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

In pregnant women with symptomatic hyperparathyroidism, parathyroidectomy should be undertaken during the second trimester. We feel that the woman who is initially diagnosed well into the third trimester should be treated medically unless the hypercalcemia worsens or other complications occur. Since the treatment of asymptomatic hyperparathyroidism itself is controversial, it is even more difficult to define the treatment plan for an asymptomatic pregnant patient who has primary hyperparathyroidism. However, a recent consensus panel recommended that young patients with asymptomatic hyperparathyroidism be treated surgically. Accordingly, we believe that the asymptomatic pregnant patient should also be treated surgically, preferably in the second trimester. Whether a patient is treated medically or surgically in these situations, the pregnancy should be considered high-risk. The neonate should be monitored carefully for signs of hypocalcemia or impending tetany. If the mother is treated medically to term (or if spontaneous or elective abortion occurs), the mother should be monitored for hyperparathyroid crisis postpartum. Sudden worsening of hypercalcemia can result from the loss of the placenta (active placental calcium transport may be somewhat protective) and dehydration. Finally, every effort should be made to make the definitive diagnosis early in pregnancy in order to initiate optimal management. The diagnosis should be suspected during pregnancy if the following conditions exist: appropriate clinical signs or symptoms (especially nephrolithiasis or pancreatitis), hyperemesis beyond the first trimester, history of recurrent spontaneous abortions/stillbirths or neonatal deaths, neonatal hypocalcemia or tetany, or a total serum calcium concentration greater than 10.1 mg/dL (2.52 mmol/L) or 8.8 mg/dL (2.2 mmol/L) during the second or third trimester, respectively.
J Gen Intern Med
PMID:Hyperparathyroidism and pregnancy: case report and review. 150 54

The diagnosis of primary hyperparathyroidism (HPT) relies principally on repeated measurements of total serum calcium and determination of intact parathyroid hormone. A careful patient history and routine blood chemistry will generally verify symptoms in the common patient with HPT, who should be a candidate for surgery. The operative treatment in primary HPT is efficient, with reported high success rate, minimal complications and frequent alleviation of symptoms. Nonoperative medical surveillance should preferentially be considered in elderly patients with borderline increases in serum calcium of around 2.7 mmol/L or less, who in fact constitute a major proportion of hypercalcemic individuals detected at population screening. The patients in whom an operation is deferred should lack any symptoms or complications associated with primary HPT known to benefit from surgery, and this includes the commonly encountered neurobehavioral disability. Surveillance may also occasionally be chosen for really old individuals, when expected improvement fails to justify operative risks. In keeping with the generally liberal indications for parathyroid surgery, surveillance may be time limited if the patients develop disability or display a rise in serum calcium during follow-up.
Curr Opin Gen Surg 1993
PMID:Medical and radiologic evaluation and operative treatment of primary hyperparathyroidism. 758 47

This article presents a case report in which a systemic disease was first suspected by viewing a panoramic radiograph. A 49-year-old man sought prosthetic rehabilitation with implants. Panoramic radiography revealed an osteolysis of poorly defined limits in the apical region of teeth No. 26 to 28. The patient's medical history included the recent removal of a giant cell lesion from the left tibia. During palpation of the neck, a fixed nodule was detected on the superior portion of the left thyroid gland. Biochemical tests showed elevated levels of serum alkaline osphatase, serum calcium, and parathyroid hormone. As the serum phosphate was low, the final diagnosis was primary hyperparathyroidism. A CT scan showed a hypodense lesion involving teeth No. 26 to 28, with preserved cortical bone. A whole-body bone scintigraphy showed lesions in the mandible and other long bones. A high radiopharmaceutical capitation was present in the left parathyroid gland. The patient was referred to a head and neck surgeon, who removed the left thyroid lobule and the parathyroid gland. The microscopic diagnosis was parathyroid carcinoma. After eight months of follow-up, the mandibular lesion disappeared.
Gen Dent
PMID:Panoramic radiography and its role in the diagnosis of systemic disorders. 2012 92