Parathyroid surgery
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Additional testing may be useful for patients whose calcium and PTH levels are borderline, to either confirm the diagnosis of hyperparathyroidism or determine the severity of end-organ manifestations. For example, an ionized calcium level may give a more accurate assessment of the physiologic calcium level in the bloodstream. Twenty-four-hour urine calcium should be done routinely to rule out the rare condition of familial hypercalcemic hypocalciuria, which is a relative contraindication to surgery [1]. A high urine calcium level may also help to measure the severity of hyperparathyroidism. Finally, bone densitometry is useful to determine the degree of bone loss and may help in determining the need for surgery. It should be noted, however, that bone density naturally decreases over time, thus the older the patient, the less useful the test becomes in determining the usefulness of surgery.
Treating the Dysmetabolism Underlying Osteoporosis
Kohlstadt Ingrid, Cintron Kenneth in Metabolic Therapies in Orthopedics, Second Edition, 2018
In hyperparathyroidism, parathyroid hormone (PTH) stimulates a release of calcium from bone by an increase in osteoclast activity. It does so by increasing activation of 25-hydroxy vitamin D3 to 1.25-dihydroxy vitamin D3 which increases bone resorption. Primary hyperparathyroidism is frequently a consequence of a benign adenoma, yet may also be caused by a malignant tumor. In secondary hyperparathyroidism, the major causes are vitamin D deficiency and chronic kidney disease. Secondary hyperparathyroidism is the response to a lowered serum calcium level resulting in an increase in PTH levels and increased bone resorption. Consequences of hyperparathyroidism include hypercalciuria, hypercalcemia, hypophosphatemia, osteopenia/osteoporosis, osteomalacia, and kidney stones [67, 68].
The neck, Thoracic Inlet and Outlet, the Axilla and Chest Wall, the Ribs, Sternum and Clavicles.
Fred W Wright in Radiology of the Chest and Related Conditions, 2022
Hyperparathyroidism may be primary or secondary. Illustrations of both are shown in Illus. HYPERPARATHYROIDISM. The hands show subperiosteal erosions of the middle phalanges of the fingers, cysts in carpal bones, etc. and small 'brown tumours' or osteoclastomata. The skull may be decalcified with a 'pepper and salt' appearance with mixed sclerosis and porosis, and may be thickened as well as osteoporotic. The spine typically shows osteoporotic changes with progression to 'cod fish vertebrae', and the pelvis may become triradiate, with a narrowed cavity. The ribs may be generally softened in patients with renal failure, leading to a Harrison's sulcus, whilst in those with a primary hyperparathyroidism only some of the ribs may be radiologically affected; these my become expanded and twisted as with fibrous dysplasia, show healing or healed fractures, and localised swellings due to brown tumours. See also Illus. RENAL FAILURE.
Primary hyperparathyroidism associated with non-Hodgkin lymphoma: a case report and literature review
Published in Postgraduate Medicine, 2020
Yuanyuan Deng, Jiao Wang, Honghong Liu, Jianying Liu, Jixiong Xu
Primary hyperparathyroidism causes hypercalcemia through excessive secretion of PTH. NHL produces hypercalcemia mainly through two mechanisms: (1) local osteolytic hypercalcemia: tumor cells cause hypercalcemia through bone metastasis, bone destruction, bone calcium directly into the blood, and secretion of cytokines with osteolytic activity such as IL-1, IL-6, TNF-α,etc. (2) humoral hypercalcemia of malignancy: the main mechanism involves that lymphoma cells elicits parathyroid hormone-related protein (PTHrP) or 1-α-hydroxylase [7]. Some studies have also shown that certain malignant lymphomas can cause hypercalcemia by producing 1,25-dihydroxyvitamin D or stimulating macrophages to produce 1-alpha hydroxylase [5,17] . In this case, the patient presented clinical manifestations of high calcium. After removal of the parathyroid adenoma, the patient’s serum calcium level returned to normal, but PTH was low. Although PTH suppression is found in patients with hypercalcemia due to diffuse bone metastasis (in a feed-back mechanism), high-functioning adenomas may also inhibit normal parathyroid function. Combined with that the patients did not have any clinical manifestations of pain and serum calcium was normal after repeated examinations. Therefore, the low PTH may be caused by temporary suppression of normal parathyroid function after surgery. We consider that this case of hypercalcemia is caused only by primary hyperparathyroidism.
Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study
Published in Renal Failure, 2020
Yan Yu, Ming Bai, Zhang Wei, Lijuan Zhao, Yangping Li, Feng Ma, Shiren Sun
Hypercalcemia is an electrolyte disorder commonly seen in routine clinical practice and accounts for approximately 0.6% of all emergency hospital admissions, with a prevalence rate of 1–7/1000 in the general population [1,2]. Primary hyperparathyroidism and malignancy are the most common causes for hypercalcemia [2,3]. Although severe hypercalcemia (‘hypercalcemic crisis’) only occurs 1.6–6.7% in hypercalcemia patients, it leads to a 14-fold increase in acute kidney injury (AKI) risk [4,5] and is associated with a mortality that ranges from 15% to 100% [6–10]. Nausea, vomiting, weakness, arrhythmia, and disorientation are the major symptoms of hypercalcemia [1,2]. Conventional treatments for hypercalcemia include intravenous fluids, loop diuretics, steroids, calcitonin, and bisphosphonates [11]. To treat the primary disease, efforts should include surgery, chemotherapy, and/or radiation [12]. For patients with severe hypercalcemia, a poor response to conservative treatment, renal dysfunction, and heart failure, intermittent hemodialysis treatment is recommended [1,5,11,13]. However, intermittent hemodialysis with calcium-free/low-calcium dialysate might result in rebound hypercalcemia, hypovolemia, and hypotension [4,14]. Continuous renal replacement therapy (CRRT), especially continuous venovenous hemofiltration (CVVH), is the most commonly used hemodialysis modality for critically ill patients, especially for those with hemodynamic instability [15,16]. Several case reports have shown that CRRT could successfully reduce serum calcium concentration with stable hemodynamics [17–20].
The Value of Preoperative and Intraoperative Ultrasound in the Localization of Intrathyroidal Parathyroid Adenomas
Published in Journal of Investigative Surgery, 2022
Wei Zhao, Ruigang Lu, Li Yin, Bojun Wei, Mulan Jin, Chun Zhang, Ruijun Guo, Xiuzhang Lv
IPA is rare and may be misdiagnosed as one of the thyroid nodules. The sonographic appearance of IPAs was identified as profoundly hypoechoic solid nodules with clear boundary, regular shape, rich blood vessels, and the presence of polar feeding vessels which originate from thyroid artery by color doppler sonography was regarded as characteristic features of US for IPAs in this research. The accuracy of ultrasonic diagnosis and localization of IPA depends on the experience of ultrasound physicians. In our hospital, the serum calcium and PTH level are routinely measured for suspected hyperparathyroidism before ultrasonic examination. However, if hypercalcemia was not noted in advance, it is difficult to identify parathyroid adenomas, especially parathyroid adenomas located in the thyroid gland. Additionally, intraoperative ultrasound can make the whole operation more time-saving and accurate.
Related Knowledge Centers
- Benign Tumor
- Hypercalcaemia
- Parathyroid Adenoma
- Parathyroid Gland
- Parathyroid Hormone
- Secondary Hyperparathyroidism
- Osteoporosis
- Blood
- Primary Hyperparathyroidism
- Kidney Stone Disease