scholarly journals Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

2014 ◽  
Vol 58 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Larissa Pimentel ◽  
Sirley Portela ◽  
Alyne Loureiro ◽  
Francisco Bandeira
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Normal Serum ◽  
T Score ◽  
Sestamibi Scan ◽  
Normal Serum Calcium ◽  
Long Term Follow Up ◽  
Serum Pth

Normocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications.

scholarly journals No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

2010 ◽  
Vol 162 (2) ◽  
pp. 399-406 ◽  
Author(s):  
Janneke E Witteveen ◽  
Job Kievit ◽  
Hans Morreau ◽  
Johannes A Romijn ◽  
Neveen A T Hamdy
Keyword(s):  
Primary Hyperparathyroidism ◽  
Safety Net ◽  
Normal Serum ◽  
Cure Rate ◽  
Men 2 ◽  
Initial Surgery ◽  
Normal Serum Calcium ◽  
Long Term Follow Up

ObjectiveCure rate for primary hyperparathyroidism (PHPT) is reported to be 94–100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1–5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT.DesignEvaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1–24 years prior to the study.Patients and methodsWe identified 111 patients who underwent initial PTx between 1984 and 2008, and had no MEN-1, MEN-2, or CaR mutation; parathyroid carcinoma; a history of lithium use; or renal failure. Thirty-eight patients were lost to follow-up or were unwilling or unable to participate in the study. Cure was defined as maintenance of normal serum calcium and parathyroid hormone concentrations 6 months after PTx.ResultsCure was achieved in 68 of 73 patients studied (93%) and was sustained in all for 6±5 years.ConclusionThe cure rate of sporadic PHPT after initial surgery is 93%. When cure is achieved, this is sustained in 100% of the patients for up to 24 years post-operatively. Our data suggest that closer early follow-up is advocated in all patients undergoing PTx to definitively establish cure and to provide a safety net for those with residual gland pathology. The data do not support the need for long-term follow-up when cure is established 6 months after PTx.

IDIOPATHIC HYPERCALCEMIA

PEDIATRICS ◽  
1959 ◽  
Vol 24 (2) ◽  
pp. 258-269
Author(s):  
David W. Smith ◽  
Robert M. Blizzard ◽  
Harold E. Harrison
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Normal Serum ◽  
Early Infancy ◽  
Serum Assay ◽  
Supplemental Vitamin ◽  
Normal Serum Calcium

A case of idiopathic hypercalcemia present from early infancy and diagnosed at 5 years of age is reported in which the serum assay of vitamin D indicated elevated levels. After discontinuation of supplemental vitamin D and a diet low in calcium the concentrations of calcium and vitamin D in the serum gradually returned to normal over a period of 18 months. Roentgenograms of the bones showed evidence of demineralization rather than increased density as reported in other cases of "idiopathic" hypercalcemia. During a subsequent 2-year follow-up the patient has maintained a normal serum calcium. The etiology is discussed with particular reference to the role of vitamin D in this case

Forearm bone density in primary hyperparathyroidism: long-term follow-up with and without parathyroidectomy

2003 ◽  
Vol 58 (3) ◽  
pp. 348-354 ◽  
Author(s):  
D. Sudhaker Rao ◽  
Elizabeth A. Wallace ◽  
Rosella F. Antonelli ◽  
Gary B. Talpos ◽  
Mohammed R. Ansari ◽  
...  
Keyword(s):  
Bone Density ◽  
Primary Hyperparathyroidism ◽  
Long Term Follow Up ◽  
Forearm Bone

Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases

2006 ◽  
Vol 121 (3) ◽  
pp. 237-241 ◽  
Author(s):  
C Page ◽  
V Strunski
Keyword(s):  
Total Thyroidectomy ◽  
Parathyroid Gland ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Normal Serum ◽  
Permanent Hypoparathyroidism ◽  
Multinodular Goitre ◽  
Serum Calcium Concentration ◽  
Normal Serum Calcium

Aims: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery.Materials and methods: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination.Results: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery.Conclusion: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.

scholarly journals Long term follow up of untreated primary hyperparathyroidism.

BMJ ◽  
1985 ◽  
Vol 290 (6461) ◽  
pp. 64-65 ◽  
Author(s):  
C Nagant de Deuxchaisnes ◽  
J P Devogelaer ◽  
J P Huaux
Keyword(s):  
Primary Hyperparathyroidism ◽  
Long Term Follow Up
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