Signs Of Hyperparathyroidism Research Articles

SAT197 A Rare Case Of Infected Parathyroid Cyst Associated With Hyperparathyroidism

Abstract Disclosure: B. Ataallah: None. M. Al Tameemi: None. P.R. Orlander: None. Introduction: Parathyroid cysts are considered rare lesions compromising 1-5 % of neck masses. Clinical pictures can range from asymptomatic to symptoms and signs of hyperparathyroidism, and it may lead to compressive symptoms as well. Infection of the parathyroid cyst is not reported in literature. We are presenting a patient with parathyroid cyst and was found to be infected with E-coli. Case presentation: A 59-year-old woman presented with neck swelling and ear pain. She was initially diagnosed with otitis externa and was treated with antibiotics. Her neck swelling worsens over a brief period with associated ear drainage and shortness of breath. Computed tomography (CT) scan of the neck revealed a large cystic lesion up to 10 cm in largest diameter in the region of the thyroid gland with inflammatory changes extending to the prevertebral soft tissues. CT scan of the chest showed a mass effect on the trachea and adjacent structures with possible hemorrhage. Eventually the patient was intubated. Laboratory evaluation revealed parathyroid hormone (PTH) at 455 pg/ml, corrected calcium of 11.3 mg/dl, Ionized calcium of 1.41 mMol/L, and phosphorus at 3.0 mg/dl. Aspiration of the cyst was done prior to surgery and the culture grew E-coli. She started on antibiotics, and eventually underwent a total thyroidectomy with excision of the parathyroid cyst and adenoma. Pathology showed a ruptured cyst with marked inflammation and granulation tissue with hypercellular left superior parathyroid gland. Postoperatively, corrected calcium dropped to 10.1mg/dl and PTH to 38.5 pg/ml. Discussion: Parathyroid cyst (PC) is a relatively rare neck or mediastinal lesion, representing less than 0.5% of parathyroid gland disorders. Most PCs are nonfunctional, but some may produce excess parathyroid hormone or can cause local compressive symptoms like dyspnea, dysphagia, or hoarseness of voice, depending on the size and location of the lesion. There are no distinct clinical or radiological features to differentiate parathyroid cysts, and that makes preoperative diagnosis challenging, and most cases are diagnosed during surgery or postoperatively. Aspiration and fluid analysis can confirm the diagnosis preoperatively, and the treatment can be achieved either by cyst aspiration for small lesions with less than 2.5 cm in diameter, through sclerosing agent injection, or by surgical resection. In this patient, the culture of the aspirated parathyroid cyst surprisingly grew E coli. It is unusual to have an infection with E coli in the neck tissues or the surrounding structures, and it is unknown whether the cyst infection is related to the ear infection that our patient has. Parathyroid cyst infection is not reported in literature reviews, and it is important to consider fluid analysis and culture to confirm the diagnosis preoperatively and to rule out cyst infection Presentation: Saturday, June 17, 2023

Роль костного метаболизма в патогенезе гонартроза

Актуальность проблем остеоартроза коленных сочленений (гонартроза) обусловлена широкой его распространенностью и высоким риском развития ограничений функции суставов с нарушением трудоспособности и снижением качества жизни пациентов. Целью и задачами данной работы стала оценка роли костного метаболизма при разных вариантах клинического течения гонартроза, связей с развитием остеопороза, с костно-деструктивными изменениями коленных суставов по данным рентгенографии, сонографии, магнитно-резонансной томографии, рентгеновской денситометрии. Материал и методы. Обследовано 104 больных остеоартрозом (47 % мужчин и 53 % женщин) в возрасте от 32 до 76 лет. Гонартроз установлен в 96 % наблюдений. Манифестный реактивный синовит по результатам клинико-сонографического исследования диагностирован в 62 % случаев, полиартроз — в 55 %, системный остеопороз — в 14 %, остеокистоз — в 91 %, а спондилопатия в виде остеохондроза и дугоотростчатого артроза — в 72 %. Результаты. У больных гонартрозом наблюдаются значительные изменения в крови маркеров костного метаболизма (МКМ), проявляющиеся дисбалансом остеоассоциированных макроэлементов (кальция, магния, фосфора) с развитием гипокальциемии, которая регистрируется соответственно в 98 %, высокой активностью щелочной фосфатазы (в 47 % случаев), признаками гиперпаратиреоидизма и гиперостеокальциемией. Нарушения костного метаболизма при остеоартрозе коленных сочленений связаны с темпами прогрессирования заболевания и распространенностью суставного синдрома, а показатели МКМ могут иметь прогностическое значение. МКМ (остеоассоциированные макроэлементы, гормоны — паратирин, кальцитонин, остеокальцин, а также фермент щелочная фосфатаза) участвуют в патогенетических построениях гонартроза, определяя развитие отдельных рентгенологических, сонографических и магнитно-резонансных артикулярных и периартикулярных признаков патологии коленных суставов (степень сужения суставных щелей, эпифизарный остеопороз, трабекулярный отек в мыщелках бедренной и большеберцовой костей, изменения рогов менисков, формирование кист Бейкера, интраартикулярных хондромных тел и тел Гоффа). Вывод. Нарушения костного метаболизма имеют клинико-патогенетическое значение при гонартрозе, что требует разработки специальной медицинской технологии проведения лечебно-реабилитационных мероприятий у таких больных.

Primary Hyperparathyroidism: Modern Conception and Clinical Observation

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

Primary Hyperparathyroidism: Modern Conception and Clinical Observation

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

AGGRESSIVE IDIOPATHIC BILATERAL CENTRAL GIANT CELL GRANULOMA OF THE JAW: A CASE REPORT

Central giant cell granuloma (GCCG) is a benign osteolytic proliferation with diverse clinical and radiologic behavior patterns, characterized by the presence of multinucleated giant cells in a vascular stroma. A 25-year-old man presented with bilateral swelling in the posterior mandibular region of 2-month duration with painful symptomatology. Intraoral exam showed bilateral expansion of the vestibular cortical bones in the mandibular retromolar region. Panoramic radiograph and computed tomography revealed extensive bilateral multilocular mandibular areas causing bilateral expansion of the vestibular cortical bones. The histopathologic examination showed benign fibroblasts matrix with variable number of giant cells and hemorrhagic content. Immunohistochemistry for CD-68 glycoprotein showed positive immunoreactivity. Biochemical examination showed no signs of hyperparathyroidism. Diagnosis of CGCG is a complex task, even more so when the clinical presentation is unusual. Currently, it is known that the occurrence of multiple lesions of CGCG is associated with different systemic diseases.

Unusual case of chronic recurrent multifocal osteomyelitis

BackgroundChronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory bone disorder that primarily affects young girls, with a mean age of 10 years at onset. Generally, it is a self-limited disease. However, recent data indicate that more than 50% of patients have a chronic persistent disease and about 20% a recurring course of this condition. Also, there are more cases reported with associated auto-inflammatory and autoimmune diseases. In this case report, we present a rare case of sporadic CRMO in which the patient eventually developed C-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibodies)-associated renal vasculitis and hyperparathyroidism.Case presentationA 14 year old female patient was brought to the emergency department with a sudden onset of left leg pain and oedema. After physical evaluation and initial investigation, she was diagnosed with femoral and pelvic deep vein thrombosis. While searching for possible thrombosis causes, osteomyelitis of the left leg was identified. Additional CT and MRI scans hinted at the CRMO diagnosis. Due to the multifocal lesions of CRMO, endocrinological evaluation of calcium metabolism was done. The results showed signs of hyperparathyroidism with severe hypocalcaemia. Moreover, when kidney damage occurred and progressed, a kidney biopsy was performed, revealing a C-ANCA associated renal vasculitis. Treatment was started with cyclophosphamide and prednisolone according to the renal vasculitis management protocol. Severe metabolic disturbances and hyperparathyroidism were treated with alfacalcidol, calcium and magnesium supplements. Secondary glomerulonephritis (GN) associated hypertension was treated with ACE (angiotenzine converting enzyme) inhibitors. Anticoagulants were prescribed for deep vein thrombosis. After 1.5 years of treatment, the patient is free of complaints. All microelement and parathormone levels are within normal range. Kidney function is now normal. To date, there are no clinical or diagnostic signs of deep vein thrombosis.ConclusionsThis case report presents a complex immunodysregulatory disorder with both auto-inflammatory and autoimmune processes. We hypothesize that the long lasting active inflammation of CRMO may induce an autoimmune response and result in concomitant diseases like C-ANCA-associated vasculitis in our patient. Any potential specific pathogenic relationships between these two rare pathologies may need to be further studied. Furthermore, there is a lack of specific biomarkers for CRMO and more studies are necessary to identify CRMO’s characteristic patterns and how to best monitor disease progression.

Unusual presentations of functional parathyroid cysts: a case series and review of the literature

BackgroundCysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnostic challenge to clinicians. We report here on three cases of functional parathyroid cysts that illustrate diagnosis difficulties related to unusual clinical presentations in three Caucasian women, including negative parathyroid scintigraphy.Case presentationsPatient 1, an 87-year-old Caucasian woman presented with confusion and dysphagia. She had hypercalcemia and elevated parathyroid hormone levels suggesting primary hyperparathyroidism. Parathyroid scintigraphy did not reveal any focal uptake, but a computed tomography scan of her neck identified a large cyst in the upper right thyroid region. At cervicotomy, a parathyroid cystic adenoma was removed. Patient 2, a 31-year-old Caucasian woman was investigated after a hypertensive crisis related to primary hyperparathyroidism. Cervical ultrasound identified a large cystic lesion in the lower left thyroid lobe that was removed by minimally invasive cervicotomy. Patient 3, a 34-year-old Caucasian woman presented with an indolent growing mass of the neck and a past medical history of kidney stones. Primary hyperparathyroidism was diagnosed. Ultrasound showed a cystic mass, but parathyroid scintigraphy was negative. Cervical exploration revealed a large cystic adenoma, containing high parathyroid hormone levels.ConclusionsDiagnosis of functional parathyroid cysts can be challenging due to various clinical presentations and negative parathyroid scintigraphy. Surgery, but not fine-needle sclerotherapy, appears to be the safest treatment option. Despite its rarity, differential diagnosis of cystic lesion of the neck should include primary hyperparathyroidism due to functional parathyroid cysts.

The clinical analysis of preventable reoperation for primary hyperparathyroidism

Objective: To discuss the diagnosis, preoperative imaging and surgical technique of patients who underwent reoperation for persistent hyperparathyroidism. Methods: A prospective database about primary hyperparathyroidism in Department of General Surgery, Peking Union Medical College Hospital was searched for the patients who underwent reoperation for persistent hyperparathyroidism from January 2009 to December 2016. The information about the initial operation, preoperative imaging study and result of reoperations were collected and reviewed. A total of 58 patients underwent reoperation for hyperparathyroidism. Eleven of these patients were referred to this institute for reoperation after missing single parathyroid lesion in the initial parathyroidectomy. Nine patients were female, and the mean patient age at reoperation was 54.9 years. Results: For this group, the accuracy of ultrasound neck scan and sestamibi scintigraphy was 10/11 in identifying diseased parathyroid gland before reoperation. Combined with enhanced CT and SPECT, all parathyroid lesions were localized before reoperations. With general anesthesia or cervical plexus block, all diseased parathyroid glands were removed in the reoperations. No signs of hyperparathyroidism appeared during follow-up. Conclusions: The initial surgery for primary hyperparathyroidism should be performed in experienced center to avoid reoperations. Combining preoperative localization and cervical exploration will help to increase the success rate of reoperation.

Thyroid and parathyroid tumours in patients submitted to X-ray scalp epilation during the tinea capitis eradication campaign in the North of Portugal (1950-1963).

Tinea capitis attained epidemical proportions in the fifth and sixth decades in Portugal, as in other countries. Before starting the utilization of griseofulvin in 1959, the best approach to treat tinea capitis infection was X-ray scalp epilation combined with topical antimycotic ointments. A long-term side effect of this therapy is thyroid disease, namely thyroid cancer; data on parathyroid lesions (hyperplasia, adenoma and carcinoma) are scarce. We observed clinically 1,375 individuals irradiated in childhood for tinea capitis treatment in the North of Portugal with the main purpose of evaluating thyroid and parathyroid tumours as possible sequelae of the irradiation treatment. For each individual, a cervical ultrasound and a serum calcium measurement were proposed. Fine needle aspiration cytology was suggested whenever ultrasound thyroid nodules presented suspicious features. We observed a 54 % frequency of thyroid nodules and a 2.8 % frequency of thyroid carcinoma (38/1,375). Nineteen of the 38 (50 %) carcinomas were diagnosed by us, whereas the remaining 19 carcinomas had been diagnosed and treated prior to our observation. The carcinomas were significantly more frequent in women than in men. Benign excised lesions were also significantly more frequent in women and in patients irradiated at younger ages. Seven women, considered asymptomatic until our clinical observation, had laboratory signs of hyperparathyroidism. The data we have obtained, namely high thyroid cancer frequency, corroborate previous data from childhood irradiated cohorts and highlight the need for the close follow-up of these populations in order to identify and treat early undiagnosed head and neck lesions. No evidence of increased parathyroid disease was found in this cohort of head and neck X-irradiated patients.

Apparent Recurrence of Hyperparathyroidism following Quadruple Parathyroidectomy

Recurrent hyperparathyroidism can occur following quadruple parathyroidectomy and during radical parathyroidectomy and so that future hypoparathyroidism is avoided autotransplantation of parathyroid tissue is often preformed. Herein, I describe a patient who was thought to have recurrent hyperparathyroidism following a quadruple parathyroidectomy based solely on a high intact parathyroid hormone level. The patient neither had clinical symptoms or signs of hyperparathyroidism nor did the laboratory data other than the increased intact PTH level suggest hyperparathyroidism. A more comprehensive history revealed the cause of the elevated intact PTH so that further expensive, invasive, and potentially dangerous investigations were avoided.

Hypovitaminosis D Is Associated with Systemic Inflammation and Concentric Myocardial Geometric Pattern in Hemodialysis Patients with Low iPTH Levels

Background: Vitamin D [25(OH)D] deficiency is a cardiovascular risk factor in the hemodialysis (HD) population. The aim of this study was to identify hypovitaminosis D in HD patients without signs of hyperparathyroidism and to analyze its association to inflammation and echocardiographic alterations. Methods: Patients on HD with iPTH <300 pg/ml not receiving vitamin D therapy were recruited. Hypovitaminosis D was defined as 25(OH)D <30 ng/ml. High-sensitivity C-reactive protein, interleukin-6 and serum albumin were used as inflammation markers. Echocardiograms were performed in an interdialytic mid-week day. Results: Sixty-one patients (mean age of 56 ± 15 years, 52% males, 93% Caucasians, 31% diabetic) were included, and 75% presented hypovitaminosis D. Inflammation was more prevalent among those with hypovitaminosis D, and these patients presented higher relative wall thickness (0.48 ± 0.11 vs. 0.42 ± 0.10 mm; p = 0.05) and lower left ventricular diastolic (49.8 ± 6.2 vs. 54.7 ± 5.8 mm; p = 0.013) and systolic (31.9 ± 5.7 vs. 36.8 ± 7.2 mm; p = 0.012) diameters. Conclusions: Hypovitaminosis D is associated with inflammation and concentric geometric pattern of the left ventricle, even in the absence of high iPTH levels. Vitamin D repletion (aiming to reduce cardiovascular complications) should also be considered in HD patients with normal or low iPTH levels.

Maladie cœliaque révélée par une hypocalcémie secondaire à une thyroïdectomie totale : à propos d’un cas

In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.

Clinical and Radiological Signs of Hyperparathyroidism.

Clinical and Radiological Signs of Hyperparathyroidism.

Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

Vagus-sparing gastric fundectomy in the rat: development of osteopenia, relationship to urinary phosphate and net acid excretion, serum gastrin and vitamin D.

In man and experimental animals, partial and total gastrectomy and gastric vagotomies disturb extracellular mineral homeostasis, osteopenia being among the late outcomes. The sequence of events is complex and insufficiently understood. We report on the long-term effects of gastric fundectomy (FX; FX-1, n=11; sham-operated controls, n=14) sparing gastric vagal fibers at the lesser curvature in the rat, a procedure eliminating gastric acid production but preserving gastric reservoir function. After FX-1 there was a marked increase of gastrinemia [FX-1: 590 (SE 95); controls: 82 (5) pg-equiv/ml; P<0.001], serum 1,25-dihydroxyvitamin D [FX-1: 188 (17); controls: 86 (6) pg/ml; P<0.001], phosphaturia [FX-1: 32 (2); controls 23 (2) micromol/h; P<0.001] due to increased fractional phosphate clearance, elevated urinary net acid [FX-1: 21 (2); controls: 16 (1) micromol/h; P=0.03], and low urinary pH. The urinary excretion of hydroxyproline was increased [FX-1: 137 (15); controls: 99 (8) micromol/h; P=0.01], and crosslinks were also high. These changes were associated with a significant decrease of bone ash calcium, magnesium, and phosphorus. Bone histomorphometry revealed signs of high bone turnover. No signs of hyperparathyroidism were detectable. Acute stimulation of serum gastrin by gastric acid abolishing omeprazole failed to provoke extra-osseous changes, as seen in the long-term after fundectomy. It was concluded that the described type of fundectomy disturbs gastrinemia, acid-base and phosphorus metabolism, thereby initiating osteopenia. This animal model may be suitable for research into post-gastrectomy bone disease.

The pathogenesis of parathyroid gland hyperplasia in chronic renal failure

A 58-year-old female dialysis patient was admitted to the Nephrology Department at the Hopital Necker because of severe secondary hyperparathyroidism. She had had chronic interstitial nephritis with slowly progressive chronic renal failure for more than 10 years. Intermittent home hemodialysis treatment was started 18 years ago. Symptoms and signs of hyperparathyroidism were present before the patient developed end-stage renal failure, and the severity of osteitis fibrosa progressed despite the initiation of renal replacement therapy. Thirteen years ago, the patient first underwent a surgical neck exploration. One large parathyroid gland weighing 4500 mg was removed. One other gland was identified, which was biopsied and had a normal aspect; it was left in place. The remaining glands could not be identified. Operative and light microscopic findings were compatible with the diagnosis of primary adenoma. The plasma calcium concentration decreased markedly immediately after parathyroidectomy, and radiologic signs of osteitis fibrosa regressed. Severe aluminum intoxication, mainly due to aluminum-contaminated dialysis fluid, was diagnosed 9 years ago. An appropriate dialysis water purification system with reverse osmosis was put in place, and the patient received deferoxamine treatment for several months 8 years ago. Soon thereafter, recurrence of hyperparathyroidism became evident. Several attempts at treating the osteitis fibrosa medically were undertaken, first using calcium carbonate and thereafter small doses of oral 1-alpha cholecalciferol. Several transient hypercalcemic and hyperphosphatemic episodes finally led to cessation of the administration of vitamin D derivatives. Three years ago, the plasma calcium level ranged between 2.5 and 2.7

Highly selective vagotomy in the rat: effects on bone and mineral metabolism.

Highly selective vagotomy (HSV) or sham operation was performed in male rats. Fifteen weeks later bone mineralization, fractional intestinal absorption and balance, urinary excretion, and serum levels of calcium, magnesium and phosphorus, together with serum gastrin, parathyroid hormone, calcitonin, vitamin D metabolites, osteocalcin, isoenzymes of alkaline phosphatase, and the urinary excretion of cyclic AMP and hydroxyproline were assessed. HSV induced chronic hypergastrinemia and enhanced the weight of the fundus, antrum, and pancreas. Body weight, food intake, intestinal absorption, mineral balance, and bone mineralization were unaffected by HSV, whereas serum parathyroid hormone levels and urinary hydroxyproline excretion were increased. It is concluded that in the rat 1) HSV has a trophic effect on gastric and extragastric tissues; 2) gastric acid production is not a major determinant of intestinal calcium absorption; and 3) normal bone mass in the presence of signs of hyperparathyroidism indicates an intrinsic capacity of HSV to interfere with calcium metabolism, probably via hypergastrinemia, gastrin being an element of the gastro-parathyroid axis. Our present findings underscore the fact that osteopenia after HSV in man may be a rare finding, but it cannot be ruled out that bone disease found after partial or total gastrectomy may be due in part to concomitant vagotomy.

Parathyroid Hormone and Cardiovascular Effects of Dihydropyridines in Chronic Renal Failure

We studied the influence of parathyroid gland activity on cardiovascular response to dihydropyridines (nicardipine (NIC), 80 mg/day for 4 weeks) in 20 hypertensive patients with end-stage renal failure (ESRF). Before the treatment hyperparathyroidism (HPTH) was estimated on the basis of serum parathormone (PTH), and bone histomorphometry (osteoclastic resorption surfaces (ORS), and number of osteoclasts (NO]. NIC induced a significant decrease in systolic (SAP) and diastolic (DAP) arterial blood pressure, but did not significantly change the heart rate (HR) or the SAP X HR (myocardial oxygen consumption estimate). Changes in SAP and DAP were correlated to baseline serum PTH (P less than .001), to ORS (P less than .01) and to NO (P less than .01). Furthermore, a significant decrease in blood pressure was observed only in patients with histological signs of hyperparathyroidism (ORS greater than 1%). In this subset of patients NIC induced a significant decrease in SAP X HR (P less than .02) which was correlated to PTH and histomorphometric indexes of HPTH (P less than .01). The results of the present study show that blood pressure response to dihydropyridines in ESRF is associated with parathyroid activity as judged from serum PTH and bone histomorphometry.

A peripheral giant-cell granuloma manifestation of primary hyperparathyroidism: report of case

Profuse granulomatous masses of the gingiva frequently occur in patients with gingival and periodontal disease. A 33-year-old female was seen for followup of a previously treated peripheral giant-cell granuloma. Two years earlier, a mass had been removed from the gingiva between the maxillary right central and lateral incisors. Current laboratory test results indicated hyperparathyroidism, and led to the discovery of a parathyroid adenoma. After the gingival lesion, adjacent teeth, and parathyroid adenoma were removed, the patient had no further recurrence of the lesion or signs of hyperparathyroidism.

Bilateral Symmetrical Metastases to the Clavicular Heads from Bronchogenic Carcinoma Simulating Primary Hyperparathyroidism

A case of bronchogenic carcinoma with signs of hyperparathyroidism and bilateral symmetrical metastasis to the clavicles is presented. Ectopic hyperparathyroidism was confirmed. The clinical and laboratory differentiation of primary and ectopic hyperparathyroidism is discussed. A case of bronchogenic carcinoma with signs of hyperparathyroidism and bilateral symmetrical metastasis to the clavicles is presented. Ectopic hyperparathyroidism was confirmed. The clinical and laboratory differentiation of primary and ectopic hyperparathyroidism is discussed.