Primary Hyperparathyroidism Masquerading as Acute Pancreatitis

2021 ◽  
Vol 53 (06) ◽  
pp. 377-381
Author(s):  
Saurabh Arora ◽  
Parminder Singh ◽  
Rohit Verma ◽  
Naveen Mittal ◽  
Ajit Sood ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Primary Hyperparathyroidism ◽  
Control Group ◽  
Initial Manifestation ◽  
Female Ratio ◽  
Skeletal Involvement ◽  
Severe Pancreatitis ◽  
Male Preponderance ◽  
The Mean ◽  
High Index Of Suspicion

AbstractAcute pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT) is a rare occurrence and timely diagnosis of PHPT is crucial in preventing repeat attack of pancreatitis. The study aimed at evaluating the clinico-radiological profile of patients admitted with acute pancreatitis as the index presentation of PHPT and to determine the factors associated with development of severe pancreatitis. This series included retrospective analysis of medical records of 30 patients admitted with acute pancreatitis as initial manifestation of PHPT. Additionally, we analyzed the data of another 30 patients admitted with PHPT but without any evidence of pancreatitis, to serve as control group. The mean age of the subjects was 44.9±13.9 years with male to female ratio of 1.30. The mean serum calcium level was 12.24±2.79 mg/dl and five (16.6%) patients had normocalcemia at time of presentation. Presence of nephrolithiasis was significantly associated with severe pancreatitis. One patient had refractory hypercalcemia associated with renal failure and was successfully managed with denosumab. Patients with PHPT associated with acute pancreatitis had significantly higher calcium levels and lower frequency of skeletal involvement as compared to PHPT patients without pancreatitis. PHPT masquerading as acute pancreatitis is rare and high index of suspicion is required to diagnose this condition especially in the presence of normocalcemia at presentation. Patients with PHPT associated pancreatitis had male preponderance, higher calcium levels, and lower frequency of skeletal involvement as compared to PHPT patients without pancreatitis.

scholarly journals Potential Clinical Utility of a New IRMA for Parathyroid Hormone in Postmenopausal Patients with Primary Hyperparathyroidism

2004 ◽  
Vol 50 (3) ◽  
pp. 626-631 ◽  
Author(s):  
Vincenzo Carnevale ◽  
Simona Dionisi ◽  
Italo Nofroni ◽  
Elisabetta Romagnoli ◽  
Federica Paglia ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Clinical Utility ◽  
Second Generation ◽  
Control Group ◽  
Roc Curve Analysis ◽  
Potential Clinical Utility ◽  
The Mean ◽  
Serum Pth ◽  
First And Second Generation

Abstract Background: A new commercially available (so-called second-generation) IRMA for parathyroid hormone (PTH) separately detects intact PTH and its N-truncated fragments; however, no studies have compared the first- and second-generation IRMAs for PTH in patients with primary hyperparathyroidism (PHPT) to assess their respective diagnostic accuracies. Methods: We concomitantly investigated 39 postmenopausal patients with PHPT and a control group of 70 healthy postmenopausal women matched for age, renal function, and vitamin D status. In all individuals, PTH was measured with a classic IRMA (PTH-S; DiaSorin Inc.), which uses antibodies directed against epitopes 1–34 and 39–84, and a new method (Scantibodies Laboratory. Inc.), which uses antibodies against epitopes 1–4 and 39–84 (PTH-W) and epitopes 7–34 and 39–84 (PTH-T). We also assayed serum PTH in 10 PHPT patients every 24 h for 5 days after successful surgery. Results: The different assays gave serum PTH values that were >2 SD higher than values for the control population in 59% (PTH-S), 77% (PTH-W), and 82% (PTH-T) of patients with PHPT. However, ROC curve analysis showed no significant differences among the three PTH assays, demonstrating overlapping diagnostic sensitivities. In PHPT patients, the correlation among the assays was highly significant (r = 0.91–0.92; P <0.001). The ratio PTH-W:PTH-T × 100 showed a gaussian distribution in both PHPT patients and controls, whose mean (SD) values [63.4 (13.3)% vs 64.5 (9.5)%, respectively] did not differ significantly. After parathyroidectomy, the mean percentages of variation in PTH detected with all of the assays were quite similar. Conclusions: The distribution of the PTH-W:PTH-T ratio in patients and controls suggests that PHPT does not markedly influence the rate at which biologically inactive fragments are generated by central or peripheral cleavage of PTH. The similar postoperative curves seem to contradict the hypothesized effect of acute hypocalcemia in modulating the central secretion of hormonal fragments. Our results indicate that the three investigated assays have similar diagnostic sensitivities in PHPT.

scholarly journals Early enteral nutrition in acute pancreatitis - how beneficial is it?

2021 ◽  
Author(s):  
Shruthikamal Venkat ◽  
Rajesh Subramaniam ◽  
Vijai Raveendran
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Pain Score ◽  
Tamil Nadu ◽  
Early Enteral Nutrition ◽  
Medical College ◽  
Severe Pancreatitis ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

Background: Acute pancreatitis is an inflammatory disease of pancreas and is one of the leading cause of acute abdomen requiring hospital admission. Nutritional support plays a crucial role in this hypercatabolic state in not only providing calories but also in preventing complications and decreasing recovery time.Methods: This prospective study was done among 120 patients with acute moderate and severe pancreatitis who got admitted in department of general surgery at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India between 2018 and 2019.Results: 67 (55.8%) patients were in early enteral and 53 (44.2%) were in parenteral/delayed enteral group. Maximum number of patients were in 30-40 years age group. The mean of patient age was 40.33. Mean duration of hospital stay in enteral group was 7.06 and in parenteral/delayed enteral group it was 14.09 (p<0.001). Mean pain score in enteral group was 2.69 and in parenteral group it was 6.51 (p<0.001).Conclusions: There was significant (p<0.001) decrease in hospital stay duration and pain score in early enteral group compared to parenteral/delayed enteral group. Infections related to feeding route was found high in parenteral group. No significant difference found in complications of acute pancreatitis. Hence early enteral feeding is more beneficial in terms of shortened hospital stay, decreased pain score leading to reduction in usage of analgesics and reducing the recovery time and less nutrition related complications in management of acute moderate and severe pancreatitis.

scholarly journals Serum TLR9 and NF-κB Biochemical Markers in Patients with Acute Pancreatitis on Admission

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Erdal Demirtas ◽  
İlhan Korkmaz ◽  
Kıvanç Cebecioğlu ◽  
Mustafa Ayan ◽  
Esin Demirtaş ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Biochemical Markers ◽  
Inflammatory Process ◽  
Clinical Severity ◽  
Control Group ◽  
Discriminative Ability ◽  
Cutoff Value ◽  
B Values ◽  
Patient Groups ◽  
The Mean

Aim. The aim of this study was to investigate the serum TLR9 and NF-κB levels in patients for the diagnosis and prognostication of AP in the emergency department. Methods. In the current study, we looked at the TLR9 and NF-κB pathways in a cohort of 45 acute pancreatitis patients and compared them with the control group. We also divided the patient groups as mild-moderate or severe and compared the biomarker levels between the groups. Results. Of the patients with acute pancreatitis, 22 (49%) were male and 23 (51%) were female. The mean age of the patient group was 62 years, with a range of 25–95 years. The control group consisted of 19 (43.1%) male and 25 (56.9%) female patients. The serum TLR9 and NF-κB values were significantly higher than those of the control group [1104.44 ± 339.20 vs. 702.08 ± 203.94; p<0.001 and 8.04 ± 1.76 vs. 4.76 ± 1.13; p<0.001, respectively]. We found that TLR9 and NF-κB had a significant discriminative ability, while the cutoff value for TLR9 was 950.4, with a sensitivity of 73% and specificity of 93% (p<0.001), and the cutoff value for NF-κB was 6.32, with a sensitivity of 89% and specificity of 100% (p<0.001). Conclusion. We demonstrated that the TLR9 and NF-κB pathway is activated in acute pancreatitis and increases the inflammatory process. This may help to further understand the pathogenesis of disorder, diagnosis, and clinical severity. We proposed that blockage of these inflammatory pathways may play a role in the prevention of the disease progression and development of inflammatory complications.

Severity markers in patients with acute pancreatitis

Open Medicine ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. 556-564 ◽  
Author(s):  
Abdullah Kisaoglu ◽  
Bulent Aydinli ◽  
Gurkan Ozturk ◽  
Sabri Atamanalp ◽  
Bunyami Ozogul ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
High Sensitivity ◽  
Scoring Systems ◽  
Serum Levels ◽  
Apache Ii ◽  
Control Group ◽  
Correct Prediction ◽  
Total N ◽  
The Mean ◽  
The Difference

AbstractTo evaluate the effectiveness of serum levels of resistin and CD14 expression in monocytes, and high-sensitivity C-reactive protein (hsCRP) in early stages of acute pancreatitis and correct prediction of the severity of acute pancreatitis (AP) using scoring systems. The study involved 10 (29.41%) male and 24 (70.59%) female patients (total n=34) followed for AP diagnosis at the Department of General Surgery, Ataturk University Medical School between July 2008 and September 2009. In all the patients, Ranson and APACHE II scores, serum resistin, hsCRP, and monocyte CD14 expression levels were determined. The patients were divided into two groups as mild and severe AP groups. A control group was formed and the intergroup comparisons were made. Values ≥ 3 based on the Ranson scoring scale and values ≥ 8 in APACHE II scoring scale were considered to indicate severe AP. Evaluations were based on the values obtained on the 1st and 7th days for serum resistin and hsCRP levels and monocyte CD 14 expression. In 17 (50%) patients, severe AP was determined. No statistically significant differences were found between the mean serum resistin levels of AP groups, while the difference for the same parameter between the mild and severe AP groups and the control group was statistically significant. In the severe AP group, the mean 1st day and 7th day serum hsCRP levels were statistically significantly higher. The CD14 expression in monocytes was similar in all the groups. Serum hsCRP concentrations and Ranson and APACHE II scores and serum resistin and hsCRP concentrations on the 1st day were positively correlated. Serum hsCRP measurement is effective in determining the severity of acute pancreatitis. Serum resistin measurement may be a useful early marker in determining the inflammatory response in AP. However, CD14 expression in monocytes was not found to be a useful marker in the diagnosis and prediction of the disease severity in AP patients.

Lipid fractions in primary hyperparathyroidism before and after surgical cure

1983 ◽  
Vol 102 (4) ◽  
pp. 539-542 ◽  
Author(s):  
N. D. Vaziri ◽  
L. Wellikson ◽  
G. Gwinup ◽  
C. Byrne
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Lipids ◽  
Control Group ◽  
Lipid Levels ◽  
Serum Triglycerides ◽  
Mean Values ◽  
Lipid Fractions ◽  
Before And After ◽  
Surgical Cure ◽  
The Mean

Abstract. A number of previous studies has suggested that PTH may possess a hyperlipimic property. We determined various lipid fractions in 24 patients with primary hyperparathyroidism before and 1–3 months after surgical cure. The mean values for serum total cholesterol, triglycerides. LDL-Chol, VLDL-Chol and HDL-Chol did not change significantly with definitive correction of hyperparathyroidism. The mean values for all lipid fractions were comparable to those of the age and sex-matched normal control group except for HDL-Chol which was significantly lower in the hyperparathyroid group both before and after definitive cure of hyperparathyroidism. Only one patient with combined elevation of serum triglycerides and cholesterol exhibited normalization of the lipid levels after surgery. Two other patients with hypertriglyceridaemia failed to show any reduction in their triglyceride levels after correction of their hyperparathyroidism. Our data suggest that long-standing elevation of PTH to the extent seen in primary hyperparathyroidism and in the absence of predisposing conditions does not increase serum lipids in human.

scholarly journals Evaluation of Carotid Intima-Media Thickness in Sub-clinical Hypothyroid Patients

2018 ◽  
Vol 19 (2) ◽  
pp. 123
Author(s):  
Farhana Rahman ◽  
Fatema Sultana Haque ◽  
Shankar Kumar Biswas ◽  
Rubina Begum ◽  
Sadia Hossain ◽  
...  
Keyword(s):  
Rank Correlation ◽  
Intima Media Thickness ◽  
Control Group ◽  
Control Groups ◽  
College Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Media Thickness ◽  
The Mean ◽  
And Control

<p><strong>Objective:</strong> Endothelial dysfunction and atherosclerosis may be associated with subclinical hypothyroidism (SCH) in multiple ways. The intima-media thickness of the common carotid artery (CIMT) is an important parameter for early atherosclerotic change. Previously several studies addressed the association between SCH and CIMT. Some studies indicate that SCH might be related to increase CIMT, while other studies revealed no significant association.   The aim of the study was to further examine the relationship between CIMT and SCH patients in our own laboratory setting in Bangladesh.</p><p><strong>Patients and Methods: </strong>This cross sectional study was carried out at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Dhaka Medical College Hospital Campus, Dhaka during the period of January 2016 to October 2016. The study included 56 consecutive patients. Out of 56 patients, 26 were in SCH group and 30 were in euthyroid control group. CIMT was measured in each subject via High resolution B-mode ultrasonography. Data were analyzed between these two groups in respect to age, sex, BMI, and mean CIMT.</p><p><strong>Results: </strong>Out of 56 subjects, 26 were SCH group and 30 were euthyroid control group. Male to female ratio was 3:23 and 9:21 in SCH and control groups respectively. The mean age was 30±7.4 and 32±8.7 years in SCH and control groups respectively. The mean BMI was 25.6±4.7 kg/m<sup>2</sup> in SCH and 25.1±4.1 kg/m<sup>2</sup> in control group. The mean CIMT was significantly (p≤0.05) higher in SCH group (Right-0.80±0.05 mm, Left-0.80±0.07 mm) than control group (Right-0.60±0.05 mm, Left- 0.61±0.05 mm). SCH group was further subdivided into two groups with a cut off value of serum TSH at 10 mIU/L.  The mean CIMT was significantly higher in SCH with TSH above 10 mIU/L than SCH group with TSH less than 10 mIU/L (p≤0.05). Pearson’s rank correlation test showed significant positive correlation between both CIMT and TSH values.</p><p><strong>Conclusion: </strong>Our study showed that CIMT was significantly higher in SCH group than euthyroid control group. The CIMT values were positively correlated with the TSH values. Therefore we may conclude that SCH is an independent risk factor for atherosclerosis  in addition to other  classical risk factors.</p><p>Bangladesh J. Nuclear Med. 19(2): 123-127, July 2016</p>

scholarly journals Changes in the management of patients with severe acute pancreatitis

2008 ◽  
Vol 45 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Tercio De Campos ◽  
Candice Fonseca Braga ◽  
Laíse Kuryura ◽  
Denise Hebara ◽  
José Cesar Assef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Specific Approach ◽  
Severe Pancreatitis ◽  
Group A ◽  
The Mean ◽  
Fluid Collections ◽  
Group B

BACKGROUND: Severe acute pancreatitis is present in up to 25% of patients with acute pancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2 decades contributed to reduce the mortality. AIM: To show the evolution in the management of severe acute pancreatitis, comparing two different approaches. METHODS: All patients with severe acute pancreatitis from 1999 to 2005 were included. We compared the results of a retrospective review from 1999 to 2002 (group A) with a prospective protocol, from 2003 to 2005 (group B). In group A severe pancreatitis was defined by the presence of systemic or local complications. In group B the Atlanta criteria were used to define severity. The variables analyzed were: age, gender, etiology, APACHE II, leukocytes, bicarbonate, fluid collections and necrosis on computed tomography, surgical treatment and mortality. RESULTS: Seventy-one patients were classified as severe, 24 in group A and 47 in group B. The mean APACHE II in groups A and B were 10.7 ± 3.5 and 9.3 ± 4.5, respectively. Necrosis was seen in 12 patients (50%) in group A and in 21 patients (44.7%) in group B. Half of the patients in group A and two (4.3%) in group B underwent to pancreatic interventions. Mortality reached 45.8% in group A and 8.5% in group B. CONCLUSION: A specific approach and a prospective protocol can change the results in the treatment of patients with severe acute pancreatitis.

scholarly journals CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY VERSUS FIBER-OPTIC BRONCHOSCOPE DURING OROTRACHEAL INTUBATION IN PATIENTS UNDERGOING ELECTIVE SURGERY

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S180-85
Author(s):  
Moazzam Ali ◽  
Maliha Khawar ◽  
Maryam Nazneen ◽  
Zaqawat Nazneen
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Fiber Optic ◽  
Cardiovascular Response ◽  
Macintosh Laryngoscope ◽  
Orotracheal Intubation ◽  
Control Group ◽  
Female Ratio ◽  
The Mean

Objective: To compare the hemodynamic response between flexible fiber optic bronchoscope (FOB) andMacintosh laryngoscope during orotracheal intubation. The secondary objective was to calculate the timerequired for intubation between these two techniques Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Frontier Corps Hospital Quetta, from Oct 2016 to Apr2017. Methodology: Eighty patients fulfilling the inclusion/exclusion criteria were included in this study and weredivided randomly into two groups. Group L was intubated with Macintosh laryngoscope (control group) whereas group F was intubated with Fiber optic bronchoscope. Mean arterial pressure and heart rate was recorded as baseline, pre-intubation and then every 01 minute for 03 minutes. Changes in heart rate and mean arterial pressure were recorded in the proforma by another anesthetist who was blinded to the procedure performed. Results: The mean age in group L was 41.23 ± 8.37 years and in group F was 40.73 ± 9.77 years. The mean weight in group L was 69.63 ± 8.92 kg and in group F was 70.6 ± 9.20 kg. In group L, male to female ratio was 26:14 whereas in group F it was 28:12. Mean heart rate and mean arterial pressure did not show significant change over time between groups. Time required for intubation was significantly less (22.45 ± 4.12 secs) in laryngoscopy group versus Fiber-Optic Bronchoscope group (44.68 ± 5.88 secs). Conclusion: In conclusion we can say that our study demonstrated that using laryngoscope or Fiber-OpticBronchoscope for orotracheal..........

scholarly journals Temperament and character of patients with alcohol toxicity during COVID -19 pandemic

2021 ◽  
Author(s):  
AliReza Estedlal ◽  
Arash Mani ◽  
Hossein Molavi Vardanjani ◽  
Mahsa Kamali ◽  
Leila Zarei ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Normal Population ◽  
Drinking Motives ◽  
Personality Factors ◽  
Control Group ◽  
Stressful Situation ◽  
Novelty Seeking ◽  
Female Ratio ◽  
The Mean ◽  
Self Transcendence

Abstract Background: Corona virus epidemic may be acts as a stressor or trauma that affects both physical health and mental health. People exhibited various reactive behaviors to confront with this stressful situation. In Iran, one of the common motives for alcohol consumption is to scape problems and cope with stresses. It has been shown that personality factors influence alcohol consumption, since they are associated with drinking motives. The main purpose of this study was to investigate the correlation between temperament and character and alcohol abuse. Methods: This cross-section study was conducted on 135 alcohol intoxicated patients admitted to emergency room in March 2020 and 255 participants who were randomly selected from public in Shiraz. A questionnaire consisted of TCI (Temperament and character inventory) and several questions about COVID-19 pandemic. It was completed by a trained interviewer using the matched answer technique. Demographic factors were self-reported. Results: Among the alcohol intoxicated group, 117 (86.7%) were males and 18(13.3%) were females. The mean age of the participants was 32.43±10.81 years. Among control group, 99 (38.8%) were males and 156 (61.2%) were females. The mean age of control group was 33.12±14.77 years. Alcohol toxicity was mostly observed among the young males (male/female ratio was 6.45). According to temperament and character index, mean scores of novelty seeking, harm avoidant, and self-transcendence were higher in the alcohol toxicity group than normal population (P<0.01). Mean scores of reward dependent, cooperativeness, and self-directedness were higher in normal population than the alcohol toxicity group (P<0.001). The mean score of persistence was not significantly different between methanol intoxicated and normal population groups (P=0.718). Conclusion: Alcohol intoxicated patients had higher scores of novelty-seeking and self-transcendence and lower scores of reward-dependency scores, cooperativeness and self-directedness. These scores are associated with higher likelihood of personality disorders.

scholarly journals A Case Report on Recurrent Acute Pancreatitis with Primary Hyperparathyroidism

2016 ◽  
Vol 11 (1) ◽  
pp. 36-38
Author(s):  
Mukesh Prasad Sah ◽  
Dewan Saifuddin Ahmed ◽  
Syeda Nur E Jannat ◽  
Md Alamgir Kabir ◽  
Muhammad Rezeul Huq ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Calcium Concentration ◽  
Viral Infections ◽  
Recurrent Acute Pancreatitis ◽  
Common Cause ◽  
Severe Pancreatitis ◽  
Gall Stones ◽  
Common Causes

Pancreatitis is a common non-bacterial inflammatory disease caused by activation, interstitial liberation and auto digestion of pancreas by its own enzymes. Common causes of acute pancreatitis are gall stones, alcohol, drugs, trauma, viral infections and hypertriglyceridemia. Much is known about the causes of pancreatitis but huge experimental data available about understanding of its pathogenesis is still incomplete. Hypercalcemia as a cause of pancreatitis is rarely reported. Hypercalcemia is usually the result of Primary hyperparathyroidism (PHPT) and the most common cause of PHPT is parathyroid adenoma. It is thought that the increased calcium concentration in pancreatic juice resulting from hypercalcemia may prematurely activate proteases. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. Here we present a case of recurrent acute pancreatitis resulting from hypercalcemia due to parathyroid adenoma in a 38-year-old man. Hyperparathyroidism was suspected when despite severe pancreatitis calcium level remained high and parathormone level was grossly raisedFaridpur Med. Coll. J. Jan 2016;11(1): 36-38

Sign in / Sign up

Export Citation Format

Share Document