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1.
Actual. osteol ; 19(2): 160-166, sept. 2023. ilus, tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1525671

RESUMO

Introducción: describir el caso de un paciente con pancreatitis aguda secundaria a hipercalcemia por hiperparatiroidismo prImario. Esta es una causa poco frecuente de pancreatitis, asociada a morbimortalidad significativa en caso de no ser diagnosticada oportunamente Caso clínico: un hombre de 44 años, con antecedente de pancreatitis de presunto origen biliar que había requerido previamente colecistectomía, consultó por dolor abdominal y náuseas. Los estudios complementarios fueron compatibles con un nuevo episodio de pancreatitis aguda. Presentaba hipercalcemia y hormona paratiroidea (PTH) elevada, configurando hiperparatiroidismo primario. La gammagrafía informó hallazgos compatibles con adenoma paratiroideo. Se inició tratamiento con reanimación hídrica y analgesia con adecuada disminución de calcio sérico y resolución de dolor abdominal. Después de la paratiroidectomía se logró normalizar los niveles de calcio y PTH. Discusión: la pancreatitis aguda es una condición potencialmente fatal, por lo que la sospecha de causas poco frecuentes como la hipercalcemia debe tenerse en cuenta. El tratamiento de la hipercalcemia por adenoma paratiroideo se basa en reanimación hídrica adecuada y manejo quirúrgico del adenoma, con el fin de evitar recurrencia de pancreatitis y mortalidad. (AU)


Introduction: we describe the case of a patient with acute pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism. This is a rare cause of pancreatitis associated with significant morbidity and mortality if not diagnosed in time. Clinical case: a 44-year-old man with a history of pancreatitis of presumed biliary origin, which had previously required cholecystectomy, consulted for abdominal pain and nausea. The laboratory findings were compatible with a new episode of acute pancreatitis. He presented hypercalcemia and an elevated parathyroid hormone (PTH), configuring primary hyperparathyroidism. Scintigraphy was performed, yielding findings compatible with parathyroid adenoma. Treatment with fluid resuscitation and analgesia was started, resulting in an adequate decrease in serum calcium and resolution of abdominal pain. After parathyroidectomy, calcium and PTH levels were normalized. Discussion: acute pancreatitis is a potentially fatal condition; therefore the suspicion of rare causes, such as hypercalcemia, should be considered. The treatment of hypercalcemia due to parathyroid adenoma is based on adequate fluid resuscitation and surgical management of the adenoma, to avoid recurrence of pancreatitis and death. (AU)


Assuntos
Humanos , Masculino , Adulto , Pancreatite/etiologia , Neoplasias das Paratireoides/diagnóstico por imagem , Hiperparatireoidismo Primário/diagnóstico por imagem , Hipercalcemia/etiologia , Pancreatite/prevenção & controle , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Cintilografia , Tecnécio Tc 99m Sestamibi , Hiperparatireoidismo Primário/complicações , Hipercalcemia/sangue , Hipercalcemia/terapia
2.
Rev. venez. cir ; 75(1): 41-44, ene. 2022. ilus
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1391613

RESUMO

El hiperparatiroidismo primario es el tercer trastorno endocrino más común, alrededor del 85% de los casos se debe a adenomas paratiroideos. El tratamiento definitivo es la paratiroidectomía, siendo la causa más común de fracaso la resección inadecuada y la localización de tejido ectópico, representando un desafío para el cirujano. En el presente trabajo se presenta el caso de un paciente con diagnóstico de adenoma paratiroideo mediastínico gigante, siendo este el de mayor longitud descrito en la literatura en los últimos 10 años. Caso clínico: Paciente masculino de 70 años de edad quien consulta por presentar convulsiones, polidipsia y poliuria. Se determinan niveles elevados de PTH, hipercalcemia e hipofosfatemia. Estudios de imagen describen lesión alargada localizada en espacio paratraqueal derecho extendiéndose hasta el polo inferior de lóbulo tiroideo derecho. Se decide resolución quirúrgica, mediante la realización de cervicotomía y toracoscopia con evolución satisfactoria del paciente. Conclusión: Los adenomas paratiroideos ectópicos constituyen una causa común de falla quirúrgica e hiperparatiroidismo persistente, su sospecha es de gran importancia. El tratamiento definitivo es la cirugía. La localización preoperatoria por pruebas de imagen es fundamental para seleccionar correctamente la técnica quirúrgica y garantizar el éxito de la cirugía. El abordaje cervical y toracoscópico es una alternativa segura y eficaz(AU)


Primary hyperparathyroidism is the third most common endocrine disorder, about 85% of cases are due to parathyroid adenomas. The definitive treatment is parathyroidectomy, being the most frequent cause of failure the inadequate resection and the location of ectopic tissue. The ectopic parathyroid adenomas represent a challenge for the surgeon. In this paper a case of a patient diagnosed with giant mediastinal parathyroid adenoma is presented, and is the largest reported in the literature in the last 10 years. Clinical case: 70-year-old male patient presented with seizures, polydipsia and polyuria, reason for which he consults. Elevated PTH levels, hypercalcemia, and hypophosphatemia are determined. Imaging studies report an elongated lesion located in the right paratracheal space that extends to the lower pole of the right thyroid lobe. Surgical resolution was decided, by performing cervicotomy and thoracoscopy with satisfactory recovery of the patient. Conclusion: Ectopic parathyroid adenomas are a common cause of surgical failure and persistent hyperparathyroidism; their suspicion is of great importance. The definitive treatment is surgery. Preoperative localization through imaging tests is essential to correctly select the surgical technique and guarantee the success of the surgery, the cervical and thoracoscopic approach is a safe and effective alternative(AU)


Assuntos
Humanos , Masculino , Idoso , Glândula Tireoide , Adenoma , Hiperparatireoidismo Primário/fisiopatologia , Neoplasias das Paratireoides , Toracoscopia , Paratireoidectomia
3.
Actual. osteol ; 18(3): 183-191, 2022. ilus
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1509337

RESUMO

La crisis hipercalcémica (CH) es una emergencia endocrina inusual, definida por la presencia de calcemia > 14 mg/dl asociada a disfunción renal, alteraciones cardiovasculares, gastrointestinales y del sensorio; también podría considerarse en pacientes con síntomas graves y calcemia menor. El hiperparatiroidismo primario (HPTP) y las neoplasias malignas son las etiologías más comunes de la hipercalcemia (90% de los casos); sin embargo, rara vez el primero se presenta como CH. Debido a la alta mortalidad asociada a esta entidad, es de gran importancia establecer diagnóstico y tratamiento precoces. Presentamos dos pacientes con crisis hipercalcémica como primera manifestación del HPTP, el 1.° con bloqueo auriculoventricular (AV) completo y el 2.° con pancreatitis aguda. La anatomía patológica (AP) reveló adenoma oxifílico en ambos casos, que es una variante histológica poco frecuente y puede manifestarse clínicamente de forma grave. Conclusiones: los adenomas paratiroideos son causa poco frecuente de CH. Consideramos el tipo histológico observado (adenoma oxifílico) como probable factor condicionante. La pancreatitis y especialmente el bloqueo AV son manifestaciones poco frecuentes de la CH. Resaltamos la importancia de la determinación de los niveles de calcio dentro de la evaluación inicial de todo paciente con bloqueo AV. (AU)


Hypercalcemic crisis (HC) is an unusual endocrine emergency, defined as the presence of serum calcium > 14 mg/dl related to kidney dysfunction, cardiovascular, gastrointestinal and sensory disturbances. It could also be considered in patients with severe symptoms and lower serum calcium levels. Primary hyperparathyroidism (PHPT) and malignant neoplasms are the most common hypercalcemia etiologies (90% of cases), nevertheless, the former hardly ever occurs as HC. Due to the high mortality associated with HC, it is crucial to establish early diagnosis and treatment.We report two patients with HC as the first manifestation of PHPT; the former with atrioventricular (AV) block and the latter with acute pancreatitis. Pathology revealed oxyphilic adenoma in both cases, which is an infrequent histological variant that can have a severe clinical manifestation. Conclusions: parathyroid adenomas are a rare cause of HC. We consider the histological type observed (oxyphilic adenoma) as a probable conditioning factor. Pancreatitis and especially AV block are rare manifestations of HC. We emphasize the importance of determining calcium levels in the initial evaluation of all patients with AV block. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias das Paratireoides/complicações , Adenoma/complicações , Hiperparatireoidismo Primário/complicações , Hipercalcemia/diagnóstico , Pancreatite/etiologia , Hormônio Paratireóideo/análise , Neoplasias das Paratireoides/patologia , Adenoma/patologia , Cálcio/sangue , Células Oxífilas/patologia , Bloqueio Atrioventricular/etiologia , Hipercalcemia/etiologia
4.
Rev. cir. (Impr.) ; 73(6): 748-752, dic. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1388891

RESUMO

Resumen Introducción: A pesar de que el carcinoma de paratiroides es uno de los cánceres menos frecuentes del mundo, es importante tenerlo en cuenta al plantear el diagnóstico diferencial del hiperparatiroidismo primario, ya que su diagnóstico temprano tiene repercusiones en el tratamiento y el pronóstico vital del paciente. Caso Clínico: A continuación, se expone un caso clínico de un paciente con sintomatología abigarrada de hiperfunción paratiroidea que, dada la sospecha clínica de carcinoma de paratiroides y la no infiltración de estructuras adyacentes, fue tratado con una paratiroidectomía. Conclusión: Esta cirugía supone una menor morbilidad, sin suponer un detrimento para la supervivencia global del paciente.


Introduction: Parathyroid carcinoma should be taken into consideration among the differential diagnosis of primary hyperparathyroidism, even though it is one of the less common malignant tumours in the world, because an early diagnosis is essential for the treatment and the prognosis of the patient. Case Report: We present the case of a patient whose symptoms were compatible with hyperfunction of parathyroid gland. Due to the malignant disease suspicion and the non-invasion of adjacent tissue, he was treated with a parathyroidectomy. Conclusión: This type of treatment supposes a lower morbidity without decrease in overall survival, according to bibliography.


Assuntos
Humanos , Masculino , Adulto , Hormônio Paratireóideo/metabolismo , Neoplasias das Paratireoides/metabolismo , Metástase Linfática , Neoplasias das Paratireoides/patologia , Tireoidectomia , Tomografia Computadorizada por Raios X , Paratireoidectomia , Ultrassonografia
5.
Rev. méd. Urug ; 37(1): e702, mar. 2021. graf
Artigo em Espanhol | LILACS, BNUY | ID: biblio-1180966

RESUMO

Resumen: Introducción: el hiperparatiroidismo primario por un adenoma gigante de paratiroides es infrecuente. Los adenomas de mayor tamaño reportados ocurrieron sobre paratiroides ectópicas (mediastinales). Comparte con el carcinoma su gran tamaño y elevadas cifras de calcemia y de hormona paratiroidea, hecho que dificulta el diagnóstico. Su tratamiento quirúrgico es la paratiroidectomía mediante una cervicotomía transversa centrada en la región infrahioidea. Objetivo: presentar un caso clínico de hiperparatiroidismo primario por un adenoma gigante de paratiroides tratado quirúrgicamente mediante un abordaje selectivo. Caso clínico: paciente de 53 años, sexo femenino, con antecedentes de litiasis ureteral, dolores óseos y tumoración infrahiodea de 4 cm de diámetro que imagenológicamente presentó las características de un adenoma paratiroideo inferior izquierdo. La valoración funcional confirmó hiperparatiroidismo. Con diagnóstico de hiperparatiroidismo primario por adenoma gigante se trató quirúrgicamente a través de una incisión pequeña y centrada en la tumoración, realizándose la paratiroidectomía inferior izquierda con la cual remitió la sintomatología y normalizó la funcionalidad paratiroidea. Discusión: el hiperparatiroidismo primario por adenoma gigante de paratiroides tiene indicación quirúrgica y es curativo. El caso presentado demuestra la factibilidad y seguridad de un abordaje selectivo a lo que suma una menor afectación cosmética, dejando indemne la logia tiroidea contralateral ante futuras cirugías sobre ésta.


Summary: Introduction: primary hyperparathyroidism caused by giant parathyroid adenoma is a rather unusual condition. Reported large adenomas occurred in ectopic parathyroid glands (mediastinal). Just like carcinomas, they are large, present high calcemia and parathyroid hormone values, what complicates diagnosis. Surgical treatment consists in parathyroidectomy by means of transversal cervicotomy around the infrahyoid region. Objective: the study presents the clinical case of primary hyperparathyroidism caused by giant parathyroid adenoma that was treated by selective surgery approach. Clinical case: 53 year-old female patient with a history of uretheral lithiasis, bone pain and 4-cm-diameter infrahyoid tumor. Imagenology studies revealed the characteristics of lower left parathyroid adenoma. Functional assessment confirmed hyperparathyroidism. Upon the diagnosis of primary hyperparathyroidism caused by giant parathyroid adenoma it was surgically addressed by means of a small cut around the tumour and performing a lower left parathyroidectomy, what resulted in the remission of symptoms and normalized parathyroid functionality. Discussion: primary hyperparathyroidism caused by giant parathyroid adenoma has an indication for surgery and is therapeutic. The case presented shows the feasibility and safety of a selective approach, as well as its smaller cosmetic harm, managing to keep the contralateral thyroid loggia intact, in view of future surgeries involving it.


Resumo: Introdução: o hiperparatireoidismo primário devido a adenoma de paratireoide gigante é raro. Os maiores adenomas relatados ocorreram em paratireoides ectópicas (mediastinais). Compartilha com o carcinoma seu grande tamanho e altos níveis de cálcio e hormônio da paratireoide, o que torna o diagnóstico difícil. Seu tratamento cirúrgico é a paratireoidectomia por meio de cervicotomia transversa com foco na região infra-hióidea. Objetivo: apresentar um caso clínico de hiperparatireoidismo primário por adenoma gigante da paratireoide tratado cirurgicamente por abordagem seletiva. Caso clínico: paciente do sexo feminino, 53 anos, com história de litíase ureteral, dor óssea e tumor infra-hióideo de 4 cm de diâmetro que apresentava características de imagem de adenoma de paratireoide inferior esquerdo. A avaliação funcional confirmou hiperparatireoidismo. Com diagnóstico de hiperparatireoidismo primário por adenoma gigante, foi tratada cirurgicamente por meio de pequena incisão focada no tumor, realizando paratireoidectomia inferior esquerda com remissão dos sintomas e normalização da funcionalidade da paratireoide. Discussão: o hiperparatireoidismo primário devido ao adenoma gigante da paratireoide tem indicação cirúrgica e é curativo. O caso apresentado demonstra a viabilidade e segurança de uma abordagem seletiva que apresenta um menor envolvimento estético, deixando o espaço contralateral da tireoide sem danos para futuras cirurgias.


Assuntos
Neoplasias das Paratireoides , Adenoma , Paratireoidectomia , Hiperparatireoidismo Primário/cirurgia
6.
Rev. méd. Chile ; 149(3): 399-408, mar. 2021. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1389472

RESUMO

Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It should be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.


Assuntos
Humanos , Masculino , Feminino , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico , Hiperparatireoidismo Primário , Hipercalcemia/etiologia , Hormônio Paratireóideo , Paratireoidectomia , Recidiva Local de Neoplasia
7.
Rev. colomb. cir ; 36(1): 110-119, 20210000. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1150525

RESUMO

Durante las últimas décadas, la incidencia del hiperparatiroidismo primario ha venido en aumento, muy probablemente relacionado con la mayor accesibilidad a los estudios diagnósticos; sin embargo, la forma más común de presentación clínica del hiperparatiroidismo primario es asintomática, en más del 80 % de los pacientes. En la actualidad, es menos frecuente el diagnóstico por las complicaciones renales (urolitiasis) u óseas (osteítis fibrosa quística) asociadas. Un tumor benigno de la glándula paratiroides (adenoma único), es la principal causa de esta enfermedad. Por tanto, su tratamiento usualmente es quirúrgico. A pesar de ello, no es frecuente el manejo de esta patología por el cirujano general. En este artículo se revisan conceptos claves para el diagnóstico y manejo de esta enfermedad para el médico residente y especialista en Cirugía general


During the last decades, the incidence of primary hyperparathyroidism has been increasing, most probably related to the greater accessibility to diagnostic studies; however, the most common form of clinical presentation of primary hyperparathyroidism is asymptomatic in more than 80% of patients. Diagnosis is less frequent due to associated renal (urolithiasis) or bone (osteitis fibrosa cystica) complications. A benign tumor of the parathyroid gland (single adenoma) is the main cause of this disease. Therefore, its treatment is usually surgical. Despite this, the management of this pathology by the general surgeon is not frequent. This article reviews key concepts for the diagnosis and management of this disease for the resident physician and specialist in General Surgery


Assuntos
Humanos , Glândulas Paratireoides , Neoplasias das Paratireoides , Paratireoidectomia , Hiperparatireoidismo Primário
8.
Actual. osteol ; 17(2): 92-103, 2021. ilus, tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1370258

RESUMO

El carcinoma paratiroideo (CP) es una neoplasia maligna con una incidencia de 0,015 cada 100.000 habitantes por año. Representa el 1% de los diagnósticos de hiperparatiroidismo primario y se manifiesta entre la 4.a y 5.a década de la vida, con una incidencia similar entre hombres y mujeres. La etiología del CP es incierta, ha sido asociada a formas esporádicas o familiares. Está caracterizado por altos niveles séricos de calcio y PTH y el desafío clínico-quirúrgico es el diagnóstico diferencial con otras entidades benignas como el adenoma o la hiperplasia de paratiroides. Aunque el diagnóstico de certeza es anatomopatológico, la sospecha clínica y el uso de métodos de baja complejidad (ecografía) con operadores avezados permite una correcta localización y abordaje pertinente del paciente para dirigir el tratamiento quirúrgico adecuado (resección en bloque) evitando persistencias y recurrencias de enfermedad. Se presenta el caso clínico de un paciente masculino que ingresa por síndrome de impregnación asociado a hipercalcemia, su abordaje diagnóstico, tratamiento y manejo interdisciplinario con discusión y revisión bibliográfica. (AU)


Parathyroid carcinoma (CP) is a malignant disease with an incidence of 0.015 per 100,000 inhabitants per year. It accounts for 1% of primary hyperparathyroidism diagnoses and occurs between the 4th and 5th decade of life, with a similar incidence between men and women. The etiology of CP is uncertain and has been associated with sporadic or family forms. CP is characterized by high serum calcium and PTH levels and the clinical-surgical challenge is the differential diagnosis with other benign entities such as parathyroid adenoma or hyperplasia. Although the diagnosis of certainty is achieved by pathological anatomy examination, the clinical suspicion and the use of low complexity methods (ultrasound) by experienced operators allows a correct localization and a patient-specific approach to direct the appropriate surgical treatment (block resection), avoiding persistence and recurrences of disease. The clinical case of a male patient admitted for severe hypercalcemia with multiple organ disfunction, the diagnostic approaches, treatment, and interdisciplinary management, together with review and discussion of the current literature are presented. (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/etiologia , Neoplasias das Paratireoides/diagnóstico por imagem , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/patologia , Calcitriol/administração & dosagem , Gluconato de Cálcio/administração & dosagem , Radiografia , Tomografia , Cálcio/administração & dosagem , Ultrassonografia , Diagnóstico Diferencial , Hipercalcemia/sangue
9.
Actual. osteol ; 17(1): 45-56, 2021. ilus, graf, tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1292122

RESUMO

El hiperparatiroidismo primario (HPTP) es poco frecuente en niños y adolescentes. Hay escasos datos para el manejo de estos pacientes en pediatría. Las glándulas paratiroideas son glándulas endocrinas que secretan hormona paratiroidea (PTH) y regulan el metabolismo del calcio y del fósforo. La sobreexpresión de PTH se llama hiperparatiroidismo, que se clasifica en primario, secundario y terciario. En los adolescentes, 80 a 92% de los hiperparatiroidismos primarios se deben a adenoma paratiroideo. Presentamos el caso clínico de una adolescente con una primera manifestación atípica de HPTP, la presencia de un tumor pardo del paladar, presentación rara de adenoma paratiroideo, acompañado de hipercalcemia, marcada elevación de PTH y varias lesiones óseas. (AU)


Primary hyperparathyroidism (PHPT) in children and adolescents is uncommon. Guidelines for management in pediatric patients are limited. Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calciumphosphate metabolism. The overexpression of PTH is called hyperparathyroidism, and is classified as primary, secondary, and tertiary. In adolescents, 80 to 92% of PHPT cases are due to a parathyroid adenoma. We present here a case report of an adolescent with a brown tumor of the palate as the first manifestation of the disease, atypical and rare presentation of parathyroid adenoma in an adolescent. She had hypercalcemia, marked elevation of PTH and bone lesions. (AU)


Assuntos
Humanos , Feminino , Criança , Neoplasias das Paratireoides/diagnóstico , Neoplasias Palatinas/etiologia , Adenoma/diagnóstico , Hiperparatireoidismo Primário/complicações , Neoplasias das Paratireoides/cirurgia , Neoplasias Palatinas/diagnóstico por imagem , Adenoma/cirurgia , Hiperparatireoidismo Primário/etiologia
10.
Autops. Case Rep ; 11: e2021270, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1249033

RESUMO

Background Hemangiomas are benign neoplasms of capillary proliferation that arise from a developmental anomaly where angioblastic mesenchyme fails to form canals. Most hemangiomas arise in the head and neck region, either superficially in the skin or deeper within endocrine organs such as the parotid gland. Parathyroid hemangiomas, however, are extremely rare, with only five cases previously reported in the literature. Case presentation Herein, we present a case of a 68-year-old man with a hemangioma almost completely replacing the right upper parathyroid gland, grossly measuring 1.3 × 1.3 × 1.2 cm and weighing 700 mg, associated with primary hyperparathyroidism. Conclusions Parathyroid gland enlargement due to vascular neoplasms such as hemangiomas can mimic, both clinically and radiographically, hyperplasias and/or adenomas. Surgeons need to be aware of the presence of this entity and should consider it in the differential diagnosis of hyperparathyroidism or parathyroid gland enlargement.


Assuntos
Humanos , Masculino , Idoso , Neoplasias das Paratireoides/patologia , Adenoma/patologia , Hemangioma/patologia , Doenças das Paratireoides/complicações , Diagnóstico Diferencial
11.
Rev. bras. ginecol. obstet ; 42(12): 841-844, Dec. 2020.
Artigo em Inglês | LILACS | ID: biblio-1156070

RESUMO

Abstract Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsiamotivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.


Resumo O hiperparatiroidismo primário é umdistúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Pancreatite/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Pré-Eclâmpsia/diagnóstico , Diagnóstico Pré-Natal , Adenoma/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Pancreatite/complicações , Neoplasias das Paratireoides/complicações , Complicações Neoplásicas na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Adenoma/complicações , Diagnóstico Diferencial , Hiperparatireoidismo Primário/complicações
13.
Rev. colomb. radiol ; 31(2): 5354-5359, jun. 2020. imag, ilus
Artigo em Inglês, Espanhol | LILACS, COLNAL | ID: biblio-1343461

RESUMO

El carcinoma de paratiroides es una causa excepcional de hiperparatiroidismo primario. Los tumores pardos se desarrollan como manifestaciones esqueléticas de hiperparatiroidismo primario en el contexto de una enfermedad avanzada. Son lesiones óseas líticas, altamente vasculares con un proceso celular reparador en lugar de un proceso neoplásico. Pueden identificarse en las formas secundarias de la enfermedad; sin embargo, son más frecuentes en el hiperparatiroidismo primario. Se presenta el caso de múltiples tumores pardos secundarios a un carcinoma de paratiroides. La manifestación inicial del hiperparatiroidismo primario fue una fractura patológica secundaria a tumor pardo asociado con hipercalcemia y niveles elevados de hormona paratiroidea (PTH), lo cual es infrecuente debido a que en las últimas décadas la incorporación del calcio sérico en las pruebas de rutina de laboratorio detecta esta enfermedad en estadios asintomáticos o mínimamente sintomáticos. Por ultrasonido se detectó lesión sólida vascularizada en sitio anatómico de paratiroides inferior izquierda y nefrocalcinosis. Se sometió a resección quirúrgica de la lesión en hemicuello izquierdo y la biopsia reportó carcinoma de paratiroides. Los tumores pardos son lesiones no neoplásicas que no tienen potencial maligno por lo que se consideran granulomas reparadores.


Parathyroid carcinoma is an exceptional cause of primary hyperparathyroidism. Brown tumors develop as skeletal manifestations of primary hyperparathyroidism in the context of advanced disease. They are highly vascular, lytic bone lesions with a reparative cellular process instead of a neoplastic process. They can be identified in the secondary forms of the disease, however, they are more frequent in primary hyperparathyroidism. We present a case of multiple brown tumors secondary to parathyroid carcinoma. The initial manifestation of primary hyperparathyroidism was a pathological fracture secondary to brown tumor associated with hypercalcemia and elevated levels of parathyroid hormone (PTH), which is rare due to the fact that in recent decades the incorporation of serum calcium in routine laboratory tests detects this disease in asymptomatic or minimally symptomatic stages. Ultrasound detected a vascularized solid lesion in the anatomical site of the left lower parathyroid and nephrocalcinosis. The lesion was surgically resected in the left hemicolumn and the biopsy reported parathyroid carcinoma. Brown tumors are non-neoplastic lesions that do not have malignant potential and are therefore considered repairing granulomas.


Assuntos
Osteíte Fibrosa Cística , Neoplasias das Paratireoides , Radiografia , Hiperparatireoidismo Primário
14.
Rev. méd. hondur ; 87(2): 76-70, abr.-dic. 2019. ilus
Artigo em Espanhol | LILACS, BIMENA | ID: biblio-1097735

RESUMO

Antecedentes: El hiperparatiroidismo primario, tercer trastorno metabólico más común a nivel mundial, provoca un aumento del calcio sérico y de la hormona paratiroidea, causado por una hiperactividad de las glándulas paratiroideas. En el 85% de los casos, se debe a un adenoma paratiroideo. Es predominantemente asintomático (>80%), pero sus manifestaciones pueden ser musculo-esqueléticas, neurológicas, psiquiátricas, renales, cardiovasculares, y gastrointestinales. Descripción del Caso Clínico: Paciente femenina de 53 años de edad, con antecedente de hipercolesterolemia familiar heterocigoto e hipertensión arterial; presenta insomnio, náuseas, pérdida de peso, mialgias, astenia, relujo gastroesofágico e irritabilidad. Ante indicación de exámenes de labo-ratorio muestra hipercalcemia leve. Se comprueba un adenoma paratiroideo derecho y nódulos tiroideos coloides benignos en lóbulo izquierdo mediante gammagrafía Tc99m MIBI, siendo sometida a su resección con posterior evolución satisfactoria. Conclusiones: Considerando la predilección asintomática del hiperparatiroidismo primario y su preferencia de presentación como adenoma, resulta indispensable su sospecha ante toda hipercalcemia. Requiere entonces una concientización amplia no solo en el ámbito médico sino también en la comunidad, ampliando esfuerzos entre el clínico, cirujano, y patólogo. Se recomienda medir el calcio y fósforo sérico de forma rutinaria en la evaluación clínica cotidiana de cada paciente para su detección...(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Glândula Tireoide/cirurgia , Hiperparatireoidismo Primário/diagnóstico , Hipercalcemia
15.
Prensa méd. argent ; 105(8): 431-435, sept 2019. graf
Artigo em Espanhol | BINACIS, LILACS | ID: biblio-1023142

RESUMO

Introducción: La monitorización con hormona tiroidea intraoperatoria (IOPTH) es utilizada en la práctica médica para predecir la cura bioquímica durante la paratiroidectomía del hiperparatiroidismo primario. Sin embargo, existen diversos criterios utilizados para predecir la normocalcémica luego de una paratiroidectomía. El propósito de este estudio es determinar cuál criterio es aquel que se corresponde con el menor riesgo de presentar un hiperparatiroidismo persistente luego de una paratiroidectomía por hiperparatiroidismo primario. Material y métodos: Se han analizado publicaciones realizadas en los últimos 10 años tomando como fuente de recopilación la base de datos de Pub-Med, trabajos publicados en Journal of the American Medical Associatiion y World Journal of Surgery. Conclusión: El criterio de IOPTH final en valores por debajo de los 65 pg/mL, y en especial, por debajo de los 40 pg/mL parece comportarse como mejor predictor de bajo riesgo de enfermedad persistente en comparación con el criterio de disminución de IOPTH por debajo del 50% del valor basal (AU)


Introduction: Monitoring with intraoperative thyroid hormone (IOPTH) is used in medical practice to predict the biochemical cure during the parathyroidectomy of primary hyperparathyroidism. However, there are several criteria used to predict normocalcemia after a parathyroidectomy. The purpose of this study is to determine which criterion is the one that correspons to the lowest risk of presenting a persistent hyperparathyroidism after a parathyroidectomy due to primary hyperparathyroidism. Materials and methods: Publications made in the last 10 years have been analyzed taking as a source of compilations the PubMed database, works published in Journal of the American Medical Association and World Journal of Surgery. Conclusiion: The final IOPTH criterion in values below 65 pg/mL, and especially below 40 pg/mL, seems to be the best predictor of low risk of persistent disease compared to the IOPTH decrease criterior Below 50% of the basal value (AU)


Assuntos
Humanos , Hormônio Paratireóideo , Neoplasias das Paratireoides/cirurgia , Medição de Risco , Hiperparatireoidismo Primário/cirurgia , Estudos de Viabilidade
16.
Int. j. odontostomatol. (Print) ; 13(3): 266-270, set. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1012420

RESUMO

RESUMEN: Se presenta el caso de un paciente sexo femenino 31 años, insuficienciente renal crónica en hemodiálisis, hipertensa secundaria, consulta por aumento de volumen oral en relación a encía marginal vestibular izquierda, 6 meses de evolución. Al examen se observa aumento de volumen de 15 mm en relación a piezas. 3.6 y 3.7. Radiografía muestra compromiso periodontal pieza 3.7. Se realiza biopsia excisional y exodoncia pieza 3.7. Histopatología informa granuloma periférico de células gigantes. Se solicitan exámenes de laboratorio para estudio de hiperparatiroidismo (PTH elevada, calcemia fosfatemia normales). Evoluciona favorablemente. Sin signos de recidiva a los 3 meses. El diagnóstico histopatológico de lesión de células gigantes debe ser complementado con la clínica, exámenes de laboratorio e imagenología, el objetivo final es definir si tal diagnóstico corresponde a un tumor pardo, a un granuloma central de células gigantes o a un granuloma periférico de células gigantes. En la literatura los reportes de asociación entre granuloma periférico de células gigantes e hiperparatiroidismo son escasos. Este caso corresponde a granuloma periférico células gigantes, asociado a hipersecreción de paratohormona.


ABSTRACT: A 31-year-old female patient with chronic renal insufficiency in hemodialysis and secondary hypertension consulted due to an enlarging intraoral lesion in relation to the left marginal vestibular gingival, with 6 months of evolution. A 15mm mass in relation to mandibular left molars was noted. Radiograph showed periodontal involvement of mandibular left second molar. Excisional biopsy and tooth 3.7 extraction were performed. Histopathology reported a peripheral giant cell granuloma. Laboratory tests were requested for suspected hyperparathyroidism (aiding in the diagnosis) (high PTH, normal phosphatemia and calcemia). Evolution was favorable, without signs of reappearance after 3 months. The histopathological diagnosis of giant cell lesions should be complemented with clinical, laboratory and imaging tests. The final objective is to make the differential diagnosis between brown tumor, central giant cell granuloma and peripheral giant cell granuloma because the treatment varies considerably. There are few reports in the literature about the association between peripheral giant cell granuloma and hyperparathyroidism. This case corresponds to peripheral giant cell granuloma, possibly associated with parathormone hypersecretion.


Assuntos
Humanos , Feminino , Adulto , Neoplasias das Paratireoides/cirurgia , Granuloma de Células Gigantes/diagnóstico , Granuloma de Células Gigantes/patologia , Hiperparatireoidismo Primário/cirurgia , Doenças da Gengiva/etiologia , Doenças da Gengiva/patologia , Radiografia Panorâmica , Procedimentos Cirúrgicos Bucais/métodos , Doenças da Gengiva/cirurgia
17.
Rev. méd. Chile ; 147(8): 1078-1081, ago. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1058646

RESUMO

Acute pancreatitis during pregnancy is uncommon and usually associated with gallstones. However other etiologies must be considered. We report a 24 years old woman with a 32 weeks pregnancy consulting for abdominal pain, nausea and vomiting. She had elevated lipase and amylase levels, a corrected serum calcium of 13.1 mg/dl and a serum phosphate of 1.6 mg/dl. A magnetic resonance colangiopancreatography showed an enlarged pancreas with inflammatory changes and a normal Wirsung duct. A parathyroid nodule was found on cervical ultrasonography. The patient was treated initially with cinacalcet with partial response. A parathyroidectomy was performed at 39 weeks of pregnancy with a good maternal and fetal evolution.


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Pancreatite/etiologia , Complicações na Gravidez/etiologia , Hipercalcemia/complicações , Pancreatite/cirurgia , Pancreatite/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Complicações na Gravidez/cirurgia , Adenoma/diagnóstico por imagem , Dor Abdominal/etiologia , Paratireoidectomia/métodos , Resultado do Tratamento , Colangiopancreatografia por Ressonância Magnética/métodos
18.
Rev. chil. endocrinol. diabetes ; 12(4): 205-207, 2019.
Artigo em Espanhol | LILACS | ID: biblio-1088026

RESUMO

INTRODUCCIÓN: El carcinoma de paratiroides es una enfermedad de difícil diagnóstico, siendo perentorio una detección precoz y un tratamiento oportuno para prevenir las complicaciones. CASO CLÍNICO: Se presenta paciente de 42 años que debuta con hipercalcemia de 16.1 mg/dl, PTH 1573 pg/mL y lesión sugerente de adenoma de paratiroides. Biopsia quirúrgica identifica carcinoma paratiroideo sin invasión, realizándose posteriormente lobectomía derecha con foco de 0,1 mm de carcinoma paratiroideo, con bordes libres. En comité oncológico se decide seguimiento estricto; sin embargo, a los seis meses requiere hospitalización nuevamente por hipercalcemia, a la ecografía cervical presenta dos nódulos hipoecogénicos menores a 1 cm en lecho quirúrgico. Tomografía computada sin evidencia de lesiones. Con estos antecedentes, se decide exploración cervical, encontrándose tumor de 2 cm, multilobulado, paraesofágico. Biopsia evidencia carcinoma paratiroideo con invasión en tejido graso y músculo estriado. Se descarta radioterapia paliativa y quimioterapia debido a escasa evidencia, quedando en cuidados paliativos. DISCUSIÓN: El cáncer de paratiroides es una enfermedad de difícil diagnóstico. En muchos casos se ha descrito la crisis hipercalcémica como presentación inicial. La resección en bloque de la lesión de paratiroides con hemitiroidectomía ipsilateral es el tratamiento estándar. Es un tumor radio resistente y la quimioterapia adyuvante no ha demostrado aumento en la sobrevida. En pacientes con enfermedad inoperable, el pronóstico es pobre, siendo fundamental el control de calcemia y PTH, las cuales son la causa principal de morbimortalidad. CONCLUSIONES: El carcinoma paratiroideo es una enfermedad rara, cuyo diagnóstico y tratamiento representan un verdadero desafío clínico, siendo crucial el alto índice de sospecha. Su curso es crónico y de mal pronóstico, por lo que para pacientes de alto riesgo debe considerarse una cirugía radical desde el inicio.


INTRODUCTION: Parathyroid carcinoma is a difficult diagnosis, with early detection and timely treatment to prevent complications being imperative. CLINICAL CASE: A 42-year-old patient presenting with hypercalcemia of 16.1 mg / dl, PTH 1573 pg / mL and suggestive lesion of parathyroid adenoma is presented. Surgical biopsy identifies parathyroid carcinoma without invasion, subsequently performing right lobectomy with 0.1 mm focus of parathyroid carcinoma, with free borders. Oncological committee, strict follow-up is decided; However, at six months he requires hospitalization again for hypercalcemia, at cervical ultrasound he presents two hypoechogenic nodules smaller than 1 cm in the surgical bed. CT scan without evidence of injuries. With this background, cervical exploration is decided, finding a 2 cm, multilobed, paraesophageal tumor. Biopsy shows parathyroid carcinoma with invasion of fatty tissue and striated muscle. Palliative radiotherapy and chemotherapy are ruled out due to limited evidence, remaining in palliative care. DISCUSSION: Parathyroid cancer is a difficult diagnosis disease. In many cases the hypercalcemic crisis has been described as an initial presentation. Block resection of the parathyroid lesion with ipsilateral hemitiroidectomy is the standard treatment. It is a radioresistant tumor and adjuvant chemotherapy has not shown an increase in survival. In patients with inoperable disease, the prognosis is poor, with the control of calcemia and PTH being essential, which are the main cause of morbidity and mortality. CONCLUSIONS: Parathyroid carcinoma is a rare disease, the diagnosis and treatment of which represent a real clinical challenge, the high index of suspicion being crucial. Its course is chronic and has a poor prognosis, so for high-risk patients, radical surgery should be considered from the beginning.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Adenoma/complicações , Adenoma/diagnóstico , Hipercalcemia/etiologia , Neoplasias das Paratireoides/cirurgia , Adenoma/cirurgia
19.
Int. arch. otorhinolaryngol. (Impr.) ; 22(4): 382-386, Oct.-Dec. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-975609

RESUMO

Abstract Introduction Intraoperative parathyroid hormone (ioPTH) testing is a widely accepted standard for assessing the parathyroid gland function. A decline of preoperative parathyroid hormone (PTH) levels by more than 50% is one accepted measure of parathyroid surgery adequacy. However, there may be a variation between preoperative PTH levels obtained at a clinic visit and pre-excisional ioPTH. Objective Our study explores the differences between preoperative PTH and pre-excisional ioPTH levels, and the potential impact this difference has on determining the adequacy of parathyroid surgery. Methods A retrospective study that consisted of 33 patients that had undergone parathyroid resection between September 2009 and March 2016 at a tertiary academic center was performed. Each subject's preoperative PTH levels were obtained from clinic visits and pre-excisional ioPTH levels were recorded along with the time interval between the measurements. Results There was a significant difference between the mean preoperative PTH and the pre-excisional ioPTH levels of 147 pg/mL (95% confidence interval [CI] 11.43 to 284.47; p= 0.0396). The exclusion of four outliers revealed a further significant difference with a mean of 35.09 pg/mL (95% CI 20.27 to 49.92; p< 0.0001). The average time interval between blood draws was 48 days + 32 days. A weak correlation between the change in PTH values and the time interval between preoperative and pre-excision blood draws was noted (r2 = 0.15). Conclusion Our study reveals a significant difference between the preoperative PTH levels obtained at clinic visits and the pre-excisional intraoperative PTH levels. We recommend routine pre-excisional intraoperative PTH levels, despite evidence of elevated preoperative PTH levels, in order to more accurately assess the adequacy of surgical resection.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Monitorização Intraoperatória , Paratireoidectomia , Neoplasias das Paratireoides/cirurgia , Imunoensaio , Registros Médicos , Estudos Retrospectivos , Período Pré-Operatório , Hiperparatireoidismo/cirurgia , Período Intraoperatório
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