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Familial Hyperparathyroidism
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Luigia Cinque, Alfredo Scillitani, Vito Guarnieri
Surgical removal is the gold standard for the treatment of parathyroid disease, being the adequate surgical approach applied depending on the type of the lesion, for the reasons explained above about the long-term overall survival (in cases of parathyroid carcinoma) and also because recurrence and the need for a second operation usually accompanies all the comorbidities associated with relapse of the disease, with a higher risk for the patient [107]. Possible repeated surgery, defined as “debulking,” is indicated in cases of metastatic disease, for removal of PTH-secreting lesions that represent the real cause of mortality, rather than the tumor mass, so that survival is possible only if the hypercalcemia is controlled [108].
Endocrine surgery
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Ross M. Warner, Richard Boulton
The most common surgical presentation of parathyroid disease and indication for parathyroid surgery is hypercalcaemia caused by primary hyperparathyroidism (all three types of hyperparathyroidism are summarised in Table 16.1).
The Thyroid and the Parathyroid Glands
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The surgeon who is planning to explore the neck for a parathyroid disease must be familiar with certain characteristics of these glands. There are four parathyroid glands in 90% of the patients; however, 5% of the patients may only have 3 glands. Another 3.5% may have 5 glands. Each normal gland weighs 35 to 40 mg. The parathyroid glands are pale structures and are usually located two on each side behind the thyroid gland. In 80% of the cases, the inferior thyroid artery supplies the lower 2 glands if not the 4 glands. Several reports have described abnormal position of the parathyroid glands, but the fact is that one or more may be displaced inferiorly into the upper mediastinum either anteriorly or posteriorly. Although a single adenoma in 1 gland can cause primary hypercalcemia in 80 to 90% of the cases, and only 10 to 20% have multiple gland disease, it is highly recommended that the 4 glands be explored and biopsied at the time of initial surgery to minimize the need for re-exploration for persistent postoperative hypercalcemia.17
Parathyroid carcinoma in chronic renal disease – a case series of three patients and review of literature
Published in Acta Chirurgica Belgica, 2023
Vladan Zivaljevic, Rastko Zivic, Nikola Slijepcevic, Matija Buzejic, Dusko Dundjerovic, Jasna Trbojevic Stankovic, Dejan Stojakov, Milan Jovanovic, Ivan Paunovic
Chromogranin A is positive in patients with metastases to the lung, as reported by Khan et al. [24] and confirmed in our third case. In 2002, a germline HRPT2 (also known as CDC73) mutation was reported as the cause of hyperparathyroidism jaw tumour (HPT-JT) syndrome, an autosomal dominant hereditary tumour syndrome, associated with a lifetime risk of parathyroid carcinoma approaching 15% [39]. Bi-allelic inactivation or mutation of HRPT2 has been reported in the majority of parathyroid carcinomas, but very rarely in sporadic benign parathyroid disease [29]. Furthermore, testing for HRPT2 mutation in patients presenting with parathyroid carcinoma often identifies occult HPT-JT syndrome, even in the absence of a family history or other manifestations of this syndrome [39]. Parafibromin as a product of the mutation of HRPT2 gene, plays an important role in the pathogenesis of parathyroid carcinoma because it is rarely altered in benign parathyroid conditions. Parafibromin is a predominantly nuclear protein that acts as a tumour suppressor. A loss in immunostaining is characteristic for parathyroid carcinoma [27]. However, further studies on this topic are required to provide clinical tests that could predict which patients are susceptible to developing or have developed already a parathyroid carcinoma.
Occult urolithiasis in asymptomatic primary hyperparathyroidism
Published in Endocrine Research, 2018
Yu-Kwang Donovan Tay, Minghao Liu, Leonardo Bandeira, Mariana Bucovsky, James A. Lee, Shonni J. Silverberg, Marcella D. Walker
In this study, we further showed an association between 1,25(OH)2D and stones as well as a positive correlation between 24-hour urinary calcium excretion and 1,25(OH)2D. Other PHPT studies have shown a similar association between urinary calcium and 1,25(OH)2D.34–36 It is unclear why stone-forming PHPT patients have high 1,25(OH)2D levels, since PTH levels are similar between groups. One possible mechanism is that stone formers have dysregulation of the 1-alpha hydroxylase or 1,25-dihydroxyvitamin D 24-hydroxylase enzymes. This pattern of increased activated vitamin D is similar to the biochemical profile observed in patients with “idiopathic hypercalciuria”37 and suggests that stone formers with PHPT could have risk factors unrelated to their parathyroid disease.
Associations between serum electrolyte and short-term outcomes in patients with acute decompensated heart failure
Published in Annals of Medicine, 2023
Kai Zhao, Qun Zheng, Jiang Zhou, Qi Zhang, Xiaoli Gao, Yinghua Liu, Senlin Li, Weichao Shan, Li Liu, Nan Guo, Hongsen Tian, Qingmin Wei, Xitian Hu, Yingkai Cui, Xue Geng, Qian Wang, Wei Cui
ADHF was defined as a de novo AHF or decompensation of CHF. Inclusion criteria for the study were: (1) age ≥18 y; (2) unplanned admission; (3) typical symptoms or signs of ADHF; and (4) brain natriuretic peptide (BNP) levels > 100 pg/mL or N-terminal pro-brain natriuretic peptide (NT-proBNP) levels > 300 pg/mL. Exclusion criteria for the study were: (1) hospitalization < 24 h; (2) heart transplantation; (3) ongoing renal replacement therapy; (4) massive stroke; (5) concomitant terminal disease; or (6) patients lost to follow-up. Furthermore, patients with history of parathyroid disease or vitamin D-related disorders were excluded from the study.