China
Africa
Explore chapters and articles related to this topic
Generalized and Metabolic Disease
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Implications of the vascular findings remain under debate (Chiodini et al., 2018). There is no consensus about the management of mild primary hyperparathyroidism. The operative procedure is delicate and not without risk. Its benefit in extending life and health has not been established. While stiffness seems to improve after parathyroidectomy in most patients (Schillaci et al., 2011), some studies suggest this effect may be due to changes in blood pressure postoperatively, and no data are available in terms of the effect of this improvement in future outcomes (Chiodini et al., 2018).
‘The heart of the matter’: a parent’s perspective
Published in Paul Bowie, Carl de Wet, Aneez Esmail, Philip Cachia, Safety and Improvement in Primary Care: The Essential Guide, 2020
When adjudicating on the quality of Kevin’s care in the autumn of 1997, medical experts later stated: The combination of bone pain, hypercalcaemia and renal failure in a young patient points either to a diagnosis of primary hyperparathyroidism or metastatic malignancy and these ominous results should have been investigated as a matter of urgency
Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
A 50-year-old woman presents to her GP with fatigue, constipation and mild depression. Initial blood tests reveal a raised serum calcium and PTH. How would you manage this patient?The raised calcium and raised PTH suggest a diagnosis of primary hyperparathyroidism. Fatigue is the most common presenting symptom.I would take a thorough history, looking for other symptoms of hypercalcaemia (stones, bones, groans, moans), history of renal disease/transplant, and a family history of endocrine disease (familial hyperparathyroidism, MEN 1 and 2a).I would examine her neck.I would request thyroid function tests, vitamin D levels, phosphate levels, 24-hour urinary calcium (to exclude familial hypocalciuric hypercalcaemia).I would request renal USS and DEXA bone scan to assess for evidence of end-organ damage (i.e. renal stones, osteoporosis).
Secondary hypertension as a cause of treatment resistance
Published in Blood Pressure, 2023
Isabella Sudano, Paolo Suter, Felix Beuschlein
Sporadic primary hyperparathyroidism is an endocrine disorder usually characterised by persistent fasting hypercalcaemia attributable to autonomous overproduction of parathyroid hormone by parathyroid adenoma or hyperplasia (hypercalcaemic primary hyperparathyroidism).70 However, a proportion of patients with primary hyperparathyroidism (20%) show normal total and ionised serum calcium levels in the presence of persistently elevated parathyroid hormone concentrations [30]. Primary hyperparathyroidism is associated with an increased risk of arterial hypertension [30]. Recent investigations have reported high blood pressure in 40–65% of patients with primary hyperparathyroidism [31]. Despite variations in published data due to different patient selection criteria, the prevalence of hypertension in patients with primary hyperparathyroidism is higher than in the general population regardless of age [31]. However, elevated parathyroid hormone levels have also been reported in a subgroup of patients with primary (essential) hypertension. Proposed mechanisms linking hypertension and primary hyperparathyroidism include abnormalities in major endocrine pressor factors, such as the sympathetic nervous system and/or the renin– angiotensin–aldosterone axis, dysfunction or structural changes of resistance vessels documented either by an altered vasodilatory response, and/or an enhanced vascular constriction to pressor hormones.
Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center
Published in Journal of Investigative Surgery, 2022
Lei Liu, Jia-qi Zhang, Gui-ge Wang, Ke Zhao, Chao Guo, Cheng Huang, Shan-qing Li, Ye-ye Chen
This study enrolled 28 patients, accounting for 35% (28/80) of ectopic parathyroid tumors diagnosed at our center during the same period. The male-to-female ratio was 12:16, and the median age was 59 (19-71) years. In the enrolled patients, the median longest diameter of the tumor in the enrolled patients was 2.0 (1.0-8.0) cm. The enrolled patients experienced various clinical symptoms, including bone pain, vomiting, backache, and urinary tract stones. After confirming the qualitative diagnosis of primary hyperparathyroidism (PHPT) according to significantly elevated blood calcium and PTH levels than normal in laboratory tests, and the localization diagnosis can be completed in the follow-up imaging examination (Figure 1). Of 28 patients enrolled, 26 were located in the anterior superior mediastinum, and 2 were in the middle mediastinum. According to postoperative pathological results, there were 23 cases of parathyroid adenoma, 4 cases of parathyroid hyperplasia, and 1 case of parathyroid cyst.
Comparison of ultrasound-guided percutaneous microwave ablation and parathyroidectomy for primary hyperparathyroidism
Published in International Journal of Hyperthermia, 2019
Fangyi Liu, Xiaoling Yu, Zhoulu Liu, Zhi Qiao, Jianping Dou, Zhigang Cheng, Zhiyu Han, Jie Yu, Ping Liang
Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterized by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone (PTH). Primary hyperparathyroidism is most commonly due to a single benign parathyroid adenoma (approximately 80% of patients), with multiglandular disease seen in approximately 15–20% of patients [1]. Parathyroid cancer is rare and accounts for well under 1% of all cases of primary hyperparathyroidism [2]. Primary hyperparathyroidism is generally discovered when asymptomatic but the disease always has the potential to become symptomatic, resulting in bone loss and kidney stones. Surgery remains the only definitive treatment for hyperparathyroidism according to the guidelines from the 4th International Workshop [3]. However, the morbidity and mortality associated with parathyroid surgery are increased in elderly patients [4]. Although minimally invasive parathyroidectomy relies on localization technology and intraoperative adjuvant measures to reduce the risk to some extent, it is still challenging for patients with mild hypercalcemia and multiple glands [5].