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)

Twenty-five consecutive patients with either persistent or recurrent symptomatic primary hyperparathyroidism after 36 prior operations were prospectively studied to compare the usefulness of intraoperative measurement of urinary cyclic adenosine monophosphate (UcAMP) levels with standard surgical procedures to predict outcome during tedious parathyroid reoperations. The criterion based on UcAMP to predict successful outcome was a 50% decline in intraoperative UcAMP levels from the median baseline level after removal of abnormal parathyroid tissue. Standard surgical criteria were resection of four abnormal glands for hyperplasia and resection of one abnormal gland and biopsy examination of one normal gland for adenoma. In 15 patients (60%) surgery was terminated on the basis of UcAMP criterion. In one patient elevated UcAMP levels never changed and correctly predicted unsuccessful surgery. In nine patients surgery was terminated on the basis of surgical criteria, and each of these patients had a successful outcome. Operative UcAMP levels dropped after the completion of the procedure in six of these latter nine patients. Three patients did not show a significant decrease in UcAMP levels despite successful surgery, and one patient displayed an early false-positive decrease in UcAMP level. The intraoperative UcAMP criterion accurately predicted outcome in 21 of 25 patients (84%). Sensitivity of the UcAMP criterion was 87% and specificity was 50%. The results indicate that by either method a reliable prediction of the outcome of reoperative parathyroid surgery may be made. Intraoperative determination of UcAMP levels will allow successful termination of the reoperation in some patients before operative identification of adequate parathyroid tissue necessary to confidently establish the pathologic diagnosis.
Surgery 1988 Dec
PMID:Prospective analysis of intraoperative and postoperative urinary cyclic adenosine 3',5'-monophosphate levels to predict outcome of patients undergoing reoperations for primary hyperparathyroidism. 284 25

This study evaluates prospectively the effect of parathyroidectomy on basal acid output (BAO), maximal acid output (MAO), fasting serum gastrin, secretin-stimulated serum gastrin, and sensitivity to antisecretory medication in 10 consecutive patients with primary hyperparathyroidism (PHP), Zollinger-Ellison syndrome (ZES), and multiple endocrine neoplasia type I (MEN-I). After parathyroidectomy, 9 of 10 patients remained normocalcemic, and each had a lower BAO; 6 of 9 no longer had gastric acid hypersecretion (less than 15 mEq/hr). Seven of 9 normocalcemic patients had a lower MAO, and a decrease in fasting serum gastrin. Two patients showed no evidence of ZES, a normal BAO, normal fasting serum gastrin concentration, and a negative secretin response after parathyroidectomy. Parathyroidectomy also reduced the dose of histamine H2-receptor antagonist required to control gastric acid secretion in 60% of patients. After successful parathyroidectomy three patients were studied for drug sensitivity, and each had greater acid inhibition with a given dose of histamine H2-receptor antagonist than preoperatively. One patient remained hypercalcemic after surgery and had no change in BAO, MAO, or gastrin. All patients with postoperative normocalcemia will have a lower BAO, 80% a lower MAO, 80% a decreased fasting serum gastrin, and 33% a negative secretin test. Antisecretory medication dose can be reduced because patients have reduced BAO and increased sensitivity to histamine H2-receptor antagonist. The study supports parathyroidectomy as the initial surgical procedure of choice in patients with PHP, ZES, and MEN-I.
Surgery 1987 Dec
PMID:Effect of parathyroidectomy in patients with hyperparathyroidism, Zollinger-Ellison syndrome, and multiple endocrine neoplasia type I: a prospective study. 289 Dec 1

We found that a few patients with urolithiasis had normal parathyroid hormone levels but high cyclic AMP excretion. The purpose of this paper was to study the endocrinological mechanism. Male rats were given intraperitoneally dibutyryl cyclic AMP (DBcAMP), a derivative of cyclic AMP, per 100 gm of body weight for 50 days. Feed and water were supplied ad libitum. Crystal formation or calcification in mainly the dystal tubules and collecting system were found in 3 out of 10 rats, and renal calcium stones in 2 rats. The cyclic AMP of the renal parenchyma, especially the renal medulla, was elevated by more than 100 times after DBcAMP administration. Serum calcium levels, urinary calcium and phosphate excretion, and the adrenaline levels of the renal parenchyma were significantly increased. Serum parathyroid hormone was slightly enhanced, but vitamin D and the noradrenaline levels of the renal parenchyma were not changed. Based on these findings, it is suspected that stone formation in rats injected DBcAMP occurs through the action of DBcAMP on the renal tubules to increase urinary calcium excretion and to make renal stones as a form of primary hyperparathyroidism.
Hinyokika Kiyo 1985 Dec
PMID:[Studies on the endocrinological metabolism of the parathyroid. I. The production of renal calcinosis by cyclic AMP injection in rat]. 300 37

Parathyroid hormone (PTH) is strongly concerned with the pathogenesis of urinary stones. PTH is mainly regulated by the serum calcium concentration and not by other hormones, as is usually the case. We studied whether PTH is also regulated by adrenocorticotrophic hormone (ACTH) or not. ACTH (0.25 mg) was injected intravenously to 17 patients with primary hyperparathyroidism PHP, 7 patients with urolithiasis, 7 patients with malignant hypercalcemia, and 6 control subjects. Serum calcium was significantly increased in only PHP. The serum calcium increase rate showed a significant positive correlation with serum alkaline phosphatase, and a negative correlation with the preinjected serum calcium. PTH was slightly increased in all four groups. Serum cortisol and ACTH concentrations were not significantly different among the groups. PTH concentration in a culture medium of parathyroid tissues increased after ACTH addition. Serum calcium was significantly increased after ACTH injection in an adrenalectomized rat, and decreased in a parathyroidectomized rat. From our data and those of others, it appears that ACTH acts on the adrenal glands to decrease the serum calcium concentration, and might act directly on the parathyroid gland or bones to increase it.
Hinyokika Kiyo 1985 Dec
PMID:[Studies on the endocrinological metabolism of the parathyroid. II. Influence of ACTH on parathyroid function and calcium metabolism]. 300 38

The technetium-thallium subtraction scintigram was utilized preoperatively in 14 consecutive patients explored for primary hyperparathyroidism. The scintigram accurately identified the site of a parathyroid adenoma in 12 of 13 patients.
Laryngoscope 1986 Dec
PMID:Preoperative parathyroid adenoma localization by the technetium-thallium subtraction scan. 302 72

Ten hypercalcaemic patients with solid tumours were studied to evaluate the renal response on PTH infusion as assessed by nephrogenous cAMP excretion and maximum tubular re-absorption of phosphate. In addition, 20 normocalcaemic patients, 11 with an adenocarcinoma and 9 with a squamous cell carcinoma, were studied. All cancer patients had moderately extensive disease. Results were compared with those of 9 patients with primary hyperparathyroidism and with 10 elderly controls. All groups studied had comparable renal function, magnesium and 25-hydroxy-vitamin D levels. Comparable results were obtained in patients with an adenocarcinoma and in controls. cAMP response (delta nephrogenous cAMP) was significantly lower in the hypercalcaemic patients with a solid tumour compared with the controls (8.13 +/- 4.68 nmol/100 ml glomerular filtrate vs 29.52 +/- 25.62 nmol/100 ml glomerular filtrate; P less than 0.005). In the group of patients with primary hyperparathyroidism delta nephrogenous cAMP was 13.41 +/- 7.54 nmol/100 ml glomerular filtrate (P less than 0.06 vs controls). The group of patients with a squamous cell cancer showed an intermediate value of 14.83 +/- 10.74 nmol/100 ml glomerular filtrate (P less than 0.025 vs the normocalcaemic adenocarcinoma patients, but NS vs controls). In two hypercalcaemic patients with a solid tumour in whom PTH infusion was repeated after normalization of serum calcium no influence on renal responsiveness was observed. Responses of maximum tubular re-absorption of phosphate were lowest in the group of hypercalcaemic patients with a solid tumour and in the patients with primary hyperparathyroidism compared with controls (0.11 +/- 0.10 vs 0.22 +/- 0.09 mmol/l and 0.09 +/- vs 0.22 +/- 0.09 mmol/l; P less than 0.025 and P less than 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Acta Endocrinol (Copenh) 1986 Dec
PMID:End-organ resistance to PTH infusion in hypercalcaemic and normocalcaemic patients with solid tumours. 302 41

Of 522 patients with hyperparathyroidism operated on from 1973 to 1987 at our institution, there were seven (1.3%), each with an ectopic, hyperfunctioning mediastinal parathyroid adenoma, who required median sternotomy. In three of these seven patients, the tumor was located in the aorticopulmonary window. A 61-year-old woman with primary hyperparathyroidism had a preoperative thallium-technetium subtraction scan that showed thallium uptake at the base of the heart without any uptake in the neck. After further workup and without prior neck exploration, a parathyroid adenoma was found in the aorticopulmonary window through a median sternotomy. Six months later, serum calcium, phosphorus, and parathyroid hormone values remain normal. Two other cases of parathyroid adenoma in the aorticopulmonary window are presented. Of these two patients, the thallium scan was a key element in the immediate mediastinal exploration of one, who was transferred from another hospital comatose and intubated, in acute hypercalcemic crisis. Since mediastinal parathyroid tumors that necessitate median sternotomy occur in less than 2% of patients with primary hyperparathyroidism, we do not advocate routine preoperative localization studies before an initial cervical operation; localization, however, may be justified in selected cases, such as in critically ill patients or in instances of acute hyperparathyroidism, when the first operation needs to be curative.
Surgery 1988 Dec
PMID:Resection of parathyroid tumor in the aorticopulmonary window without prior neck exploration. 305 71

We compared the clinical performance of a carboxyl-terminal radioimmunoassay for human parathyroid hormone (iPTH), using either a dynamic reference interval (95% confidence limits of serum iPTH concentrations observed in 11 normal individuals during intravenous infusions of Na2EDTA and CaCl2) or a gaussian (2 SD) reference interval derived from 233 normocalcemic individuals. The 2 SD ranges were 3.5 to 9.8 pmol/L for serum iPTH and 2.19 to 2.53 mmol/L for total calcium. The iPTH dynamic interval was lower for calcium concentrations greater than 2.50 mmol/L; it was higher, wider, and continued to increase for calcium values less than or equal to 2.25 mmol/L. Use of the dynamic reference interval increased the clinical sensitivity of our assay from 81% and 61% to 100%, respectively, in primary hyperparathyroidism (n = 47) and hypoparathyroidism (n = 18). Test specificity was maintained at 100% in hypocalcemic disorders but fell to 93% (62/67) in hypercalcemic disorders. Overall, use of the dynamic reference interval improved the assay performance.
Clin Chem 1988 Dec
PMID:Clinical performance of a parathyrin immunoassay with dynamically determined reference values. 305 63

The approach to the patient with hypercalcemia requires a solid understanding of the principles of calcium homeostasis, knowledge of its differential diagnosis and the associated pathophysiologies, and the clinical judgment to know when and how to administer appropriate therapy. Recent advances in our understanding of the regulation of mineral metabolism have led to new insights into these areas and have improved our ability to deal with this rather common clinical entity. The purpose of this monograph is to give a current view of hypercalcemia as it is appreciated in the outpatient and the inpatient setting. It is designed to focus the evaluation of the hypercalcemic patient in a way that is both expedient and accurate as well as to take advantage of available therapies. A summary of the underlying physiological principles of calcium homeostasis is followed by a consideration of the complete differential diagnosis of hypercalcemia. The two most important causes of hypercalcemia, primary hyperparathyroidism and malignancy, are emphasized. Signs and symptoms of hypercalcemia are discussed with particular attention to those factors that are influential in accentuating or masking these features. Finally, an approach to the therapy of hypercalcemia is presented within a pathophysiological framework.
Dis Mon 1988 Dec
PMID:Hypercalcemia. 306 60

Ultrasonography of the neck was performed in 42 consecutive patients with primary hyperparathyroidism (PHP). In 30 patients with subsequent neck exploration, ultrasonography localised 24 of 34 parathyroid tumours correctly (71%), and in 22 patients (73%) the diagnosis PHP was confirmed by identification of at least one parathyroid tumour. In 11 patients - who were not operated - ultrasonography disclosed a parathyroid tumour in four. Of all 42 patients, ultrasonography disclosed at least one parathyroid tumour in 26 (63%). The parathyroid tumours varied in echo pattern, and localisation difficulties were in particular related to associated nodular changes of the thyroid gland and the anatomic distribution of the enlarged parathyroid tissue.
Dan Med Bull 1988 Dec
PMID:Parathyroid ultrasonography in patients with primary hyperparathyroidism. 306 79


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