A CASE OF PRIMARY HYPERPARATHYROIDISM

Первичный гиперпаратиреоз - одно из распространенных, но трудно диагностируемых в реальной клинической практике эндокринных заболеваний у взрослых. Актуальность данной публикации определяется высокой частотой заболевания у лиц старше 40 лет. Риск его возникновения у людей 40-50 лет достигает 2%. Имеются все основания считать, что данный показатель с течением времени будет увеличиваться, поскольку согласно прогнозам отдела народонаселения Организации Объединённых Наций от 2001г. удельный вес пожилых людей к 2050г. в мире достигнет 21% в сравнении с 10% в 2000г. Особенно подвержены первичному гиперпаратиреозу женщины менопаузального возраста, у которых заболевание встречается с частотой 1:500. В большинстве случаев первичный гиперпаратиреоз возникает вследствие солитарной доброкачественной аденомы паращитовидных желез. В данной статье представлен случай аденомы паращитовидной железы с развитием гиперкальциемического криза у женщины в возрасте 49 лет, выбор дальнейшей тактики ведения - консервативное или оперативное лечение, а также рекомендации по наблюдению в динамике. Приведенный случай будет интересен специалистам как терапевтического, так и хирургического профиля. Primary hyperparathyroidism is one of the common but difficult to diagnose endocrine diseases in adults in real clinical practice. The relevance of this publication is determined by the high incidence of the disease in persons over 40 years of age. The risk of its occurrence in people 40-50 years old reaches 2%. There is every reason to believe that this figure will increase over time, since according to the projections of the UN Population Division for 2001, the proportion of elderly people in the world will reach 21% by 2050, compared with 10% in 2000. Menopausal women are especially susceptible to primary hyperparathyroidism which the disease occurs with a frequency of 1: 500. In most cases, primary hyperparathyroidism occurs due to solitary benign adenoma of the parathyroid glands. This article presents a case of parathyroid adenoma with the development of a hypercalcemic crisis in a woman aged 49 years, the choice of further management tactics - conservative or surgical treatment, as well as recommendations for monitoring over time. The given case will be of interest to specialists of both therapeutic and surgical profile.

Primary Hyperparathyroidism - Case Report of a Female Patient with Hypercalcemic Crisis

Primary hyperparathyroidism is a result of increased and uncontrolled function of the parathyroid hormone caused by hyperfunction of one or more parathyroid glands. The cause of hyperfunction of the parathyroid glands could be adenoma, hyperplasia, and carcinoma. Primary Hyper parathyroidism is the most common cause of Hypercalcemia in outpatient population. The paper presents the case report of a 60years old female treated in our Hospital in March 2013. She presented in outpatient department with complaints of joints pain, Hypertension and renal failure for last 8years. After clinical, laboratory and radiological examination she was diagnosed as a case of PHPT due to a Giant Parathyroid Adenoma. After supportive, symptomatic and surgical treatment, the patient was back to normal daily activities without any signs of disease.

Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study

Background The occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT. Methods This was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group. Results Among the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged. Conclusion Biochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

The use of hemodialysis in hypercalcemic crisis secondary to primary hyperparathyroidism

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.