoma only. If primary hyperparathyroidism is due to multiple gland involvement in one-third to one-half of patients, an appreciable number of patients with recurrent disease should have been encountered during this study of the results of conservative no instances of permanent tetany, supports the conservative approach to the treatment when only a single enlarged gland is encountered. Subtotal parathyroidectomy should be reserved for those few cases in which multiple enlarged glands are found, especially in association with multiple endocrine neoplasm, familial hyperparathyroidism, and secondary hyperparathyroidism.
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PMID:Primary hyperparathyroidism: the case for conservative surgery. 738 86

Two hundred forty-two patients with primary hyperparathyroidism operated on at Akron City Hospital are reviewed. The importance of the association of peptic ulcer and pancreatitis with primary hyperparathyroidism is stressed. Nineteen percent of the patients had associated peptic ulcer or pancreatitis. The mechanisms involved in the production of these diseases in patients with primary hyperparathyroidism are emphasized. The two deaths occurred in the small but challenging group of patients with acute parathyroid crisis and carcinoma. The decision concerning the extent of parathyroidectomy should be made by the surgeon for each patient, based on the number, location and gross appearance of the identified glands. Removal of a single enlarged gland, if the other three glands are normal, is all that needs to be done in most cases. A recurrence rate of 1 percent and an appreciable decrease in postoperative tetany support this conservative approach. Subtotal parathyroidectomy should be reserved for patients with diffuse hyperplasia.
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PMID:Primary hyperparathyroidism. A personal experience with 242 cases. 743 21

Primary hyperparathyroidism has to be accused to cause serious morbidity during pregnancy not only on the maternal, but also on the fetal side: the fetus is threatened by prematurity, dystrophy and an increased risk of stillbirth. Postpartually hypocalcaemia and tetany may be observed as the result of neonatal hypoparathyroidism caused by maternal and thus also fetal hypercalcaemia. We report the case of a 32-year-old pregnant woman suffering from a severe form of primary hyperparathyroidism caused by an adenoma of the parathyroidea. The tumor was removed in the 34. week of pregnancy. Six weeks later the patient delivered a healthy boy (birth weight 3450 g). A survey is given of the therapeutical procedures that should be arranged individually by interdisciplinary consulting depending on the degree of maternal disease and on the gestational age.
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PMID:[Primary hyperparathyroidism and pregnancy. Aspects of neonatal morbidity]. 794 30

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

Studies of the effect of parathyroidectomy (PTX) on bone turnover in patients with the combination of primary hyperparathyroidism (PHPT) and Paget's disease (PD) are largely limited to case reports. The etiology of the combination is disputed. We report 30 patients and their biochemical (n = 17) and histomorphometric (n = 4) responses to PTX in 18. All 18 patients except one had a post-PTX fall in plasma alkaline phosphatase (pAP). There was a significant positive correlation between the degree of post-PTX fall in pAP and both the preoperative plasma total corrected calcium (CaC) (P < 0.01) and serum ionized calcium (P < 0.05). For the patients with CaC levels >3.0 mmol/liter, the mean % fall in pAP was 68% of pretreatment (to 32%). For those with CaC levels >/=2.68 mmol/liter the fall in pAP was >18%. Of 12 literature cases treated by PTX and followed up, 11 had a postoperative fall in pAP (range 6-83%). Pretreatment bone biopsies (n = 6) could not be distinguished from uncomplicated PD. No significant histomorphometric changes were documented postoperatively in the four patients studied; however, % fibrotic surfaces declined in each of the four. Of the 18 patients, only one had radiologic subperiosteal erosions preoperatively; none had clinical tetany postoperatively-thus distinguishing this combination of diseases from severe PHPT bone disease-a situation easily biochemically confused with this combination. The sex distribution of 2.75:1 F/M in this series resembles reported ratios in pure PHPT of 2.37:1, unlike the ratios found in pure PD (0.49-1.01:1). The prevalence of PHPT in PD is 2.2-6.0% (mean 4.4%) in 1836 patients. In our series, 73% of patients with both diseases were females >60 years of age. In population studies >60 years, PHPT was present in 3% of women and 1% of men. Hypercalcemia in PD is frequently attributed to immobilization. As part of this study, we examined 184 patients referred with PD for the existence of, and cause of hypercalcemia. Of this group, 21 were hypercalcemic, 19 (90%) of whom had PHPT; none had immobilization hypercalcemia. In patients with both disorders, the indications for PTX should include the potential post-PTX improvement in pagetic biochemistry and symptoms. The sex distribution (resembling pure PHPT) and the similar prevalence of PHPT in Paget's, and in the elderly population, support the likelihood, in most cases, that these two common diseases are associated by chance.
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PMID:Thirty cases of concurrent Paget's disease and primary hyperparathyroidism: sex distribution, histomorphometry, and prediction of the skeletal response to parathyroidectomy. 1059 60

The authors describe a female patient with large parathyroid gland adenoma presenting with clinical symptoms of primary hyperparathyroidism and severe hypercalcaemia. Before planned surgical treatment the patient spontaneously developed clinical symptoms of tetany. Hypocalcaemia was confirmed by laboratory test. The reason turned out to be spontaneous necrosis of the parathyroid adenoma, resulting in remission of hyperparathyroidism. After stabilization of calcium levels, the necrotic adenoma was removed and histopathological examination revealed necrotic adenoma with only occasional vital adenoma cells. During the next follow-up the patient was without any subjective complaints and her state was stable. This phenomenon, yet described in the literature in past, belongs to unusual findings.
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PMID:[Spontaneous necrosis of parathyroid adenoma]. 1563 35


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