Acute Primary Hyperparathyroidism Research Articles

Parathyroid Adenoma Revealed by Acute Pancreatitis: Case Report

The association between acute pancreatitis and primary hyperparathyroidism (PHPT) has widely been reported in literature, but a causal relationship remains controversial. This case report is about a patient admitted with acute pancreatitis as a first manifestation of a parathyroid adenoma. The initial medical management followed by surgery permitted a total recuperation. The purpose of this paper is to keep in mind the metabolic etiology, by evaluating calcium and parathyroid hormone (PTH) in the differential diagnosis of non-biliary, non-alcoholic acute pancreatitis.

Features of diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism

Aim: To identify a connection between acute and chronic pancreatitis and primary hyperparathyroidism on the base of clinical cases. To consider the features of the diagnosis and treatment of acute and chronic pancreatitis with primary hyperparathyroidism.Materials and methods: Over the past 10 years, there have been observed 3 cases of pancreatitis with primary hyperparathyroidism. Two patients were diagnosed with chronic pancreatitis, one patient was diagnosed with acute destructive pancreatitis. Patients were undergoing surgery, parathyroidectomy was performed.Results: Primary hyperparathyroidism is rarely associated with the occurrence of acute or chronic pancreatitis, but hypercalcemia plays an important role in the pathogenesis of these diseases. Pancreatitis usually occurs in the late stage of hyperparathyroidism, which explains the low prevalence of this association in developed countries, where primary hyperparathyroidism is diagnosed at an early stage of the disease.Conclusion: These clinical cases of radical surgical treatment of parathyroid adenoma associated with severe concomitant pathology testifies to the effectiveness of the surgical method in some cases. It is necessary to take into account severe concomitant pathology and diagnose and correct it in time.

Acute pancreatitis and primary hyperparathyroidism

Background: The association between primary hyperparathyroidism (PHPT) and acute pancreatitis (AP) is well known. However, the causal association is disputed. Aims: The present cohort study of PHPT patients was done: (1) to assess the prevalence of AP and (2) to assess the effect of successful parathyroidectomy in preventing further recurrence. Materials and Methods: Case records of patients admitted with AP during the study period were reviewed. Diagnosis of PHPT among this group was based on serum level of corrected calcium and parathyroid hormone. Review of records of patients who were successfully operated for PHPT was done. Records of patients treated with confirmed diagnosis of AP during the study period were reviewed. Variables used for analysis were serum levels of calcium (adjusted to serum albumin), phosphate, intact parathyroid hormone, 25-OH-Vitamin D, alkaline phosphatase, and estimated glomerular filtration rate (eGFR). For continuous/numerical variables with two groups, Mann–Whitney U-test was applied. Multivariate regression analysis was done if the univariate analysis showed significance (P Results: There were 13 (7.5%) patients with confirmed diagnosis of AP and serum calcium level significantly elevated in this group. There was a linear association of serum calcium with AP. Successful parathyroidectomy prevented further episodes in 11 (84.6%) of patients. There was 2% prevalence of PHPT among 558 patients with AP. Conclusions: Hypercalcemia in PHPT patients was significantly associated with AP and early parathyroidectomy prevented further recurrence.

Acute pancreatitis and hyperparathyroidism: A case series

Primary hyperparathyroidism is a rare cause of acute pancreatitis. Five consecutive patients with acute or recurrent acute pancreatitis and primary hyperparathyroidism were included. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Both ultrasonography and Sestamibi scan was used to localize parathyroid adenoma. Except for one, all patients underwent parathyroidectomy and postoperative histology was consistent with parathyroid adenoma. One patient died while on treatment. Metabolic causes of acute pancreatitits, though uncommon, are important as early recognition helps management and prevents recurrence.

Acute pancreatitis and primary hyperparathyroidism — an infrequent association

Acute pancreatitis and primary hyperparathyroidism — an infrequent association

Giant intrathyroidal parathyroid adenoma

Primary hyperparathyroidism (PHPT) is not an uncommon endocrine disorder. However, acute primary hyperparathyroidism, or parathyroid crisis (PC), is a rare clinical entity characterized by life-threatening hypercalcemia of a sudden onset in patients with PHPT. We describe a patient with PC who presented with acute worsening of depressive symptoms, nausea and vomiting, and required emergency surgery. Serum calcium, alkaline phosphatase, and parathyroid hormone were elevated and serum phosphorus was low. An emergency hemithyroidectomy was performed because of none medical control of hypercalcemia. A giant intrathyroidal parathyroid adenoma was diagnosed. PHTP can be a life-threatening situation for patients, requiring immediate surgical treatment. A giant intrathyroidal parathyroid adenoma is an uncommon cause of PC.

Pancréatite aiguë et hyperparathyroïdie primaire : étude multicentrique de l’Association francophone de chirurgie endocrinienne

Primary hyperparathyroidism is an unusual cause of acute pancreatitis. The aim of this study was to analyse data from multiple centers concerning patients with primary hyperparathyroidism and associated acute pancreatitis and to analyze potential predictive factors.In this retrospective multicentric study, 19 patients were identified (Group A) with the associated diagnoses of acute pancreatitis and primary hyperparathyroidism. Their clinical data was compared to that of a control group of 65 patients (group B) with primary hyperparathyroidism without acute pancreatitis.Age, parathormone levels and pathology (uni/multiglandular disease) were similar between the two groups. The mean plasma calcium level was significantly higher in group A (12.64 mg/100ml) than in group B patients without pancreatitis (11.28 mg/100ml) (p<0.0001).This study confirms the causal relationship between primary hyperparathyroidism and acute pancreatitis. The degree of hypercalcemia may play an important role in this association. Calcium levels should be measured in all patients with acute pancreatitis.

Acute Pancreatitis in Primary Hyperparathyroidism: A Population-Based Study

The association between acute pancreatitis and primary hyperparathyroidism (PHPT) is controversial. The aim of the study was to address the incidence and disease characteristics of acute pancreatitis in PHPT from a large inception cohort of community residents. Patients with acute pancreatitis were identified in an Olmsted County, Minnesota, cohort of PHPT subjects diagnosed from 1965-2001 and compared to matched control subjects. The estimated rate of developing acute pancreatitis was calculated by person-years method. Cox models assessed the effect of PHPT disease status on the development of acute pancreatitis. Of 684 patients with PHPT, 10 patients (1.5%) developed acute pancreatitis, compared to 32 of 1364 control patients (2.3%). The estimated rate of development of acute pancreatitis in PHPT was 114 per 100,000 person-years, compared to 140 per 100,000 person-years in control subjects (P = 0.56). The estimated hazard ratio of acute pancreatitis for PHPT relative to the control subjects was 0.84 (P = 0.89). The majority of subjects with PHPT and acute pancreatitis were women (n = 7), and the mean age was 70.6 yr at the time of acute pancreatitis. PHPT was present an average of 137 months before the development of acute pancreatitis, and contributing causes for acute pancreatitis were in identified in four patients. Maximal serum calcium levels in PHPT were not significantly associated with the development of acute pancreatitis. Acute pancreatitis was not increased in community patients with PHPT, and therefore, there does not appear to be a causal relationship between PHPT and acute pancreatitis.

Parathyroid crisis as first manifestation of primary hyperparathyroidism

We report the case of a 61-year-old woman who suffered a parathyroid crisis due to a parathyroid adenoma. The patient presented with the typical clinical symptoms of hypercalcemia. Ca + 2 and PTH were markedly increased. Initially, she was treated conservatively until Ca + 2 returned to normal levels. Then, she underwent surgical excision of a newly diagnosed parathyroid adenoma. Parathyroid crisis (PC), also known as parathyroid storm or acute primary hyperparathyroidism, is a rare and serious complication of primary hyperparathyroidism (PH). Fewer than 200 cases have been described in the literature. Prognosis is poor: mortality is 100% in non-operable cases and 20% in cases in which parathyroidectomy is performed. We emphasize the importance of early diagnosis and aggressive treatment.

Acute primary hyperparathyroidism: experience of 59 cases.

Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.

Primary hyperparathyroidism: diagnosis and management in the older individual.

As more and more cases of primary hyperparathyroidism are being detected by screening for serum calcium concentration, the majority of patients are older individuals who are asymptomatic or have symptoms which are difficult to ascribe to hyperparathyroidism. Long-term follow-up has provided evidence that most asymptomatic patients who do not undergo parathyroidectomy will not develop symptomatic complications. Some asymptomatic patients, however, have progression of disease over time. These observations and the lack of reliable predictors of the rate of progression in most patients reinforce the need for careful monitoring in elderly individuals who do not undergo surgery. Biannual measurements of serum calcium concentrations and annual measurements of urinary calcium excretion and bone mineral density should be performed in all patients who are managed conservatively. In elderly patients with symptomatic or complicated primary hyperparathyroidism, parathyroidectomy results in biochemical cure and increased bone density, both at the lumbar spine and the femoral neck, and should be considered. Criteria for surgery include significant hypercalcemia (>1 mg/dl above the upper limit of normal), marked hypercalciuria (>400 mg per day), low bone density, unexplained renal insufficiency and an episode of acute primary hyperparathyroidism. Consideration of parathyroidectomy should also be given to elderly patients with primary hyperparathyroidism who are vitamin D deficient. Radionuclide scanning has become the initial non-invasive study of choice when parathyroid gland localization is necessary before parathyroidectomy; this is generally for fragile patients and reoperative cases. In a subset of older individuals, surgery may not be an option because of coexisting medical problems even though surgical indications are present.

MEDICAL APPROACHES TO PRIMARY HYPERPARATHYROIDISM

Medical therapy is useful in cases of acute primary hyperparathyroidism, patients with recurrent disease, and parathyroid carcinoma. Among the therapeutic agents that have been employed, oral phosphate, bisphosphonates, and estrogens have been successful. The newly described calcimimetic agents directly block secretion of parathyroid hormone from the glands and offer an important new approach to medical therapy of primary hyperparathyroidism.

Recurrent Acute Primary Hyperparathyroidism in an Adult Male Patient

To report the occurrence of recurrent acute primary hyperparathyroidism (HPT), a rare disorder that occurs in only 1 to 2% of patients with primary HPT. We describe a patient who had two separate episodes of acute primary HPT and discuss the appropriate treatment of parathyroid crisis. In 1990, primary HPT developed in a 41-year-old man, who underwent surgical removal of a parathyroid adenoma. He remained normocalcemic until 1995, when acute primary HPT developed after lithium therapy was initiated because of depression. Calcium and parathyroid hormone (PTH) levels declined after lithium therapy was discontinued, but they remained slightly above the normal range. Nine months later, he was rehospitalized with acute primary HPT. After stabilization, a second parathyroid adenoma was successfully resected, and calcium and PTH levels subsequently remained normal. In this disorder, levels of PTH are increased up to 20 times normal, and the clinical manifestations are similar to parathyroid carcinoma. Treatment involves rehydration, antiresorptive agents, and parathyroidectomy. Our patient initially was thought to have lithium-induced primary HPT, which can occur in up to 10% of patients on long-term lithium therapy. The mechanism is unknown but may be an alteration of the calcium-PTH "set-point." Patients with asymptomatic primary HPT should have close follow-up because of the risk of development of acute primary HPT. Patients at risk, such as those with immobilization or severe illness, should be identified. Drugs known to interfere with calcium metabolism (for example, lithium) should be avoided in patients with primary HPT.

Two-site enzyme immunoassay for measuring intact human osteocalcin in serum.

We developed a sensitive two-site sandwich ELISA for quantitative analysis of human osteocalcin in serum or plasma. Our method is based on two different highly specific antibodies recognizing epitopes at different ends of the protein so that only intact osteocalcin is detected. The method is fast (total analysis time less than 6 h/96 wells), precise (intraassay variation less than 2.3% at four different levels; n = 10, and interassay variation less than 2.5%, n = 5, respectively), and accurate, with a mean recovery of 105%. The detection limit in serum is approximately 0.1 micrograms/liter. The mean concentration of osteocalcin in normal serum with this assay is 3.3 micrograms/liter (SD 3.7 micrograms/liter; range 0.1-13.1 micrograms/liter; n = 41), and the reference range is 0.28-10.1 micrograms/liter (10 and 90% confidence limits). The method shows a reasonable positive linear correlation with other osteocalcin assays (Incstar, r = 0.55, p < 0.05, n = 13; Henning Oscatest, r = 0.52, p < 0.005, n = 34). A good correlation (r = 0.70, p < 0.001) between individual osteocalcin and bone-specific alkaline phosphatase serum concentrations was observed in normal subjects. We found a low or undetectable concentration of intact osteocalcin in serum of all four of our patients with acute primary hyperparathyroidism, and in all five patients with hypocalcemic secondary hyperparathyroidism, which suggests that PTH effectively inhibited the synthesis of osteocalcin in osteoblasts. The serum concentration of intact osteocalcin was elevated in two of three patients with chronic primary hyperparathyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Primary Hyperparathyroidism

Acute primary hyperparathyroidism is an unusual form of primary hyperparathyroidism characterized by life-threatening hypercalcemia. Forty-three cases reported in the literature since 1974 are reviewed, along with five new cases. The average age of the patients was 55 (27 to 82), with an even distribution between men and women. Marked hypercalcemia (17.5 +/- 2.1 mg/dl) was accompanied by parathyroid hormone levels 20 times normal. Virtually all patients had symptoms. Hyperparathyroid bone disease occurred in 53 percent of patients; even more (69 percent) had nephrolithiasis or nephrocalcinosis. Combined renal and skeletal involvement was seen in 50 percent. Only three deaths were recorded. The pathophysiology of the acute hyperparathyroid state is unknown but appears to consist of uncontrolled parathyroid hormone secretion followed by cycles of hypercalcemia, polyuria, dehydration, reduced renal function, and worsening hypercalcemia. These features of acute primary hyperparathyroidism are compared with the features reported in the literature antedating multichannel screening, and with the features of the common form of primary hyperparathyroidism. Clinical guidelines by which the diagnosis may be suspected are also reviewed.