676
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Allbery SM, Swischuk LE, John SD. Hypercalcemia associated with dysgerminoma: case report and imaging findings. Pediatr Radiol 1998; 28:183-5. [PMID: 9561542 DOI: 10.1007/s002470050327] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypercalcemia associated with malignancy is rare in children. We report a case of hypercalcemia associated with ovarian dysgerminoma in a 13-year-old girl with renal medullary calcinosis and vascular calcifications. To our knowledge this is the first report of the imaging findings in this condition and only the fourth case report of hypercalcemia associated with dysgerminoma.
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677
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Payne RB. Renal tubular reabsorption of phosphate (TmP/GFR): indications and interpretation. Ann Clin Biochem 1998; 35 ( Pt 2):201-6. [PMID: 9547891 DOI: 10.1177/000456329803500203] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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678
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Greenwald RA, Stein B, Miller F. Rapid skeletal turnover and hypercalcemia associated with markedly elevated interleukin-6 levels in a young black man. Bone 1998; 22:285-8. [PMID: 9514222 DOI: 10.1016/s8756-3282(97)00283-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 24-year-old black man presented with diffuse musculoskeletal pain and shotty lymphadenopathy. Laboratory studies revealed hypercalcemia and hyperphosphatemia, very high serum alkaline phosphatase activity, diffuse but intense uptake of radionuclide on a bone scan, urinary N-telopeptide excretion 30 times the upper limit of normal, and serum interleukin-6 100 times the upper limit of normal. An extensive workup for etiologies of the disorder was negative. A bone biopsy revealed intense osteoclastic resorption coupled with rapid bone formation and/or remodeling. This case appears to represent a new entity. Treatment with bisphosphonates produced symptomatic and biochemical improvement.
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679
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Achard JM, Bataille P, Hottelart C, Pruna A, Ghazali A, Oprisiu R, Rumpala C, el Esper N, Fournier A. [Idiopathic calcium lithiasis. Practical guide for dietary measures prescriptions]. Presse Med 1998; 27:230-7. [PMID: 9768019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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680
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Royen HI, Westedt ML, den Ottolander GJ, Bieger R. A 78-year-old women with hypercalcemia now and malignancy of unknown origin 11 years ago. Ann Hematol 1998; 76:95-8. [PMID: 9540767 DOI: 10.1007/s002770050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
MESH Headings
- Aged
- Biopsy
- Bone Marrow/pathology
- Diagnosis, Differential
- Female
- Humans
- Hypercalcemia/diagnosis
- Hypercalcemia/etiology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Neoplasm Staging
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681
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Carnaille B, Oudar C, Pattou F, Quievreux J, Proye C. Improvements in parathyroid surgery in the intact 1-84 PTH assay era. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:112-6. [PMID: 9494001 DOI: 10.1111/j.1445-2197.1998.tb04718.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Measurement of intact 1-84 parathormone (PTH) level by immunometric assays has been an important tool in the medical management of hypercalcaemia. The aim of the present study was to evaluate its practical contribution in the diagnosis and surgical treatment of primary hyperparathyroidism. METHODS The results of surgery were compared (number of failed and inadequate cervicotomies, number of overlooked cervical glands) in two groups of primary hyperparathyroid patients operated on without (group I, n = 624) and with (group II, n = 360) intact PTH evaluation. The postoperative intact PTH level was measured 1-50 months after surgery in 109 unselected normocalcaemic patients. The benefit of intact PTH assay was studied in borderline patients. We tried to settle a correlation between parathyroid resected weight and intact PTH pre-operative level in different subsets of the disease. RESULTS The sensitivity for the diagnosis of primary hyperparathyroidism was 86.6% for intact PTH level alone, and 95.9% when plotted with synchronous serum total calcium. Hyperfunctional adenoma was incidentally discovered in 14 asymptomatic normocalcemic normo-PTH patients. The predictive positive value of intact PTH assay for the diagnosis of primary hyperparathyroidism was 99.3%. Intact PTH assay often affirmed the diagnosis of primary hyperparathyroidism in borderline cases. The postoperative intact PTH measurement was not a good indicator for evaluating the late outcome in seemingly cured patients. Sharp but statistically significant correlation was found between the resected weight and the intact PTH level. The discovery of a small adenoma in a patient with high intact PTH level, bone disease and low vitamin D level should raise suspicion of a second hyperfunctioning gland. CONCLUSIONS Intact PTH assay was a main contributor to the surgical management of primary hyperparathyroidism, reducing the number of unnecessary cervicotomies and enabling the cure of all cases of primary hyperparathyroidism except those due to mediastinal glands. It raised unanswered problems in the late postoperative course.
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682
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Cordeiro AC, Montenegro FL, Kulcsar MA, Dellanegra LA, Tavares MR, Michaluart P, Ferraz AR. Parathyroid carcinoma. Am J Surg 1998; 175:52-5. [PMID: 9445240 DOI: 10.1016/s0002-9610(97)00228-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Parathyroid carcinoma is rare and represents 0.1% to 5% of the cases of hyperparathyroidism. New accounts are important to the understanding of these tumors. Experience in 9 cases is reported. METHODS From 1970 to 1995, 10 patients with parathyroid carcinoma demonstrated by clinical course or pathologic features of malignancy were treated. The patient's clinical data, laboratory and imaging examinations, surgical findings, pathology, recurrences, and survival were analyzed. RESULTS One male patient was excluded because of insufficient data. Average age was 51 years, with female:male ratio of 2:1. Average calcium level was 14,3 mg/dL. Palpable mass was found in 55%, bone disease in 89%, and renal disease in 78%. Four patients were reoperations. Five were operated on for hyperparathyroidism (1/tertiary). Capsular invasion was the most incident pathologic feature. Local recurrence occurred in 55%; neck node and bone metastasis in 11%, and lung in 33%. Two patients are alive and 5 died of disease. CONCLUSIONS Parathyroid carcinoma has clinical and laboratory features that can help diagnosis at the first surgery. It seems to have variable malignancy.
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683
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Riopel MA, Perlman EJ, Seidman JD, Kurman RJ, Sherman ME. Inhibin and epithelial membrane antigen immunohistochemistry assist in the diagnosis of sex cord-stromal tumors and provide clues to the histogenesis of hypercalcemic small cell carcinomas. Int J Gynecol Pathol 1998; 17:46-53. [PMID: 9475192 DOI: 10.1097/00004347-199801000-00009] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ovarian sex cord-stromal tumors are a morphologically diverse group of neoplasms that can mimic the appearance of other ovarian tumors. Because the treatment and prognosis of sex cord-stromal tumors differs substantially from those of other ovarian neoplasms, the development of an immunohistochemical panel to support the diagnosis of the former group of tumors would be useful. In this report, the utility of immunostaining for inhibin alpha, epithelial membrane antigen, MIC2 gene protein product, and keratin in the differential diagnosis of sex cord-stromal tumors was assessed in formalin-fixed, paraffin-embedded sections. In addition, the immunohistochemical staining pattern of ovarian small cell carcinomas (SCCs), hypercalcemic type, was analyzed in an attempt to clarify the histogenesis of these tumors. Thirty-two (97%) of 33 granulosa cell tumors (GCTs), 10 (91%) of 11 Sertoli-Leydig cell tumors (SLCTs), and 4 (8%) of 51 carcinomas showed inhibin alpha immunopositivity. None of the 3 lymphomas, 5 carcinoids, 6 dysgerminomas, or 12 SCCs showed inhibin alpha positivity. Eighteen (55%) GCTs, 6 (55%) SLCTs, 6 (12%) carcinomas, and 7 (58%) SCCs showed MIC2 gene expression. None of the GCTs and only one SLCT showed epithelial membrane antigen (EMA) positivity, although 92% of surface epithelial carcinomas and 75% of SCCs were immunoreactive. These data suggest that detection of inhibin immunoreactivity in an ovarian tumor that is EMA-negative provides both sensitive and specific support for the diagnosis of a sex cord-stromal tumor. Because SCCs generally stain for EMA but not for inhibin, it appears that SCCs probably represent a variant of surface epithelial tumor rather than a type of sex cord-stromal tumor.
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684
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Fournier A, Said S, Ghazali A, Sechet A, Ezaitouni F, Marie A, Westeel PF, Morinière P, Boudailliez B. The clinical significance of adynamic bone disease in uremia. ADVANCES IN NEPHROLOGY FROM THE NECKER HOSPITAL 1997; 27:131-66. [PMID: 9408446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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685
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Hadjadj S, Nunez S, Bohme P, Goulet Salmon B, Klein M, Weryha G, Leclere J. [False elevated serum level of circulating calcitonin induced by omeprazole]. Presse Med 1997; 26:1859. [PMID: 9569909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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686
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Frølich A. Combined reports on serum calcium and discriminant functions increase the diagnostic rate of hypercalcaemia. Scand J Clin Lab Invest 1997; 57:725-9. [PMID: 9458496 DOI: 10.3109/00365519709105235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypercalcaemia is a condition easily overlooked by the clinician. Prompted by the observation that computerized reminders could increase the awareness, we have examined whether the combined reporting of increased serum calcium results and the results from diagnostic discriminating calculations could increase the clinical awareness of hypercalcaemia. Albumin-corrected serum calcium was estimated in all 4500 patients admitted to the hospital during a period of 2 months. Eighty-seven patients were found with hypercalcaemia and were assigned randomly to 2 groups: A (40 patients) and B (47 patients). In group A, the increased serum calcium and the results of the discriminant functions were reported; in group B, the serum calcium was reported only if requested and the discrimination diagnosis withheld. The clinical records were examined 3 weeks after admission. At this time the records in group A contained a relevant clinical diagnosis explaining the hypercalcaemia in 81% of the cases. This was in contrast to only 31% of the records in group B. We conclude that this combined reporting leads to a considerable improvement in the clinical awareness of hypercalcaemia and results in a diagnosis explaining the condition in the majority of cases.
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687
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Ashby JP, Newman DJ, Gow SM. Clinical application of intact parathyroid hormone assays. Ann Clin Biochem 1997; 34 ( Pt 6):588-98. [PMID: 9366997 DOI: 10.1177/000456329703400603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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688
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Freitag J, Göbel U, Passfall J, Kettritz U, Schneider W, Luft FC. Consider sarcoidosis in patients with nephrocalcinosis, even if the chest roentgenogram is normal. Nephrol Dial Transplant 1997; 12:2161-5. [PMID: 9351084 DOI: 10.1093/ndt/12.10.2161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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689
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Sakoulas G, Tritos NA, Lally M, Wanke C, Hartzband P. Hypercalcemia in an AIDS patient treated with growth hormone. AIDS 1997; 11:1353-6. [PMID: 9302445 DOI: 10.1097/00002030-199711000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
METHOD Recombinant human growth hormone (rhGH) is a newly approved treatment for weight loss and wasting in patients with AIDS. We report a male patient with advanced AIDS who developed hypercalcemia 2 weeks after institution of rhGH therapy. RESULTS Parathyroid hormone, parathyroid hormone-related peptide and 1,25-dihydroxyvitamin D levels were suppressed, suggesting that hypercalcemia was mediated through alternative mechanisms. The hypercalcemia responded to discontinuation of rhGH and a single dose of intravenous pamidronate disodium and has not recurred in 8 months of follow-up. CONCLUSION We believe this to be the first reported case of rhGH-induced hypercalcemia in an HIV-infected patient.
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690
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Fernández-Fernández FJ. Primary hyperparathyroidism. Lancet 1997; 350:365. [PMID: 9251657 DOI: 10.1016/s0140-6736(05)63419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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691
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Gakiya I, Kugai Y, Hayashi S, Nimura S, Zaha O, Kouchi A, Oshiro J, Sakugawa H, Kitukawa K, Kinjou F, Saitou A, Araki K. Varioliform mucosal polypoid lesions in intestinal tract in a patient with adult T-cell leukemia. J Gastroenterol 1997; 32:553-7. [PMID: 9250907 DOI: 10.1007/bf02934099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe a case of adult T-cell leukemia (ATL) with intestinal infiltration. In the early clinical stage, the endoscopic findings for the intestine were similar to those of amebic enterocolitis, i.e., varioliform mucosal polypoid lesions, and amebic cyst was detected with stool examination. Although no specific pathological factor could be identified on biopsy, the patient was treated for amebiasis as a diagnostic therapy. The findings of varioliform mucosal polypoid lesions were detected in the duodenum on endoscopic examination, but the lesions eventually disappeared during the treatment for amebiasis. We then suspected lymphoma partially masked by the amebiasis. Immunological staining of a specimen of the colonic mucosa revealed T cell invasion and Southern blotting demonstrated adult T-cell leukemia provirus invasion. Thus, ATL cell infiltration of the intestinal tract was confirmed. It is suggested that systemic disease should also be considered when varioliform mucosal polypoid lesions are found on colonoscopic examination.
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692
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693
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Abstract
Familial hypocalciuric hypercalcemia (FHH) is often considered in the differential diagnosis of hyperparathyroidism, but is rarely diagnosed. So far, FHH has not been documented in Israel. This report presents preliminary evidence for the occurrence of FHH in Israel.
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694
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Förster C, Ostertag H, Schmitt J, Roessner A. Small cell carcinoma of the ovary, hypercalcemic type. A case report with immunohistochemical, ultrastructural and cytophotometric analysis and review of the literature. GENERAL & DIAGNOSTIC PATHOLOGY 1997; 142:365-70. [PMID: 9228263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Small cell carcinomas of the ovary, hypercalcemic type, are unilateral tumors occurring almost exclusively in young women. 60% of the cases are associated with hypercalcemia. Microscopic examination shows diffuse clusters of small cells and follicle-like spaces. Immunohistochemically, the tumor cells are positive for epithelial and mesenchymal markers, and ultrastructurally they contain an abundance of dilated rough endoplasmatic reticulum and numerous free ribosomes. By DNA-single cell photometry, the neoplastic cells show a diploid DNA-content.
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695
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Chan FK, Koberle LM, Thys-Jacobs S, Bilezikian JP. Differential diagnosis, causes, and management of hypercalcemia. Curr Probl Surg 1997; 34:445-523. [PMID: 9186232 DOI: 10.1016/s0011-3840(97)80008-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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696
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Teachout DJ, Taylor SM, Archer FJ. A comparison of serum ionized calcium concentrations and serum total calcium concentrations in dogs with lymphoma. ZENTRALBLATT FUR VETERINARMEDIZIN. REIHE A 1997; 44:195-200. [PMID: 9270341 DOI: 10.1111/j.1439-0442.1997.tb01101.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Serum ionized calcium and total calcium concentrations were measured in 16 dogs with lymphoma and 49 healthy control dogs. Blood samples for all determinations of ionized calcium were collected into tubes containing silicone separator gel and processed under a closed anaerobic system. An ionized calcium analyser with ion selective electrodes was used to determine pH, ionized calcium and ionized calcium adjusted to pH 7.4. Reference ranges for ionized calcium (iCa pH 7.4) of 1.30-1.46 mmol/l, and for total calcium of 2.37-2.82 mmol/l were established. A stronger correlation (r = 0.85) was found between measured ionized calcium and total calcium levels in dogs with lymphoma and hypercalcaemia than in those with lymphoma and normocalcaemia (r = 0.64). Measurement of serum ionized calcium was diagnostically concordant with the measurement of serum total calcium in the determination of calcium status in all dogs with lymphoma. Serum ionized calcium did not provide a diagnostic advantage over total calcium in the detection of hypercalcaemia of malignancy in these dogs.
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697
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698
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Reasner CA, Isley WL. Endocrine emergencies. Recognizing clues to classic problems. Postgrad Med 1997; 101:231-4, 237-8, 241-2. [PMID: 9074561 DOI: 10.3810/pgm.1997.03.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although the possibility of an endocrine emergency occurring in a primary care setting may seem remote, awareness of such emergencies is crucial for appropriate management. While some symptoms are specific to classic endocrine disorders, other symptoms, such as nausea, vomiting, and diarrhea, are so general that the diagnosis may not be considered initially. In these situations, careful and thoughtful diagnostic studies can be lifesaving.
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699
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Luboshitzky R, Hardoff R. Recovery from metabolic bone disease in a girl with vitamin D deficiency rickets associated with primary hyperparathyroidism. J Pediatr Endocrinol Metab 1997; 10:237-41. [PMID: 9364360 DOI: 10.1515/jpem.1997.10.2.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe a 13 year-old Ethiopian girl with vitamin D deficiency rickets. Hypercalcemia, increased serum alkaline phosphatase and PTH levels, together with low serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D suggested the co-existence of primary hyperparathyroidism. The surgical removal of a parathyroid adenoma led to bone healing and normalization of blood chemistry. We conclude that vitamin D deficiency masked the hyperparathyroidism and hypercalcemia, while excess PTH secretion delayed the cure of rickets until successful parathyroidectomy had been carried out.
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700
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Schweizer I, Bleisch JA, Gemsenjäger E. [Primary hyperthyroidism 1996]. SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT 1997; 127:243-53. [PMID: 9157529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
55 prospectively documented patients aged 20-84 (median 67) years (47 women, 8 males) underwent surgery for primary hyperparathyroidism (pHPT). The most frequent symptoms and associated conditions were nephrolithiasis (42%) and neuropsychiatric symptoms (39%). Only one case of asymptomatic and one case of "normocalcemic" pHPT were found in this series. 47 patients (89%) were cured following initial neck exploration, and 3 further patients (6%) were cured by a second operation. Reoperation also led to cure in 2 patients operated on elsewhere in the first instance. 6 patients (11%) had double adenoma (bilaterally) and 36% of the adenomas had an ectopic location, with an intrathyroidal adenoma in 2 cases. In 2 patients sternotomy was carried out. Persistent pHPT was observed in 3 patients (following initial exploration in 2 cases and reoperation in one). These patients had a supernumerary adenomatous gland with ectopic location in 2 cases and a double adenoma with ectopic position of one adenoma in a further case. One 80-year-old patient died post-operatively from intestinal ischemia. 2 patients had permanent postoperative hypoparathyroidism; in no case was a permanent recurrent laryngeal nerve palsy observed. Bilateral parathyroid exploration with thyroid mobilization by capsular dissection is the procedure of choice for pHPT. In 2 patients with the MEN 2A-syndrome and with medullary thyroid carcinoma thyroidectomy, lymphadenectomy and autotransplantation of normal parathyroids to the arm was performed, with normal parathyroid function in both cases.
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