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

Urolithiasis occurs in about 20% of patients undergoing cervical exploration for primary hyperparathyroidism. A small number of these patients may require surgical removal of the renal stones because of either obstruction or infection. The traditional surgical modalities for stone removal have been replaced by extracorporeal shock-wave lithotripsy, ureteroscopic stone removal, and percutaneous lithotripsy. During the period 1980 through January 1989, 22 patients underwent combined cervical exploration for primary hyperparathyroidism and treatment of renal or ureteral stones with a single general anesthetic at our institution. This study demonstrates that this approach can be performed safely with a high success rate and negligible morbidity and that this approach may have cost-effective implications.
Surgery 1989 Dec
PMID:Primary hyperparathyroidism and urolithiasis: concomitant surgical management. 258 26

Although potentially useful in the understanding of hypercalcemic states, a satisfactory animal model of primary hyperparathyroidism has not been developed. Models that use transplants of supernumerary parathyroid (PT) glands or chronic parathyroid hormone (PTH) infusion are not ideal for many reasons. We report a new animal model in which athymic nude mice were used as recipients of human PT tissue heterografts. Three groups received 14, six, or one piece of PT adenoma tissue, and one group received six pieces of normal PT tissue. The significantly higher PTH levels in mice that received adenoma heterografts versus those with similar amounts of normal tissue suggest that adenomatous tissue is functionally distinct. A dose-response relationship between induction of hypercalcemia and the number of pieces implanted was in evidence, although only a small percentage of the mice with high PTH levels developed hypercalcemia. This differential response could be the result of any of several factors: (1) loss of ability to secrete bioactive PTH, (2) differing secretion rates among donor adenomas, (3) variability in host responsiveness to human PTH, and (4) requirement of additional factor(s) to generate consistently the hypercalcemia characteristic of human primary hyperparathyroidism.
Surgery 1989 Dec
PMID:Primary hyperparathyroidism: a new experimental animal model. 258 27

Nifedipine was administered orally to 2 patients with primary hyperparathyroidism before and after parathyroidectomy. The operation lowered serum calcium concentration and parathyroid hormone but did not alter plasma renin activity, plasma aldosterone concentration, and serum magnesium. The hypotensive effects of nifedipine were markedly enhanced with the decrease in serum calcium concentration following parathyroidectomy. Thus, the level of serum calcium concentration may modulate the hypotensive effect of nifedipine in humans.
Angiology 1989 Dec
PMID:Hypotensive effects of nifedipine in patients with primary hyperparathyroidism: case reports. 259 42

The prevalence of peptic ulcer disease was retrospectively analysed in 35 patients affected by primary hyperparathyroidism consecutively observed from 1977 through 1987. Eight of the examined patients (22.8%) had peptic ulcer (7 duodenal and 1 gastric ulcer), that in five cases (14%) represented the first clinical manifestation of the endocrine disease. A Zollinger-Ellison syndrome was demonstrated in three cases (8.5% of the total series, 37% of the patients with ulcer). There was no difference in calcium, gastrin and parathormone serum level between patients with and without ulcer, excluding patients with Zollinger-Ellison syndrome. These data confirm the high prevalence of peptic ulcer disease in hyperparathyroidism, but the mechanism causing this association remains to be elucidated.
Minerva Med 1989 Dec
PMID:[Primary hyperparathyroidism and peptic ulcer]. 262 74

The aim of this study was to assess the effect of hypercalcaemia due to primary hyperparathyroidism on the pressor and aldosterone responses to angiotensin II (Ang II) infusion. Five patients with hyperparathyroidism were studied, before and after parathyroidectomy, and were compared with five normal subjects. After 30 min of equilibration, Asp1-Val5 Ang II was infused in all subjects at stepwise increasing dose rates of 2 and 4 ng/kg per min for 30 min each. In the hyperparathyroid patients the baseline levels of plasma parathyroid hormone and calcium were significantly higher than in the controls, and returned to normal after the parathyroidectomy; plasma aldosterone and renin activity were normal both before and after the parathyroidectomy. Two hyperparathyroid patients had high blood pressure levels, which were normalized after surgery. The increase in the aldosterone response from baseline at each time point of the Ang II infusion was greater in the hyperparathyroid patients before than after the operation (P less than 0.05), and greater than in the normals (P less than 0.05). No difference in the increased response of systolic or diastolic blood pressure was observed between the hyperparathyroid patients, either before or after the parathyroidectomy, and the normal subjects. High levels of extracellular calcium or parathyroid hormone, or both, might play a primary role in the aldosterone hyper-responsiveness to Ang II in the hyperparathyroid patients. The similar pressor response to Ang II in hyperparathyroid patients and the normal subjects suggests that hypercalcaemia does not potentiate the vasoconstrictive action of Ang II.
J Hypertens Suppl 1989 Dec
PMID:Aldosterone and pressor responses to angiotensin II in primary hyperparathyroidism. 263 14

Twenty of 31 consecutive ultrasound examined patients with primary hyperparathyroidism were selected for treatment with ultrasound-guided percutaneous injection of ethanol (96%) into biopsy-verified solitary parathyroid tumours following a strict protocol with regard to dose, number of treatments and a minimum of 6 months follow-up. Of 18 patients completing the above protocol, a biochemical improvement was observed in 12, of whom eight became normocalcaemic during the follow-up period of 6 months after the last treatment. An obvious clinical improvement was seen in eight of the patients. In four patients, a unilateral vocal cord paralysis was observed, but was permanent in only one patient. Progressive fibrosis of the parathyroid tumours following injections impeded the intraglandular dissemination of ethanol. Another problem noted was the inability of ultrasound to detect multiglandular involvement. We find ultrasound-guided chemical parathyroidectomy an attractive alternative to surgery in patients who are not well suited for surgical intervention. However, the technique has not been fully developed, and in the present study, possible improvements are indicated.
Br J Radiol 1989 Dec
PMID:Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a prospective study. 269 Oct 6

In the submitted review the author pays attention to mechanisms of control of insulin secretion and the mutual interaction of other messengers (cAMP, calcium and inisitol triphosphate) with special attention to the calcium signal which plays a most important role in the stimulation of the excitable B cell. The trigger of the two-stage insulin secretion is cyclic accumulation of calcium in the cytosol of the B cell and the mutual harmony between calcium of the intra- and extracellular compartment. In the early stage of insulin secretion in particular the intracellular compartment is the source of calcium; from there the ion is released due to the action of inositol triphosphate (IP3) activated by phospholipase C. Calcium of the extracellular compartment is mobilized also in the early secretory stage by opening of the depolarization-dependent calcium channels, it plays, however, a more important part during the second stage. Activation of the other messengers, incl. the calcium signal, depends on the type of secretagogue stimulus. During systemic changes of calcium homeostasis in vivo the calcium signal of the B cell is activated or inhibited in different ways. In the course of hypercalcaemia, in particular if acute, the direct influence of calcium ions on insulin secretion is modulated by further factors, e.g. somatostatin, calcitonin, cholecystokinin, glucagon, adrenocortical hormones, opioids and other substances released into the blood stream. In chronic hypercalcaemia which is the result of primary hyperparathyroidism or vitamin D intoxication the action of calcium on the metabolic and hormonal response is enhanced by the ionophoretic action of parathormone or active vitamin D metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)
Cas Lek Cesk 1989 Dec 08
PMID:[The calcium signal in the regulation of insulin secretion]. 269 62

In this review, 123 explorations for primary hyperparathyroidism were performed, at which at least three glands were identified and specimens were taken for biopsy. Gross operative and histologic findings were evaluated and correlated with follow-up data. A new classification for disease of the parathyroid glands is devised in which microhyperplasia occurring in grossly normal glands is subclassified into two groups. One (Class II), consisting of hypercellularity only, is thought not to produce clinical hyperparathyroidism. The second group (Class III), which includes glands with nodular hyperplasia, abnormal cytologic findings or oxyphilic nodules, is considered clinically significant. Evaluation and follow-up study revealed three instances of clinical hyperparathyroidism attributed to Class III histologic changes, while there were no instances of recurrent or persistent hyperparathyroidism attributable to Class II disease. Involvement of multiple glands, both gross and microscopic, occurred frequently (26 per cent) and was often bilateral and nonuniform. We concluded that optimal surgical management of primary hyperparathyroidism is achieved by selective removal of parathyroid glands guided by the histologic findings in each gland.
Surg Gynecol Obstet 1989 Dec
PMID:Intraoperative histologic evaluation in exploration of the parathyroid glands. 281 66

The increase of nephrogenic cyclic AMP is an excellent index of parathyroid hypersecretion. A successful treatment of primary hyperparathyroidism results in a rapid fall in nephrogenic cAMP. In a series of 24 patients with proven primary hyperparathyroidism (hyperplasia 3, adenoma 21) and 2 patients with suspected hyperparathyroidism, the success of surgical excision was evaluated by measuring the urinary cAMP/urinary creatinine ratio (R), which in the absence of renal impairment, is proportional to the level of nephrogenic cAMP. Sequential assays of urinary cAMP and creatinine were performed during surgery; laboratory results were available within less than one hour. Among 22 patients with elevated baseline value or R, R became normal in 18 and decreased by more than 50% in 3; these findings suggested that the operation would be successful. In 1 case, R was not measured as the patient had impaired renal function. In another patient with normal baseline value of R, R did not significantly decrease after excision. Surgery failed in 1 patient, although the high value of R at the end of the operation should have prompted us to continue. Finally, in 2 patients the diagnosis was erroneous since R was lower than 0.5 as in controls. Surgeons, therefore, now have a reliable biochemical method at their disposal, but its use will be limited by its cost and complexity.
Presse Med 1987 Dec 19
PMID:[Surgery of primary hyperparathyroidism. Contribution of the peroperative assay of urinary cyclic AMP]. 282 56

To evaluate the cause of hypercalciuria, we carried out the oral calcium tolerance test before and after parathyroidectomy in a patient with primary hyperparathyroidism who had recurrent and multiple nephrolithiasis. Preoperative laboratory examination showed hypercalcemia, hypophosphetamia, hypercalciuria, decrease in % tubular reabsorption of phosphorus and strikingly elevated urinary cyclic AMP excretion. The oral calcium tolerance test indicated a significantly greater increase in serum calcium (delta serum calcium: 1.4 mg/dl vs 0.8 mg/dl) and a significantly greater suppression of urinary cyclic AMP excretion (delta U-cyclic AMP:-3.56 moles/gCre vs-1.17 moles/gCre) before parathyroidectomy than after. These results showed that hypercalciuria in this case was induced not only by the significant increase in the filtrated load of calcium but by the reduction in the resorption of calcium in the distal tubule caused by the significantly suppressed parathyroid hormone effect.
Hinyokika Kiyo 1987 Dec
PMID:[A case report: primary hyperparathyroidism--comparison before and after parathyroidectomy by oral calcium tolerance test]. 283 26


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