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1.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547117

RESUMO

The report describes a patient with cholestatic jaundice who had incidentally detected parathyroid hormone-independent hypercalcaemia. The differential diagnosis for this presentation includes systemic granulomatous and infiltrative disorders, drug-induced liver injury and malignancy. As the initial investigations were non-contributory towards the aetiology, she was given steroids and later plasma exchange for symptomatic treatment. The differentials were revised again in view of no clinical and biochemical response. A repeat fine-needle aspiration cytology of the thyroid nodule (seen on positron emission tomography/CT) revealed papillary carcinoma of the thyroid. The patient underwent total thyroidectomy. There was a complete normalisation of liver function tests and serum calcium, and resolution of pruritus 3 months post surgery. She was retrospectively diagnosed as a case of papillary carcinoma of the thyroid with paraneoplastic manifestations-hypercalcaemia and cholestatic jaundice-which got resolved with treatment of the primary tumour.


Assuntos
Hipercalcemia/etiologia , Icterícia Obstrutiva/etiologia , Prurido/etiologia , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/cirurgia , Adulto , Biomarcadores/sangue , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/terapia , Icterícia Obstrutiva/terapia , Prurido/terapia , Câncer Papilífero da Tireoide/diagnóstico por imagem , Tireoidectomia
2.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558377

RESUMO

A 43-year-old African American man presented with right upper quadrant pain and elevated blood pressure. Investigations revealed elevated lipase, hypercalcaemia and elevated creatinine. CT abdomen with contrast revealed extensive intraabdominal lymphadenopathy with an initial suspicion for a lymphoproliferative malignancy. Patient was managed for acute pancreatitis, with further workup of hypercalcaemia revealing an elevated ACE level. Inguinal lymph node biopsy confirmed a non-caseating granuloma leading to the diagnosis of sarcoidosis.


Assuntos
Pancreatopatias/diagnóstico , Pancreatite/etiologia , Sarcoidose/diagnóstico , Lesão Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Adulto , Biópsia , Creatinina/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiologia , Lipase/sangue , Linfonodos/patologia , Masculino , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/tratamento farmacológico , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Tomografia Computadorizada por Raios X
3.
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
4.
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
5.
J Surg Res ; 257: 79-84, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818787

RESUMO

BACKGROUND: The incidence of primary hyperparathyroidism (PHP) is likely underestimated. Nephrolithiasis may indicate PHP with indication for parathyroidectomy. We sought to determine the proportion of patients with an index diagnosis of nephrolithiasis that have serum calcium levels measured, parathyroid hormone (PTH) levels measured if hypercalcemic, and time to referral for definitive management if PHP is diagnosed. METHODS: A single-institution retrospective review was performed of adult patients presenting with nephrolithiasis between July 1, 2016 and December 31, 2018. Exclusion criteria included currently admitted patients, prior nephrolithiasis, congenital or acquired urinary tract anomalies, and patients on calciuretics. Records were assessed for serum calcium and PTH measurement, as well as referrals. Univariate statistical analysis was performed. RESULTS: Of 1782 patients with nephrolithiasis screened, 968 met inclusion criteria. Patients were 49.8% female, 88.9% white. Mean age was 53 y. Within this cohort, 620 (64.0%) patients had a calcium measured, with a mean elapsed time from presentation of 27 d (interquartile range [IQR] 0-8). Twelve patients (1.58%) with calcium measured were hypercalcemic and eight (66.7%) had PTH measured with a mean elapsed time from presentation of 183 d (IQR 72-310), all had elevated or non-suppressed PTH. Five (62.5%) were referred to surgeons with mean elapsed referral time of 270 d (IQR 95-492). CONCLUSIONS: Many with index nephrolithiasis are not assessed for hypercalcemia or hyperparathyroidism. Patients with serum calcium and PTH values indicating PHP diagnosis may have significant delay to parathyroidectomy. Targeted interventions with electronic health record alerts or automated reflex testing may improve care in this domain.


Assuntos
Hipercalcemia/sangue , Hiperparatireoidismo Primário/diagnóstico , Nefrolitíase/sangue , Hormônio Paratireóideo/sangue , Adulto , Idoso , Cálcio/sangue , Feminino , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitíase/etiologia , Paratireoidectomia
6.
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
7.
Ann R Coll Surg Engl ; 102(8): e192-e195, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436720

RESUMO

We describe the case of an 89-year old Caucasian woman admitted with confusion and severe clinical manifestations of acute hypercalcaemia. There was no history suggestive of any malignancy and initial management included correction of the hypercalcaemia with intravenous fluid therapy. Sestamibi parathyroid scintigraphy and neck ultrasonography demonstrated a 4cm left-sided thyroid lesion and a nearly 2cm right-sided thyroid lesion. The patient underwent a total thyroidectomy and parathyroidectomy. Histology confirmed a concomitant parathyroid adenoma, parathyroid carcinoma and follicular thyroid carcinoma. To our knowledge, this is the first reported case in the literature.


Assuntos
Adenocarcinoma Folicular , Neoplasias das Paratireoides , Neoplasias da Glândula Tireoide , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercalcemia/etiologia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Cintilografia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Tireoidectomia
8.
Transplant Proc ; 52(4): 1178-1182, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32340747

RESUMO

BACKGROUND: Pneumonia caused by opportunistic fungi is a serious complication in immunocompromised patients. Hypercalcemia has been described in renal transplantation associated with Pneumocystis jirovecii (PJP) or Histoplasma capsulatum (HCP) pneumonia. METHODS: We describe 5 patients who underwent kidney transplant between 2014 and 2019 and developed hypercalcemia before the diagnosis of pulmonary fungal infection: 4 patients with PJP and 1 with HCP. We assessed calcium metabolism and kidney function by total and ionized calcium, phosphorus, intact parathormone (iPTH), 25-OH vitamin D, 1,25(OH)2 vitamin D, and serum creatinine levels. RESULTS: Mean albumin-corrected calcium and ionized calcium were 12.56 mg/dL (range, 10.8-13.8 mg/dL) and 1.57 mmol/L (range, 1.43-1.69 mmol/L). Patients were normocalcemic, at 10.12 mg/dL (range, 9.6-10.5 mg/dL), before diagnosis and resolved hypercalcemia after antifungal treatment, at 8.86 mg/dL (range, 8.0-9.5 mg/dL). All patients had low or normal iPTH values, at 29.1 pg/mL (range, <3-44 pg/mL), with higher PTH levels 3 months before diagnosis and after treatment, at 147.3 pg/mL (range, 28.1-479 pg/mL) and 117.5 pg/mL (range, 18.2-245 pg/mL), respectively. The mean value for 25-OH vitamin D was 30.8 ng/mL (range, 14.6-62.8 ng/mL). This supports a PTH-independent mechanism, and we postulated an extrarenal production of 1,25(OH)2 vitamin D. CONCLUSION: In kidney transplant patients, hypercalcemia independent of PTH and refractory to treatment should alert for the possibility of opportunistic fungal pneumonia.


Assuntos
Hipercalcemia/etiologia , Hospedeiro Imunocomprometido , Transplante de Rim , Micoses/imunologia , Infecções Oportunistas/complicações , Pneumonia/imunologia , Adulto , Feminino , Histoplasmose/sangue , Histoplasmose/imunologia , Humanos , Hipercalcemia/sangue , Hipercalcemia/imunologia , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/complicações , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Pneumonia/complicações , Pneumonia/microbiologia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/imunologia , Adulto Jovem
9.
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
10.
Ann R Coll Surg Engl ; 102(6): e111-e114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233855

RESUMO

INTRODUCTION: Bilateral giant parathyroid adenoma in the absence of multiple endocrine neoplasia (MEN) type 1 is extremely rare and literature on this subject is limited. CASE HISTORY: A 79-year-old man presented with acute kidney injury secondary to hypercalcaemia. Blood test results indicated primary hyperparathyroidism. Ultrasonography revealed bilateral parathyroid adenomas measuring 19.4mm x 19.5mm x 18.8mm (left) and 15.2mm x 18.3mm x 19.6mm (left) whereas on computed tomography, the measurements were 31mm x 20mm (left) and 30mm x 14mm (right). Intraoperatively, giant adenomas measuring 50mm x 25mm x 12mm (left, weighing 8.101g) and 48mm x 22mm x 10mm (right, weighing 7.339g) were identified and excised. Parathyroid hormone level dropped from 44.6pmol/l preoperatively to 8.9pmol/l postoperatively (normal range 1.3-7.6pmol/l). The patient was discharged with no complications. CONCLUSIONS: We report a rare phenomenon where bilateral giant parathyroid adenoma occurred in the absence of MEN type 1. It highlights the importance of cross-sectional imaging in delineating the anatomy of adenomas as their size can be grossly underestimated by ultrasonography alone.


Assuntos
Adenoma/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/diagnóstico , Paratireoidectomia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Adenoma/complicações , Adenoma/patologia , Adenoma/cirurgia , Idoso , Cálcio/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Ultrassonografia
11.
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
12.
Med Clin North Am ; 104(3): 525-538, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312413

RESUMO

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.


Assuntos
Emergências/epidemiologia , Cuidados Paliativos na Terminalidade da Vida/normas , Planejamento de Assistência ao Paciente/normas , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Diagnóstico Diferencial , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Hipercalcemia/etiologia , Pessoa de Meia-Idade , Neoplasias/complicações , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Planejamento de Assistência ao Paciente/tendências , Prognóstico , Fatores de Risco , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia
15.
Transplant Proc ; 52(5): 1284-1286, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204903

RESUMO

BACKGROUND: Persistent post-transplant hyperparathyroidism (PPTHP) can occur in 20% to 50% of renal transplant recipients. The aim of this study was to analyze safety and efficacy of long-term cinacalcet therapy in a group of renal transplant recipients with PPTHP. METHODS: A single center retrospective cohort study including renal transplant recipients, adults (>18 years old) with PPTHP and hypercalcemia. Inclusion criteria for cinacalcet therapy was increased parathormone levels (PTH > 65 pg/mL) associated with serum calcium >11.5 mg/dL any time after transplant or calcium >10.2 mg/dL within the first year after transplant. The follow-up period was 3 years. Demographic, laboratory data and adverse events were assessed. RESULTS: Forty-six patients were included, mean age of 50 ± 11 years old, majority of white race (60%), male (58%), with a pretransplant length on dialysis of 67 ± 34 months. Cinacalcet therapy was started 37 ± 40 months after transplant, and normal calcium levels were achieved after 6 months of therapy. PTH levels presented a steady reduction over time, reaching levels near normal after 36 months (317 ± 242 vs 145 ± 72 pg/mL, baseline × month 36, P < .05). Renal function remained stable over time (GFR > 60 mL/min/1.73 m2) and no acute rejection episodes were observed. Most common adverse events were mild gastrointestinal symptoms. In 6 patients (12.5%) treatment was interrupted due to adverse events. Only 1 case (2%) was classified as treatment failure. CONCLUSION: Cinacalcet therapy proved to be efficient for PPTHP and safe for graft and patient. Long-term treatment reduced PTH levels to near normal range.


Assuntos
Cinacalcete/administração & dosagem , Hipercalcemia/tratamento farmacológico , Hiperparatireoidismo/tratamento farmacológico , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Cálcio/sangue , Esquema de Medicação , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo/sangue , Hiperparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
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
18.
BMJ Case Rep ; 13(1)2020 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-31988055

RESUMO

A 76-year-old renal transplant patient due to autosomal dominant polycystic kidney disease who resumed chronic haemodialysis was admitted to our hospital for confusion and lassitude. He was afebrile and physical examination revealed diffuse bilateral rales with decreased respiratory sounds in lower right lung. Laboratory data showed hypercalcaemia (total calcium 3.92 mmol/L (normal range 2.2-2.6 mmol/L), ionised calcium 1.87 mmol/L (1.15-1.35 mmol/L)), low intact parathyroid hormone (iPTH) 15 ng/L, (15-65 ng/L) and high 1,25(OH)2D3 128.9 pg/mL, (15.2-90.1 pg/mL). Chest CT-scan revealed bilateral apical lung lesions after 15 days of antibiotics. Bronchoalveolar sample was PCR positive for Pneumocystis jirovecii He was treated with an extra session of haemodialysis with 1.25 mmol/L dialysate calcium concentration, oral trimethoprim-sulfamethoxazole was started and oral corticosteroid dose increased to 1 mg/kg for 1 week. Hypercalcaemia decreased progressively after initiation of these treatments. We concluded a case of hypercalcaemia secondary to P. jirovecii infection.


Assuntos
Hipercalcemia/etiologia , Pneumonia por Pneumocystis/diagnóstico , Rim Policístico Autossômico Dominante/complicações , Idoso , Humanos , Masculino , Pneumonia por Pneumocystis/complicações , Diálise Renal
19.
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
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