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1.
Ann Otol Rhinol Laryngol ; 129(1): 70-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31510765

RESUMO

OBJECTIVE: Prediction and early intervention for hypocalcemia following parathyroidectomy and total thyroidectomy can decrease hospital cost and prevent severe hypocalcemia-related complications. This study aims to predict the severity of hypocalcemia after parathyroidectomy or thyroidectomy and to stratify patients into groups with different levels of risk for developing severe hypocalcemia, so that higher risk patients may be monitored more closely and receive earlier interventions. METHODS: This was a retrospective cohort study of 100 patients with primary hyperparathyroidism who underwent parathyroidectomy as the primary treatment modality at a tertiary care hospital. Clinical information, including demographic information, perioperative PTH and calcium levels, vitamin D levels, weight of the pathologic glands removed, gland pathology, and re-admission rates, were retrieved. Statistical analysis was performed to analyze the association between collected variables and percentage of calcium drop following parathyroidectomy with statistical significant set at P-values <0.05. RESULTS: Age, sex, and vitamin D level provided very minimal information to quantify risks of postoperative hypocalcemia. The percentage of decrease from preoperative PTH level to the lowest PTH level after the removal of the abnormal gland(s) is the most significant predicting factor for the severity of postoperative hypocalcemia. There is a mathematic regressional correlation between them. A formula was generated to quantify this linear relationship between them, and the nadir calcium can be calculated as Canadir=Capreop*[1-0.35*(PTHpreop-PTHintraop)2PTHpreop2], where Canadir = the lowest postoperative calcium level, and PTHintraop = PTH level 15 minutes after removal of the abnormal gland, with the value of R2 > 0.7. The formula has been tested primarily in our patient population with good reliability. CONCLUSIONS: The highest preoperative, lowest postoperative, and change in PTH level can help us reliably calculate the trend of postoperative calcium level. Decision to pursue early interventions can be made based on the calculated result from the formula we obtained.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Hipocalcemia/epidemiologia , Paratireoidectomia , Complicações Pós-Operatórias/epidemiologia , Adenoma/sangue , Adenoma/patologia , Adenoma/cirurgia , Adulto , Fatores Etários , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hipocalcemia/sangue , Hipocalcemia/terapia , Período Intraoperatório , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Tireoidectomia , Carga Tumoral , Vitamina D/sangue
2.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 924-927, 2019 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-31887819

RESUMO

Objective: To investigate the etiology, characteristics and prevention of severe facial deformity in patients with uremia entering the dialysis stage. Methods: Four cases with uremia in the dialysis stage who presented with severe facial deformity between October 2011 and November 2018 were reviewed, including 3 males and 1 female. The ages were 31, 15, 51 and 61, respectively. The general information, clinical symptoms, biochemical indicators, relevant imaging indicators, diagnoses, treatments and efficacies of the 4 patients admitted to the First Affiliated Hospital of Anhui Medical University were collected. Results: All the 4 patients appeared obviously shorter, accompanied by a certain degree of decline in self-care ability, multiple bone and joint pain and severe facial deformity. They presented with significantly increased serum levels of alkaline phosphatase, calcium, phosphorus and parathyroid hormone, and parathyroid hormone level>2 500 pg/ml.Ultrasonography and (99)Tc(m) radionuclide scan showed in situ or ectopic hyperplasia of parathyroid tissue. Bone radiography showed local decrease of bone mineral density and cystic changes.After parathyroidectomy, the serum levels of alkaline phosphatase, parathyroid hormone, calciumand phosphorus decreased significantly, while bone pain symptoms and facial deformities gradually improved. Conclusion: Secondary hyperparathyroidism is a serious complication in patients with dialysis and few of patients may have severe facial deformity (Sagliker syndrome) affecting their normal life and social activities. Parathyroidectomy can improve the facial deformity and the quality of life of patients.


Assuntos
Hiperparatireoidismo Secundário , Uremia , Adolescente , Adulto , Cálcio , Feminino , Humanos , Hiperparatireoidismo Secundário/complicações , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides , Hormônio Paratireóideo , Paratireoidectomia , Qualidade de Vida , Uremia/complicações
3.
Medicine (Baltimore) ; 98(47): e17649, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764770

RESUMO

RATIONALE: We studied the feasibility of total arathyroidectomy(tPTX)+multi-point transplantation in the forearm for treatment of secondary hyperparathyroidism. Considering the controversial nature of the appropriate timing for and location of this type of surgery, relevant research is relatively rare. Our experience may be a relatively successful one. PATIENT CONCERNS: Our patient was a 28-year-old woman with end-stage renal disease (ESRD), who was on dialysis for 7 years, and a 2-year history of progressively aggravated bone pain. She also had hypercalcemia and hyperphosphatemia. DIAGNOSES: Given the patient's history of long-term dialysis, bone pain, high levels of intact parathyroid hormone(i-PTH) and hypercalcemia, we performed ultrasonography which showed solid nodules in the bilateral parathyroid glands. She was accordingly diagnosed with SHPT. INTERVENTIONS: The patient underwent tPTX+multi-point subcutaneous transplantation in the forearm. OUTCOMES: Her i-PTH level dropped to < 300 pg/mL, and the symptoms of bone pain markedly reduced after surgery. LESSONS: Total parathyroidectomy+multi-point subcutaneous transplantation in the forearm may be a reliable surgical approach for patients with ESRD.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Glândulas Paratireoides/transplante , Paratireoidectomia , Adulto , Estudos de Viabilidade , Feminino , Antebraço/cirurgia , Humanos , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Paratireoidectomia/métodos
4.
Chirurgia (Bucur) ; 114(5): 541-549, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670629

RESUMO

It is estimated that up to 90% of patients with chronic kidney disease develop secondary hyperparathyroidism (sHPT). Although the disease has multiple manifestations, the most important pathological feature, from the point of view of increased mortality, is represented by the ectopic arterial, myocardial and cardiac valvular calcifications. The calcifications are progressive and lead to high blood pressure, left ventricular hypertrophy, atrio-ventricular blocks, angina and myocardial infarction. Therefore the risk of cardio-vascular events is increased. Failure of drug therapy to control disease progression is an indication for parathyroidectomy. In sHPT all parathyroid glands are affected, hence the need to detect 4 glands intraoperatively, by bilateral cervical exploration. However, considering the possibility of ectopic localization of these glands as well as the possibility of some supernumerary glands, it is desirable to have an imagistic map as accurate as possible, thus avoiding the risk of postoperative recurrence. The available imaging investigations are represented by the ultrasound of the cervical region, the parathyroid scintigraphy and those of the second line - CT or MRI examination. If in primary hyperparathyroidism, where there is only one parathyroid adenoma (or two), the preoperative imaging results are satisfactory, in sHPT there are many cases in which the imaging does not reveal all four parathyroid glands.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Calcinose/etiologia , Doenças Cardiovasculares/etiologia , Humanos , Hiperparatireoidismo Secundário/etiologia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Calcificação Vascular/etiologia
5.
Chirurgia (Bucur) ; 114(5): 594-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670635

RESUMO

The secondary hyperparathyroidism (sHPT) affects all patients with chronic renal failure in different degrees. The chronic kidney disease is often associated with multiple severe comorbidities, therefore the figures for mortality are higher than in the general population. The failure of medical treatment is an indication for surgical treatment. The recurrence of the disease in secondary hyperpara-thyroidism after surgical treatment using total parathyroid with autotransplantation or subtotal parathyroidectomy may be a challenge due to hyperplasia of the remaining tissue. The purpose of this retrospective study was to highlight the risk factors for the occurrence of glandular hyperplasia in patients with secondary hyperparathyroidism and to determine optimal surgery approach for secondary hyperparathyroidism in order to minimize relapse rates. Parathyroid size evaluation may suggest the presence of nodular hyperplasia contributing to an early parathyroidectomy and at the same time selecting the best surgical treatment for sHPT patients. As resistance to medical therapy is due to the presence of nodular hyperplasia, some authors recomends subtotal parathyroidectomy with the excision of these glands, with the remaining parathyroids tissue and function controlled by medical therapy (20).


Assuntos
Hiperparatireoidismo Secundário/patologia , Falência Renal Crônica/complicações , Glândulas Paratireoides/patologia , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Hiperplasia , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/transplante , Paratireoidectomia , Estudos Retrospectivos , Fatores de Risco
6.
Harefuah ; 158(11): 716-720, 2019 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-31721513

RESUMO

INTRODUCTION: The transcervical approach has been the primary route of access for thyroid and parathyroid glands since its description by Kocher 140 years ago. Several approaches have been suggested for minimizing the surgical scar but none of them have become common practice. Thus, a role for a new novel technique still exists for improving surgical esthetic outcome. Trans-oral endoscopic trans-vestibular approach (TOETVA) has recently been reported as a novel approach for the extraction of thyroid or parathyroid tumors. AIMS: To show the safety and feasibility of TOETVA for thyroid and parathyroid surgery in Israel. METHODS: Case series of patients who underwent TOETVA at our institution. The study was approved by our Institutional Board IRB retrospectively. RESULTS: Ten patients (5 thyroidectomies and 5 parathyroidectomies) underwent TOETVA and were included in the study. The average time of surgery was 3.3 hours. One patient had transient vocal cord paralysis, a second patient had altered sensation of chin and a third patient had seroma that was resolved by aspiration. Surgery was successful in all patients and complete resection of the thyroid lobe as well as the parathyroid adenomas was achieved. No permanent complications were encountered. CONCLUSIONS: In this study TOETVA was found to be feasible and safe for the resection of selected thyroid and parathyroid tumors. DISCUSSION: We report the first series of patients in Israel undergoing TOETVA for thyroid and parathyroid tumors. The learning curve is steep and improving. Surgery was uneventful and safe. The results are comparable to other reports from various centers which adopted this novel technique.


Assuntos
Paratireoidectomia , Tireoidectomia , Humanos , Israel , Glândulas Paratireoides/cirurgia , Paratireoidectomia/métodos , Estudos Retrospectivos , Tireoidectomia/métodos
7.
Am Surg ; 85(9): 939-943, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638503

RESUMO

Reoperative parathyroid surgery (REOPS) is often associated with lower cure rates and greater risk of nerve injury and hypoparathyroidism. The aim of this study was to evaluate cure rates, pathology, complications, and the efficacy of preoperative localization in patients requiring REOPS. Between 1992 and 2017, 2491 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism. With Institutional Review Board approval, our prospectively collected parathyroidectomy outcomes database was queried for operative findings, outcomes, pathology, and localization methodology. Three hundred forty-six patients had REOPS (111 men/32% and 235 women/68%), with an overall cure rate of 91 per cent and a mean follow-up of 1.9 ± 0.7 years. The average preoperative serum calcium and parathyroid hormone were 11 ± 1 mg/dL and 373 ± 796 pg/mL, respectively. Normalization of intraoperative parathyroid hormone occurred in 248 patients and it was predictive of cure in 98.8 per cent of patients. A single adenoma was resected in 253 patients (75%), and the superior gland location was most common at 57 per cent. Ectopic glands were identified in only 33 patients. When preoperative imaging localized a lesion, a tumor was identified in that location in 75.4 per cent of sestamibi or SPECT/CT scans, 57.8 per cent of CT, 61.2 per cent of MRI, and 46.2 per cent of US. When at least two imaging modalities were concordant, sensitivity improved to 91.6 per cent (P < 0.001). Complication rates of permanent hypoparathyroidism and recurrent nerve palsy occurred in 0.03 per cent of patients. REOP for recurrent or persistent primary hyperparathyroidism has a cure rate of 91 per cent. Most missed parathyroid tumors are in the neck, and multimodal imaging improves preoperative localization and success.


Assuntos
Adenoma/cirurgia , Hiperparatireoidismo Primário/cirurgia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Reoperação , Adenoma/sangue , Adenoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico por imagem , Hipoparatireoidismo , Masculino , Pessoa de Meia-Idade , Paralisia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/diagnóstico por imagem , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Adulto Jovem
8.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(9): 1083-1088, 2019 Sep 28.
Artigo em Chinês | MEDLINE | ID: mdl-31645501

RESUMO

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder. A 44-year-old man visited second Xiangya Hospital, Central South University due to hypoglycemia. He was eventually diagnosed as MEN1. A novel homozygous frameshift for c.640-643delCAGA (p.V215Mfs*13) of MEN1 gene was identified in the patient. After MDT (Multiple Disciplinary Team), open bilateral exploration with total parathyroidectomy and autotransplantation as well as partial pancreatectomy excision of all the macroscopic pancreatic tumors were performed at the same time. The patient recovered well. Individualized diagnosis and treatment are important for MEN1 patients.


Assuntos
Insulinoma , Neoplasia Endócrina Múltipla Tipo 1 , Neoplasias das Paratireoides , Adulto , Humanos , Masculino , Neoplasias Pancreáticas , Paratireoidectomia
9.
Clin Nucl Med ; 44(12): 971-974, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31652163

RESUMO

Brown tumors are rare skeletal anomalies occurring in patients with hyperparathyroidism and exposing patients to pathological fractures. We report the case of a 26-year-old woman with severe primary hyperparathyroidism (calcemia, 2.9 mmol/L; parathyroid hormone, 59 pmol/L) who underwent F-fluorocholine (FCH) PET/CT before parathyroidectomy. FCH PET localized the hyperfunctioning parathyroid gland and showed multiple foci in correspondence with bone lytic lesions on CT. Those lesions were not visible on the Tc-MIBI dual-phase scintigraphy. The pathology of one of the FCH-positive bone lesions corresponded to a brown tumor related to hyperparathyroidism.


Assuntos
Colina/análogos & derivados , Hiperparatireoidismo Primário/complicações , Osteíte Fibrosa Cística/complicações , Osteíte Fibrosa Cística/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adulto , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Osteíte Fibrosa Cística/patologia , Paratireoidectomia , Tecnécio Tc 99m Sestamibi
10.
Ann R Coll Surg Engl ; 101(8): e178-e183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509000

RESUMO

Parathyromatosis is a rare entity and usually appears as a consequence of the seeding on previous parathyroid surgery which was applied for the secondary hyperparathyroidism. A 63-year-old woman presented with a history of subtotal thyroidectomy 20 years ago and parathyroidectomy due to primary hyperparathyroidism (PHPT) four years ago. Imaging methods revealed multiple parathyromatosis foci on subcutaneous tissue of the neck. En-bloc resection was performed and pathological examination confirmed the diagnosis of parathyromatosis. After an uneventful 10 months, biochemical and radiological tests revealed recurrence on bilateral thyroid lodges. En-bloc resection was performed. The patient has remained well for 24 months after the second operation and has been followed-up with normal parathormone and serum calcium values. To the best of our knowledge, this report describes the twenty-first case of parathyromatosis in PHPT setting in the literature. It should be kept in mind that parathyromatosis may recur at different sites in the neck even in patients with PHPT.


Assuntos
Coristoma/complicações , Hiperparatireoidismo Primário/etiologia , Glândulas Paratireoides , Coristoma/diagnóstico por imagem , Coristoma/cirurgia , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Paratireoidectomia , Cintilografia , Recidiva , Tela Subcutânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
11.
BMC Surg ; 19(1): 133, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510980

RESUMO

BACKGROUND: Tumoral calcinosis (TC) is a rare disease derived from uremic secondary hyperparathyroidism (SHPT). However, parathyroidectomy (PTX) seems to be ineffective at relieving TC in some patients. In this study, we investigated the relationship between PTX and TC shrinkage. METHODS: We retrospectively followed up nine TC patients who underwent PTX, dividing them into two groups: those with TC size reduced by > 80% were in the "effective group" (group A), and the rest in the "ineffective group" (group B). RESULTS: We enrolled nine patients (7 men; mean age 38.6 ± 10.9 years) with SHPT-related TC. One patient with calciphylaxis was excluded due to sudden death. The efficiency of PTX in causing TC regression was 62.5% (5 patients in group A). Group A had a shorter overall duration of TC (6 [5.5, 6.0] vs. 9 [8.0, 10.0] months; P = 0.02) and higher serum levels of alkaline phosphatase (ALP; 408.0 [217.9, 1101.7] vs. 90.8 [71.0, 102.1] pg/ml; P = 0.03) and high-sensitivity C-reactive protein (hs-CRP; 82.7 [55.0, 112.4] vs. 3.1 [3.1, 4.5] mg/l; P = 0.02). Average calcium supplementation within 1 week of surgery was significantly greater in group A than in group B (96.8 [64.1, 105.3] vs. 20.1 [13.1, 32.7] g; P = 0.04). Patients in both the groups demonstrated similar serum phosphate levels before PTX, but these levels were higher in group B than in group A at follow-up times (3 months, P = 0.03; 6 months, P = 0.03). CONCLUSIONS: The shorter duration of pre-existing TC and higher ALP levels before PTX, as well as lower serum phosphate levels after PTX, were correlated with effective SHPT-TC shrinkage.


Assuntos
Calcinose/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Adulto , Proteína C-Reativa/metabolismo , Calcinose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Endocr Pract ; 25(11): 1117-1126, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31414903

RESUMO

Objective: While intraoperative parathyroid hormone (IOPTH) monitoring with a ≥50% drop commonly guides the extent of exploration for primary hyperparathyroidism (pHPT), receiver operating characteristic (ROC) analysis has not been performed to determine whether other criteria yield better sensitivity and specificity. The aim of this study was to identify the optimum percent change of IOPTH following removal of the abnormal parathyroid pathology, in order to predict biochemical cure. Secondary aims were to identify patient subgroups with increased area under the ROC curve (AUC) and the need for moderated criteria. Methods: A retrospective review was performed on patients undergoing primary parathyroid surgery for sporadic pHPT between 1999 and 2010 at a tertiary center for endocrine surgery. Eight hundred and ninety-six patients with primary hyperparathyroidism were included. Multigland disease (MGD) was defined as the intraoperative detection of more than 1 enlarged hypercellular gland or persistent disease after single gland excision. ROC analysis was used to determine the value with the best performance at predicting MGD, following bilateral exploration. Results: MGD was diagnosed in 174 patients (19.4%). ROC analysis demonstrated an AUC of 0.69. An IOPTH drop of 72% was the point of optimal discrimination with a sensitivity of 55% and specificity of 76% for predicting MGD. Subgroup analysis by preoperative calcium, preoperative PTH, localization studies, or pre- and post-excision IOPTH, did not identify any factors associated with an improved AUC. Conclusion: To our knowledge, this is the first study to use ROC analysis in a large patient cohort. An IOPTH drop of 72% was found to have optimal discriminating ability. We failed to identify a subset of patients for whom there was substantial improvement in the AUC, sensitivity, or specificity. Abbreviations: AUC = area under the ROC curve; BE = bilateral neck exploration; FE = focal parathyroid exploration; IOPTH = intraoperative parathyroid hormone; MGD = multigland disease; MIBI = Tc99m-sestamibi I-123 subtraction single-photon emission computed tomography/computed tomography; pHPT = primary hyperparathyroidism; ROC = receiver operating characteristic; SGD = single gland disease; US = surgeon-performed neck ultrasound.


Assuntos
Hormônio Paratireóideo/sangue , Humanos , Hiperparatireoidismo Primário , Glândulas Paratireoides , Paratireoidectomia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Endocr Pract ; 25(11): 1127-1136, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31414909

RESUMO

Objective: Due to a lack of typical clinical manifestations and physiologic changes in calcium metabolism during pregnancy, primary hyperparathyroidism (PHPT) during pregnancy is commonly underdiagnosed, and treatment during this unique period presents a clinical challenge. Hence, the aim of the present study was to summarize the cases of 8 pregnant patients with PHPT who were treated at our center to provide better clinical insight into this condition. Methods: Our study comprised a retrospective analysis of 8 pregnant PHPT patients and a control group of 22 age-matched, nonpregnant PHPT patients during the same period. Clinical manifestations, biochemical indices, pathologic types, therapeutic strategies, and pregnancy outcomes were compiled, and 25 patients were screened for germline mutations in the MEN1, CDC73, and CaSR genes. Results: The most-common symptoms in the pregnancy group involved the gastrointestinal tract (GIT) in 7/8 cases (87.5%), followed by urinary system involvement (50%) and joint pain (50%). In contrast, GIT symptoms in the control group were significantly less common (31.82%; P = .012). There was a trend of more-severe elevation of serum parathyroid hormone levels in the control group compared to that in the pregnancy group (P = .053). No differences were found in blood-ionized calcium, phosphate, or alkaline phosphatase levels between the two groups. In the pregnancy group, the serum albumin-corrected calcium level was reduced from 3.42 ± 0.66 mmol/L to 2.89 ± 0.46 mmol/L (P = .025) after hydration and medical treatment. Six patients, three of whom were in the second trimester of pregnancy, underwent parathyroidectomy, and 3 patients were after childbirth or had induced labor. Postoperative serum calcium levels were reduced to within the normal range. Fetal/neonatal complications were observed in 4 of 5 patients who had not received surgical treatment during pregnancy. In addition, 2 of 5 pregnant PHPT patients were found to carry MEN1 mutations, whereas no mutations were detected in any of the 20 nonpregnant patients. Conclusion: In this case series of PHPT during pregnancy, the most-common complaint of GIT symptoms may be easily confused with pregnancy reactions, which might contribute to the under- or misdiagnosis of this clinical entity. Patients who did not receive surgical treatment during pregnancy had high incidences of fetal/neonatal complications and worse pregnancy outcomes. Abbreviations: CaSR = calcium-sensing receptor; CDC73 = cell division cycle 73; GIT = gastrointestinal tract; MEN = multiple endocrine neoplasia; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; SCa = serum calcium.


Assuntos
Hiperparatireoidismo Primário , Complicações na Gravidez , Cálcio , Feminino , Humanos , Hormônio Paratireóideo , Paratireoidectomia , Gravidez , Estudos Retrospectivos
14.
Am J Case Rep ; 20: 1170-1174, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395848

RESUMO

BACKGROUND Calciphylaxis is a rare and fatal systemic disease which most commonly occurs in patients with end-stage renal disease. It is a poorly understood vascular calcification with unclear pathology that leads to vascular compromise due to vascular occlusion with endoluminal calcification. CASE REPORT We report a case of a 61-year-old male with chronic kidney disease stage 5 who developed calciphylaxis. The patient was diagnosed with dry gangrene of the second and third digits of the right hand and second, third, and fourth phalanges of the left hand. Despite medical therapy and local wound care, the lesions progressively worsened with time. The patient was found to have secondary hyperparathyroidism (parathyroid hormone was 1028 pg/mL) and underwent subtotal parathyroidectomy. In our patient, the skin lesions due to calciphylaxis completely resolved over the course of 12 months. CONCLUSIONS Parathyroidectomy has been associated with clinical benefit in patients with calciphylaxis. Clinicians should consider parathyroidectomy in the setting of high parathyroid hormone and calciphylaxis. Although parathyroidectomy is an effective treatment option for calciphylaxis it is not a definitive treatment and calciphylaxis can occur, though rarely, even after parathyroidectomy. There is a need to do further studies in order to confirm the efficacy of parathyroidectomy.


Assuntos
Calciofilaxia/etiologia , Dedos/patologia , Gangrena/etiologia , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia , Insuficiência Renal Crônica/complicações , Calciofilaxia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
15.
Int J Hyperthermia ; 36(1): 835-840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452422

RESUMO

Purpose: To compare the clinical efficacy of ultrasound-guided percutaneous microwave ablation (MWA) and parathyroidectomy for primary hyperparathyroidism. Methods: In an observational retrospective study, we compared the outcomes in patients with primary hyperparathyroidism who underwent ultrasound-guided MWA with the outcomes in those who underwent surgical resection (SR). The primary outcome was cure rate. Secondary outcomes were the rate of complications, and the difference of the treatment parameters of two treatment methods. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Results: Among 108 patients who met inclusion criteria, 28 patients who underwent ultrasound-guided MWA (MWA group) and 28 who underwent SR (SR group) had similar propensity scores and were included in the analyses. There was no significant difference in the cure rate between MWA group and SR group (82.1% vs. 89.3%, p = .705). Patients who underwent MWA had significantly less estimated blood loss and shorter surgical time than those who underwent SR (p < .001). The incidence of side effects and complications was comparable between MWA group and SR group (21.4% vs. 25%, p = .752). Conclusions: MWA and SR provided comparable short-term results in terms of cure rate and complications in treatment of primary hyperparathyroidism. Ultrasound-guided percutaneous MWA is a promising and minimally invasive method for primary hyperparathyroidism.


Assuntos
Ablação por Cateter , Hiperparatireoidismo Primário/cirurgia , Micro-Ondas/uso terapêutico , Paratireoidectomia , Ultrassonografia de Intervenção , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Surgery ; 166(4): 678-685, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31466855

RESUMO

BACKGROUND: Preoperative localization of abnormal parathyroid glands in primary hyperparathyroidism is often obtained by sestamibi, and ultrasonography. We aimed to identify which modality is most accurate when laterality of abnormal glands on preoperative imaging is discordant. METHODS: A single institution retrospective review identified 112 consecutive patients with primary hyperparathyroidism who underwent successful parathyroidectomy and sestamibi with pertechnetate. RESULTS: Sestamibi with pertechnetate had a sensitivity of 72% and positive predictive value of 90%; ultrasonography had sensitivity of 50% and positive predictive value 80%. Patients with thyroiditis had lesser sensitivity and positive predictive value on sestamibi with pertechnetate (53% and 77%, respectively), in contrast to ultrasonography (54%, 88%, respectively). The sensitivity and positive predictive value of sestamibi with pertechnetate and ultrasonography did not differ in patients with thyroid nodules. Seventeen patients (15%) had discordant laterality on preoperative imaging. In discordant cases, sestamibi with pertechnetate was correct in 53% overall but in only 17% of those with thyroiditis (P = .01), whereas ultrasonography was correct in 26% overall but in 50% of those with thyroiditis (P = .01). CONCLUSION: Thyroiditis decreased the sensitivity and positive predictive value of sestamibi with pertechnetate in primary hyperparathyroidism. In patients with discordant laterality on preoperative imaging, sestamibi with pertechnetate is the more accurate choice to guide operative planning, although ultrasonography may be a better guide in those with thyroiditis.


Assuntos
Hiperparatireoidismo/diagnóstico por imagem , Paratireoidectomia/métodos , Cintilografia/métodos , Ultrassonografia Doppler/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tecnécio Tc 99m Sestamibi
17.
Int J Surg ; 70: 13-18, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404676

RESUMO

OBJECTIVE: Thermal ablation and parathyroidectomy (PTX) have been recommended for patients with secondary hyperparathyroidism (SHPT). However, it is uncertain which is the better method. The aim of the present meta-analysis was to evaluate the efficacy and surgical complications of the two treatment methods. METHODS: The following databases were searched from inception to December 31, 2018: PubMed, EMBASE, the Cochrane Library, CNKI, and Wanfang. Eligible studies comparing thermal ablation and PTX for SHPT were included. Data were analysed using Review Manager Version 5.3. RESULTS: Six studies were included in the meta-analysis. Four cohort studies and two randomized controlled trials involving 326 patients with SHPT were identified. There was no difference concerning parathyroid hormone (PTH) levels (MD 58.04, 95% CI -17.60-133.68, P = 0.13), calcium levels (MD -0.07, 95% CI -0.17-0.04, P = 0.21), phosphorus levels (MD 0.21, 95% CI -0.18-0.61, P = 0.29), or hoarseness (OR 0.53, 95% CI 0.24-1.16, P = 0.11) between the two surgical methods. Compared with PTX, thermal ablation reduced the risk of hypocalcaemia (OR 0.23, 95% CI 0.11-0.47, P < 0.01). However, thermal ablation increased the risk of SHPT persistence and/or recurrence compared with PTX (OR 4.24, 95% CI 1.44-15.76, P = 0.03). CONCLUSION: Thermal ablation and PTX were effective surgical approaches for SHTP. Thermal ablation reduced the risk of hypocalcaemia and increased the risk of SHPT persistence and recurrence. More large multicentre randomized controlled trials are necessary to confirm the conclusions.


Assuntos
Técnicas de Ablação/métodos , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Adulto , Idoso , Estudos de Coortes , Humanos , Hiperparatireoidismo Secundário/sangue , Hipocalcemia/prevenção & controle , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue
20.
Endocr Pract ; 25(12): 1279-1285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31412223

RESUMO

Objective: To evaluate calcitonin (CT) levels in sporadic primary hyperparathyroidism (PHPT), which has to date rarely been considered. Methods: We evaluated serum CT levels in 290 consecutive patients with sporadic PHPT at diagnosis. Results: Mild elevations in CT levels (hyperCT) were found in 25 patients (8.6%), with no correlation among the demographic, clinical, and biochemical findings. In addition, no differences were found between patients with and without hyperCT. Follow-up data were available for 19/25 patients, but CT values were only available for 10. CT normalized in all surgically cured patients regardless of the extent of the surgery (parathyroidectomy [PTX] only in 8 and associated with partial or total thyroidectomy for benign nodular goiters in 7). Conclusion: hyperCT is an uncommon feature of sporadic PHPT and not related to biochemical or clinical features of the disease. In addition, hyperCT is reversible after PTX, regardless of whether concomitant thyroidectomies have been conducted. Abbreviations: CT = calcitonin; eGFR = estimated glomerular filtration rate; hyperCT = hypercalcitoninemia; MEN = multiple endocrine neoplasm; MTC = medullary thyroid carcinoma; PHPT = primary hyperparathyroidism; PPI = proton pump inhibitor; PTH = parathyroid hormone; PTX = parathyroidectomy.


Assuntos
Hiperparatireoidismo Primário , Calcitonina , Humanos , Hormônio Paratireóideo , Paratireoidectomia , Tireoidectomia
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