scholarly journals Vitamin A and Hydrochlorothiazide Causing Severe Hypercalcemia in a Patient With Primary Hyperparathyroidism

2019 ◽  
Vol 7 ◽  
pp. 232470961882380 ◽  
Author(s):  
Ron T. Varghese ◽  
Khaled Khasawneh ◽  
Raman K. Desikan ◽  
Anandaraj Subramaniam ◽  
Todd Weaver ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin A ◽  
Primary Hyperparathyroidism ◽  
Public Awareness ◽  
Altered Mental Status ◽  
Response To Therapy ◽  
White Female ◽  
Laboratory Findings ◽  
Severe Hypercalcemia ◽  
The Right

Objective. To report a case of severe hypercalcemia, exacerbated by vitamin A supplementation and hydrochlorothiazide, in a patient with primary hyperparathyroidism. Methods. Clinical and laboratory findings are presented along with response to therapy. Results. A 68-year-old white female presented to the emergency department complaining of nausea, vomiting, and altered mental status. Laboratory findings revealed calcium 15.8 mg/dL (8.4-10.2), albumin 4.1 g/dL (3.8-4.8), and parathyroid hormone 62 pg/mL (14-64). Serum calcium improved after intravenous hydration with normal saline. Prior to this hospitalization, over-the-counter medications were significant for calcium (600 mg daily), vitamin A (11 000 IU daily), and vitamin D (800 IU daily).The patient’s prescription medications were significant for hydrochlorothiazide (12.5 mg daily). Twenty-four-hour urine calcium was subsequently found to be 146 mg (35-250). Myeloma, lymphoma, and sarcoidosis were ruled out as the etiology for hypercalcemia. The diagnosis of primary hyperparathyroidism was confirmed. She was treated surgically for primary hyperparathyroidism. The right and left superior parathyroid showed hypercellular parathyroid on pathology. The patient was normocalcemic after surgery. Conclusion. Previous reports suggest that very high doses of vitamin A is required to cause hypercalcemia. This case suggests that in a setting of primary hyperparathyroidism and hydrochlorothiazide therapy, vitamin A may contribute to the development of severe hypercalcemia in patients who are on calcium and vitamin D supplements. Given their biologic effects, public awareness needs to be created regarding the injudicious use of vitamins.

scholarly journals Overlap of Pseudohypoparathyroidism and Primary Hyperparathyroidism in a Patient: Just a Coincidence?

2011 ◽  
Vol 3 (3) ◽  
pp. 128-130
Author(s):  
Ana Karena Neukirch ◽  
Christian Heckmann ◽  
Norbert Weyerbrock ◽  
Silke Günther ◽  
Cornelia Dotzenrath
Keyword(s):  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Female Patient ◽  
Oral Calcium ◽  
Albright’S Hereditary Osteodystrophy ◽  
Lower Position ◽  
The Right ◽  
Inactivating Mutation ◽  
Gnas1 Gene

ABSTRACT A 56-year-old female patient with the phenotype of Albright's hereditary osteodystrophy (AHO) and pseudohypoparathyroidism 1a (PHP) diagnosed in 1987 was shown to have a heterozygote inactivating mutation on the GNAS1 gene. The patient has been treated with oral calcium and vitamin D since diagnosis of PHP 1a and developed primary hyperparathyroidism (pHPT) in 2009. Ultrasound as well as 99Tcsestamibi could demonstrate a lesion in the right lower position. Intraoperatively, a solitary parathyroid adenoma was found and resected leading to a ‘normalization’ of PTH and calcium. This case highlight is the rare coincidence of PHP, AHO and pHPT.

scholarly journals Rare Case of Severe Hypercalcemia Secondary to Atypical Sestamibi Negative Parathyroid Cystic Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A266-A267
Author(s):  
Timur Gusov ◽  
John Chen Liu ◽  
Sowjanya Naha ◽  
F N U Marium ◽  
Joseph Theressa Nehu Parimi ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Severe Hypercalcemia ◽  
Parathyroid Adenomas ◽  
Sestamibi Scan ◽  
Serum Pth ◽  
The Right ◽  
99Mtc Sestamibi ◽  
Cystic Adenoma

Abstract Primary hyperparathyroidism (PHPT) is defined as excessive secretion of parathyroid hormone (PTH) originating from the parathyroid gland. The most common cause is a single parathyroid adenoma which is typically solid. Cystic parathyroid adenomas (CPA) are the cause of about 1–2% of cases of primary hyperparathyroidism. It is known that cystic parathyroid adenomas are a result of degeneration of an existing parathyroid adenoma. SestaMIBI is an imaging study based on uptake of radioactive technetium99 and used to localize parathyroid adenomas. We describe an unusual case of severe hypercalcemia secondary to 99mTc sestaMIBI negative atypical parathyroid cystic adenoma. A 56-year-old male presented to our facility with nausea and vomiting. His past medical history included hypertension and hepatitis C with no history of fractures or kidney disease. Physical examination was normal. Upon admission the patient was afebrile with blood pressure of 170/120 mmHg and heart rate of 62 bpm. Chemistry showed Calcium of 14.5 mg/dL (8.6–10.2mg/dL), phosphorus 2.2 (2.7–4.5) mh/dL, magnesium 1.8 (1.7–2.6)mg/dL, intact PTH of 375 (15–65) pg/mL, PTH-related peptide <2.0 pmol/L(<2 pmol/L), 25-OH vitamin D of 19 ng/ml (30–80), Creatinine 1.22 (0.7–1.2)mg/dL, alkaline phosphatase 95 (40–129) units/L. He was started on aggressive hydration, calcitonin 4 units/kg, 4 mg of IV Zolendroninc acid. Neck sonogram revealed a large, complex, predominantly anechoic lesion with solid vascular components and thick internal septations in the inferior and medial aspect of the right thyroid lobe measuring 3 x 2 x 5.5 cm. Findings were confirmed with CT of the neck. Since Sestamibi scan (planar and SPECT/CT) did not show uptake in parathyroid glands, the cyst was thought to be of thyroid origin. Fine needle aspiration was not able to detect cellular material, but PTH was >100 pg/ml on the FNA sample. Otolaryngology service was consulted for parathyroidectomy. During the surgical treatment, the right upper parathyroid gland was removed with no changes in serum PTH. Next, the cystic lesion was removed with normalization of serum PTH (from 218 pg/ml to 35.2 pg/ml respectively). Intraoperative frozen section analysis was read as a cystic parathyroid adenoma. The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia. Hypercalcemia resolved. Conclusions: Atypical cystic parathyroid adenomas are a rare cause of PHPT. 90% of parathyroid cysts are nonfunctional. Above mention is a case of a patient presenting with hypercalcemic crisis secondary to cystic parathyroid adenoma, which posed a diagnostic challenge as both neck ultrasound and 99mTc sestaMIBI scan were inconclusive. These findings should trigger suspicion for functional parathyroid lesions. Cystic components should be evaluated for PTH levels and if significantly elevated should be treated as a parathyroid adenoma.

scholarly journals Primary Hyperparathyroidism Manifesting with Severe Hypercalcemia in a Nonagenarian Man: Pitfall of Common Imaging Techniques, Localization by 18F-Choline Positron Emission Tomography/Computed Tomography and Successful Management with Calcimimetics

2019 ◽  
Vol 62 (4) ◽  
pp. 156-160 ◽  
Author(s):  
Luca Foppiani ◽  
Gianluca Bottoni ◽  
Arnoldo Piccardo
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Condition ◽  
Imaging Techniques ◽  
Gastrointestinal Symptoms ◽  
First Year ◽  
Old Patients ◽  
Severe Hypercalcemia ◽  
Positron Emission ◽  
Vitamin D Levels ◽  
The Right

A nonagenarian hypertensive man with chronic kidney disease (CKD) was admitted to the emergency department for gastrointestinal symptoms and worsening symptoms of depression. Severe hypercalcemia (15.3 mg/dL) was found and he was hospitalized. Fluids, loop diuretics and glucocorticoids were administered intravenously, which partially reduced calcium levels over a few days and improved his clinical condition. PTH levels proved increased (306 pg/mL) and 25-OHD levels were reduced; primary hyperparathyroidism (PHPT) was diagnosed. Neck ultrasonography (USG) did not show parathyroid enlargement, nor did 99mTechnetium-sestamibi (SESTAMIBI) scintigraphy reveal hyperfunctioning parathyroid glands. By contrast, 18F-choline PET/CT evidenced a nodule located close to the oesophagus, behind the right thyroid lobe, which proved compatible with a hyperfunctioning parathyroid gland. Since the patient declined surgery, and zoledronate was unfit owing to areas of rarefaction of the jaw, the calcimimetic cinacalcet was started; the dosage was progressively titrated up to 120 mg/day with normalisation of calcium levels over time. PTH levels, however, proved erratic and showed an upward trend over the first year of therapy; however its levels partially decreased following increase of vitamin D levels by replacement therapy. Cinacalcet is a useful and safe drug, which can normalise calcium levels and improve the clinical condition, even in very old patients with severe PHPT who decline or are unfit for surgery.

Patient Case Report: Gabapentin-Induced Hypoglycemia

2020 ◽  
pp. 089719002096122
Author(s):  
William J. Hayes ◽  
Abigale Ferdinand ◽  
Stephan Neabore ◽  
John A. Kappes ◽  
Katie M. Hayes ◽  
...  
Keyword(s):  
Case Report ◽  
Calcium Channels ◽  
Case Reports ◽  
Severe Hypoglycemia ◽  
Altered Mental Status ◽  
White Female ◽  
Future Research ◽  
Gamma Aminobutyric Acid ◽  
Laboratory Findings ◽  
Patients With Diabetes

Purpose: Gabapentin is an analog of gamma-aminobutyric acid (GABA), but its complete mechanism is not well understood. Common adverse effects from gabapentin include somnolence, sedation, and dizziness. Hyperglycemia is listed as a possible adverse drug reaction in the labeling. Case reports describe hypoglycemia in patients with diabetes, peritoneal dialysis, and/or incomplete medication records. The following case report details a hypoglycemia episode as a potential result of a gabapentin use in a patient without diabetes. Summary: A 47-year old, 68 kg, white female presented to the emergency department with altered mental status. Her blood glucose level was 33 mg/dL. Gabapentin was started 1 week prior to the hypoglycemia episode. Her past medical history, concomitant medications, and other laboratory findings were not likely causes of her severe hypoglycemia. Conclusion: Gabapentin appears to have effects on several voltage-gated calcium channels. Hypoglycemia may be due to gabapentin binding to the alpha2delta subunit of the calcium channels in the pancreas. Future research should investigate gabapentin and the potential for hypoglycemia.

scholarly journals Primary Hyperparathyroidism Caused by Single Parathyroid Adenoma

2018 ◽  
Vol 35 (9-10) ◽  
pp. 236-40
Author(s):  
Jose R. L. Batubara ◽  
Paruhum T. Siregar ◽  
M. Lutfi ◽  
Daniel Makes ◽  
Wawan Hermawan
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Ultrasound Examination ◽  
Color Doppler ◽  
Roentgenologic Examination ◽  
Laboratory Findings ◽  
First Case ◽  
Pathologic Fractures ◽  
The Right

Primary hyperparathyroidism is rarely found in children under sixteen years old. We report the first case seen at the Department of Child Health, Medical School, University of Indonesia, Jakarta. This 15-year old girl was admitted to the Department, referred by an orthopedic surgeon because of pathologic fractures suspected to be caused by hyperparathyroidism. The physical examination was unremarkable, and the laboratory findings showed increased level of parathyroid hormone. Roentgenologic examination showed lytic skull lesions, loss of the lamina dura of the dentis, subperiosteal resorption of the symphysis and generalized osteoporosis with pathologic fractures. Color Doppler USG using a high resolution ultrasound examination was performed to find the etiology of primary hyperparathyroidism. The result revealed single parathyroid adenoma in the right superior region measuring 2.7 x 1.7 x 1 cm. The clinical manifestation and laboratory findings showed improvement following surgery.

scholarly journals The use of hemodialysis in hypercalcemic crisis secondary to primary hyperparathyroidism

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
Catarina Marouço ◽  
◽  
Fernando Caeiro ◽  
Bernardo Costa ◽  
David Navarro ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Medical Therapy ◽  
Mental Status ◽  
Kidney Injury ◽  
Altered Mental Status ◽  
Medical Emergency ◽  
Hypercalcemic Crisis ◽  
Standard Medical Therapy ◽  
Severe Hypercalcemia ◽  
Stage Renal Disease

Severe hypercalcemia can be either acute or decompensate from a chronic state to a medical emergency, the hypercalcemic crisis. The presence of symptoms such as altered mental status or potentially fatal ECG abnormalities demand an expeditious decrease in serum calcium levels. Standard medical therapy consists of vigorous volume replacement, calcitonin and, depending on the etiology, bisphosphonates, cinacalcet or glucocorticoids. Hypercalcemic crisis is a rare indication for urgent hemodialysis and is reserved for patients with severe symptoms, ineffective medical therapy or end stage renal disease. The use of hemodialysis in this scenario is not commonly reported. We hereby report a patient who presented with altered mental status and acute kidney injury due to a hypercalcemic crisis secondary to primary hyperparathyroidism. Treatment included urgent hemodialysis to effectively lower calcium levels.

scholarly journals Functional Parathyroid Cyst: A Rare Cause of Malignant Hypercalcemia with Primary Hyperparathyroidism—A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Areej Khan ◽  
Yusra Khan ◽  
Shahzad Raza ◽  
Ghulam Akbar ◽  
Monis Khan ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Recurrent Laryngeal Nerve ◽  
Parathyroid Carcinoma ◽  
Anterior Mediastinum ◽  
Laryngeal Nerve ◽  
Rare Presentation ◽  
Parathyroid Cyst ◽  
Severe Hypercalcemia ◽  
Parathyroid Cysts ◽  
The Right

Parathyroid cysts are rare lesions found in the neck and anterior mediastinum. They are often nonfunctional (>90%) and rarely in the functional form. This paper discusses a case of severe hypercalcemia (23 mg/dL) secondary to a rare functional parathyroid cyst. The patient was later found to have a hemorrhagic cyst with compression of the right recurrent laryngeal nerve. Preoperative diagnosis of the lesion was parathyroid carcinoma. However, reexploration of the parathyroid mass along with microscopic study confirmed the diagnosis of a parathyroid cyst. Following cystectomy, the patient restored her baseline functional status with preservation of the right recurrent laryngeal nerve. Postoperative followup three years later showed no evidence of cyst recurrence. This paper illustrates the rare presentation of parathyroid functional cysts with severe hypercalcemia and primary hyperparathyroidism. Physicians should be aware of the presence of hemorrhage, inflammation, and compressive symptoms in these cysts which mimic parathyroid carcinoma. These patients should be managed with aggressive medical and surgical intervention.

Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

1983 ◽  
Vol 41 ◽  
pp. 790-791
Author(s):  
Melinda L. Estes ◽  
Samuel M. Chou
Keyword(s):  
Vastus Lateralis ◽  
Inflammatory Myopathy ◽  
Muscle Disease ◽  
White Female ◽  
Inflammatory Cell Infiltrate ◽  
Limb Weakness ◽  
Muscle Diseases ◽  
History Of ◽  
The Right ◽  
Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

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