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1.
Z Gastroenterol ; 59(2): 143-148, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33556973

RESUMO

BACKGROUND: Neuroendocrine tumors (NET) diagnosed during pregnancy are extremely rare. This case report describes diagnosis and treatment of a metastasized pancreas NET that became symptomatic in the second trimester. CASE DESCRIPTION: A 33-year-old patient presented to the emergency department in the 19th week of pregnancy (WOP) with persistent diarrhea. Laboratory tests showed a pronounced hypercalcemia (3.53 mmol/l). Imaging revealed a mass in the pancreatic corpus/tail with extensive liver metastasis. Histologically, a NET (G2, SSTR-positive) with paraneoplastic parathormone-related-peptide secretion was found to be the cause of hypercalcemia. Under a treatment with octreotide, calcium values normalized and diarrhea stopped. After delivery of a healthy child (32.WOP via cesarean section) tumor progress was found. The pancreatic mass was resected completely, the liver metastases as far as possible. Postoperatively, in a CT scan, residual suspicious liver lesions could be found, and a palliative therapy with lanreotide was initiated. With this treatment, the patient has been asymptomatic for one year, and serum calcium remained normal. The child developed normally. DISCUSSION: This unusual case shows that even in extensively metastasized symptomatic NETs during pregnancy, there may be sufficient diagnostic and therapeutic options that allow for a continuation of pregnancy in close interdisciplinary cooperation under careful risk-benefit assessment for mother and child.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Diarreia/etiologia , Hipercalcemia/tratamento farmacológico , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/fisiopatologia , Octreotida/uso terapêutico , Neoplasias Pancreáticas/fisiopatologia , Adulto , Cesárea , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hiperparatireoidismo/sangue , Hiperparatireoidismo/complicações , Recém-Nascido , Neoplasias Hepáticas/patologia , Metástase Neoplásica , Tumores Neuroendócrinos/sangue , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/terapia , Proteína Relacionada ao Hormônio Paratireóideo/sangue , Gravidez , Resultado da Gravidez , Índice de Gravidade de Doença , Resultado do Tratamento
2.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462034

RESUMO

A 21-year-old woman presented to hospital with abdominal pain and nausea. She had a history of Graves' disease which had been effectively treated with carbimazole for 15 months. Investigations revealed a serum adjusted calcium level of 3.69 mmol/L with a suppressed parathyroid hormone, thyroid stimulating hormone <0.01 mu/L (0.2-5.0) and free T4 of 76.1 pmol/L (9-24). She was treated as a relapsed case of Graves' disease and started on propylthiouracil. Calcium levels continued to increase over the next 3 days despite adequate fluid resuscitation. A decision was taken to administer intravenous bisphosphonate (pamidronate) which resulted in a lowering of calcium levels. She became mildly hypocalcaemic following treatment with pamidronate which was presumed secondary to low vitamin D and oral vitamin D replacement was commenced. This case was unique as this is to our knowledge the most significant hypercalcaemia observed in a patient with hyperthyroidism. All other causes of hypercalcaemia were excluded. The learning points were recognising hypercalcaemia as a complication of thyrotoxicosis and the risk of hypocalcaemia following bisphosphonate therapy with low vitamin D stores.


Assuntos
Doença de Graves/complicações , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Feminino , Doença de Graves/diagnóstico , Doença de Graves/terapia , Humanos , Hipercalcemia/terapia , Adulto Jovem
3.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462026

RESUMO

A 65-year-old woman presented to the emergency room with a syncope. An ECG done revealed complete heart block with a narrow QRS escape rhythm and a normal QT interval. Further investigation revealed severe hypercalcaemia and elevated parathormone levels. Her heart block disappeared on correction of the hypercalcaemia. A right inferior parathyroid adenoma was found and surgically removed. Thus, hypercalcaemia may lead to reversible complete heart block without QT interval shortening.


Assuntos
Bloqueio Cardíaco/etiologia , Hipercalcemia/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Bloqueio Cardíaco/diagnóstico , Humanos , Hipercalcemia/complicações
4.
Rev. ORL (Salamanca) ; 11(3): 347-359, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-7491

RESUMO

INTRODUCCIÓN Y OBJETIVO: Describir la etiopatogenia y el diagnóstico diferencial entre el hiperparatiroidismo primario y otras causas de hipercalcemia. SÍNTESIS: El hiperparatiroidismo primario (HPP) es una enfermedad endocrina frecuente, que se define de forma convencional como la existencia de hipercalcemia en presencia de niveles elevados de hormona paratiroidea (PTH). Aunque la forma más común de presentación en la actualidad sea como hipercalcemia asintomática, la elevada morbilidad asociada con esta patología requiere que se realice un diagnóstico precoz y preciso, tanto de la etiología como de sus complicaciones, para poder llevar a cabo un manejo adecuado de los pacientes afectados


INTRODUCTION AND OBJECTIVE: To describe the etiopathogenesis and differential diagnosis between primary hyperparathyroidism and other causes of hypercalcemia. SYNTHESIS: Primary hyperparathyroidism (PHPT) is a common endocrine disease, which is conventionally defined as the existence of hypercalcemia in the presence of elevated levels of parathyroid hormone (PTH). Although the most common form of presentation nowadays is as asymptomatic hypercalcemia, the high morbidity associated with this pathology requires that an early and precise diagnosis be made, both of the etiology and its complications, in order to carry out an adequate management of the affected patients


Assuntos
Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Hipercalcemia/etiologia , Vitamina D , Hiperparatireoidismo Primário/patologia , Diagnóstico Diferencial , Diagnóstico Precoce , Hipercalcemia/diagnóstico , Hipercalciúria/diagnóstico , Hipercalciúria/etiologia
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 357-363, jun.-jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193360

RESUMO

INTRODUCCIÓN: El HPTP frecuentemente permanece sin diagnosticar en pacientes con hipercalcemia, lo que podría ocasionar un aumento de la morbilidad en estos sujetos. OBJETIVO: Identificar la presencia de hipercalcemia y de criterios de tratamiento quirúrgico (CTQ) no identificados desde al menos un año antes de su remisión a endocrinología en pacientes operados de HPTP. Valorar si este retraso terapéutico se asocia a mayor morbilidad. MÉTODOS: Estudio observacional en 116 pacientes consecutivos. Mediante la revisión de los registros anteriores a 12 meses previos a su derivación a endocrinología se dividieron en 4 grupos: hipercalcemia con CTQ (grupo 1, n = 43), hipercalcemia sin CTQ (grupo 2, n = 23), calcemias normales (grupo 3, n = 18) o ausencia de calcemias en dichos registros (grupo 4, n = 32). RESULTADOS: En 84 pacientes (72,4%) había calcemias previas, 66 (56,9%) con hipercalcemia, de ellos 43 (37%) con CTQ no valorados. La demora media hasta su remisión fue de 57 meses. Casi la mitad de las calcemias del grupo 1 procedían de urgencias. Respecto al grupo 4 los pacientes del grupo 1 tenían menor edad, mayor incidencia de nefrolitiasis e insuficiencia renal al remitírseles. Las calcemias en el momento de su derivación eran similares, superiores a las de los grupos 2 y 3. DISCUSIÓN: Los pacientes con HPTP y CTQ se remiten a endocrinología con un retraso medio de 5 años. La inadvertencia de la hipercalcemia y/o el desconocimiento de los CTQ retrasan esta derivación, determinada por hipercalcemias superiores, y se asocian a una afectación renal más severa. Son precisas medidas correctoras para evitar este retraso en el diagnóstico y curación del HPTP


INTRODUCTION: Primary hyperparathyroidism (PHPT) remains underdiagnosed among patients with hypercalcemia, potentially causing increased morbidity. OBJECTIVE: To identify in surgically operated patients the presence of overlooked hypercalcemia and patients with criteria for surgery (CFS) for PHPT at least one year prior to referral to Endocrinology, and to determine whether this diagnostic delay leads to increased morbidity. METHODS: An observational study was carried out in 116 consecutive patients. We evaluated electronic medical records registered at least 12 months prior to referral and divided them in four groups: hypercalcemia with CFS (group 1), hypercalcemia without CFS (group 2), normocalcemia (group 3), and cases without previous biochemical evaluation (group 4). RESULTS: A total of 84 patients (72.4%) had a previous measurement of serum calcium at a time interval of ≥ 12 months. Sixty-six (56.9%) had hypercalcemia and 43 of them (37%) had ≥ 1 CFS, with an average delay of 57 months in receiving proper evaluation. Almost half of the calcemia measurements in group 1 had been made in the emergency room. Patients from group 1 were younger, and had a greater frequency of nephrolithiasis and renal impairment than patients in group 4. The serum calcium values at referral were similar in both groups and higher than the values found in patients from the other two groups. DISCUSSION: In patients with PHPT and CFS, referral to an endocrinologist is made with an average delay of almost 5 years. The identified causes of this delay, which conditions more kidney disease, are unrecognized hypercalcemia and/or unawareness of the surgical criteria, while calcium elevations promote referral. Interventions are needed to avoid this delay in the diagnosis and resolution of PHPT


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Tempo para o Tratamento , Diagnóstico Tardio , Indicadores de Morbimortalidade , Hipercalcemia/diagnóstico , Hipercalcemia/classificação , Estudos Retrospectivos , Fosfatase Alcalina/análise , Insuficiência Renal , Paratireoidectomia/normas , Encaminhamento e Consulta/normas
6.
Ann R Coll Surg Engl ; 102(5): 363-368, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233846

RESUMO

INTRODUCTION: Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. METHODS: The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. RESULTS: Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40-71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14-22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4-38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1-5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. CONCLUSIONS: Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.


Assuntos
Adenoma/complicações , Carcinoma/complicações , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/etiologia , Neoplasias das Paratireoides/complicações , Adenoma/sangue , Adenoma/cirurgia , Adulto , Idoso , Cálcio/sangue , Carcinoma/sangue , Carcinoma/cirurgia , Difosfonatos/administração & dosagem , Feminino , Furosemida/administração & dosagem , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/sangue , Paratireoidectomia , Período Pós-Operatório , Diálise Renal , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
7.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281761

RESUMO

We report the case of a 37-year-old woman that developed severe hypercalcemia due to a parathyroid gland mass. After the initial medical treatment, only a minimal reduction of calcemia was observed and her clinical condition worsened; thus, she required continuous renal replacement therapy (CRRT) that resulted in the normalization of calcium serum level. She then underwent a left thyroid lobectomy with exeresis of the associated parathyroid glands; the histological diagnosis revealed a giant parathyroid adenoma (GPA). CRRT, initially recommended only in case of severe refractory hypercalcemia poorly responsive to pharmacological approaches, is now being evaluated in the first line treatment of life-threatening cases, with or without associated acute kidney injury (AKI).


Assuntos
Adenoma/diagnóstico , Hipercalcemia/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Lesão Renal Aguda/complicações , Adenoma/sangue , Adenoma/etiologia , Adulto , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/complicações
8.
Am J Respir Crit Care Med ; 201(8): e26-e51, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293205

RESUMO

Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability.Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality.Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.


Assuntos
Cardiomiopatias/diagnóstico , Nefropatias/diagnóstico , Hepatopatias/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Biópsia , Broncoscopia , Cálcio/sangue , Cardiomiopatias/sangue , Cardiomiopatias/fisiopatologia , Creatinina/sangue , Ecocardiografia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Endossonografia , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Nefropatias/sangue , Hepatopatias/sangue , Linfonodos/patologia , Linfadenopatia , Imagem por Ressonância Magnética , Mediastino , Tomografia por Emissão de Pósitrons , Pneumologia , Sarcoidose/sangue , Sarcoidose/diagnóstico , Sarcoidose/patologia , Sarcoidose/fisiopatologia , Sarcoidose Pulmonar/sangue , Sarcoidose Pulmonar/patologia , Sarcoidose Pulmonar/fisiopatologia , Sociedades Médicas , Vitamina D/sangue
11.
J Zoo Wildl Med ; 51(1): 245-248, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32212572

RESUMO

Hypervitaminosis D was diagnosed in a giant anteater (Myromecophaga tridactyla) and a large hairy armadillo (Chaetophractus villosus) being fed a commercial insectivore diet. Clinical findings included weight loss, reduced appetite, vomiting, and suspected abdominal discomfort. Hypercalcemia (3.68 and 2.04 mmol/L total and ionized calcium, respectively) was detected in the anteater, and plasma 25(OH)D levels were measured and found to be 808.7 and 379.4 nmol/L for the anteater and armadillo, respectively. Dietary change resulted in a reduction of 25(OH)D levels in both animals and resolution of hypercalcemia in the giant anteater. Dietary analysis of the commercial insectivore food revealed levels of vitamin D3 higher than the data-sheet values. This case report demonstrates that hypervitaminosis D in Xenarthra can be associated with significant clinical signs.


Assuntos
25-Hidroxivitamina D 2/sangue , Cingulados , Transtornos Nutricionais/veterinária , Vitamina D/sangue , Animais , Tatus , Dieta/efeitos adversos , Dieta/veterinária , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hipercalcemia/veterinária , Masculino , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/etiologia
13.
Neonatal Netw ; 39(1): 35-39, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31919292

RESUMO

Calcium, the most abundant ion in the neonate, plays a role in bone formation, blood coagulation, muscle contractility, and nerve conduction. Calcium levels are regulated via a negative feedback loop by the parathyroid hormone, calcitonin, and vitamin D. Calcium levels in the neonate must be monitored carefully to avoid complications that affect the central nervous system as well as the cardiac and musculoskeletal systems.


Assuntos
Cálcio/sangue , Hipercalcemia/diagnóstico , Hipocalcemia/diagnóstico , Triagem Neonatal/métodos , Hormônio Paratireóideo/sangue , Diagnóstico Precoce , Seguimentos , Humanos , Hipercalcemia/sangue , Hipocalcemia/sangue , Recém-Nascido , Masculino , Monitorização Fisiológica/métodos , Medição de Risco
14.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964759

RESUMO

This set of recommendations is designed to assist the pediatrician in caring for children with Williams syndrome (WS) who were diagnosed by using clinical features and with chromosome 7 microdeletion confirmed by fluorescence in situ hybridization, chromosome microarray, or multiplex ligation-dependent probe amplification. The recommendations in this report reflect review of the current literature, including previously peer-reviewed and published management suggestions for WS, as well as the consensus of physicians and psychologists with expertise in the care of individuals with WS. These general recommendations for the syndrome do not replace individualized medical assessment and treatment.


Assuntos
Síndrome de Williams/complicações , Adolescente , Adulto , Fatores Etários , Anormalidades Cardiovasculares/etiologia , Anormalidades Cardiovasculares/terapia , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Assistência Odontológica para Crianças/métodos , Facies , Feminino , Transtornos da Audição/etiologia , Humanos , Hipercalcemia/complicações , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hipotireoidismo/etiologia , Lactente , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Fotografação , Exame Físico , Comportamento Problema/psicologia , Transição para Assistência do Adulto , Sistema Urinário/anormalidades , Síndrome de Williams/genética , Síndrome de Williams/terapia , Adulto Jovem
15.
Ann Hematol ; 99(2): 229-239, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31907572

RESUMO

The prognostic significance of hypercalcemia in lymphoma has only been studied on small series to date. We conducted a retrospective, monocentric, matched-control study that aimed to compare the outcome of patients diagnosed with any histological subtype of lymphoma associated with hypercalcemia, at diagnosis or relapse, with a group of controls matched for histological and prognostic factors. Sixty-two and 118 comparable patients treated between 2000 and 2016 were included in hypercalcemia and control cohorts, respectively. Hypercalcemia was found mainly at diagnosis (71%) in higher-risk patients (prognosis scores ≥ 3, 76%) and those with diffuse large B cell lymphoma (67.7%), stage III/IV disease (91.9%), and elevated LDH (90.3%). Two-year progression-free survival (PFS) was shorter in the hypercalcemia than control cohort [30.1% (95% confidence interval (95% CI) 18.3-41.9) vs 63.9% (95% CI 5.1-72.7), p < 0.001]. Two-year overall survival (OS) was 40.6% (95% CI 28.1-53.1) and 77.7% (95% CI 70.1-85.3) in the hypercalcemia and control cohorts, respectively (p < 0.001). Hypercalcemia was independently associated with poor PFS [HR = 2.5 (95% CI 1.4-3.5)] and OS [HR = 4.7 (95% CI 2.8-7.8)] in multivariate analysis. Among the 40 patients who received autologous stem cell transplantation (ASCT), hypercalcemia was still associated with shorter OS [2-year OS: 65% (95% CI 40.1-89.9) vs 88.0 (95% CI 75.3-100), p = 0.04]. Hypercalcemia may be associated with chemo-resistance, given its impact on PFS and OS. Hence, these data suggest that alternate strategies for lymphoma patients with hypercalcemia should be developed.


Assuntos
Hipercalcemia , Linfoma Difuso de Grandes Células B , Transplante de Células-Tronco , Idoso , Autoenxertos , Intervalo Livre de Doença , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/mortalidade , Hipercalcemia/terapia , Linfoma Difuso de Grandes Células B/sangue , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
16.
Praxis (Bern 1994) ; 109(1): 35-41, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910762

RESUMO

CME: Hypercalcemia Abstract. Hypercalcemia is defined as albumin-corrected calcium >2.6 mmol/l. Symptoms of hypercalcemia are mainly neurological-psychiatrical and cardiovascular. Severe symptomatic hypercalcemia is an emergency and requires an immediate therapy. At the same time, the underlying cause of hypercalcemia has to be identified and treated. Based on pathophysiology, hypercalcemia can be divided into four groups: parathyroid hormone dysfunction, disturbances of vitamin D metabolism, of bone metabolism or of renal calcium excretion. Medical history and specific laboratory diagnostics help to identify one of these groups and to make the correct final diagnosis.


Assuntos
Hipercalcemia , Cálcio/metabolismo , Cálcio na Dieta , Emergências , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hormônio Paratireóideo
17.
Surgery ; 167(1): 168-172, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31543325

RESUMO

BACKGROUND: Normocalcemic primary hyperparathyroidism may be more challenging to cure compared with classical primary hyperparathyroidism. The aim of this study was to utilize a multi-institutional database to better characterize this condition. METHODS: The Collaborative Endocrine Surgery Quality Improvement Program database was queried for all patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism. Patient characteristics, operative details, pathology, and outcomes data were compared between patients with normocalcemic primary hyperparathyroidism and those with hypercalcemia. RESULTS: Among 7,569 patients, 9.7% (733) were normocalcemic primary hyperparathyroidism. Mean age at surgery and sex were similar for normocalcemic primary hyperparathyroidism and primary hyperparathyroidism with hypercalcemia. The primary hyperparathyroidism with hypercalcemia cohort had a single parathyroid resected more frequently than the normocalcemic primary hyperparathyroidism group (73.3%% vs 47.5%, P < .05). Patients with normocalcemic primary hyperparathyroidism had a higher rate of subtotal (3.5 gland) resection (10.0% vs 4.7%, P < .05). Pathology reported a higher frequency of multigland hyperplasia in the normocalcemic primary hyperparathyroidism cohort (43.1% vs 21.9%, P <.05). In the normocalcemic primary hyperparathyroidism cohort, 47 patients (6.4%) underwent remedial surgery compared with 307 patients (4.5%) with primary hyperparathyroidism with hypercalcemia (P < .05). The rate of clinical concern for persistent hyperparathyroidism was similar between the 2 groups (P = .09) but not reported in 25% overall. CONCLUSION: Patients with normocalcemic primary hyperparathyroidism have higher rates of multigland disease and remedial surgery compared with primary hyperparathyroidism with hypercalcemia.


Assuntos
Cálcio/sangue , Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides/patologia , Paratireoidectomia/estatística & dados numéricos , Melhoria de Qualidade , Idoso , Estudos de Coortes , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/cirurgia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/patologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/cirurgia , Avaliação de Programas e Projetos de Saúde , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
18.
Surgery ; 167(1): 155-159, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31604587

RESUMO

BACKGROUND: Our study seeks to find a cost-saving screening strategy in a primary care population for diagnosing primary hyperparathyroidism based on peak serum total calcium level, age, and patient sex. METHODS: Laboratory data resulting from primary care office visits at our institution between January 2016 through December 2017 to evaluate patients who had at least 1 episode of hypercalcemia (≥10.5 mg/dL). For each serum calcium threshold, we calculated the percentage of patients who were found to have an increased parathyroid hormone level (≥65 pg/mL). We determined whether net cost savings could be achieved by screening hypercalcemic patients given their probability of primary hyperparathyroidism and expected cost savings from fracture risk reduction, given their sex and age. RESULTS: From 155,350 unique patients in the study period, a total of 2,271 had a minimum of 1 hypercalcemic lab value. After exclusion criteria, there were 1,326 patients of whom 27.5% had a parathyroid hormone level checked. Cost savings was established at a screening threshold of 10.5 for all patients until age 66 years for men and 69 years for women. For men aged 67-68 y and women aged 70-71 years, the optimal screening threshold was 10.8 mg/dl. CONCLUSION: Cost savings can be achieved by screening hypercalcemic patients with a life expectancy exceeding 16 years, with varying thresholds based on age and sex.


Assuntos
Redução de Custos , Fraturas Ósseas/prevenção & controle , Hipercalcemia/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Programas de Rastreamento/economia , Idoso , Doenças Assintomáticas/economia , Cálcio/sangue , Estudos de Coortes , Análise Custo-Benefício , Diagnóstico Tardio , Feminino , Fraturas Ósseas/etiologia , Humanos , Hipercalcemia/economia , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/economia , Hiperparatireoidismo Primário/terapia , Expectativa de Vida , Masculino , Programas de Rastreamento/métodos , Modelos Econômicos , Hormônio Paratireóideo/sangue
19.
Surgery ; 167(1): 160-165, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31606193

RESUMO

BACKGROUND: A recent study with unusually lengthy follow-up after surgery for primary hyperparathyroidism reported higher recurrence rates than previously appreciated. We sought to identify specific factors associated with late recurrence after seemingly curative parathyroidectomy. METHODS: Prospectively collected data were retrieved for patients who had surgical treatment of sporadic primary hyperparathyroidism with ≥ 3-year follow-up (3-17.6 years). Recurrence was defined by 6 months of eucalcemia with subsequent hypercalcemia and a high or unsuppressed parathyroid hormone. Recurrent patients were compared with cured patients (defined by consistent eucalcemia). RESULTS: Among 261 patients, 28 (10.7%) had recurrence and 233 (89.3%) were cured. The mean time to recurrence was 77 months (range 13-170). The mean final intraoperative parathyroid hormone (49.0 pg/mL vs 37.5 pg/mL, P < .01), 6-month calcium levels (9.6 mg/dL vs 9.2 mg/dL, P = .02) and mean 6-month parathyroid hormone levels (86.5 pg/mL vs 59.6 pg/mL, P = .04) were higher for recurrence. By multivariable analysis, 6-month calcium ≥ 9.7 and eucalcemic elevation of the parathyroid hormone at 6 months were independently associated with recurrent primary hyperparathyroidism. CONCLUSION: Long-term follow-up after apparent curative surgery for primary hyperparathyroidism identified a high late recurrence rate (10.7%), up to 17 years later. A 6-month calcium >9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 months may be associated with recurrence, and such findings may help guide management.


Assuntos
Cálcio/sangue , Hipercalcemia/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Hormônio Paratireóideo/sangue , Paratireoidectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Fatores de Tempo , Adulto Jovem
20.
Am J Surg ; 220(1): 127-131, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31648774

RESUMO

BACKGROUND: Porcelain gallbladder is characterized by calcification of the gallbladder wall, possibly associated chronic inflammation from cholelithiasis. It is unknown whether porcelain gallbladder is associated with higher rates of hypercalcemia and/or hyperparathyroidism compared to cholelithiasis without porcelain gallbladder. METHODS: We searched our patient database for patients with porcelain gallbladder on imaging and patients with cholelithiasis without porcelain gallbladder. We collected data on patient age, gender, calcium levels, parathyroid hormone (PTH) levels, and medications/comorbidities known to cause hypercalcemia. RESULTS: 1000 patients within our database had porcelain gallbladder on imaging. Of these, 661 (245 male) had at least one serum calcium value for analysis. These patients were matched by age and gender with 6610 patients with cholelithiasis who had at least one serum calcium value. Rates of recurrent/persistent hypercalcemia were higher among patients with porcelain gallbladder at 16.8% versus 11.1% (p < 0.01). Rates of hyperparathyroidism were also higher among porcelain gallbladder patients at 12% versus 7.5% (p < 0.01). CONCLUSION: Patients with porcelain gallbladder show higher rates of hypercalcemia and hyperparathyroidism than patients with cholelithiasis alone.


Assuntos
Calcinose/complicações , Colelitíase/complicações , Doenças da Vesícula Biliar/complicações , Hipercalcemia/epidemiologia , Hiperparatireoidismo/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercalcemia/diagnóstico , Hiperparatireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Adulto Jovem
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