scholarly journals MON-123 Underdiagnosis of Primary Hyperparathyroidism in the Outpatient Setting of an Academic Health Care System

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nardeen Dawood ◽  
Dalena Nguyen ◽  
Chi-Hong Tseng ◽  
Masha Jean Livhits ◽  
Angela M Leung ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
International Workshop ◽  
Elevated Serum ◽  
Outpatient Setting ◽  
Total Calcium ◽  
Ipth Level ◽  
Serum Total Calcium ◽  
Tertiary Healthcare ◽  
Study Population ◽  
Repeat Assessment

Abstract Background: Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia in the outpatient population and is associated with nephrolithiasis, osteoporosis, and further end-organ effects. When indicated, parathyroidectomy is an effective intervention. The aim of this study was to assess the prevalence of patients with hypercalcemia resulting from undiagnosed PHPT within a large, urban, academic healthcare system. Methods: The study population comprised all patients within UCLA Health. The electronic medical record was queried between 01/01/2016-12/31/2018 to include patients with at least two elevated serum total calcium concentrations (>10.4 mg/dL) within a six-month period in the outpatient setting. Causes of secondary and tertiary PHPT were excluded. In concordance with the PHPT diagnostic criteria outlined by the Fourth International Workshop, we evaluated the proportion of patients with hypercalcemia who were further assessed with a serum intact parathyroid hormone (iPTH) test. The study identified cases of PHPT as defined by confirmed elevated serum total calcium concentrations and elevated or inappropriately normal iPTH concentrations. Results: There were 7102 patients with a single elevated serum total calcium result who never received a repeat assessment within the study period. Although there were 5617 patients with confirmed hypercalcemia, only 2773 (51%) had an iPTH level assessed within six months of the repeated calcium measurement. Of those who underwent iPTH testing, 1931 (69%) were biochemically confirmed to have classic (34.2%) or normohormonal (35.4%) PHPT; the remaining 31% had an appropriately suppressed iPTH concentration relative to the hypercalcemia. Conclusions: In a large, academic, tertiary healthcare center, over half of the ambulatory patients with confirmed hypercalcemia did not receive further work-up to assess for possible PHPT. Efforts to improve diagnosis of PHPT and expand curative treatment have the potential to decrease the prevalence of nephrolithiasis, bone loss, and further end-organ effects associated with the disease.

NEONATAL HYPOCALCEMIA IN LOW BIRTH WEIGHT INFANTS

PEDIATRICS ◽  
1970 ◽  
Vol 45 (5) ◽  
pp. 773-781
Author(s):  
Reginald C. Tsang ◽  
William Oh
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Normal Values ◽  
Elevated Serum ◽  
Total Calcium ◽  
Low Birth Weight Infants ◽  
Lower Serum ◽  
Oral Calcium ◽  
Serum Total Calcium ◽  
Neonatal Hypocalcemia

During an 8-month period, 37 of 124 infants (29.8%) admitted to a low birth weight (LBW) nursery developed hypocalcemia at a mean age of 29 hours. Ten factors were associated with hypocalcemia, three of which appear particularly relevant: (1) low gestational age (32 weeks or less) with appropriate birth weight, (2) low oral calcium intake, (3) correction of acidosis with NaHCO3. Biochemical determinations showed that, in hypocalcemic infants, there were: (1) lower serum total calcium values at 8 hours of life, prior to the actual development of hypocalcemia at 29 hours; (2) elevated serum phosphorus values; (3) acidotic values in the first hours of life, corrected to normal values at the time of hypocalcemia, and (4) lower serum protein values at 8 hours of life. Three signs were significantly related to hypocalcemia, namely, twitching of one or more extremities, high-pitched cry, and hypotonia.

scholarly journals Multiple ectopic parathyroid adenomas

2004 ◽  
Vol 122 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Rogério Aparecido Dedivitis ◽  
André Vicente Guimarães ◽  
Gustavo Bastos de Goes Pontes
Keyword(s):  
Primary Hyperparathyroidism ◽  
Histopathological Examination ◽  
Thyroid Cartilage ◽  
Elevated Serum ◽  
Neck Surgery ◽  
Tissue Mass ◽  
Serum Total Calcium ◽  
Parathyroid Adenomas ◽  
Sestamibi Scanning ◽  
Ectopic Parathyroid

CONTEXT: Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery. CASE REPORT: A 65-year-old female presented with nephrolithiasis. Her serum total calcium was found to be elevated. The diagnosis of primary hyperparathyroidism was confirmed by the elevated serum intact parathyroid hormone levels. Ultrasound was only successful in localizing one adenoma in the lower right gland. Technetium sestamibi scanning correctly localized the same adenoma and showed another contralateral image, lateral to the thyroid cartilage. Fiber optic laryngoscopy showed an extrinsic mass pushing against the lateral and posterior walls of the left pyriform sinus. Resonance imaging revealed a soft tissue mass. RESULTS: The patient underwent bilateral neck exploration. Histopathological examination confirmed the diagnosis of parathyroid double adenomas. The late-stage postoperative checkups were normal. DISCUSSION: Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.

Effect of Hypocalcemia on Cardiac Function in Very-Low-Birth-Weight Preterm Neonates: Studies of Blood Ionized Calcium, Echocardiography, and Cardiac Effect of Intravenous Calcium Therapy

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 543-550
Author(s):  
Pankaja S. Venkataraman ◽  
Don A. Wilson ◽  
Roger E. Sheldon ◽  
Radhakrishna Rao ◽  
Michael K. Parker
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cardiac Function ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Very Low Birth Weight ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Total Calcium ◽  
Serum Total Calcium

Traditionally, in infants, a serum calcium value less than 7.0 mg/dL is considered to impair cardiac function. In very-low-birth-weight infants, we studied the hypotheses that decline in serum calcium to 6.0 mg/dL (1) would not impair cardiac function and (2) ionized calcium would remain greater than 3.0 mg/dL. We also evaluated the effect of calcium infusion on cardiac function. We studied 15 normokalemic and normonatremic infants whose birth weights were 822 to 1,450 g and were less than 32 weeks' gestation. When serum calcium declined to less than 6.0 mg/dL, 18 mg/kg of calcium as 5% calcium gluconate was infused for 10 minutes. Serum total calcium concentration, blood ionized calcium concentration, ECG, and M-mode echocardiogram were obtained on entry into the study, when the infants were hypocalcemic, immediately after treatment with calcium, and eight hours after treatment. Ionized calcium values were calculated based on serum total calcium and serum protein, and corrected calcium values were calculated based on serum total calcium, serum albumin, and blood pH. In all infants, serum calcium value declined to less than 7.0 and in eight infants to less than 6.0 mg/dL. Assessment of heart rate, systolic blood pressure, ejection fraction, left ventricular systolic time interval, right ventricular systolic time interval, fiber shortening index, and left ventricular mean velocity of circumferential fiber shortening showed no significant alteration from baseline during hypocalcemia or in association with intravenous slow bolus infusion of 18 mg/kg of calcium. In association with a decline in serum total calcium to as low as 6.0 mg/dL, whole blood ionized calcium was maintained at more than 3.0 mg/dL. Serum total calcium and calculated ionized calcium values correlated significantly with measured blood ionized calcium concentrations; however, these measures were not reliable predictors of blood ionized calcium. We speculate that the hypoproteinemia and hypoalbuminemia noted in these infants may result in relative protection of the blood ionized calcium in these infants. We suggest that in neonates with wide ranges in gestation, serum protein, and blood pH levels, total serum calcium and calculated ionized calcium values may be poor measures of derangement of calcium metabolism. Decline in total serum calcium concentration to 6.0 mg/dL was not associated with impaired cardiac function, and slow bolus calcium infusion in these hypocalcemic very-low-birth-weight infants neither improved nor impaired cardiac function.

scholarly journals Primary Hyperparathyroidism due to Parathyroid adenoma presenting as recurrent acute pancreatitis

2017 ◽  
Vol 8 (1) ◽  
pp. 98-100
Author(s):  
Tarun J George ◽  
Pughazhendhi Thangavelu ◽  
S Zahir Hussain ◽  
MP Kumaran ◽  
Kini Ratnakar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Elevated Serum ◽  
Surgical Excision ◽  
Medical Sciences ◽  
Thyroid Lobe ◽  
Recurrent Acute Pancreatitis ◽  
Hypoechoic Nodule ◽  
Left Thyroid Lobe

Primary hyperparathyroidism (PHPT) due to parathyroid adenoma presenting as recurrent acute pancreatitis is a rare entity. A 17-year-old male presented with recurrent attacks of pancreatitis and was found to have elevated serum calcium and Parathyroid hormone levels, 11.9mg/dL (8.5-10.2 mg/dL) and 396 pg/ml (10-65pg/ml) respectively. USG neck showed a 1.1 x 0.9 cm hypoechoic nodule in the superior aspect of left thyroid lobe. Parathyroid scintigraphy findings were consistent with parathyroid adenoma. After recovery of pancreatitis, surgical excision of the adenoma was done and the histopathological findings confirmed parathyroid adenoma. There were no further recurrence of pancreatitis following the excision.Asian Journal of Medical Sciences Vol.8(1) 2017 98-100

Adjustment of Serum Total Calcium for Albumin Concentration: Values Change with Age in Women but Not in Men

1996 ◽  
Vol 33 (1) ◽  
pp. 59-62 ◽  
Author(s):  
R B Payne ◽  
J H Barth
Keyword(s):  
Serum Albumin ◽  
Albumin Concentration ◽  
Least Squares Regression ◽  
Total Calcium ◽  
Computer Data ◽  
Younger Women ◽  
Serum Total Calcium ◽  
Wide Range ◽  
Computer Data Base ◽  
Low Prevalence

A total of 669 women and 609 men were selected from a laboratory computer data base in such a way that they would be expected to have a low prevalence of disturbances of calcium homeostasis but a wide range of serum albumin concentrations. The least squares regression coefficients of total calcium on albumin did not differ between men and women, nor did they differ at different ages. Mean serum albumin-adjusted calcium concentrations did not change with age in men from 1 to 90 years, and values were similar in women aged 1–20 years. However, adjusted calcium concentrations were significantly lower in women aged 21–50 and higher in women aged 61–90 than in younger women and all men. The differences were small and are unlikely to affect clinical interpretation.

scholarly journals SAT-380 A Case of Primary Hyperparathyroidism on the Third Trimester of Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Alexandra Carranceja Villapol ◽  
Maria Princess L Kanapi
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Elevated Serum ◽  
Stable Condition ◽  
Abdominal Ultrasound ◽  
Pressure Control ◽  
Ibandronic Acid ◽  
The Right

Abstract Introduction: This is the case of a pregnant woman on her 3rd trimester who was diagnosed with primary hyperparathyroidism. Since there are two patients involved, the potential complications that can be brought about by the diagnostic tests and the treatment had to be weighed against the benefits. Case: The patient is SA, a 34-year old female on her 29th week of pregnancy, admitted due to a month history of abdominal pain described as intermittent, crampy, generalized, non-radiating, and mild-to-moderately severe in intensity. She was advised to do tests but did not comply. In the interim, there was recurrence of symptoms but with resolution. However, the crampy abdominal pain recurred, now localized at the right upper quadrant and epigastric areas, radiating to the right upper back, moderate in intensity, and with associated nausea and vomiting, leading to admission. She was first managed under OB-Gynecology, given hydration, pain management and Betamethasone. She was also referred to Cardiology for blood pressure control, and Surgery for evaluation of the abdominal pain. Due to an increasing trend of her blood glucose, she was referred to Endocrinology and started on insulin. Mild bilateral nephrocalcinoses seen in an abdominal ultrasound prompted work-up showing an elevated serum ionized calcium at 1.88 meq/L (n 1.12-1.32 meq/L), elevated intact PTH at 451.13 pg/ml (n <67.9 pg/ml), and low Vitamin D at 10.96 ng/ml (n >30ng/ml). Parathyroid ultrasound showed nonthyroidal tissue measuring 0.4 x 0.6 cm at the right inferior area. Saline hydration and diuresis with Furosemide were started to manage the hypercalcemia. A multi-disciplinary meeting was held to discuss the options for management and risks involved. The goal was to deliver the baby in stable condition possibly to term, while keeping maternal calcium levels and blood pressure normal. However on her 30th week of gestation, she had persistent elevated blood pressure and underwent emergency caesarian section. After delivery, the patient was advised against breastfeeding for adequate management of her hypercalcemia. She was started on Cinacalcet, Calcitonin, and Ibandronic Acid. A Parathyroid Sestamibi Scan done showed a parathyroid adenoma on the right inferior lobe, and she underwent right inferior parathyroidectomy, with left thyroidectomy and isthmusectomy. Findings showed a right inferior parathyroid adenoma and a benign follicular nodule on the left thyroid. She was started on Calcium Carbonate and Calcitriol, and discharged stable. Conclusions: This case shows that when two lives are at stake every step of the management, whether diagnostic or therapeutic, must be communicated well to the patient and to the other members of the team. It is ultimately a choice made by the expectant mother but through the proper guidance and updated knowledge of the team, combined with a good clinical eye especially in the treatment of pregnant women.

scholarly journals Correlation of serum calcium levels with infarct size and severity of stroke using NIHSS score in patients with acute ischemic stroke

2019 ◽  
Vol 8 (1) ◽  
pp. 55
Author(s):  
Prabhakar K. ◽  
Pujitha S. N. ◽  
Phaneesh Bharadwaj B. S.
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Acute Ischemic Stroke ◽  
Serum Calcium ◽  
Negative Correlation ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Significant Negative Correlation ◽  
Total Calcium ◽  
Nihss Score

Background: Normal cerebral membrane integration is important to maintain the cellular calcium homeostasis. Recent studies have suggested that elevated serum calcium levels at presentation correlates well with the infarct size and severity of stroke.Methods: A total of 73 patients with acute ischemic stroke satisfying inclusion and exclusion criteria were included in the study from November 1st 2017 to April 30th 2019 at a tertiary care centre in Kolar, Karnataka. Serum calcium (total, ionized and albumin corrected calcium) levels were measured at the time of presentation and compared with the infarct size and severity of stroke using NIHSS score (National Institute of Health Stroke Scale).Results: The levels of total calcium, albumin-corrected calcium, and ionized calcium were 9.13±0.89 mg/dL (range: 8.24-10.02), 9.56±0.82 mg/dL (range: 8.74-10.38), and 4.79±0.47 mg/dL (range: 4.3-5.2), respectively. Mean stroke size as measured on the CT scan was 47.38±17.7 cm (range: 21-88). Analysis revealed significant negative correlation between calcium levels (total, corrected, and ionized) and infarct size and severity of stroke.Conclusions: In this study, it was found that there was a statistically significant negative correlation between total, ionized and corrected calcium with the infarct size in patients with ischemic stroke and also the total calcium at presentation and severity of stroke calculated using NIHSS score.

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