In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnan...In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.展开更多
Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized...Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.展开更多
Objective:To investigate the clinical effect of combined application of calcitriol and low-calcium dialysate in the treatment of secondary hyperparathyroidism(SHPT).Methods:Eighty-nine patients with SHPT who visited t...Objective:To investigate the clinical effect of combined application of calcitriol and low-calcium dialysate in the treatment of secondary hyperparathyroidism(SHPT).Methods:Eighty-nine patients with SHPT who visited the hospital from February 2023 to February 2025 were included in the study.They were divided into an observation group(n=45)and a control group(n=44)using a random number table method.The observation group received calcitriol combined with low-calcium dialysate treatment,while the control group received calcitriol combined with conventional dialysate treatment.The differences in intact parathyroid hormone(iPTH),calcium and phosphorus metabolism indicators,renal function indicators,and adverse reaction rates were compared and evaluated before and after treatment between the two groups.Results:Compared with before treatment,the levels of iPTH,serum phosphorus,and calcium-phosphorus product were significantly reduced in both groups after treatment,and the observation group had lower levels than the control group(P<0.05).Additionally,the blood calcium levels in both groups increased compared to before treatment,and the observation group had higher levels than the control group(P<0.05).After intervention,there was no statistically significant difference in renal function indicators between the two groups(P>0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:The combination of calcitriol and low-calcium dialysate for the treatment of SHPT can effectively reduce the levels of iPTH,serum phosphorus,and calcium-phosphorus product,increase blood calcium levels,and has a low incidence of adverse reactions.It has no significant effect on renal function and is a safe and effective treatment method.展开更多
In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent...In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and ex...BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.展开更多
BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To det...BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.展开更多
BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest cli...BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.展开更多
Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptoma...Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.展开更多
BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying ...BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.展开更多
Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX bet...Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.展开更多
Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calci...Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and <sup>99m</sup>Tc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative <sup>99m</sup>Tc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with <sup>11</sup>C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including <sup>99m</sup>Tc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with <sup>11</sup>C-Choline and <sup>18</sup>F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.展开更多
<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal ...<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. <strong>Method:</strong> Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. <strong>Results:</strong> Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. <strong>Conclusion:</strong> Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.展开更多
We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially th...We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.展开更多
The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting...The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultra-sonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of asso-ciated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.展开更多
BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of bloo...BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of blood vessels and soft tissues,which greatly increases the risk of death.AIM To discuss the outcome,safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT.METHODS We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019.They received paricalcitol injection for 24 wk(starting dose,0.06–0.08μg/kg),three times per week.They were followed up at the baseline(week 0),week 4,week 12 and week 24.The primary outcome indicator was the percentage of patients with a>30%decrease in intact parathyroid hormone(iPTH)levels at week 24 compared with the baseline.The secondary outcome indicators included percentage decrease in iPTH levels at week 24,standard-reaching rate of iPTH(percentage of patients with iPTH down to 130–585 pg/mL),changes in serum levels of calcium(Ca),phosphate(P),Ca×P product,alkaline phosphatase(ALP),creatinine(Cre),hemoglobin(Hb),and C-reactive protein(CRP),and incidence of adverse events(AEs).RESULTS After 24 wk of treatment,iPTH levels decreased significantly(598.88±381.29 pg/mL vs 888.84±376.88 pg/mL,P<0.05).More than 30%decrease of iPTH was found in 21 of 36(58.33%)patients.The average decrease in iPTH levels was 32.16±4.33%;the standard-reaching rate of iPTH levels was 66.67%(24/36);and ALP levels decreased significantly compared with the baseline(113.72±41.73 IU/L vs 133.45±56.86 IU/L)(t=2.798,P<0.05).There were no significant differences in the serum levels of calcium,Hb,Cre and CRP compared with the baseline(P>0.05).After 24 wk of treatment,serum P levels decreased compared with the baseline(1.91±0.40 mmol/L vs 2.16±0.66 mmol/L)(t=2.830,P<0.05).Ca×P product decreased significantly compared with the baseline(56.38±13.22 mg2/dL2 vs 63.97±20.30 mg2/dL2)(t=2.717,P<0.05).No serious adverse events occurred.CONCLUSION Paricalcitol was a safe and effective treatment for hemodialysis patients with SHPT.It decreased serum levels of iPTH,ALP and P and maintained stability of serum Ca levels.展开更多
In the 1970s, with the advent of biochemical multichannel screening in the United States and other western countries, the clinical presentation of primary hyperparathyroidism （PHPT） changed from a symptomatic to an ...In the 1970s, with the advent of biochemical multichannel screening in the United States and other western countries, the clinical presentation of primary hyperparathyroidism （PHPT） changed from a symptomatic to an asymptomatic disorder. However, in Asian countries, like China, PHPT did not show this evolution, but rather continued to be a symptomatic disease with target organ involvement. In this paper, we revisit the clinical features of PHPT in New York and Shanghai, representative United States and Chinese cites, over the past decade. The questions we address are whether the disease evolved in China to a more asymptomatic one and, whether in the United States further changes are evident. The results indicate that while PHPT con- tinues to present primarily as an asymptomatic disease in the United States, a new phenotype characterized by normal serum calcium and high parathyroid hormone levels, normocalcemic PHPT, has emerged. Data from Shanghai demonstrates a trend for PHPT to present more commonly as an asymptomatic disorder in China. However, most patients with PHPT in China still manifest classical symptoms, i.e. nephrolithiasis and fractures. A comparison of the two cohorts shows that Chinese patients with PHPT are younger, with higher serum calcium and PTH levels, and lower 25-hydroxyvitamin D levels than patients in New York. Normocalcemic PHPT has not yet been recognized in Shanghai. In summary, although the phenotypes of PHPT in both cities are evolving towards less evident disease, sharp clinical and biochemical differences are still apparent in PHPT as expressed in China and the United States.展开更多
BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patien...BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patient.Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man.The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension,abdominal pain,nausea,vomiting,electrolyte disturbance,renal dysfunction,and acute pancreatitis.Due to prolonged hypercalcemia,the patient subsequently underwent surgical resection of the parathyroid adenoma.Two weeks after surgery,his serum calcium,amylase,and lipase concentrations were normal.The patient had a good recovery after a series of other relevant therapies.CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.展开更多
Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total para...Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total parathyroidectomy and total parathyroidectomy plus autologous transplantation(tPTX+AT).Each of the three types of surgery has advantages and disadvantages.The present study retrospectively analyzed the efficacy of tPTX+AT for the treatment of SHPT over 1 year.Thirty-seven patients who were diagnosed with secondary nephrogenic hyperparathyroidism and treated with tPTX+AT were selected between September 2014 and October 2016 and followed up for 1 year.Their average age was 66.5±46.0 years,and the average time of dialysis was 48.1±8.2 months.The patients1 conditions,including the levels of intact parathyroid hormone(iPTH)and bone metabolism,were compared preoperatively and 1 and 7 days and 1,3,6 and 12 months after surgery.In addition,the postoperative complications,pathological data,SHPT recurrence and prognosis were examined.The results showed that the postoperative level of ostalgia and cutaneous pruritus significantly decreased in the patients.An inspection of the parathyroid tissues during the operation confimied the presence of parathyroid gland hyperplasia with no carcinoma detected?Three patients with hoarseness recovered within 1 month,and 1 patient with unilateral recurrent laryngeal nerve injury improved after 6 months of voice training.Conipared to the preoperative condition,the postoperative serum iPTH,serum calcium and serum phosphate levels were significantly decreased(P<0.001),and these differences remained significant 12 months after surgery.Compared to the preoperative condition,the alkaline phosphatase(ALP)concentration was decreased on postoperative day 1(P<0.05),but no differences were observed on day 7 or at 1 month(P>0.05).The ALP levels continuously decreased at 3,6 and 12 months(P<0.01).In conclusion,tPTX+AT significantly improves the quality of life and serum biomarker levels of these patients.The convenient surgical removal of the hyperplastic parathyroid gland for postoperative recurrence supports tPTX+AT as the recommended treatment for relevant patients.展开更多
BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH oc...BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.展开更多
文摘In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.
文摘Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.
文摘Objective:To investigate the clinical effect of combined application of calcitriol and low-calcium dialysate in the treatment of secondary hyperparathyroidism(SHPT).Methods:Eighty-nine patients with SHPT who visited the hospital from February 2023 to February 2025 were included in the study.They were divided into an observation group(n=45)and a control group(n=44)using a random number table method.The observation group received calcitriol combined with low-calcium dialysate treatment,while the control group received calcitriol combined with conventional dialysate treatment.The differences in intact parathyroid hormone(iPTH),calcium and phosphorus metabolism indicators,renal function indicators,and adverse reaction rates were compared and evaluated before and after treatment between the two groups.Results:Compared with before treatment,the levels of iPTH,serum phosphorus,and calcium-phosphorus product were significantly reduced in both groups after treatment,and the observation group had lower levels than the control group(P<0.05).Additionally,the blood calcium levels in both groups increased compared to before treatment,and the observation group had higher levels than the control group(P<0.05).After intervention,there was no statistically significant difference in renal function indicators between the two groups(P>0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:The combination of calcitriol and low-calcium dialysate for the treatment of SHPT can effectively reduce the levels of iPTH,serum phosphorus,and calcium-phosphorus product,increase blood calcium levels,and has a low incidence of adverse reactions.It has no significant effect on renal function and is a safe and effective treatment method.
文摘In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
基金Supported by Sichuan Province Science and Technology Program,No.2024YFHZ0214 and No.2023YFS0299Chengdu Science and Technology Program,No.2024-YF05-01820-SN.
文摘BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.
文摘BACKGROUND Primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been described.Due to this rarity,there are no diagnostic or treatment algorithms for pregnant patients.AIM To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.METHODS A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google Scholar.The Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was followed.The search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved studies.Demographic,imaging,surgical,obstetric,and outcome data were obtained.RESULTS Fifty-four cases were collected from the 51 studies.The median maternal age was 29 years.PHPT-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were reported.In 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of hyperplasia.In the remaining 5 cases,the diagnosis was not reported.Neck ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the preferred treatment during pregnancy in 33 cases(median week of gestation 25,Q1-Q3=20-30)and postpartum in 12 cases.The timing was not reported in the remaining 9 cases,or surgery was not performed.AP was managed surgically in 11 cases and conservatively in 43(79.6%)cases.Maternal and fetal mortality was 9.3%(5 cases).Surgery was more common in deceased mothers(60.0%vs 16.3%;P=0.052),and PTH values tended to be higher in this group(910 pg/mL vs 302 pg/mL;P=0.059).Maternal mortality was higher with higher serum lipase levels and earlier delivery week.Higher calcium(4.1 mmol/L vs 3.3 mmol/L;P=0.009)and PTH(1914 pg/mL vs 302 pg/mL;P=0.003)values increased fetal/child mortality,as well as abortions(40.0%vs 0.0%;P=0.007)and complex deliveries(60.0%vs 8.2%;P=0.01).CONCLUSION If serum calcium is not tested during admission,definitive diagnosis of PHPT-induced AP in pregnancy is delayed,while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.
文摘BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.
文摘Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.
文摘BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.
文摘Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.
文摘Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and <sup>99m</sup>Tc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative <sup>99m</sup>Tc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with <sup>11</sup>C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including <sup>99m</sup>Tc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with <sup>11</sup>C-Choline and <sup>18</sup>F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.
文摘<strong>Introduction:</strong> Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. <strong>Method:</strong> Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. <strong>Results:</strong> Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. <strong>Conclusion:</strong> Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.
文摘We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.
基金Project (No. 2007C34001) supported by the Science and TechnologyResearch Foundation of Zhejiang Province, China
文摘The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultra-sonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of asso-ciated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.
基金Supported by 2019 Anhui University Natural Science Research Project,No.KJ2019A0094,No.KJ2019A0095Huainan City"50 Science and Technology Stars"Innovation Team Projectand Scientific Research Platform of Huainan Science and Technology Bureau,No.2017G32.
文摘BACKGROUND Secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients.SHPT can increase bone fragility and calcification of blood vessels and soft tissues,which greatly increases the risk of death.AIM To discuss the outcome,safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT.METHODS We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019.They received paricalcitol injection for 24 wk(starting dose,0.06–0.08μg/kg),three times per week.They were followed up at the baseline(week 0),week 4,week 12 and week 24.The primary outcome indicator was the percentage of patients with a>30%decrease in intact parathyroid hormone(iPTH)levels at week 24 compared with the baseline.The secondary outcome indicators included percentage decrease in iPTH levels at week 24,standard-reaching rate of iPTH(percentage of patients with iPTH down to 130–585 pg/mL),changes in serum levels of calcium(Ca),phosphate(P),Ca×P product,alkaline phosphatase(ALP),creatinine(Cre),hemoglobin(Hb),and C-reactive protein(CRP),and incidence of adverse events(AEs).RESULTS After 24 wk of treatment,iPTH levels decreased significantly(598.88±381.29 pg/mL vs 888.84±376.88 pg/mL,P<0.05).More than 30%decrease of iPTH was found in 21 of 36(58.33%)patients.The average decrease in iPTH levels was 32.16±4.33%;the standard-reaching rate of iPTH levels was 66.67%(24/36);and ALP levels decreased significantly compared with the baseline(113.72±41.73 IU/L vs 133.45±56.86 IU/L)(t=2.798,P<0.05).There were no significant differences in the serum levels of calcium,Hb,Cre and CRP compared with the baseline(P>0.05).After 24 wk of treatment,serum P levels decreased compared with the baseline(1.91±0.40 mmol/L vs 2.16±0.66 mmol/L)(t=2.830,P<0.05).Ca×P product decreased significantly compared with the baseline(56.38±13.22 mg2/dL2 vs 63.97±20.30 mg2/dL2)(t=2.717,P<0.05).No serious adverse events occurred.CONCLUSION Paricalcitol was a safe and effective treatment for hemodialysis patients with SHPT.It decreased serum levels of iPTH,ALP and P and maintained stability of serum Ca levels.
基金supported by a grant from the NIH:DK32333supported by the National Natural Science Foundation of China (81070693 and 81200647)
文摘In the 1970s, with the advent of biochemical multichannel screening in the United States and other western countries, the clinical presentation of primary hyperparathyroidism （PHPT） changed from a symptomatic to an asymptomatic disorder. However, in Asian countries, like China, PHPT did not show this evolution, but rather continued to be a symptomatic disease with target organ involvement. In this paper, we revisit the clinical features of PHPT in New York and Shanghai, representative United States and Chinese cites, over the past decade. The questions we address are whether the disease evolved in China to a more asymptomatic one and, whether in the United States further changes are evident. The results indicate that while PHPT con- tinues to present primarily as an asymptomatic disease in the United States, a new phenotype characterized by normal serum calcium and high parathyroid hormone levels, normocalcemic PHPT, has emerged. Data from Shanghai demonstrates a trend for PHPT to present more commonly as an asymptomatic disorder in China. However, most patients with PHPT in China still manifest classical symptoms, i.e. nephrolithiasis and fractures. A comparison of the two cohorts shows that Chinese patients with PHPT are younger, with higher serum calcium and PTH levels, and lower 25-hydroxyvitamin D levels than patients in New York. Normocalcemic PHPT has not yet been recognized in Shanghai. In summary, although the phenotypes of PHPT in both cities are evolving towards less evident disease, sharp clinical and biochemical differences are still apparent in PHPT as expressed in China and the United States.
文摘BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported.Here we describe the process of acute pancreatitismediated PHPT induced by hypercalcemia in a male patient.Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man.The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension,abdominal pain,nausea,vomiting,electrolyte disturbance,renal dysfunction,and acute pancreatitis.Due to prolonged hypercalcemia,the patient subsequently underwent surgical resection of the parathyroid adenoma.Two weeks after surgery,his serum calcium,amylase,and lipase concentrations were normal.The patient had a good recovery after a series of other relevant therapies.CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.
文摘Parathyroidectomy is useful for the treatment of secondary hyperparathyroidism(SHPT)caused by chronic renal failure.The following three types of parathyroidectomy can be performed:subtotal parathyroidectomy,total parathyroidectomy and total parathyroidectomy plus autologous transplantation(tPTX+AT).Each of the three types of surgery has advantages and disadvantages.The present study retrospectively analyzed the efficacy of tPTX+AT for the treatment of SHPT over 1 year.Thirty-seven patients who were diagnosed with secondary nephrogenic hyperparathyroidism and treated with tPTX+AT were selected between September 2014 and October 2016 and followed up for 1 year.Their average age was 66.5±46.0 years,and the average time of dialysis was 48.1±8.2 months.The patients1 conditions,including the levels of intact parathyroid hormone(iPTH)and bone metabolism,were compared preoperatively and 1 and 7 days and 1,3,6 and 12 months after surgery.In addition,the postoperative complications,pathological data,SHPT recurrence and prognosis were examined.The results showed that the postoperative level of ostalgia and cutaneous pruritus significantly decreased in the patients.An inspection of the parathyroid tissues during the operation confimied the presence of parathyroid gland hyperplasia with no carcinoma detected?Three patients with hoarseness recovered within 1 month,and 1 patient with unilateral recurrent laryngeal nerve injury improved after 6 months of voice training.Conipared to the preoperative condition,the postoperative serum iPTH,serum calcium and serum phosphate levels were significantly decreased(P<0.001),and these differences remained significant 12 months after surgery.Compared to the preoperative condition,the alkaline phosphatase(ALP)concentration was decreased on postoperative day 1(P<0.05),but no differences were observed on day 7 or at 1 month(P>0.05).The ALP levels continuously decreased at 3,6 and 12 months(P<0.01).In conclusion,tPTX+AT significantly improves the quality of life and serum biomarker levels of these patients.The convenient surgical removal of the hyperplastic parathyroid gland for postoperative recurrence supports tPTX+AT as the recommended treatment for relevant patients.
基金Supported by the Subject of Beijing Science and Technology Plan,No.Z191100006619014.
文摘BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.
