scholarly journals Preterm Parturient with Polyhydramnios and Pancreatitis: Primary Presentation of Hyperparathyroidism

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Esther S. Han ◽  
Katherine Fritton ◽  
Phoebe Bacon ◽  
Martin K. Slodzinski ◽  
Cynthia Argani
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multidisciplinary Approach ◽  
Pregnant Patient ◽  
Third Trimester ◽  
Severe Hypercalcemia ◽  
Parathyroid Disease ◽  
Surgical Treatments ◽  
History Presentation ◽  
Work Up ◽  
Primary Presentation

Objective. To report a case of severe hypercalcemia secondary to primary hyperparathyroidism in a late-preterm pregnant patient and review medical and surgical treatments as well as obstetric and neonatal outcomes. Background. Diagnosis of parathyroid disease during pregnancy can be difficult due to nonspecific presentation. Management decisions are complex and require multidisciplinary collaboration. Case. A 29-year-old G2P1001 woman at 35 weeks and 3 days’ gestation presented with preterm contractions, polyhydramnios, pancreatitis, and severe hypercalcemia. Work-up revealed primary hyperparathyroidism with multiple thyroid nodules. Patient history, presentation, and biopsy were suspicious for parathyroid carcinoma. Despite severe hypercalcemia, both patient and fetus remained stable and medical management was pursued in an attempt to optimize mother and fetus prior to delivery. Due to recalcitrant hypercalcemia, surgical resection was ultimately required. She was subsequently delivered in the setting of preterm labor. Final pathology revealed parathyroid adenoma with atypia and occult papillary thyroid carcinoma. Conclusion. Symptoms of hypercalcemia can mimic those of a normal third trimester pregnancy and can have serious maternal and fetal effects if left untreated. A coordinated, multidisciplinary approach to these patients is necessary.

scholarly journals The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

2012 ◽  
Vol 94 (1) ◽  
pp. 17-23 ◽  
Author(s):  
SR Aspinall ◽  
S Nicholson ◽  
RD Bliss ◽  
TWJ Lennard
Keyword(s):  
Minimally Invasive Surgery ◽  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Negative Predictive Value ◽  
Invasive Surgery ◽  
Predictive Value ◽  
Surgical Practice ◽  
Parathyroid Disease ◽  
Operative Findings ◽  
The Impact

INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

scholarly journals A rare case report on double J stenting in a rare case antepartum patient with right sided hydronephrosis and hydroureter

2021 ◽  
Vol 10 (10) ◽  
pp. 3989
Author(s):  
Niranjan N. Chavan ◽  
Shikhanshi . ◽  
Tulika Chouhan ◽  
Shreya Kampoowale
Keyword(s):  
Rare Case ◽  
Multidisciplinary Approach ◽  
Renal Colic ◽  
Symptom Relief ◽  
Severe Form ◽  
Gravid Uterus ◽  
Potential Harm ◽  
Rare Case Report ◽  
Loin Pain ◽  
Surgical Treatments

Gestational hydronephrosis (GH) is caused due to dilatation effect of the progesterone as well as physical pressure of the gravid uterus. In pregnancy, its management is challenging as routine radiological investigations and surgical treatments cannot be performed due to the potential harm to the foetus. Women who fail to respond to conservative methods require intervention. Acute hydronephrosis and renal colic are common aetiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Double J (DJ) stenting during pregnancy is safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms. Multidisciplinary approach to this procedure is advised.

Endocrine monitoring after severe hypercalcemia due to primary hyperparathyroidism. In search of lost…MEN 2A?

2021 ◽  
Author(s):  
Laura Teodoriu ◽  
Maximilian Hogea ◽  
Viorel Scripcariu ◽  
Bianca Ioan ◽  
Letitia Leustean ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Severe Hypercalcemia ◽  
Men 2A

GCM2 Variants in Familial and Multiglandular Primary Hyperparathyroidism

2021 ◽  
Author(s):  
Sarah Vincze ◽  
Nicholas V Peters ◽  
Chia-Ling Kuo ◽  
Taylor C Brown ◽  
Reju Korah ◽  
...  
Keyword(s):  
General Population ◽  
Primary Hyperparathyroidism ◽  
Clinical Utility ◽  
Low Risk ◽  
Dna Encoding ◽  
High Frequencies ◽  
Parathyroid Disease ◽  
Potential Clinical Utility ◽  
Variant Alleles

Abstract Context Multiglandular and familial parathyroid disease constitute important fractions of primary hyperparathyroidism (PHPT). Germline missense variants of GCM2, a regulator of parathyroid development, were observed in familial isolated hyperparathyroidism (FIHP) and sporadic PHPT. However, as these previously-reported GCM2 variants occur at relatively high frequencies in the population, understanding their potential clinical utility will require both additional penetrance data and functional evidence relevant to tumorigenicity. Objective Determine the frequency of GCM2 variants-of-interest among patients with sporadic multigland or familial parathyroid disease, and assess their penetrance. Design and Patients DNA encoding PHPT-associated GCM2 germline-variants were PCR-amplified and sequenced from 107 patients with either sporadic multigland or suspected/confirmed familial parathyroid tumors. Results GCM2 variants were observed in 9 of 107 cases (8.4%): Y282D in 4 patients (6.3%) with sporadic multigland disease; Y394S in 2 patients (11.1%) with familial PHPT and three (4.8%) with sporadic multigland disease. Compared with the general population, Y282D was enriched 5.9-fold in multigland disease but its penetrance was very low (0.02%). Y394S was enriched 79-fold in sporadic multigland disease and 93-fold in familial PHPT, but its penetrance was low (1.33%, 1.04% respectively). Conclusions Observed in vitro activating GCM2 variant alleles are significantly overrepresented in PHPT patients with multiglandular or familial disease compared with the general population, yet penetrance values are very low i.e. most individuals with these variants in the population have a very low risk of developing PHPT. The potential clinical utility of detecting these GCM2 variants requires further investigation, including assessing their possible role as pathogenic/low-penetrance alleles.

scholarly journals A Case Report with Severe Thrombocytopenia Induced by Axitinib

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ulkuhan I. Koksal ◽  
Janeiro Valle Goffin ◽  
Brian Lewis ◽  
Oliver A. Sartor ◽  
Elizaveta Belyaeva ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Kinase Inhibitor ◽  
Checkpoint Inhibitors ◽  
Severe Thrombocytopenia ◽  
Vascular Endothelial ◽  
Successful Management ◽  
Antiangiogenic Therapies ◽  
Diagnostic Work ◽  
Endothelial Growth Factor ◽  
Work Up

Axitinib is an oral, second-generation tyrosine kinase inhibitor that is selective for vascular endothelial growth factor receptors (VEGFR). This agent is approved as monotherapy or in combination with immune checkpoint inhibitors for the treatment of metastatic renal cell carcinoma. Axitinib is associated with a safety profile very similar to other anti-VEGFR inhibitors but usually with fewer hematologic adverse events, due to the selectivity for VEGF. In this report, we presented a rare case of grade 4 axitinib-induced thrombocytopenia, not observed with other antiangiogenic therapies. We discuss the differential diagnostic work-up, the necessary multidisciplinary approach, and the successful management of the case.

scholarly journals Acute Type A Aortic Dissection in a 36-Week Pregnant Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Erol Kohli ◽  
Sharhabeel Jwayyed ◽  
Gary Giorgio ◽  
Mary Colleen Bhalla
Keyword(s):  
Aortic Dissection ◽  
Early Recognition ◽  
Type A ◽  
Pregnant Patient ◽  
Acute Type ◽  
Third Trimester ◽  
Type A Aortic Dissection ◽  
Increased Risk ◽  
History Of ◽  
Aortic Dissections

Aortic dissection is a relatively rare yet often fatal condition. Early recognition and treatment are crucial for survival. While the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, and a family history of aortic dissection are also at an increased risk for developing this condition. A review of the literature revealed a paucity of published cases describing the successful, emergent repair of acute type A aortic dissections in third- trimester gravid patients. We present the case of the successful diagnosis and surgical repair of a 41-year-old female who presented to the emergency department with an acute type A aortic dissection at 36 weeks of gestation.

Favorable pregnancy outcomes following continual intramuscular lorazepam use in late pregnancy

2013 ◽  
Vol 3 (2) ◽  
pp. 96-98
Author(s):  
Karen E. Moeller
Keyword(s):  
Case Report ◽  
Pregnancy Outcomes ◽  
Late Pregnancy ◽  
Pregnant Patient ◽  
High Dose ◽  
Third Trimester ◽  
The Third

Use of benzodiazepines during pregnancy is controversial due to conflicting studies in the literature. Furthermore, few published reports on continual use of parenteral benzodiazepines during the third trimester of pregnancy have been published. This case report evaluates the use of high-dose intramuscular lorazepam in a pregnant patient during her last three weeks of gestation.

Severe Hypercalcemia due to Primary Hyperparathyroidism with MEN 2A

2010 ◽  
Vol 2 (3) ◽  
pp. 131-133
Author(s):  
Geoffrey B Thompson ◽  
Benzon M Dy ◽  
Bianca Vazquez ◽  
Peter J Tebben ◽  
Seema Kumar
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Surgical Management ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Mineral Density ◽  
Normal Range ◽  
Rare Presentation ◽  
Severe Hypercalcemia ◽  
Men 2A

ABSTRACT Introduction Severe hypercalcemia due to primary hyperparathyroidism (PHPT) is rare in the setting of MEN 2A. Materials and methods Two patients with MEN 2A and severe hypercalcemia were identified recently. Their clinical presentation, evaluation, surgical management and outcomes are reviewed. Results Two patients with MEN 2A were identified with severe hypercalcemia secondary to a parathyroid adenoma. Calcium levels were elevated to 12.7 mg/dL and 15.1 mg/dL, respectively (normal range = 8.9-10.1 mg/dL). In each case, a single parathyroid adenoma was identified and surgically excised with normalization of parathyroid and calcium levels postoperatively. Clinical manifestations at the time of diagnosis included constipation, polyuria, hypercalciuria, and decreased bone mineral density. Conclusion Severe elevation of serum calcium is a rare presentation of PHPT in MEN2A. The differential diagnosis should include parathyroid adenoma, hyperplasia and parathyroid carcinoma. Early surgical management is essential in the treatment of hyperparathyroidism with severe hypercalcemia to prevent further complications.

scholarly journals Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
S. Helme ◽  
A. Lulsegged ◽  
P. Sinha
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Parathyroid Tissue ◽  
Neck Surgery ◽  
Safe Procedure ◽  
Preclinical Phase ◽  
Abnormal Parathyroid Gland ◽  
Parathyroid Disease ◽  
History Of

Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

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