scholarly journals Primary hyperparathyroidism in a child with abdominal pain and hematuria

2021 ◽  
Vol 30 (2) ◽  
pp. 111-113
Author(s):  
Yuta Fukaya ◽  
Yuji Oto ◽  
Takeshi Inoue ◽  
Hisashi Itabashi ◽  
Masahisa Shiraishi ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Primary Hyperparathyroidism

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 SAT-058 A Rare Case of Primary Hyperparathyroidism in a Pediatric Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Natalia Salazar ◽  
Jeff M Merz ◽  
Liliana Burdea ◽  
Carla Minutti
Keyword(s):  
Abdominal Pain ◽  
Primary Hyperparathyroidism ◽  
Clinical Significance ◽  
Parathyroid Tissue ◽  
High Serum ◽  
Genetic Evaluation ◽  
Atypical Presentation ◽  
Pediatric Endocrinology ◽  
Endocrine Disorder ◽  
Ret Gene

Abstract Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder in adult patients, but it is rare in pediatric patients. It is usually diagnosed when patients present with symptomatic hypercalcemia or known complications. In children, atypical presentation often results in delayed diagnosis and increased morbidity. We report a 10-year-old boy presenting with abdominal pain and emesis, found to have hypercalcemia and, ultimately, PHPT. His genetic evaluation was notable for a mutation in the RET gene (3.2C>A) of unknown clinical significance. Case presentation: A 10-year-old male with a history of constipation presented to the emergency department with five days of abdominal pain and emesis. Initial workup revealed high serum calcium (Ca) of 17.3 mg/dL (8.7-10.7) and ionized Ca (ICal) of 2.01 mmol/L (0.95-1.32). Further evaluations revealed low phosphorus level 3.5 mg/dL (4.5-6.5) and high parathyroid hormone level (iPTH) of 329.2 pg/mL (8.0-85.0). These findings were consistent with PHPT. Neck US demonstrated a cervical mass in the mid-right thyroid measuring 0.5 x0.3 x0.5cm, questionable for parathyroid adenoma, which was confirmed with 99mTc-MIBI scintigraphy and neck CT. His Ca level initially responded to fluid resuscitation and Lasix, with Ca level decreasing to 13.6. However, on hospital day two, his Ca level became refractory to all interventions, rising to 16 and prompting the use of bisphosphonates. The patient underwent neck exploration with partial parathyroidectomy and lymph node excision. Pathology revealed hypercellular parathyroid tissue consistent with parathyroid hyperplasia. Intraoperatively iPTH was reduced from 3,134.7 to 79.8 and remained within normal limits since. Postoperatively course was uncomplicated, and the patient was discharged home on oral Ca carbonate and vitamin D. A genetic evaluation was remarkable for a change in the RET gene (3.2C>A), a finding of unknown clinical significance. This change has not been seen in association with an individual who fulfills the clinical diagnosis of MEN2A. To further determine if the variant identified in the RET gene is a benign variant, the mother was tested for MEN2A and was negative. Father could not be tested, but family history was significant for thyroid malignancies. The patient is currently doing well four months postoperatively. His Ca level remains normal. Due to the genetic finding and the concern of MEN2A syndrome, the patient is followed closely by pediatric endocrinology and genetics. Conclusion: PHPT is a common endocrine disorder in adults but rare in children. The diagnosis of pediatric PHPT is almost always delayed due to atypical presentation and rarity of the disease. As secondary organ damage is common, a multi-organ assessment is mandatory. Due to the association with other syndromes, a genetic evaluation should be performed.

scholarly journals Parathyroid Adenoma Presenting with Recurrent Abdominal Pain and Renal Calculi

2018 ◽  
Vol 6 (1) ◽  
pp. 20-21
Author(s):  
Dipendra Gautam ◽  
Ishwor Raj Devkota ◽  
Sandesh Mainali ◽  
Bijaya Kumar Chaudhari
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Renal Colic ◽  
Renal Calculi ◽  
Recurrent Abdominal Pain ◽  
Neck Surgery ◽  
Present Case Report ◽  
Common Cause

Introduction: Parathyroid adenoma is the single most common cause of hyperparathyroidism. Reported incidence of parathyroid adenoma varies widely and is 30- 90%. Approximately 80% to 85% of patients with primary hyperparathyroidism were found to have solitary parathyroid adenoma.The hyperparathyroidism due to parathyroid adenoma may progress insidiously over several years and eventually presents as renal colic or symptoms may manifest over a considerably shorter period of time. Greater than 50% of patients present with nephrolithiasis or nephrocalcinosis. The present case report describes a 48 year old male patient with symptoms of abdominal pain.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015 

scholarly journals A Challenging Diagnosis of Primary Hyperparathyroidism in an Adolescent Female

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A175-A175
Author(s):  
Patricia Vining-Maravolo ◽  
Ethel Clemente ◽  
Berrin Ergun-Longmire
Keyword(s):  
Abdominal Pain ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Parathyroid Tissue ◽  
Gastrointestinal Symptoms ◽  
Vital Signs ◽  
Normal Thyroid Function ◽  
Sestamibi Scan ◽  
History Of

Abstract Background: Hypercalcemia secondary to primary hyperparathyroidism (PHPT) is less common in children than adults. Single parathyroid adenoma is commonly the cause of primary hyperparathyroidism in children. Clinical Case: We present a 15-year-old female with one-week history of abdominal pain despite taking over the counter antacids. Her initial work up by her primary care provider revealed serum calcium of 11.8 mg/dL (9.0–11.5) and creatinine of 0.8 mg/dL (0.4–1.2). A week later, she presented to the emergency department with same complaint. In ED, she was found to have hypercalcemia (12.8 mg/dl) with elevated parathyroid hormone (PTH) at 78.5 pg/mL (15–65). Her random urine calcium creatinine ratio was high at 2.1. Her 25OHD was 25 ng/mL (30–100). She had negative urine pregnancy test but had trace ketones, leukocyte esterase, blood and bacteria. CBC and CMP were otherwise unremarkable. She continued to complain abdominal pain with nausea, decrease appetite, fatigue, and general muscle weakness. There was no known family history of calcium or metabolic bone disorders. Her vital signs and physical exam were normal. Subsequent labs showed mild improvement of calcium between (11–12.3 mg/dL), PTH between 54.5 and 77 pg/mL, normal thyroid function. Ionized calcium was mildly elevated 6.0 mg/dL (4.5–5.3) but her repeat 25OHD was low at18 ng/mL. Serum phosphorus levels were relatively normal with lowest level of 2.5 mg/dL (2.7–4.5). Gliadin Deamidated IgA was detectable 15 U/mL (< 15.0 U/). Ultrasound of abdomen was significant for nonspecific mild hepatomegaly; kidneys were normal in size and appearance. Ultrasound of thyroid was significant for probably intrathyroid parathyroid, measuring 6 x 8 x 8 mm. Tc-Sestamibi scan did not confirm a parathyroid adenoma. Genetic testing for MEN-1 was negative. FHH- related genes (i.e. CASR) was positive for p.R990G variant resulting in a mild gain of function of the calcium-sensing receptor. Although previous Tc-Sestamibi scan was unremarkable, an over read of it raised a concern for questionable uptake in the left superior lobe. SPEC-CT demonstrated possible abnormal parathyroid tissue in the upper pole of the left thyroid. FNA of the left thyroid nodule confirmed likely intrathyroidal parathyroid adenoma. Subsequent follow up and treatment, including parathyroidectomy, was done by another institution. She underwent a left parathyroidectomy with normalization of serum calcium and PTH levels post operatively (10.1 mg/dl and 8 pg/mL, respectively) and has complete resolution of her previous abdominal and gastrointestinal symptoms. Conclusion: PHPT is uncommon in children and adolescents and is typically associated with a single parathyroid adenoma. High index of suspicion is key for early diagnosis of PHPT despite a negative Tc-Sestamibi initially.

scholarly journals Hypercalcemia induced pancreatitis as a rare presentation of primary hyperparathyroidism

2021 ◽  
Vol 84 (2) ◽  
pp. 367-370
Author(s):  
V Desmedt ◽  
S Desmedt ◽  
E D’heygere ◽  
G Vereecke ◽  
W Van Moerkercke
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Inflammatory Process ◽  
High Morbidity ◽  
Rare Presentation ◽  
Common Cause ◽  
Upper Abdominal

Acute pancreatitis (AP) is an inflammatory process of the pancreas. It is a relatively common cause of acute upper abdominal pain and is potentially associated with high morbidity and mortality. Underlying hypercalcemia as a cause of AP is very rare. We present a case of a hypercalcemia-induced acute pancreatitis with an underlying parathyroid adenoma in an 81-year-old woman with no previous symptoms of hypercalcemia. The parathyroid adenoma was semi-urgently surgically resected with normalization of calcium-levels. This case report summarizes the causes of acute pancreatitis and hypercalcemia and its management.

The Mechanism of Abdominal Pain

1949 ◽  
Vol 12 (3) ◽  
pp. 523
Keyword(s):  
Abdominal Pain

Vagus Nerve Section for Relief of Intractible Abdominal Pain in a Case of Gastric Carcinoma

1949 ◽  
Vol 12 (6) ◽  
pp. 993-995 ◽  
Author(s):  
Arthur I. Kugel ◽  
Jacob Janzen
Keyword(s):  
Abdominal Pain ◽  
Gastric Carcinoma ◽  
Vagus Nerve ◽  
Nerve Section
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