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

The introduction of multiphasic screening and the development of sensitive parathormone assays have changed the demography and clinical symptomatology of patients presenting with primary hyperparathyroidism. This retrospective review includes 158 patients operated on for primary hyperparathyroidism at the Medical College of Georgia from 1973-1987. Compared to the 46 patients managed prior to 1973, the frequency of subclinical hyperparathyroidism has increased from 46% to 64%. The median patient age has increased from 50 to 59 years. Recognition of primary hyperparathyroidism in a more geriatric population modifies indications for surgical intervention in subclinical disease. Osteoporosis, myalgias, fatigue, arthralgias, memory loss, or constipation occurred in 50% of patients. These complaints are frequent in normocalcemic elderly people. They represent disease, not normal aging. Their exacerbation by hypercalcemia should not go uncorrected if neck exploration can be tolerated by the patient.
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PMID:The changing face of primary hyperparathyroidism. 143 43

A premenopausal woman developed hypercalcemia 30 months after treatment for infiltrating breast cancer. After bone metastases had been excluded, primary hyperparathyroidism was suspected. A parathyroid adenoma was removed and histologically confirmed. Hypercalcemia, associated with low plasma phosphate and severely depressed plasma parathormone (PTH) levels, persisted. Further investigations showed liver metastases from the primary breast cancer and also secretion of a PTH-like substance. Antitumoral treatment was effective on the liver metastases and also normalized calcemia and the PTH-like substance, demonstrating the existence of a paraneoplastic syndrome related to the secretion of a PTH-like substance by disseminated liver metastases of primary breast cancer.
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PMID:Hypercalcemia and breast cancer related to parathormone-like secretion by liver metastases. 146 5

A case of primary hyperparathyroidism with prevalent neuromuscular symptoms is described. Clinical, diagnostic and therapeutic implications are emphasized. Particular attention must involve a full clinical examination, electromyographic data and neuromuscular biopsy to make differentiation from primary myopathy or denervation pathology. Some similarity of electromyographic data with those observed in botulism and myastenia gravis should also be taken in mind. Hypercalcemia could play a pathological role in conditioning abnormalities of nervous impulse conduction at the level of neuromuscular junction. Another possible interference might be related to a direct effect of parathormone and hypophosphataemia on nervous impulse conduction. "Glandular hyperplasia", as observed in this case at istologic examination, rises some problems as far as the prognosis is concerned.
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PMID:[Primary hyperparathyroidism with prevalent neuro-muscular manifestations]. 149 65

A report is given on 33 patients with primary hyperparathyroidism who underwent surgical treatment in our institution in the period from 1980 to 1989. In 57 per cent of the cases a hypercalcaemic syndrome was present. The primary hyperparathyroidism manifested itself in 75 per cent at the kidneys in the form of nephrolithiasis. One third of the patients showed a renal manifestation form exclusively. Remarkable is the relatively high number of exclusively gastrointestinal manifestations (11 per cent). In all patients the diagnosis was established on the coincidence of hypercalcaemia and increased parathormone in the serum. Preoperative localization diagnostics by means of parathyroid sonography, computed tomography and scintigraphy yielded unsatisfactory results. A satisfactory accuracy with regard to the lateral localization of the hyperfunctioning parathyroid tissue can presently be achieved only by selective catheterization of the cervical vein with determination of the parathormone. 35 patients clinically suspected of having primary hyperparathyroidism were subjected to a total of 44 operative interventions, i.e., apart from 35 primary operations, 7 secondary and 2 tertiary interventions. Of the 35 primary operations, 10 (28.6 per cent) were without success. This was due to 2 misdiagnoses and 8 cases with insufficient intraoperative exploration and premature discontinuation of the operation. In 67 per cent of the cases, there was a predominance of the solitary parathyroid adenoma, which was chiefly located at the dorsal lower thyroid poles. In order to reduce the number of unsuccessful primary interventions, a surgically-tactical approach is recommended.
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PMID:[Primary hyperparathyroidism. Pathogenesis--diagnosis--therapy]. 154 99

In the elderly, primary hyperparathyroidism (HPT) is often disguised as 'senility' which can, however, be alleviated or cured by parathyroid surgery. The prevalence of HPT in the non-selected 75- to 85-year-old subjects (n = 610) randomly sampled from census records was estimated by measurements of serum ionized calcium and intact parathyrin levels. The prevalence of cases that require clinical attention seems to be around 3% in women and less than 1% in men. Furthermore, this study indicates that, on average, the serum ionized calcium concentration remains stable even in the elderly.
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PMID:Serum ionized calcium and the prevalence of primary hyperparathyroidism in age cohorts of 75, 80 and 85 years. 155 27

The establishment of an abnormal calcemia first requires confirmation by a second measurement that should then be interpretated in relation to albuminemia. Should the abnormality be confirmed, measurement of intact parathormone in serum can help distinguishing between a parathyroid or nonparathyroid source of origin. In presence of a plasma calcium level lower than or equal to 2.9 mmol/l regular monitoring should be investigated and aggravating factors such as thiazide diuretics, dehydration or high calcium intake avoided. If plasma calcium is greater than 3 mmol/l the patient should first be rehydrated. In case of primary hyperparathyroidism, parathyroidectomy is the only effective treatment. In neoplastic hypercalcemia, bisphosphonates are the first-choice treatment when antitumoral therapy turns out to be insufficient. Hypocalcemia can be effectively corrected by calcium and by vitamin-D derivatives.
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PMID:[Hyper- and hypocalcemia--diagnosis and therapy]. 158 71

The establishment of an abnormal calcemia first requires confirmation by a second measurement that should then be interpreted in relation to albuminemia. Should the abnormality be confirmed, measurement of intact parathormone in serum can help distinguishing between a parathyroid or non parathyroid source of origin. In presence of plasma calcium level lower than or equal to 2.9 mmol/L regular monitoring should be provided and aggravating factors such as thiazide diuretics, dehydration or high calcium intake, avoided. If plasma calcium is greater than 3 mmol/L the patient should first be rehydrated. In case of primary hyperparathyroidism, parathyroidectomy is the only effective treatment. In neoplastic hypercalcemia bisphosphonates are the first choice treatment when antitumoral therapy turns out to be insufficient. Hypocalcemia can be effectively corrected by calcium and vitamin D derivatives.
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PMID:[Hyper- and hypocalcemia: diagnosis and treatment]. 159 69

Between 01.01.1987 and 31.12.1990 a primary operation was performed on 126 patients in the Dept. of General Surgery, University of Marburg Hospital for primary hyperparathyroidism due to a parathyroid adenoma. Their clinically relevant data were prospectively documented. In 6 patients (4.8%) a total of 7 cystic parathyroid adenomas was found. While there was no difference in age- and sex-distribution, patients with cystic adenomas were found to have markedly higher serum parathormone and alkaline phosphatase levels than patients with solid adenomas. Calcium levels were similar in both groups. Cystic adenomas were much heavier than solid adenomas. A significant number of cystic adenomas was found to be displaced into the posterior mediastinum. The property of cystic parathyroid adenomas to be frequently located away from their usual anatomical position can make the intraoperative search for them difficult.
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PMID:[Cystic parathyroid gland adenomas: pathologic-anatomic variants of parathyroid gland adenomas or a separate disease entity?]. 161 76

A 53-year-old woman with recurrent nephrolithiasis was found to have hypercalcaemia of 3.12 mmol/l and an intact parathormone level of 166 pg/ml, indicating primary hyperparathyroidism. Preoperative ultrasound examination to localize the parathyroid adenoma revealed a clear fluid-containing cyst in the right lobe of the thyroid. The aspirated fluid had an intact parathormone level of 306 pg/ml, twice that in serum. The cyst was removed surgically. 14 days postoperatively calcium and parathormone levels in serum had become normal without any calcium administration. Measuring the concentration of intact parathormone in the aspirated cyst fluid made possible not only the distinction from a thyroid cyst but also the precise preoperative localization of the parathyroid cyst.
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PMID:[Endocrinously active parathyroid cysts. Their diagnosis by the determination of intact parathormone in the cyst fluid]. 162 34

The performance and clinical utility of an automated assay of intact parathyroid hormone (parathyrin, PTH) are evaluated. The method is based on the extraction of PTH from plasma by an HPLC column containing immobilized anti-(44-68 PTH) antibodies. The PTH retained is detected with a postcolumn reactor and use of anti-(1-34 PTH) chemiluminescent-labeled antibodies. The total cycle time of the assay is 6.5 min per injection after a 1-h incubation. The lower limit of detection for PTH in a 66-microL plasma sample was 0.5 pmol/L based on peak heights and 0.2 pmol/L based on peak areas. Mean analytical recovery for PTH added to plasma was 97%. The within-day precisions (CVs) for 4.2 and 30 pmol/L PTH plasma samples were 9.2% and 5.6% and the day-to-day precisions were 10.3% and 5.7%, respectively. No significant interferences from 1-34, 44-68, or 53-84 PTH fragments were noted, even at highly increased concentrations of fragments. The correlation of results with those of a manual assay of intact PTH was 0.97, and the results showed good agreement with disease state for patients with hypo- or hyperparathyroidism. The specificity of the assay for primary hyperparathyroidism was greater than 95%. We discuss the advantages (speed and quality control) of this approach over current immunoassays and the potential use of this method for detecting other analytes.
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PMID:Intact parathyroid hormone: performance and clinical utility of an automated assay based on high-performance immunoaffinity chromatography and chemiluminescence detection. 164 22


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