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.

scholarly journals PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY

2019 ◽  
Vol 5 (6) ◽  
pp. e384-e387 ◽  
Author(s):  
Abraham E. Wei ◽  
Matthew R. Garrett ◽  
Ankur Gupta
Keyword(s):  
Computed Tomography ◽  
Rare Case ◽  
Clinical Laboratory ◽  
Parathyroid Tissue ◽  
Severe Hypercalcemia ◽  
Positron Emission ◽  
Affected Tissue ◽  
History Of ◽  
The Right ◽  
Recurrent Hyperparathyroidism

Objective: To present a rare case of parathyromatosis. Methods: We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results: A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion: This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.

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 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 Brain metastases: the role of clinical imaging

2021 ◽  
Author(s):  
Sophie H. A. E. Derks ◽  
Astrid A. M. van der Veldt ◽  
Marion Smits
Keyword(s):  
Brain Metastases ◽  
Tumour Progression ◽  
Imaging Techniques ◽  
3 Dimensional ◽  
Endogenous Contrast ◽  
Positron Emission ◽  
Golden Standard ◽  
New Biomarkers ◽  
The Right

Imaging of brain metastases (BMs) has advanced greatly over the past decade. In this review, we discuss the main challenges that BMs pose in clinical practice, and describe the role of imaging. Firstly, we describe the increased incidence of BMs of different primary tumours and the rationale for screening. A challenge lies in selecting the right patients for screening: not all cancer patients develop BMs in their disease course. Secondly, we discuss the imaging techniques to detect BMs. A 3-dimensional (3D) T1-weighted MRI sequence is the golden standard for BM detection, but additional anatomical (susceptibility weighted imaging, diffusion weighted imaging), functional (perfusion MRI) and metabolic (MR spectroscopy, positron emission tomography) information can help to differentiate from other intracranial aetiologies. Thirdly, we describe the role of imaging before, during, and after treatment of BMs. For surgical resection, imaging is used to select surgical patients, but also to assist intraoperatively (neuronavigation, fluorescence-guided surgery, ultrasound). For treatment planning of stereotactic radiosurgery, MRI is combined with CT. For surveillance after both local and systemic therapies, conventional MRI is used. However, advanced imaging is increasingly performed to distinguish true tumour progression from pseudoprogression. Lastly, future perspectives are discussed, including radiomics, new biomarkers, new endogenous contrast agents and theranostics.

scholarly journals Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review

Biomedicines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 390
Author(s):  
Donovan Tay ◽  
Jeeban P. Das ◽  
Randy Yeh
Keyword(s):  
Primary Hyperparathyroidism ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
Preoperative Localization ◽  
First Line ◽  
4D Ct ◽  
Positron Emission ◽  
Magnetic Resonance Imaging Mri ◽  
Line Setting

With increasing use of minimally invasive parathyroidectomy (PTx) over traditional bilateral neck exploration in patients with primary hyperparathyroidism (PHPT), accurate preoperative localization has become more important to enable a successful surgical outcome. Traditional imaging techniques such as ultrasound (US) and sestamibi scintigraphy (MIBI) and newer techniques such as parathyroid four-dimension computed tomography (4D-CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) are available for the clinician to detect the diseased gland(s) in the preoperative workup. Invasive parathyroid venous sampling may be useful in certain circumstances such as persistent or recurrent PHPT. We review the diagnostic performance of these imaging modalities in preoperative localization and discuss the advantages and weaknesses of these techniques. US and MIBI are established techniques commonly utilized as first-line modalities. 4D-CT has excellent diagnostic performance and is increasingly performed in first-line setting and as an adjunct to US and MIBI. PET and MRI are emerging adjunct modalities when localization has been equivocal or failed. Since no evidence-based guidelines are yet available for the optimal imaging strategy, clinicians should be familiar with the range and advancement of these techniques. Choice of imaging modality should be individualized to the patient with consideration for efficacy, expertise, and availability of such techniques in clinical practice.

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.

In the labyrinth of calcium metabolism

2013 ◽  
Vol 154 (9) ◽  
pp. 351-355
Author(s):  
Sándor Magony ◽  
Zsuzsanna Valkusz ◽  
Éva Csajbók ◽  
Krisztián Sepp ◽  
János Gardi ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Imaging Techniques ◽  
Surgical Excision ◽  
High Serum ◽  
Diagnostic Significance ◽  
Severe Hypercalcemia ◽  
Pet Ct ◽  
Parathyroid Tumour ◽  
The Right

The authors present the case of a 27-year-old male patient. In 2010, he suffered from a bone fracture of the pelvis. As imaging techniques showed multiple osseal lytic lesions, diagnostic investigations were performed for multiple myeloma. Later, a mass lesion measuring 37 mm in size was removed from the left side of his mandible. Histology revealed a giant-cell tumour of the bone and oncologic therapy was considered. However, before this planned treatment a PET-CT was performed, which showed numerous distinct lesions with enhanced glucose metabolism in the skeleton as well as in soft tissue behind the right lobe of the thyroid. Hence, the patient was referred to endocrinologists. On the basis of severe hypercalcemia (serum calcium 3.66 mmol/l) and high serum parathyroid hormone level (162.5 pmol/l) the diagnosis of a right sided parathyroid tumour was established. After surgical excision of the parathyroid tumour, high levels of serum calcium and parathyroid hormone returned to normal. Histology failed to show malignancy and the patient recovered soon. This case report may shed some light on the importance of serum calcium measurements and the differential diagnostic significance of primary hyperparathyroidism. Orv. Hetil., 2013, 154, 351–355.

A Case of Primary Hyperparathyroidism Associated with Brown Tumor of the Right Patella

2013 ◽  
Vol 64 (3) ◽  
pp. 224-230
Author(s):  
Masanori Teshima ◽  
Shigemichi Iwae ◽  
Yuji Hirayama ◽  
Hirotaka Shinomiya ◽  
Tatsuya Furukawa
Keyword(s):  
Primary Hyperparathyroidism ◽  
Brown Tumor ◽  
The Right

A Novel Secure and Robust encryption scheme for medical images

2020 ◽  
Vol 16 ◽  
Author(s):  
Siyamol Chirakkarottu ◽  
Sheena Mathew
Keyword(s):  
Medical Images ◽  
Technological Development ◽  
Imaging Techniques ◽  
Chaotic Map ◽  
Two Phase ◽  
Positron Emission ◽  
Medical Diagnostic ◽  
Wireless Medium ◽  
Health Care Applications ◽  
Magnetic Resonance Imaging Mri

Background: Medical imaging encloses different imaging techniques and processes to image the human body for medical diagnostic and treatment purposes. Hence it plays an important role to improve public health. The technological development in biomedical imaging specifically in X-ray, Computed Tomography (CT), nuclear ultrasound including Positron Emission Tomography (PET), optical and Magnetic Resonance Imaging (MRI) can provide valuable information unique to a person. Objective: In health care applications, the images are needed to be exchanged mostly over wireless medium. The diagnostic images with confidential information of a patient need to be protected from unauthorized access during transmission. In this paper, a novel encryption method is proposed to improve the security and integrity of medical images. Methods: Chaotic map along with DNA cryptography is used for encryption. The proposed method describes a two phase encryption of medical images. Results: Performance of the proposed method is also tested by various analysis metrics. Robustness of the method against different noises and attacks is analyzed. Conclusion: The results show that the method is efficient and well suitable to medical images.

The Fox Diet

2018 ◽  
Author(s):  
Yochai Benkler ◽  
Robert Faris ◽  
Hal Roberts
Keyword(s):  
First Year ◽  
Right Wing ◽  
Justice Department ◽  
Fox News ◽  
The Core ◽  
Deep State ◽  
Media Ecosystem ◽  
Conservative Media ◽  
The Right

This chapter focuses on the role of the dominant player in conservative media, Fox News, during the first year of Donald Trump’s presidency. It looks at three case studies to illustrate how Fox News used its position at the core of the right-wing media ecosystem repeatedly to mount propaganda attacks in support of Trump: the Michael Flynn firing in March 2017, when Fox adopted the “deep state” framing of the entire controversy; the James Comey firing and Robert Mueller appointment in May 2017; when Fox propagated the Seth Rich murder conspiracy; and in October and November, when the arrests of Paul Manafort and guilty plea of Flynn seemed to mark a new level of threat to the president, Fox reframed the Uranium One story as an attack on the integrity of the FBI and Justice Department officials in charge of the investigation.

Sign in / Sign up

Export Citation Format

Share Document