Faculty Opinions recommendation of High rate of occult urolithiasis in normocalcemic primary hyperparathyroidism.

2020 ◽  
Author(s):  
Frederick Singer
Keyword(s):  
Primary Hyperparathyroidism ◽  
High Rate

scholarly journals Primary Hyperparathyroidism in Homozygous Sickle Cell Patients: A Hemolysis-Mediated Hypocalciuric Hypercalcemia Phenotype?

2021 ◽  
Vol 10 (21) ◽  
pp. 5179
Author(s):  
Edmat Akhtar Khan ◽  
Lynda Cheddani ◽  
Camille Saint-Jacques ◽  
Rosa Vargas-Poussou ◽  
Vincent Frochot ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Sickle Cell ◽  
Fractional Excretion ◽  
Urinary Calcium ◽  
High Rate ◽  
Calcium Handling ◽  
Control Group ◽  
Calcium Excretion ◽  
Calcium Reabsorption ◽  
Chronic Hemolysis

Primary hyperparathyroidism (pHPT) has been reported to have a higher prevalence in sickle cell disease (SCD) patients, including a high rate of recurrence following surgery. However, most patients are asymptomatic at the time of diagnosis, with surprisingly infrequent hypercalciuria, raising the issue of renal calcium handling in SCD patients. We conducted a retrospective study including (1) 64 hypercalcemic pHPT non-SCD patients; (2) 177 SCD patients, divided into two groups of 12 hypercalcemic pHPT and 165 non-pHPT; (3) eight patients with a diagnosis of familial hypocalciuric hypercalcemia (FHH). Demographic and biological parameters at the time of diagnosis were collected and compared between the different groups. Determinants of fasting fractional excretion of calcium (FeCa2+) were also analyzed in non-pHPT SCD patients. Compared to non-SCD pHPT patients, our data show a similar ionized calcium and PTH concentration, with a lower plasmatic calcitriol concentration and a lower daily urinary calcium excretion in pHPT SCD patients (p < 0.0001 in both cases). Fasting FeCa2+ is also surprisingly low in pHPT SCD patients, and thus inadequate to be considered hypercalcemia, recalling the FHH phenotype. FeCa2+ is also low in the non-pHPT SCD control group, and negatively associated with PTH and hemolytic biomarkers such as LDH and low hemoglobin. Our data suggest that the pHPT biochemical phenotype in SCD patients resembles the FHH phenotype, and the fasting FeCa2+ association with chronic hemolysis biomarkers strengthens the view of a potential pharmacological link between hemolytic by-products and calcium reabsorption, potentially through a decreased calcium-sensing receptor (CaSR) activity.

scholarly journals From mild to severe primary hyperparathyroidism: the Brazilian experience

2006 ◽  
Vol 50 (4) ◽  
pp. 657-663 ◽  
Author(s):  
Francisco Bandeira ◽  
Luiz Griz ◽  
Gustavo Caldas ◽  
Cristina Bandeira ◽  
Eduardo Freese
Keyword(s):  
Primary Hyperparathyroidism ◽  
Severe Disease ◽  
Stone Disease ◽  
High Rate ◽  
Mineral Density ◽  
Skeletal Involvement ◽  
Asymptomatic Patients ◽  
Remarkable Recovery ◽  
Serum Pth ◽  
Histological Confirmation

Primary hyperparathyroidism often presents as an asymptomatic disorder. In our institution, routine serum calcium measurements have now been used as part of medical examination for 23 years. Out of 124 patients consecutively seen at our institution, 47% presented with no symptoms related to the disease, while 25% presented with severe skeletal involvement and osteitis fibrosa cystica, 25% with renal stone disease without overt bone involvement, and 2% with the typical neuropsychiatric syndrome. This same pattern is seen in the city of São Paulo. In severe disease pathological fractures are frequently seen, especially in long bones of the lower extremities, and also loss of lamina dura of the teeth and salt-and-pepper appearance of the skull. Bone mineral density is extremely low in these patients but usually show remarkable recovery following surgical cure. Serum PTH and bone markers are considerable higher in severely affected patients, who also have a high rate of vitamin D deficiency, and the parathyroid lesion is easier located compared with asymptomatic patients. From pathological specimens 87% had histological confirmation of a single adenoma, 6.4% multiple gland hyperplasia and 3.8% carcinoma.

scholarly journals Surgical Management of Calciphylaxis Associated with Primary Hyperparathyroidism: A Case Report and Review of the Literature

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Jennifer Bishop ◽  
Eric Brown ◽  
Augusto Podesta ◽  
Cathrine Troy ◽  
Xiang (Eric) Dong
Keyword(s):  
Primary Hyperparathyroidism ◽  
English Literature ◽  
High Rate ◽  
Medical Problems ◽  
Extensive Calcification ◽  
Calcific Uremic Arteriolopathy ◽  
Mediastinal Parathyroid Adenoma ◽  
Stage Renal Disease ◽  
End Stage ◽  
Mediastinal Parathyroid

Calciphylaxis, or calcific uremic arteriolopathy, commonly affects people with end-stage renal disease and carries with it a high rate of morbidity and mortality. Here, we present the unusual case of a 56-year-old woman, with extensive medical problems, who developed calciphylaxis in the presence of primary hyperparathyroidism. Our patient initially presented with bilateral, exquisitely tender thigh lesions. The diagnosis of calciphylaxis was rendered histologically by extensive calcification of the subcutaneous blood vessels. Subsequent parathyroidectomy identified the presence of a hyperactive mediastinal parathyroid adenoma, weighing 0.62 grams. Postoperatively, the patient had normalization of hypercalcemia and parathyroid hormone levels, with subsequent healing of her thigh wounds. Currently, there have been sixteen cases described in the English literature, with only nine being offered a potentially therapeutic parathyroidectomy. It is contingent upon the vigilant physician to diagnose and properly manage this difficult yet treatable condition.

Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

2019 ◽  
Vol 404 (4) ◽  
pp. 431-438 ◽  
Author(s):  
Emmanuelle Trébouet ◽  
Sahar Bannani ◽  
Matthieu Wargny ◽  
Christophe Leux ◽  
Cécile Caillard ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
High Rate ◽  
Multiglandular Disease ◽  
Cure Rate ◽  
Surgical Cure ◽  
Sporadic Primary Hyperparathyroidism

scholarly journals High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism

2019 ◽  
Vol 44 (5) ◽  
pp. 1189-1195 ◽  
Author(s):  
Alyne Layane Pereira Lemos ◽  
Sergio Ricardo de Lima Andrade ◽  
Lívia Laeny Henrique Pontes ◽  
Patricia Moura Cravo Teixeira ◽  
Elba Bandeira ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Kidney Stones ◽  
Urinary Calcium ◽  
Normal Serum ◽  
Urinary Calcium Excretion ◽  
High Rate ◽  
Calcium Excretion ◽  
History Of ◽  
Serum Pth

Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT.

scholarly journals Primary Hyperparathyroidism and Pancreatitis: A Rare Association with Multiple Facets

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
I. Diallo ◽  
C. A. Fall ◽  
B. Ndiaye ◽  
M. Mbaye ◽  
I. Diedhiou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Chronic Pancreatitis ◽  
Parathyroid Hormone ◽  
Retrospective Study ◽  
Primary Hyperparathyroidism ◽  
High Rate ◽  
Parathyroid Surgery ◽  
Rare Association

Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis. Hypercalcemia plays a major role in the pathogenesis. We report five cases of pancreatitis revealing PHPT. Patients and Methods. This is a retrospective study of 4 years, including all patients admitted to intensive care unit or gastroenterology department, for an acute or chronic pancreatitis revealing primary hyperparathyroidism. Results. We included 5 patients, all female, with mean age 54 years [40–76 years]. The PHPT was in all cases revealed by acute pancreatitis (AP). This one was oedematous in four cases and severe in one case. It occurred twice in calcified chronic pancreatitis (CCP). There was hypercalcemia in all cases. The PHPT was associated with a high rate of parathyroid hormone in 4 cases. The secreting lesion was an adenoma in 5 cases. Two patients had in addition bilateral renal calcifications. The outcome was favorable in 4 patients among whom 3 have had parathyroid surgery. A death was noted by superinfection of necrosis in the case of severe AP. Conclusion. The occurrence of pancreatitis during hyperparathyroidism is rare. Normal or elevated calcemia during acute or chronic pancreatitis should always get attention.

scholarly journals High rate of malignant disorders in patients with primary hyperparathyroidism

2013 ◽  
Author(s):  
Stanley Kirana ◽  
Bettina Eggert ◽  
Kirsten Oberwelland ◽  
Guido Schurmann ◽  
Joachim Feldkamp
Keyword(s):  
Primary Hyperparathyroidism ◽  
High Rate

Structure of Palladium Single-Crystal Films Prepared by Flash Evaporation onto (001) NaCl Substrates

1970 ◽  
Vol 28 ◽  
pp. 456-457
Author(s):  
L. E. Murr ◽  
G. Wong
Keyword(s):  
Single Crystal ◽  
High Vacuum ◽  
Ultra High Vacuum ◽  
High Rate ◽  
Flash Evaporation ◽  
Optimum Load ◽  
Single Crystal Films ◽  
Crystal Films ◽  
A Current

Palladium single-crystal films have been prepared by Matthews in ultra-high vacuum by evaporation onto (001) NaCl substrates cleaved in-situ, and maintained at ∼ 350° C. Murr has also produced large-grained and single-crystal Pd films by high-rate evaporation onto (001) NaCl air-cleaved substrates at 350°C. In the present work, very large (∼ 3cm2), continuous single-crystal films of Pd have been prepared by flash evaporation onto air-cleaved (001) NaCl substrates at temperatures at or below 250°C. Evaporation rates estimated to be ≧ 2000 Å/sec, were obtained by effectively short-circuiting 1 mil tungsten evaporation boats in a self-regulating system which maintained an optimum load current of approximately 90 amperes; corresponding to a current density through the boat of ∼ 4 × 104 amperes/cm2.

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