Removal Of Parathyroid Adenoma Research Articles

Gastric Secretion of Pepsin in Patients with Primary Hyperparathyroidism before and after Removal of Parathyroid Adenomas

Gastric Secretion of Pepsin in Patients with Primary Hyperparathyroidism before and after Removal of Parathyroid Adenomas

Gastric secretion of calcium in patients with primary hyperparathyroidism before and after removal of parathyroid adenomas.

Deposition of calcium salts in gastroduodenal mucosa has been mentioned as an ulcero-genetic factor in patients with primary hyperparathyroidism (HPT). In an earlier study it was shown that the basal gastric secretion of calcium was higher in patients with HPT than in normal controls. In order to elucidate this problem further, a study of gastric secretion of calcium has been carried out in 9 patients with HPT before and after removal of parathyroid adenomas, using prolonged basal secretory periods. No systematic alterations in the gastric secretion of calcium were found.

Effect of the oral administration of ammonium chloride, sodium phosphate, cellulose phosphate and parathyroid extract on the activity product of brushite in urine

The formation of renal calculi of calcium phosphate origin probably requires a state of supersaturation of urine with respect to brushite (CaHPO 4 · 2H 2O). The reduction in the degree of saturation of urine with respect to this phase should therefore be one of the basic aims of medical therapy for the patient in whom kidney stones form. This hypothesis was tested in eleven patients who had a history of passage of recurrent calcium-containing renal calculi by repeated estimation of the degree of saturation of urine from the urinary activity product of divalent calcium ions (Ca ++) and divalent phosphate ions (HPO 4 −). In ten of the eleven patients urine specimens were supersaturated, largely attributable to a high urine pH or an abnormally high urinary calcium content. The administration of ammonium chloride lowered the activity product of Ca ++ and HPO 4 − in the urine of two patients who responded with a satisfactory degree of urinary acidification. In a patient with renal tubular acidosis, this therapy resulted in a marked increase in the activity product. Orally administered sodium phosphate significantly increased the degree of saturation of urine with respect to brushite in five patients, probably by increasing the urinary excretion of phosphorus (P). (Urinary and serum orthophosphate is expressed in units of elemental phosphorus.) During the administration of cellulose phosphate the urine became less supersaturated in all nine patients tested; in six of them, it became undersaturated. These effects of cellulose phosphate probably resulted from a significant decrease in urinary calcium in the face of an only moderate increase in urinary phosphorus excretion. The administration of parathyroid extract greatly increased the activity product of Ca ++ and HPO 4 −. Surgical removal of parathyroid adenoma or hyperplasia in three patients markedly lowered the degree of saturation of urine with respect to brushite.

Effects of parathyroid hormone on plasma and urinary adenosine 3',5'-monophosphate in man.

The effects of parathyroid hormone (PTH) on plasma and urinary adenosine 3',5'-monophosphate (cyclic AMP) levels were studied in normal subjects. Under basal conditions normal adults have plasma concentrations of cyclic AMP ranging from 10 to 25 nmoles/liter and excrete from 1.5 to 5 mumoles of cyclic AMP per g of urinary creatinine. About one-half to two-thirds of the cyclic AMP excreted in the urine is derived from the plasma by glomerular filtration, and the remainder is produced by the kidney. Renal production of cyclic AMP is partly under the control of PTH. It can be suppressed by infusions of calcium and stimulated by infusions of the calcium chelating agent, EDTA. Infusions of PTH in doses up to 10 mU/kg per min were associated with dose-related increases both in urinary cyclic AMP and phosphate. Infusions of PTH in doses ranging from 20 to 80 mU/kg per min did not lead to any further increase in phosphaturia but did lead to further marked increases in urinary cyclic AMP. A modest increase in plasma cyclic AMP was noted when PTH was infused at 40 mU/kg per min. Anephric patients failed to show appreciable increases in plasma cyclic AMP in response to large doses of PTH but did show expected increases in response to glucagon. Surgical removal of parathyroid adenomas from nine patients with primary hyperparathyroidism was invariably followed by a decrease in urinary cyclic AMP, PTH, in large doses, and calcium infusion produced up to 2-fold increases in the other known naturally occurring cyclic nucleotide, guanosine 3',5'-monophosphate (cyclic GMP).

Radioimmunoassay of parathyroid hormone in primary hyperparathyroidism: studies after removal of parathyroid adenoma.

Parathyroid hormone has been measured by radioimmunoassay in eight patients with hyperparathyroidism due to parathyroid adenoma. Secretion of hormone by the adenomatas was demonstrated direct by estimating the arteriovenous gradient of parathyroid hormone across the tumours. Serial estimations following surgical removal of the adenoma showed a rapid fall in the concentration of circulating parathyroid hormone. The calculated half-life of endogenously secreted parathyroid hormone in man varied from 11.4 to 28.8 min., with a mean of 19.8 min.

Urinary free and total hydroxyproline in hyperparathyroidism and the effect of removal of parathyroid adenoma

The urinary excretion of total hydroxyproline was elevated above the upper limit of normal values in 8 out of 13 patients with surgically confirmed primary hyperparathyroidism. All patients with normal urinary total hydroxyproline excretion had normal plasma alkaline phosphatase levels and normal bone X-rays, whereas 3 of the 8 patients with increased total hydroxyproline excretion had increased plasma alkaline phosphatase levels, and 4 of these 8 patients showed evidence of bone involvement in X-rays. These results support the suggestion that the urinary excretion of total hydroxyproline may be a more sensitive index of bone involvement in hyperparathyroidism than plasma alkaline phosphatase or bone X-rays, but that even normal hydroxyproline excretion does not exclude bone involvement. After removal of the parathyroid adenoma, the urinary excretion of total hydroxyproline decreased in all 7 patients in whom this effect was studied, including 2 patients with initially normal urinary total hydroxyproline values.The ratio of free to total urinary hydroxyproline was determined in 9 patients with hyperparathyroidism, including 4 patients with normal urinary total hydroxyproline excretion. This ratio was found to be elevated in 8 out of 9 patients studied. The content of free serum hydroxyproline was normal in 3 of these 8 patients, suggesting that the increased ratio in the urine was probably due to renal effects of parathyroid hormone

The diagnostic value of determination of tubular reabsorptive capacity for glucose in parathyroid disease.

Abstract Previous observations of changes of tubular reabsorptive capacity for glucose (TmG/GFR ratio) as a consequence of parathyroid disorder are supported by the results of a follow‐up study of an additional fortyfive patients. A distinct separation by TmG/GFR ratio exists in patients with hyper‐ and hypoparathyroidism. In five of thirty‐three patients with hyperparathyroidism (15%) the values of TmG/GFR ratio were within mean ± 2 S.D. of the values obtained in twenty‐four control patients. Parathyroid extract increases and removal of parathyroid adenoma or suppression of the parathyroid function by i.v. calcium decreases the ratio.The value of a clinical application of this physiologic phenomenon is discussed. The ratio might well point to the actual parathyroid function. An increased ratio, however, does not illustrate whether a hyperparathyroidism is autonomous, secondarily stimulated, or due to secretion of a parathyroid hormone‐like substance. And a decreased ratio does not exclude hyperparathyroidism since three patients with hyperparathyroidism due to water‐clear cell affection showed low values of the ratio. Finally, other factors than parathyroid hormone influence the reabsorptive capacity for glucose.In excluding coexisting hyperparathyroidism in hypercalcemic sarcoidosis, and, probably, in separation of idiopathic hypercalcuria into a renal form with stimulated parathyroid function and an intestinal form with suppressed parathyroid function, determination of the TmG/GFR ratio might be valuable.

Regulation of hydroxyproline excretion in hyperparathyroidism.

Five patients with hyperparathyroidism with normal serum alkaline phosphatase and without roentgenological evidence of bone disease were studied before and after surgical correction of the parathyroid hyperfunction. Preoperative base-line urinary hydroxyproline was above normal in 2 patients. The infusion of calcium failed to produce normal decreases in urinary phosphorus, whereas it decreased urinary hydroxyproline by a mean of 27 % in 4 of the 5 patients. The infusion of EDTA increased urinary hydroxyproline in each patient, with a mean increase for the group of 43 %. Following the removal of parathyroid adenomas from 4 patients, base-line urinary hydroxyproline decreased markedly. Postoperatively, the responses of urinary hydroxyproline to calcium and EDTA infusions were relatively small. These results suggest that the preoperative responses to the infusions did not result entirely from modifications in the activity of nonadenomatous parathyroid tissue. Furthermore, the mean urinary hydroxyproline in n...

Parathyroids and Gastric Secretion

Summary The short-term injection of 13 normal subjects with parathyroid hormone in a total dose of 1000 units in 24 hours produced a significant increase in gastric secretory volume and total pepsin over control levels. The existence of this depends upon the assumption of a first day effect in explaining a portion of the data. The withdrawal of long-term parathyroid stimulation from 4 out of 5 hyperparathyroid patients by removal of parathyroid adenomas did not change gastric secretion. The 1 patient of the 5 who had a duodenal ulcer showed a postoperative decrease in gastric secretion. This finding raises the question of a varying response between individuals to hyperparathyroidism and keeps open the possibility of a secretory mechanism in the production of peptic ulcer in this disease; in general, however, gastric secretion is not changed by removal of a parathyroid adenoma. In 1 hypoparathyroid patient, gastric secretion was depressed at low levels of serum calcium; free acid was entirely absent when serum calcium was below 7.0 mg. per 100 ml. Free acid and pepsin activity were increased when the serum calcium was restored to normal levels. The findings in a series of 5 subjects made hypercalcemic with intravenous calcium gluconate suggest that hypercalcemia augments the production of pepsin, gastric secretory volume, and free acid, possibly by increasing the blood supply to the mucosa. In summary, notwithstanding the stimulatory effects of acute hypercalcemia and parathyroid hormone, the unaltered secretion in our patients with hyperparathyroidism leads us to believe that the ulcerogenic factor in this disease is not hypersecretion.

Hyperparathyroidism recurring ten years after removal of parathyroid adenoma.

The purpose of this paper is to report on a patient who had two episodes of primary hyperparathyroidism separated by a 10-year asymptomatic period. Report of a Case A 35-year-old man was first admitted to the Duke University Medical Center on Sept. 19, 1945, for evaluation of pain in the back, ankles, and shoulders of two years' duration. He had also noted an enlarging, painful mass on the right clavicle for about one year. In the three years preceding this admission, he had experienced generalized weakness, anorexia, nausea, vomiting, epigastric pain, constipation, polyuria, polydipsia, photophobia, and a 10-lb. (4.5-kg.) weight loss. There was no history of renal colic. On physical examination the blood pressure was 140/95 mm. Hg, with otherwise normal vital signs. The only abnormal physical finding was a non-tender, 5-by-3-cm. bony mass in the right clavicle. The admission laboratory data included a hemoglobin level of 13 Gm.%, and

Tetany after Removal of Parathyroid Adenoma

Tetany after Removal of Parathyroid Adenoma

THE DIFFERENTIAL DIAGNOSIS OF HYPERPARATHYROIDISM

Excessive parathyroid secretion, such as occurs with parathyroid adenomas, causes a drain of lime salts from the body resulting in skeletal changes classified as Recklinghausen's disease or generalized osteitis fibrosa cystica. The negative calcium and phosphorus balance is commonly associated with hypercalcuria, hypercalcemia and hypophosphatemia and with skeletal, renal and gastro-intestinal symptoms that together constitute the classic form of hyperparathyroidism. The differentiation of this disease from others involving the bones is important because surgical removal of parathyroid adenomas is usually followed by extraordinary improvement if carried out before advanced skeletal deformities or renal impairment preclude complete restitution of the patient. The differential diagnosis of hyperparathyroidism may be difficult, however. The onset of the disease is usually insidious, the early manifestations are extremely varied, aberrations from the classic picture are common and the most characteristic features may be closely simulated by other diseases involving the bones. In this study, the problems