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1.
Pediatr Endocrinol Diabetes Metab ; 27(3): 232-234, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34743507

RESUMO

Fetus and neonate are dependent maternal supply of calcium for maintaining the calcium profile in physiologic range. The disturbances in maternal calcium homeostasis leads to changes in the baby's calcium. Maternal investigations in neonatal hypocalcemia not only reveal the etiology in the baby but are sometime helpful in unmasking maternal disorder of calcium homeostasis.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Cálcio , Feminino , Feto , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Recém-Nascido , Mães , Convulsões/diagnóstico , Convulsões/etiologia
2.
Ann Palliat Med ; 10(10): 10712-10719, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763432

RESUMO

BACKGROUND: Secondary hyperparathyroidism (SHPT) is common in dialysis patients with end-stage renal disease (ESRD). Parathyroidectomy (PTX) is an effective treatment for SHPT. Postoperative severe hypocalcemia (SH) is a common and severe complication after PTX. This study aimed to investigate the potential predictive markers of SH in dialysis ESRD patients with SHPT after near-total PTX (near-tPTX) without autotransplantation (AT). METHODS: A retrospective analysis involving 131 dialysis patients with SHPT who were treated with near-tPTX without AT between January and August 2018 was performed. Demographic characteristics (age, gender, type of dialysis modality, etc.) and perioperative laboratory parameters [serum calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), and bone metabolism markers] were collected and analyzed. Postoperative serum calcium level <1.875 mmol/L (7.5 mg/dL) was defined as postoperative SH. RESULTS: Among the 131 patients, 73 (55.7%) had postoperative hypocalcemia and 43 (32.8%) had postoperative SH. Univariate analysis showed that values of preoperative serum iPTH, calcium, ALP, bone-specific alkaline phosphatase (BAP), and osteocalcin (OC) were significantly different between the SH and non-SH groups. In the multivariate logistic regression model, preoperative serum ALP was an independent risk predictor of postoperative SH. The receiver operating characteristic (ROC) curve for preoperative serum ALP was 277 U/L. The sensitivity of preoperative serum ALP was 73.8% and the specificity was 63.2%. CONCLUSIONS: The incidence rates of postoperative hypocalcemia and SH in dialysis patients with SHPT after near-tPTX without AT were 55.7% and 32.8%, respectively. Preoperative serum ALP was an independent predictor for the occurrence of postoperative SH, and dialysis patients with SHPT were susceptible to postoperative SH when preoperative serum ALP level was >277 U/L. Hence, we recommend that preoperative serum ALP be utilized to complement clinical protocols for postoperative SH management of dialysis ESRD patients with SHPT after near-tPTX without AT.


Assuntos
Hiperparatireoidismo Secundário , Hipocalcemia , Humanos , Hiperparatireoidismo Secundário/cirurgia , Hipocalcemia/etiologia , Paratireoidectomia , Diálise Renal/efeitos adversos , Estudos Retrospectivos
3.
Khirurgiia (Mosk) ; (10): 100-104, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34608787

RESUMO

Hypoparathyroidism is a failure of parathyroid glands characterized by reduced serum concentration of parathyroid hormone, hypocalcemia and hyperphosphatemia. The most common cause of hypoparathyroidism is resection or damage to parathyroid glands during thyroid surgery. Postoperative hypoparathyroidism is still an urgent problem, as it requires additional treatment and prolongs hospital-stay. Considering available literature data, the authors analyze various methods of intraoperative prevention of hypoparathyroidism.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/prevenção & controle , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/efeitos adversos
4.
J Nepal Health Res Counc ; 19(2): 284-287, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601517

RESUMO

BACKGROUND: Hyperbilirubinemia is a common problem in neonates. Phototherapy and exchange transfusion are the primary treatment modalities. Less known, but one of the potential complications of phototherapy is hypocalcemia. Most of the neonates with hypocalcemia are asymptomatic. Though asymptomatic, treatment should be initiated immediately when serum calcium level is reduced. This study was conducted to detect the incidence of hypocalcemia in jaundiced neonates receiving phototherapy. METHODS: It is a hospital-based cross-sectional study conducted from May 2020 to December 2020 in the neonatal intensive care unit of Nepal Medical College Teaching Hospital. A total of 128 full-term neonates with jaundice and a normal serum calcium level before initiating phototherapy were enrolled in the study. Serum calcium level was measured before starting conventional phototherapy and after 48 hours of continuous phototherapy. RESULTS: Hyperbilirubinemia was present in 23.3% of neonates admitted to the neonatal unit. Hypocalcemia was seen in 26 (20.3%) of term jaundiced neonates receiving phototherapy. Signs of hypocalcemia were present only in 3 (2.3%) neonates. CONCLUSIONS: Hypocalcemia is a common complication of phototherapy. Serum calcium levels should be monitored in all the full-term neonates receiving phototherapy.


Assuntos
Hipocalcemia , Icterícia , Estudos Transversais , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Recém-Nascido , Nepal , Fototerapia
5.
Praxis (Bern 1994) ; 110(14): 785-786, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34702053

RESUMO

CME/Answers: Hypocalcemia and Hypoparathyroidism Abstract. Dyselectrolytemias are common, but not immediately clearly assignable. In addition to hyponatremia, hypercalcemia plays an important role in clinical practice. Clinically no less relevant are hypocalcemias and a frequently underlying primary hypoparathyroidism, which in most cases is iatrogenic - caused by thyroid surgery. The therapeutic goal includes not only adequate calcium control but also the detection and treatment of secondary complications in cases of chronic hypoparathyroidism.


Assuntos
Hipercalcemia , Hipocalcemia , Hipoparatireoidismo , Cálcio , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hipocalcemia/terapia , Hipoparatireoidismo/complicações , Hipoparatireoidismo/diagnóstico , Tireoidectomia
6.
Praxis (Bern 1994) ; 110(13): 703-708, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34583536

RESUMO

CME: Hypocalcemia and Hypoparathyroidism Abstract. Dyselectrolytemias are common, but not immediately clearly assignable. In addition to hyponatremia, hypercalcemia plays an important role in clinical practice. Clinically no less relevant are hypocalcemias and a frequently underlying primary hypoparathyroidism, which in most cases is iatrogenic - caused by thyroid surgery. The therapeutic goal includes not only adequate calcium control but also the detection and treatment of secondary complications in cases of chronic hypoparathyroidism.


Assuntos
Hipercalcemia , Hipocalcemia , Hipoparatireoidismo , Cálcio , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hipoparatireoidismo/complicações , Hipoparatireoidismo/diagnóstico , Tireoidectomia
7.
Ger Med Sci ; 19: Doc09, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34539299

RESUMO

Objective: Neonatal seizures are alarming manifestations of an underlying significant disorder demanding immediate attention and intervention. Hypocalcemia, although rare, must be considered in the differential diagnosis of neonatal seizures. Method: We present an unusual case of a 10-day-old infant with unexplained symptomatic hypocalcemia, experiencing multiple episodes of focal tonic-clonic seizures, born by an entirely asymptomatic mother. Moreover, we conducted a systematic search in PubMed and Scopus databases to present a clinical overview of all similar cases. Result: Maternal laboratory investigation revealed markedly increased calcium levels with concomitant high parathyroid hormone levels due to a parathyroid adenoma, undiagnosed during antenatal checkup. Conclusion: This is one of the few cases in the literature where neonatal symptomatology led to the diagnosis of undiagnosed maternal hyperparathyroidism. Early detection and appropriate management of neonatal hypocalcemia could eliminate serious maternal and fetal morbidity.


Assuntos
Hipercalcemia , Hiperparatireoidismo , Hipocalcemia , Neoplasias das Paratireoides , Complicações na Gravidez , Feminino , Humanos , Hiperparatireoidismo/complicações , Hiperparatireoidismo/diagnóstico , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Recém-Nascido , Hormônio Paratireóideo , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Gravidez , Complicações na Gravidez/diagnóstico
8.
BMC Surg ; 21(1): 334, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34474672

RESUMO

BACKGROUND: Definitions of postoperative hypoparathyroidism (hypoPT) have never reached consent until the American Thyroid Association (ATA) statement was released, with new characteristics and challenges. METHODS: Patients with papillary thyroid carcinoma who underwent primary total thyroidectomy between January 2013 and June 2018 were retrospectively enrolled. Symptoms of hypocalcemia and their frequency were stringently followed. Patients were divided into groups according to the ATA statement. Incidence of postoperative hypoPT and serum parathyroid hormone levels accompanied by calcium levels, from 1-day to at least 24-month follow-up. RESULTS: A total of 1749 patients were included: 458 (26.2%) had transient and 63 (3.6%) had permanent hypoPT. Transient hypoPT was found in 363 (20.7%) patients with biochemical hypoPT, 72 (4.1%) with clinical hypoPT, and 23 (1.3%) with relative hypoPT; permanent hypoPT was detected in 8 (0.5%) patients with biochemical hypoPT, 55 (3.1%) with clinical hypoPT, and none with relative hypoPT. Female sex, age ≥ 55 years, unintentional parathyroid gland resection, and autotransplantation of ≥ 2 parathyroid glands were independent risk factors for transient biochemical hypoPT. Age ≥ 55 years, bilateral central neck dissection, and isthmus tumor location were independent risk factors for transient clinical hypoPT. A postoperative 1-day percentage of parathyroid hormone (PTH) reduction of > 51.1% was an independent risk factor for relative hypoPT (odds ratio, 4.892; 95% confidence interval, 1.653-14.480; P = 0.004). No independent risk factor for permanent hypoPT was found. CONCLUSION: ATA diagnostic criteria for postoperative hypoPT are of great value in differentiating patients by hypocalcemia symptoms and choosing corresponding clinical assistance; however, they may underestimate the actual incidence.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Neoplasias da Glândula Tireoide , Feminino , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/epidemiologia , Hipoparatireoidismo/etiologia , Pessoa de Meia-Idade , Glândulas Paratireoides , Hormônio Paratireóideo , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Estados Unidos
9.
Vet Surg ; 50(7): 1379-1388, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34365655

RESUMO

OBJECTIVE: To investigate (1a) agreement of ultrasonographic, surgical, and histopathologic findings in the diagnosis of a neoplastic etiology underlying primary hyperparathyroidism (PHPT), (1b) the ability of ultrasonographically determined parathyroid gland size to distinguish between malignant (carcinoma) and non-malignant (hyperplasia, adenoma) pathology, and (2) variables associated with postoperative hypocalcemia in dogs undergoing surgical treatment of PHPT. STUDY DESIGN: Ambidirectional cohort study. ANIMALS: Forty-seven client owned dogs with PHPT (34 retrospective; 13 prospective). METHODS: Data were extracted from medical records. Method agreements were explored using Cohen's Kappa statistic. A receiver operating characteristic curve (ROC) was used to determine a cut-off separating parathyroid pathologies. Univariable and multivariable models assessed associations between postoperative hypocalcemia and potential risk factors. RESULTS: Agreement of ultrasound and surgery for number and side of affected glands was 31/47 (65.9%) and 34/47 (72.3%), respectively. In 37/47 (78.7%) cases, parathyroid tissue was correctly assessed as pathologic by the surgeon. An ultrasonographic cut-off of ≥8.0 mm (ROC AUC = 0.82) best distinguished malignant from benign pathologies. Dogs with a preoperative serum ionized calcium (iCa) concentration ≥1.75 mEq/L had 7.5 times greater odds of becoming hypocalcemic postoperatively. CONCLUSION: A fair agreement existed between ultrasonographic and surgical findings in dogs with PHPT. A parathyroid mass ≥8.0 mm on ultrasonographic examination was suggestive of malignancy, while dogs with a preoperative serum iCa concentration ≥1.75 mEq/L were at increased risk for postoperative hypocalcemia in this study. CLINICAL SIGNIFICANCE: This study supports the use of bilateral cervical surgical exploration to identify abnormal parathyroid glands for the treatment of PHPT.


Assuntos
Doenças do Cão , Hiperparatireoidismo Primário , Hipocalcemia , Animais , Estudos de Coortes , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/etiologia , Doenças do Cão/cirurgia , Cães , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/veterinária , Hipocalcemia/etiologia , Hipocalcemia/veterinária , Glândulas Paratireoides/diagnóstico por imagem , Paratireoidectomia/veterinária , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia/veterinária
10.
BMJ Case Rep ; 14(6)2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193455

RESUMO

Hypoparathyroidism is most often the result of postsurgical damage to the parathyroid glands but may occasionally be autoimmune hypoparathyroidism. In the latter context, activating antibodies directed against the calcium-sensing receptor (CaSR) have been described. We hereby present the case of a patient suffering from chronic recurrent muscle cramps and paresthesia, presenting for a seizure due to hypocalcaemia. After eliminating the possibility of a genetic disorder, we searched for autoimmune hypoparathyroidism as there was no obvious cause of hypoparathyroidism. The search for anti-CaSR antibodies was positive. There was no argument for autoimmune polyendocrine syndrome type 1 so we concluded that it was isolated autoimmune hypoparathyroidism caused by activating antibodies to the CaSR. The patient was treated with vitamin D and calcium supplementation. The search for complications of hypoparathyroidism and hypercalciuria revealed basal ganglia calcification. The patient's hypocalcaemia is now being kept under control with oral supplementation.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Cálcio , Diagnóstico Tardio , Humanos , Hipercalciúria , Hipocalcemia/diagnóstico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Hipoparatireoidismo/complicações , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/tratamento farmacológico , Receptores de Detecção de Cálcio
11.
J Crit Care ; 65: 261-267, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34274834

RESUMO

PURPOSE: We investigated the effect of potentially modifiable continuous renal replacement therapy (CRRT)-related treatment factors on the risk of severe hypotension. MATERIALS AND METHODS: We carried out a secondary statistical analysis of the Acute Renal Failure Trial Network (ATN) trial. The primary exposures of interest were CRRT treatment dose, ultrafiltration rate, blood flow rate, ionized calcium level and type of anti-coagulation used. The primary outcome was severe hypotension, defined as vasopressor-inotropic score > 18 and calculated based on treatment doses of vasopressor and inotropic agents. RESULTS: Of 1124 individuals enrolled in the ATN Trial, 786 were managed with CRRT. 265/786 (33.7%) patients experienced severe hypotension during the trial. A serum ionized calcium <1.02 mmol/l was associated with a higher risk of severe hypotension compared to a serum calcium >1.02 mmol/l (hazard ratio 2.9; 95% CI 1.5-5.7). There was no significant difference in the risk of hypotension associated with other CRRT treatment factors. CONCLUSIONS: Of the CRRT treatment factors studied, hypocalcemia with a serum ionized calcium <1.02 mmol/l was associated with a significantly increased risk of treatment-associated hypotension. Further studies will be required to assess whether treatment targets for serum calcium improve the risk of hypotension during CRRT.


Assuntos
Injúria Renal Aguda , Terapia de Substituição Renal Contínua , Hipocalcemia , Hipotensão , Injúria Renal Aguda/terapia , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Hipotensão/epidemiologia , Hipotensão/etiologia , Terapia de Substituição Renal , Estudos Retrospectivos
12.
Transfusion ; 61 Suppl 1: S188-S194, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269436

RESUMO

BACKGROUND: Massive transfusion protocols (MTPs) are associated with severe hypocalcemia, contributing to coagulopathy and mortality in severely injured patients. Severity of hypocalcemia following massive transfusion activation and appropriate treatment strategies remain undefined. STUDY DESIGN AND METHODS: This was a retrospective study of all MTP activations in adult trauma patients at a Level 1 trauma center between August 2016 and September 2017. Units of blood products transfused, ionized calcium levels, and amount of calcium supplementation administered were recorded. Primary outcomes were ionized calcium levels and the incidence of severe ionized hypocalcemia (iCa ≤1.0 mmol/L) in relation to the volume of blood products transfused. RESULTS: Seventy-one patients had an MTP activated during the study period. The median amount of packed red blood cells (PRBCs) transfused was 10 units (range 1-52). A total of 42 (59.1%) patients had periods of severe hypocalcemia. Patients receiving 13 or more units of PRBC had a greater prevalence of hypocalcemia with 83.3% having at least one measured ionized calcium ≤1.0 mmoL/L (p = .001). The number of ionized calcium levels checked and the amount of supplemental calcium given in patients who experienced hypocalcemia varied considerably. DISCUSSION: Severe hypocalcemia commonly occurs during MTP activations and correlates with the number of packed red blood cells transfused. Monitoring of ionized calcium and amount of calcium supplementation administered is widely variable. Standardized protocols for recognition and management of severe hypocalcemia during massive transfusions may improve outcomes.


Assuntos
Transfusão de Sangue , Hipocalcemia/etiologia , Reação Transfusional/etiologia , Ferimentos e Lesões/terapia , Adulto , Idoso , Transfusão de Sangue/métodos , Cálcio/sangue , Cálcio/uso terapêutico , Suplementos Nutricionais , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/métodos , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reação Transfusional/sangue , Reação Transfusional/terapia , Ferimentos e Lesões/sangue
13.
Clin Endocrinol (Oxf) ; 95(5): 760-765, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34219257

RESUMO

OBJETIVE: We followed our previously reported algorithm based on intra and postoperative parathyroid hormone (PTH) levels to predict postthyroidectomy hypoparathyroid hypocalcemia. The objective of the study was to assess if this strategy is useful and safe to reduce hypocalcemia, hospitalisation length and postsurgery calcium sampling. DESIGN, PATIENTS, MEASSUREMENTS: We classified our series of 66 patients according to their risk of hypoparathyroidism based on PTH determinations. We treated high-risk patients with calcium and vitamin D1-25 supplementation and obtained routine daily calcium samples to control low-risk patients until 48 h postsurgery. We compared the outcomes and overall results of this new approach with those of a historical control group of patients with equivalent PTH measurements who were treated only if they presented hypocalcemia. RESULTS: In the high-risk subgroup (n = 30), five patients had hypocalcemia within the first 24 h. Compared with the high-risk control subgroup, the incidence of hypocalcemia fell from 100% to 17% (p < .001), and the median hospitalisation length from 6 to 3 days (p < .001). In the low-risk subgroup (n = 36), 28 patients remained normocalcemic with significantly less calcium sampling (p < .001). Eight patients had hypocalcemia; seven of them required neck dissection, which was the only risk factor related to postsurgical hypoparathyroidism (RR: 2.1 [confidence interval 95%: 1.4-3.1]; p < .001). The overall incidence of hypocalcemia decreased by 58% in our patients compared to the control group. CONCLUSIONS: Assessing PTH levels to classify the risk of hypoparathyroidism and to initiate preventive therapy was an effective approach that improved the safety of our paediatric patients by reducing the incidence of hypocalcemia and the length of hospitalisation after thyroidectomy in paediatric patients.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Cálcio , Criança , Humanos , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/prevenção & controle , Hormônio Paratireóideo , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/efeitos adversos
14.
Head Neck ; 43(10): 2935-2945, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34076308

RESUMO

BACKGROUND: A prospective, stratified, randomized, double-blind, placebo-controlled study was conducted to observe the impact of preoperative calcitriol supplementation on serum calcium levels following total thyroidectomy. METHODS: Subjects were randomized 1:1 to receive 1 µg calcitriol or placebo for 1 week preceding thyroidectomy. The primary outcome measure was change in serum calcium from baseline to 18 h post-thyroidectomy. Subjects were also assessed for incidence of symptomatic hypocalcemia, length of stay, readmission for hypocalcemia, and intravenous calcium supplementation. RESULTS: Forty-seven patients underwent thyroidectomy; 23 received preoperative calcitriol supplementation, and 24 received placebo. Repeated measures regression demonstrated no difference in postoperative serum calcium over time (p = 0.22). There were no occurrences of hypocalcemia, intravenous calcium supplementation, or readmission in either group. No difference was observed in length of stay (p = 0.38). One patient in the calcitriol group developed Grade 3 hypercalcemia. CONCLUSIONS: Preoperative calcitriol supplementation had no impact on postoperative serum calcium levels compared to placebo.


Assuntos
Hipocalcemia , Calcitriol/uso terapêutico , Cálcio , Humanos , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Hormônio Paratireóideo , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Tireoidectomia/efeitos adversos
15.
J Int Med Res ; 49(5): 3000605211015018, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038214

RESUMO

OBJECTIVE: To summarize the clinical features of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure and to explore the predictive factors of postoperative hypocalcemia after total parathyroidectomy in these patients. METHODS: The clinical data of 87 patients admitted to Guangdong Electric Power Hospital from May 2013 to February 2020 were reviewed. All patients underwent total parathyroid resection and sternocleidomastoid microtransplantation. Age, sex, and the serum calcium, phosphorus, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) concentrations were analyzed as predictive factors of postoperative hypocalcemia. RESULTS: Bone pain was the most common clinical manifestation in this study population, and all 87 patients experienced relief from their clinical symptoms after the surgical procedure. Age and the preoperative serum calcium, ALP, and iPTH concentrations were determined to be early predictive factors of postoperative hypocalcemia. CONCLUSIONS: Age and the preoperative calcium, ALP, and iPTH concentrations are independent risk factors for postoperative hypocalcemia in patients with SHPT and renal disease who undergo total parathyroidectomy with sternocleidomastoid microtransplantation. These factors can help identify high-risk patients who can be managed by a multidisciplinary team to improve graft survival and quality of life.


Assuntos
Hiperparatireoidismo Secundário , Hipocalcemia , Cálcio , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hormônio Paratireóideo , Paratireoidectomia , Qualidade de Vida , Estudos Retrospectivos
16.
Sci Rep ; 11(1): 9656, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958615

RESUMO

Tumor lysis syndrome (TLS) is a common and fatal complication of childhood hematologic malignancies, especially acute lymphoblastic leukemia (ALL). The clinical features, therapeutic regimens, and outcomes of TLS have not been comprehensively analyzed in Chinese children with ALL. A total of 5537 children with ALL were recruited from the Chinese Children's Cancer Group, including 79 diagnosed with TLS. The clinical characteristics, treatment regimens, and survival of TLS patients were analyzed. Age distribution of children with TLS was remarkably different from those without TLS. White blood cells (WBC) count ≥ 50 × 109/L was associated with a higher risk of TLS [odds ratio (OR) = 2.6, 95% CI = 1.6-4.5]. The incidence of T-ALL in TLS children was significantly higher than that in non-TLS controls (OR = 4.7, 95% CI = 2.6-8.8). Hyperphosphatemia and hypocalcemia were more common in TLS children with hyperleukocytosis (OR = 2.6, 95% CI = 1.0-6.9 and OR = 5.4, 95% CI = 2.0-14.2, respectively). Significant differences in levels of potassium (P = 0.004), calcium (P < 0.001), phosphorus (P < 0.001) and uric acid (P < 0.001) were observed between groups of TLS patients with and without increased creatinine. Laboratory analysis showed that older age was associated with a higher level of creatinine. Calcium level was notably lower in males. WBC count, lactate dehydrogenase, and creatinine levels were significantly higher in T-ALL subgroup, whereas procalcitonin level was higher in B-ALL children. Older age, infant, a higher level of WBC and T-ALL were risk factors TLS occurrence. Hyperleukocytosis has an impact on the severity of TLS, while renal injury may be an important feature in the process of TLS.


Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Síndrome de Lise Tumoral/etiologia , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Hiperfosfatemia/etiologia , Hipocalcemia/etiologia , Lactente , Contagem de Leucócitos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Fatores de Risco , Análise de Sobrevida , Síndrome de Lise Tumoral/mortalidade , Síndrome de Lise Tumoral/patologia
17.
Biomed Res Int ; 2021: 6667047, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33937408

RESUMO

The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Due to the presence of ACE2 receptors in the kidneys and gastrointestinal (GI) tract, kidneys and GI tract damage arising from the virus can be seen in patients and can cause acute conditions such as acute kidney injury (AKI) and digestive problems for the patient. One of the complications of kidneys and GI involvement in COVID-19 is fluid and electrolyte disturbances. The most common ones of these disorders are hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypochloremia, hypervolemia, and hypovolemia, which if left untreated, cause many problems for patients and even increase mortality. Fluid and electrolyte disturbances are more common in hospitalized and intensive care patients. Children are also at greater risk for fluid and electrolyte disturbances complications. Therefore, clinicians should pay special attention to the fluid and electrolyte status of patients. Changes in fluid and electrolyte levels can be a good indicator of disease progression.


Assuntos
Líquidos Corporais/metabolismo , COVID-19/etiologia , Eletrólitos/metabolismo , Injúria Renal Aguda/etiologia , COVID-19/complicações , Trato Gastrointestinal/fisiopatologia , Trato Gastrointestinal/virologia , Humanos , Hipocalcemia/etiologia , Hipopotassemia/etiologia , Hiponatremia/etiologia , Rim/fisiopatologia , Rim/virologia
18.
Head Neck ; 43(8): 2523-2533, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33949716

RESUMO

This meta-analysis evaluates whether near-infrared autofluorescence (NIRAF) imaging reduces the risk of hypocalcemia after total thyroidectomy. A systematic literature search in PubMed, EMBASE, Web of Science, and Cochrane Library for studies from June 2011 to January 2021 comparing total thyroidectomy with NIRAF and conventional surgery (naked eye). Six eligible studies involving 2180 patients were included. The prevalence of transient hypocalcemia was 8.11% (40/493) and 25.19% (425/1687) in the NIRAF and naked eye groups (p < 0.0001), respectively. The prevalence of permanent hypocalcemia was 0% (0/493) and 2.19% (37/1687) in the NIRAF and naked eye groups (p = 0.05), respectively. NIRAF reduces the risk of transient hypocalcemia and may possibly lower the rate of permanent hypocalcemia. Nonetheless, further studies are needed to verify our results and evaluate the cost-effectiveness of NIRAF in real-world clinical practice.


Assuntos
Hipocalcemia , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Imagem Óptica , Glândulas Paratireoides , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Comportamento de Redução do Risco , Tireoidectomia/efeitos adversos
19.
Clin Ter ; 172(3): 241-246, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33956045

RESUMO

Abstract: Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary hyperparathyroidism. Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation. Long-standing chronic kidney disease (CKD) is associated with several metabolic disturbances that lead to increased secretion of PTH, including hyperphosphatemia, calcit-riol deficiency, and hypocalcaemia. Hyperphosphatemia has a direct stimulatory effect on the parathyroid gland cell resulting in nodular hyperplasia and increased PTH secretion. Prolonged hypocalcaemia also causes parathyroid chief cell hyperplasia and excess PTH. Af-ter correction of the primary disorder CKD by renal transplant, the hypertrophied parathyroid tissue fails to resolute, enlarge over and continues to oversecrete PTH, despite serum calcium levels that are within the reference range or even elevated. They also may become resistant to calcimimetic treatment. The main indication for treatment is persistent hypercalcemia and/or an increased PTH, and the primary treatment is surgery. Three procedures are commonly performed: total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy. It is important to remove superior parts of thymus as well. The most appropriate surgical procedure, whether it be total, subtotal, or anything less than subtotal including "limited" or "focused" parathyroidectomies, continues to be unclear and controversial. Surgical complications are rare, and para-thyroidectomy appears to be a safe and feasible treatment option for HPT III.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Humanos , Hiperfosfatemia/etiologia , Hiperplasia/patologia , Hipocalcemia/etiologia , Transplante de Rim , Glândulas Paratireoides/patologia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/metabolismo , Insuficiência Renal Crônica/complicações , Transplante Autólogo
20.
J Coll Physicians Surg Pak ; 30(5): 571-575, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34027871

RESUMO

OBJECTIVE: To determine the frequency of hypomagnesaemia in patients undergoing thyroidectomy and evaluate its relationship with postoperative hypocalcaemia. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Surgical Unit 1, Benazir Bhutto Hospital, Rawalpindi, Pakistan from April 2017 to May 2019. METHODOLOGY: Preoperative and 24-hour postoperative samples for serum calcium and magnesium of 75 patients undergoing total and near-total thyroidectomy were taken.  Postoperative signs and symptoms of hypocalcaemia were documented. Data was analysed on SPSS version 22, using independent and paired t-test, Pearson correlation, linear regression, Chi-square test and Fisher's Exact test. RESULTS: Postoperatively 49 (65.3%) patients developed hypocalcaemia and 8 (10.7%) developed hypomagnesaemia. Postoperative hypocalcaemia was significantly associated with hypomagnesaemia (p=0.03) with a significant positive linear correlation. Ten patients (13.3%) developed symptomatic hypocalcaemia; however, it was not associated with postoperative hypomagnesaemia. Postoperative hypocalcaemia and hypomagnesaemia were significantly associated with preoperative calcium level (p = 0.03 and 0.04, respectively). There was significantly lower calcium level in patients with hypomagnesaemia (p = 0.002) and a significant fall in magnesium level in patients developing hypocalcaemia (p = 0.044). CONCLUSION: Postoperatively hypocalcaemia was prevalent following thyroidectomy, while hypomagnesaemia was not common.  Hypomagnesaemia and a fall in magnesium level after surgery was associated with hypocalcaemia; but not with symptomatic hypocalcaemia. Monitoring of magnesium levels in severe or persistent hypocalcaemia is recommended. While this study proves a relationship between calcium and magnesium, its clinical implication must be further studied. Key Words: Calcium, Magnesium, Postoperative, Hypocalcaemia, Hypomagnesaemia, Thyroidectomy.


Assuntos
Hipocalcemia , Cálcio , Estudos Transversais , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Magnésio , Paquistão , Complicações Pós-Operatórias/epidemiologia , Tireoidectomia/efeitos adversos
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