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Query: UMLS:C1762617 (weakness)
 37,932 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is important to localize the site of abnormal parathyroid glands in treatment of primary hyperparathyroidism. Selective venous sampling with parathyroid hormone assay is one of the methods for localization of adenoma or hyperplasia in primary hyperparathyroidism. Since Reitz first described it in 1969, it has been improved during the last two decades and there is a high sensitivity (70-80%). Especially in those cases, localization is unknown in imaging methods, the first operation fails or the patients has previously been explored in the neck, venous sampling becomes a very useful method. How to perform, indication, performance, strengths and weakness of selective venous sampling is described here.
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PMID:[Parathyroid selective venous sampling]. 775 76

Hypercalcemia was found in a dog examined for episodic weakness and disorientation. A right adrenal mass identified on abdominal ultrasonographic examination was diagnosed as a pheochromocytoma based on increased 1231-metaiodobenzylguanidine uptake and characteristic histopathological features. Serum intact parathyroid hormone (iPTH), total serum calcium, and ionized serum calcium were increased prior to surgery. Although both total and ionized serum calcium concentrations decreased to within normal reference ranges following surgery through postoperative day 17, subsequent high concentrations with increased serum iPTH concentrations confirmed concurrent primary hyperparathyroidism. A right parathyroid tumor was suspected based on a technetium-99m-sestamibi (99mTc-sestamibi) scan.
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PMID:Diagnostic and therapeutic considerations in a hypercalcemic dog with multiple endocrine neoplasia. 777 62

Primary hyperparathyroidism is a rare disease in children and is characterized by conspicuous skeletal and renal changes. A 12 year old male patient presented with symptoms of polydipsia, polyuria, general weakness, nausea, and vomiting which had begun 3 months earlier, and showed typical laboratory findings of primary hyperparathyroidism. Confirmatory diagnosis was made by elevated parathyroid hormone concentration in serum, technetium-thallium subtraction scan imaging method and histopathologic finding of chief cell hyperplasia. The laboratory findings revealed elevated levels of BUN, creatinine and decreased GFR. Kidney biopsy showed typical calcium deposits in tubules with marked tubulointerstitial infiltration. After subtotal parathyroidectomy, clinical findings improved remarkably.
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PMID:A case of primary hyperparathyroidism with hypercalcemic nephropathy in children. 799 97

This is a retrospective, clinical study evaluating the long-term outcome of subtotal parathyroidectomy (PTX) in 60 patients with chronic renal failure and severe secondary hyperparathyroidism. Patients were 41 +/- 2 years old (mean +/- SE) at the time of PTX, and followed for 69 +/- 6 months since the procedure. At the time of PTX, three patients had chronic renal failure, 53 had been on chronic hemodialysis, and four had received successful kidney transplants. In more than 80 per cent of patients, symptoms of hyperparathyroidism (bone pain and muscle weakness) resolved within weeks, and biochemical signs (hypercalcemia, and high plasma alkaline phosphatase and parathyroid hormone concentrations) returned to normal ranges within a year. Subperiosteal resorption, bone fractures, and soft tissue calcification frequently improved. Osteosclerosis (rugger-jersey spine), cystic bone changes, osteopenia, and vascular calcifications were, however, often unchanged or progressive. Five patients (8%) who had either persistent or recurrent hyperparathyroidism required additional surgical procedures, and two had subsequent improvement. Twelve patients who had aluminum associated bone disease diagnosed later continued to progress with a high incidence of bone fractures and severe osteopenia. Cystic bone changes, especially of the carpal bones, in association with carpal tunnel syndrome, probably representing amyloid bone disease, also did not respond to PTX. In conclusion, PTX is an effective surgical procedure to reverse complications of hyperparathyroidism in patients with end-stage renal disease, provided that other causes of osteodystrophy, such as aluminum or amyloid-associated bone diseases, are adequately excluded. We feel that subtotal PTX, leaving a small remnant in place, is the procedure of choice.
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PMID:Long term results of subtotal parathyroidectomy in patients with end-stage renal disease. 806 33

An unusual clinical presentation of hyperparathyroidism is reported. The 73-year-old patient was unable to maintain her head upright after ten minutes of walking or standing. Parathyroid adenoma was diagnosed on the basis of ultrasound and pathological findings and parathyroid hormone assays. Following surgery the forward sagging of the head no longer occurred and serum levels of calcium and phosphorus returned to normal. Pathophysiological hypotheses are discussed. No similar cases with isolated weakness of the cervical and dorsal paravertebral muscles has been reported to date.
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PMID:[Hyperparathyroidism disclosed by forward sagging of the head]. 812 83

This 20 year old man suffered increasingly from multifocal bone- and back pain over the last 6 months. Painful weakness of the left leg with dysesthesia of the 4th and 5th toe, a weight loss of 15 kg and polydipsia and pollakiuria had developed. The clinical workup disclosed hard tumors in the right mandible and tibia, a waddling gait with bilateral sign of Trendelenburg, reduced muscular force in the left leg with missing achilles tendon reflex and a loss of sensibility in the distal S1 segment, epigastric tenderness on pressure and hypertension with a value of 160/100 mmHg. X-rays revealed multiple cystic bone lesions at all sites. Hypercalcemia and massively elevated parathyroid hormone were measured. Since the parathyroids were enlarged on sonography, primary hyperthyroidism with fibrosing osteitis v. Recklinghausen was diagnosed.
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PMID:[Bone pain, polydipsia, polyuria]. 818 45

The purpose of the present study is to investigate whether Rocaltrol therapy in uremic patients undergoing dialysis treatment can improve muscle function. In 8 uramic patients (2--on CAPD, 6-on HD treatment) calcitriol (Rocaltrol, Roche) was given in the dosis at 1 mcg/day during 15 months. At the beginning of therapy and every month the following parameters were determined in serum: creatinine (Cr), calcium (Ca), phosphate (PO4) and parathyroid hormone (PTH). At the beginning and at the end of treatment the quantitative electromyography (EMG) was performed. We observed a slight increase of serum Cr during 15 months of treatment in 4 patients. Serum Ca, PO4 and PTH did not changed significantly. The EMG revealed abnormal polyphasic motor nerve unit potentials of brief durations, decrease in the amplitude and fibrillations potentials. The EMG findings did not change after Rocaltrol therapy, but all patients on physical examinations exhibited disappearance of clinical manifestations of uremic myopathy. In conclusion, our findings suggest that vit. D deficiency is one of the causes of uremic myopathy and a careful treatment with Rocaltrol can diminish muscle weakness in uremic patients.
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PMID:[Evaluation of skeletal muscle function during calcitriol treatment in patients dialyzed for uremia]. 867 94

The purpose of the present study is to investigate whether calcitriol therapy in uremic patients undergoing dialysis treatment can improve muscle function. In 8 uremic patients [2 on continuous ambulatory peritoneal dialysis (CAPD), 6 on hemodialysis (HD) treatment], calcitriol (Calcitriol, Roche) was given in the dose of 1 microgram/day for 15 months. At the beginning of therapy and every month, the following parameters in serum were determined: creatinine (Cr), calcium (Ca), phosphate (P), and parathyroid hormone (PTH). At the beginning and at the end of treatment, quantitative electromyography (EMG) was performed. We observed a slight increase of serum Cr during 15 months of treatment in 4 patients. Serum Ca, P, and PTH did not change significantly. The EMG revealed abnormal polyphasic motor nerve unit potentials of brief durations, a decrease in the amplitude, and fibrillation potentials. The EMG findings did not change significantly after calcitriol therapy, but all patients on physical examinations exhibited the disappearance of clinical manifestations of uremic myopathy. In conclusion, our findings suggest that vitamin D deficiency is one of the causes of uremic myopathy and a careful treatment with calcitriol can diminish muscle weakness in uremic patients.
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PMID:Does calcitriol therapy improve muscle function in uremic patients. 872 12

The case of a 67-year-old woman with primary hyperparathyroidism manifested by hypercalcemia with anorexia, nausea, and weakness; low serum phosphorus; high circulating parathyroid hormone; and mildly elevated calcitriol and parathyroid hormone-related protein is reported. A cystic lesion was removed from the inferior pole of the right lobe of the thyroid, and serum calcium levels rapidly returned to normal. The lesion was proven histologically to be a parathyroid adenoma with predominate papillary features. The differentiation of such a rare lesion from papillary carcinoma of the thyroid, both histologically and cytologically, is stressed.
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PMID:Papillary parathyroid adenoma. A rare occurrence and its importance in differentiation from papillary carcinoma of the thyroid. 914 Feb 97

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.
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PMID:Primary hyperparathyroidism with cardiac abnormalities: a case report. 950 84


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