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

The physiologic relationship between the thyroid and parathyroid glands remains poorly understood. A high incidence of coexistent thyroid disease and primary hyperparathyroidism has been well documented. Elevation of serum 1,25-dihydroxyvitamin D3 (vitamin D) has been detected in some patients with primary hyperparathyroidism. A report of specific binding sites and uptake of vitamin D by the thyrotrophs of the anterior pituitary indicates that vitamin D may modulate production or secretion of thyroid-stimulating hormone (TSH). To test this concept, we investigated the influence of elevated serum levels of vitamin D on basal and stimulated TSH. Vitamin D was administered by subcutaneously implanted sustained-release pellets at four dosages. Thyrotropin releasing hormone (TRH) stimulation tests were performed at time zero, 72 hours, 1 week, 2 weeks, and 5 weeks. Animals administered vitamin D became significantly hypercalcemic and demonstrated elevations of vitamin D, which peaked at 72 hours and remained elevated for 2 weeks after pellet implantation. TRH-stimulated TSH levels were significantly elevated at 72 hours and at 1 week and returned to normal after 5 weeks. Parathyroid hormone levels were suppressed at 72 hours and at 1 week and displayed significant elevation at 2 weeks. These results provide in vivo evidence for an interaction and a possible regulatory role of 1,25 on pituitary TSH secretion and parathyroid function.
Surgery 1989 Dec
PMID:Altered TSH levels associated with increased serum 1,25-dihydroxyvitamin D3: a possible link between thyroid and parathyroid disease. 251 35

The authors report a case of primary hyperparathyroidism in a 47 year old woman presenting with cardiac arrhythmias. She had paraoxystic supraventricular tachycardias and rate-dependent ventricular hyperexcitability suggestive of a catecholamine-induced phenomenon which were resistant to antiarrhythmic therapy over a 3 year period; the plasma calcium concentration was 3.30 mmol/l. An ectopic parathyroid adenoma was removed surgically, normalising the biological changes, and no further arrhythmias were detected by Holter monitoring during the 2 year follow-up period. The association of atrial and ventricular arrhythmias seems to be relatively rate in hyperparathyroidism; patients usually present with atrioventricular block and ventricular hyperexcitability. The other cardiovascular abnormalities observed in hyperparathyroidism are hypertension and myocardial hypertrophy. The electrophysiological mechanisms underlying the clinical manifestations remain obscure.
Arch Mal Coeur Vaiss 1989 Dec
PMID:[Primary hyperparathyroidism disclosed by heart arrhythmia]. 251 34

Endocrine tumors of the pancreas are rare disorders that can cause life-threatening symptoms related to the excessive hormonal secretion and the malignant nature of the neoplasm. In addition, these neoplasms can present as part of familial endocrinopathy syndromes, especially multiple endocrine neoplasia type 1 (MEN-1). The initial step in evaluation of a patient with an islet cell tumor is definitive diagnosis of the hormonal syndrome that usually can be achieved biochemically. The next step is to reverse the life-threatening hormonal syndrome medically to allow radiographic localization of the islet cell neoplasm and to prepare the patient for elective surgery. In general, the goal of surgery is to accurately stage the extent of disease and to totally resect the tumor resulting in complete correction of the excessive hormonal condition and freedom from malignant progression of the tumor. Resection of the neoplasm should encompass metastatic disease in select individuals in whom complete or nearly complete resection can be achieved. Surgery must be performed with acceptable morbidity and mortality because the medical management of the excessive hormonal secretion in most patients is adequate and the progression rate of malignant islet cell carcinomas is usually slow. Patients with MEN-1 should be identified during evaluation by careful history and should be managed differently. These patients always have multiple islet cell tumors and may have malignant islet cell carcinomas. Large (3 cm) imageable pancreatic neoplasms in patients with MEN-1 should be resected because nearly 50 per cent are malignant. Zollinger-Ellison syndrome in patients with MEN-1 and primary hyperparathyroidism is best managed initially by surgery directed at the hyperparathyroidism. It may be impossible to correct the biochemical abnormalities of Zollinger-Ellison syndrome by islet cell tumor resection in patients with MEN-1. However, insulinoma or VIPoma syndromes can often be corrected by islet cell tumor resection. Portal venous sampling for hormones may be helpful in determining what hormone a specific tumor is secreting.
Gastroenterol Clin North Am 1989 Dec
PMID:The role of surgery in the management of islet cell tumors. 255 34

In some cases of primary hyperparathyroidism, in particular where neck exploration has been unsuccessful, an alternative to surgical therapy may be desirable. We studied the acute and chronic metabolic effects of attempted angiographic destruction by angiographic contrast infusion of solitary parathyroid adenomas in 18 patients with symptomatic disease. Fourteen patients had failed prior surgery; 4 patients had not undergone prior surgery but were extremely high surgical risks. Cervical adenomas were present in 17 of 18 subjects; mediastinal adenoma in 1 of 18. Sixteen patients underwent selective parathyroid venous catheterization, which facilitated subsequent arteriographic localization. Selective arteriographic localization and attempted angiographic ablation were performed in all subjects with standard contrast, renografin-60. Laboratory studies, including serum calcium and PTH, were frequently performed before and after attempted angiographic parathyroid ablation. In all patients serum calcium fell to normal or subnormal levels within 48 h of attempted ablation. Prolonged follow-up (mean, 35.1 months) revealed that ablation was curative in 12 of 18 (sustained normocalcemia) and partially effective in 1 of 18 patients. For the entire group serum calcium fell from 3.14 +/- 0.07 at presentation to 2.42 +/- 0.07 mmol/L at the end of follow-up (or before surgery in unsuccessful cases; P less than 0.001). In 4 of 5 failed cases hypercalcemia recurred within 2 weeks. All 5 failed cases underwent curative surgery, aided by accurate localization achieved during angiographic procedure. Several transient complications and 1 case of permanent hypoparathyroidism were noted. We conclude that angiographic ablation of cervical parathyroid adenomas can be considered as an extension of diagnostic angiographic procedures in selected cases of primary hyperparathyroidism who have failed prior surgery of possibly in rare cases where surgery is contraindicated.
J Clin Endocrinol Metab 1989 Dec
PMID:Arteriographic ablation of cervical parathyroid adenomas. 258 59

We obtained serial serum and urine samples from 14 patients with primary hyperparathyroidism both before and 3 to 9 months after excision of their parathyroid adenomas to (1) determine whether the circadian rhythms for calcium, phosphorus, and parathyroid hormone (PTH) previously described in normal human beings are disturbed in this disorder; (2) gauge the effect of surgical treatment on the patterns observed before intervention; and (3) ascertain whether time(s) of blood sampling can be defined for optimal biochemical detection of the disease. Significant rhythms for serum phosphorus, ionized calcium, PTH, urine phosphorus, and urine calcium were observed in many but not all patients before and after surgery. Nonetheless, collective analysis revealed the following: (1) diurnal patterns for serum ionized calcium, phosphorus, urine calcium, and urine phosphorus in patients with primary hyperparathyroidism both before and after surgery, whereas a rhythm for serum PTH was uniquely observed after surgical treatment; and (2) no significant correlation between preoperative serum ionized calcium and PTH but restoration of the expected reciprocal relationship between these variables after surgery. Although variability in individual expression of the rhythm for PTH precludes precise definition of a sampling "window" when hormone levels are likely to be highest, collection of data at points throughout the day helped establish the diagnosis of primary hyperparathyroidism in several patients with borderline serum biochemistries.
Surgery 1989 Dec
PMID:Circadian rhythms for calcium, inorganic phosphorus, and parathyroid hormone in primary hyperparathyroidism: functional and practical considerations. 258 6

Although the risks of reoperative thyroidectomy and parathyroidectomy have been well studied, the problems associated with parathyroidectomy after prior thyroidectomy have not been emphasized. Among a group of 282 patients who were treated for primary hyperparathyroidism in recent years at the University of Chicago Medical Center, 14 (4.8%) had undergone one or more previous thyroidectomies, and 6 others (2.1%) had undergone thyroid ablation with radioactive iodine as therapy for Graves' disease. Numerous difficulties were encountered during surgery in the postthyroidectomy group of patients as a result of scarring and fibrosis, prior recurrent laryngeal nerve injuries in 13%, the inability to known with certainty how many viable, normal parathyroid glands remained after previous operations, and the need for additional thyroid resection, mostly for associated malignant lesions. Preoperative vocal cord assessment, evaluation of prior operative and pathology reports, and localization studies with thallium-technetium scanning and ultrasonographic techniques were especially helpful. A "lateral approach" was used frequently during surgery. Each of these 14 patients was cured of the hyperparathyroidism. The postthyroid ablation group presented fewer intraoperative challenges, although in some patients the thyroid gland was virtually absent, which obscured the normal landmarks of the surgical field. Five of these six patients were cured of hyperparathyroidism. Parathyroidectomy after thyroidectomy presents many operative challenges to the surgeon and should be approached with the same care and concern that one reserves for a reoperative parathyroid operation.
Surgery 1989 Dec
PMID:Difficulties of parathyroidectomy after previous thyroidectomy. 258 7

Review of medical records in 600 consecutive cases of primary hyperparathyroidism revealed 10 patients with a documented history of iodine 131 (131I) treatment. In seven cases 131I had been given because of Graves' disease and in three cases for ablation of thyroid remnants after tumor operations. All but one of the patients were women. Their age at the time of 131I treatment ranged from 21 to 72 years, and the interval to detection of hypercalcemia was between 3 and 27 years. It is noteworthy that all patients treated for Graves' disease had absorbed radiation doses large enough to cause permanent hypothyroidism, and half of them showed complete absence of the thyroid gland at subsequent operation for hyperparathyroidism. Furthermore, parathyroid adenomas had developed at the sites of thyroid remnants in cases with 131I ablation after tumor operations. Our findings support other observations indicating that not only external radiation but also radiation from 131I is a risk factor for development of hyperparathyroidism, and it is emphasized that age at the time of radiation treatment may be of decisive importance in this context.
Surgery 1989 Dec
PMID:Hyperparathyroidism after treatment with radioactive iodine: not only a coincidence? 258 8

The pseudogout syndrome has been suggested to be a diagnostic clue of hyperparathyroidism or a complication after parathyroidectomy that abruptly relieves hypercalcemia. In this report of 20 patients who had pseudogout, eight had intermittent attacks of arthritis associated with chondrocalcinosis that led through the pseudogout syndrome to a confirmed diagnosis of primary hyperparathyroidism. In an additional 12 patients, the diagnosis of pseudogout was made in patients who suffered from acute arthritis after parathyroidectomy that relieved the primary hyperparathyroidism. The postoperative attacks were seen most commonly on or after the second day after surgery and were associated with the lowest point in serum calcium levels. Pseudogout occurred in one or more joints, often involving the knee. The diagnosis was proved by aspiration of joint synovial fluid in many of the patients and identification of calcium pyrophosphate dihydrate crystals. To estimate the incidence of pseudogout in the population of patients with primary hyperparathyroidism, these 20 patients were distinguished in 531 patients undergoing parathyroidectomy, for a 3.8% incidence of the pseudogout feature. No other markers of higher risk for this complication were apparent, including age, sex, biochemistry, or prior history. This collected experience suggests that (1) pseudogout is a biochemical entity associated with primary hyperparathyroidism and may offer a useful clue to the recognition of the disease in screening; (2) acute arthritis after parathyroidectomy is most likely pseudogout, and this complication occurs more frequently than has been recognized previously; (3) patients with hypercalcemia have a high incidence of calcium pyrophosphate dihydrate crystal deposition in articular cartilage (chondrocalcinosis); and (4) relative hypocalcemia after parathyroidectomy is a stimulus for crystal shedding into synovial fluid, which may precipitate acute attacks of pseudogout.
Surgery 1989 Dec
PMID:Pseudogout as a clue and complication in primary hyperparathyroidism. 258 10

A retrospective analysis of our renal transplant population between 1981 and 1987 was undertaken to study the natural history of posttransplant hypercalcemia and to review indications and recommendations regarding the timing of parathyroidectomy. During this period, 1158 renal transplant procedures were performed in 1025 patients, with 819 allografts (71%) functioning currently. Posttransplant hypercalcemia greater than 10.5 mg/dl was associated with a longer duration of dialysis and developed in 227 patients, with onset of hypercalcemia occurring in 90% of these patients by 1 year. In 69% of these patients, spontaneous resolution of the hypercalcemia occurred between 6 months and 7 years after transplantation. A total of 42 patients with asymptomatic hypercalcemia are currently being followed up, with a mean serum calcium level of 11.0 +/- 0.41 mg/dl and a mean follow-up interval of 3.3 +/- 1.6 years since transplantation. Nine symptom-free patients with moderate hypercalcemia (12.0 to 12.4 mg/dl) more than 1 year after transplantation were identified. Five of these patients had spontaneous resolution of the hypercalcemia between 2 and 7 years. Fifteen patients with posttransplant hyperparathyroidism (6.6%) required parathyroidectomy--11 for symptomatic and four for asymptomatic hyperparathyroidism. One patient had symptomatic hyperparathyroidism despite the presence of normocalcemia. One symptom-free patient with significant hypercalcemia (serum calcium level, 14.7 mg/dl) underwent parathyroidectomy 3 months after transplantation. The remaining three symptom-free patients had serum calcium determinations of greater than or equal to 12.5 mg/dl more than 1 year after renal transplantation. Patients with pretransplant and posttransplant hypercalcemia required parathyroidectomy more frequently than did patients with only posttransplant hypercalcemia (18% versus 3.0%; p less than 0.001). An unusual finding was the occurrence of a single adenoma in two patients, which represents sporadic primary hyperparathyroidism in the patient undergoing renal transplantation rather than tertiary hyperparathyroidism. We recommend a conservative approach to posttransplant hypercalcemia, with surgery reserved for patients with symptomatic disease and patients with asymptomatic persistent hypercalcemia greater than or equal to 12.5 mg/dl more than 1 year after transplantation.
Surgery 1989 Dec
PMID:Tertiary hyperparathyroidism after renal transplantation: operative indications. 258 12

The significance of bone demineralization was evaluated for 97 patients treated surgically for primary hyperparathyroidism since 1980. Of 31 patients studied by bone densitometry, 16 showed moderate to severe osteoporosis. In approximately 20% of the total group, bone demineralization, including a bone fracture problem in some, was the dominant or a major indication for operation. Serial bone studies in six patients taken preoperatively or in patients not operated on for primary hyperparathyroidism showed an average loss of bone mineral density of 0.9% per year, whereas in four patients treated surgically serial studies showed an average increase of 9.8% per year. Although estrogen intake reduced serum calcium levels, significant bone demineralization or fractures were present in four patients aged 40 to 59 years and in five patients more than 60 years of age who had taken estrogens for many years. We conclude that in primary hyperparathyroidism, bone demineralization (1) justifies surgical correction in a significant number of patients; (2) should be evaluated, especially in elderly women; (3) is not prevented by estrogen intake, which may instead confuse decision making; (4) is reversed after surgical correction, but suggestions of incomplete reversal emphasize importance of this factor; (5) should be considered in postoperative management; and (6) involves many variables.
Surgery 1989 Dec
PMID:Bone demineralization, a factor of increasing significance in the management of primary hyperparathyroidism. 258 13


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