RESUMO
Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.
RESUMO
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, resulting from the autonomous production of parathyroid hormone from 1 or more abnormal parathyroid glands. Disease presentation ranges from asymptomatic to multiorgan involvement (skeletal, renal, neurocognitive, and gastrointestinal). This article outlines the epidemiology, clinical presentation, and diagnostic algorithm for PHPT. Key laboratory assessments are discussed, as are imaging studies for preoperative localization. Indications for surgical intervention are detailed, as are potential indications for surveillance. Sporadic and genetic syndromes associated with PHPT are also described.
Assuntos
Testes Genéticos/métodos , Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Humanos , Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Prognóstico , Reprodutibilidade dos TestesRESUMO
Bleeding related to endoscopic biopsies is relatively uncommon and tends to be a self-limiting process. This article aims to identify those groups of patients that are at a higher risk at the time of the pre procedural evaluation, and to review the current guidelines regarding high risk patients (with special consideration for those who are anticoagulated). It also reviews current strategies for diagnosis, initial evaluation and management of a post procedural bleed. These include all the tools in an endoscopist's armamentarium (thermal, mechanical and chemical) for local control, as well as a discussion about the more severe bleeds that might require interventional radiology or salvage surgery.