MyMedR

Fulltext Primary hyperparathyroidism--a surgical review of 12 cases

Meah FA, Tan TT, Taha A, Khalid BA

Med J Malaysia, 1991 Jun;46(2):144-9.

Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.

Matched MeSH terms: Hyperparathyroidism/diagnosis*; Hyperparathyroidism/surgery

Fulltext Pancreatitis in primary hyperparathyroidism

Abdullah M

Med J Malaysia, 2003 Oct;58(4):600-3.

PMID: 15190638

The cause and effect relationship between acute pancreatitis and primary hyperparathyroidism (pHPT) still evokes controversy. Our paper reviews the debate in the medical literature. In this controversy we add a case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. His raised serum calcium was realized rather late. Eventually, high intact parathyroid hormone levels led to open neck exploration and finding of a solitary parathyroid adenoma. Post-surgery, serum calcium returned to normal and abdominal symptoms disappeared. The case report and the accompanying literature review support our belief, that acute pancreatitis is one of the symptoms of pHPT often caused by a parathyroid adenoma and curable by its excision.

Matched MeSH terms: Hyperparathyroidism/complications*; Hyperparathyroidism/surgery

Fulltext Osseous haemophilic pseudotumour and concurrent primary hyperparathyroidism: a diagnostic conundrum

Low SF, Sridharan R, Ngiu CS, Haflah NH

BMJ Case Rep, 2014;2014.

PMID: 24729114 DOI: 10.1136/bcr-2013-203282

Pseudotumours are rare, occurring in 1-2% of severe haemophiliacs. Osseous locations are far less frequent than soft tissue location. We report a case of a 43-year-old man with haemophilia A, who presented with a gradually enlarging left thigh mass for 8 months. There were no constitutional symptoms. Plain radiograph showed an expansile lytic lesion with 'soap-bubble' appearance arising from the left femur diaphysis. On MRI, it appeared as a non-enhancing, multilobulated lesion expanding the medullary and subperiosteal spaces. The mass exhibited concentric ring sign with heterogeneous intermediate signal intensity in the core lesion, reflective of chronic haematoma with blood degradation products of different stages. A diagnosis of haemophilic pseudotumour was made. Hypercalcaemia, however, raised a diagnostic dilemma as bone malignancy needed to be considered. An open excisional biopsy and subsequent amputation confirmed the diagnosis of osseous haemophilic pseudotumour. Nuclear medicine study later revealed a concurrent parathyroid adenoma.

Matched MeSH terms: Hyperparathyroidism, Primary/complications*

Metabolic Superscan on 18 F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

Mohd Rohani MF, Bujang NL, Rosdi AH, Amir Hassan SZ

Clin Nucl Med, 2024 Jan 01;49(1):e19-e21.

PMID: 37883221 DOI: 10.1097/RLU.0000000000004941

Superscan on PET/CT has been reported in the literature and mainly involved metastatic diseases. We report an uncommon case of a metabolic superscan on 18 F-FDG PET/CT in a 56-year-old man with end-stage renal disease on hemodialysis who presented with secondary hyperparathyroidism. Parathyroid scintigraphy showed 2 lesions posteroinferior to both thyroid lobes, suggestive of parathyroid adenoma/hyperplasia. FDG PET/CT performed to assess for pulmonary nodules revealed diffuse FDG hypermetabolism involving the visualized skull, mandible, spine, sternum, ribs, and appendicular skeleton without corresponding CT lesion with no urinary radiotracer excretion, consistent with metabolic superscan secondary to renal osteodystrophy.

Matched MeSH terms: Hyperparathyroidism, Primary*

Fulltext Surgical outcome of patients with hyperparathyroidism in a non-specialist surgical ward

Roslani AC, Chang NL

Med J Malaysia, 2006 Oct;61(4):410-5.

PMID: 17243517

Aim of the study was to audit patients who had undergone parathyroidectomy in University of Malaya Medical Centre (UMMC), and compare surgical outcomes with that in the literature. Data on demography, aetiology, surgical indications, pre-operative localization, surgery and complications was obtained retrospectively from medical records of patients undergoing parathyroidectomy between 1st October 2000 to 31st October 2005. Twelve patients were identified. Mean age was 50.6 years. Sixty seven percent were females. The ratio of Chinese, Malays and Indians was 7:4:1. Most surgeries were performed in the last two years (91.7%). Aetiology was mainly tertiary hyperparathyroidism (83%). All patients had pre-operative ultrasound localization. Half underwent total parathyroidectomy without autotransplantation. There were no re-do operations. Mean duration of surgery was 1.96 hours. All patients had abnormal calcium levels at some point following surgery, but 90% were normocalcaemic at last follow up. Other complications were recurrent laryngeal nerve injury (one) and wound infection (one). There were no peri-operative mortalities. The mean duration of hospital stay was 7.75 days (range 3-17 days). The median duration of follow-up was 11 months. The outcome of parathyroidectomy in UMMC is satisfactory with few major complications. Despite this, intensive effort is needed to further improve these results to match those obtained in specialist endocrine centres.

Matched MeSH terms: Hyperparathyroidism/surgery*; Hyperparathyroidism, Secondary/surgery

Fulltext Recognition and management of hungry bone syndrome--a case report

Hisham AN, Aina EN, Zanariah H

Med J Malaysia, 2000 Mar;55(1):132-4.

PMID: 11072498

Hungry bone syndrome (HBS) following successful parathyroid surgery is a well described phenomenon. However, few studies have clearly addressed this syndrome or looked at the outcome of perioperative management. We report a case of HBS following successful parathyroid surgery. The perioperative management is discussed and literature pertaining to this interesting case is reviewed.

Matched MeSH terms: Hyperparathyroidism/surgery*

Fulltext Primary hyperparathyroidism with vitamin D deficiency in third trimester of pregnancy

Tong, Chin Voon, Mohamad Rafie Md Kaslan

International e-Journal of Science, Medicine & Education, 2015;9(3):47-51.

MyJurnal

In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy

Matched MeSH terms: Hyperparathyroidism, Secondary; Hyperparathyroidism, Primary

Fulltext Variants in ZFX are associated with an X-linked neurodevelopmental disorder with recurrent facial gestalt

Shepherdson JL, Hutchison K, Don DW, McGillivray G, Choi TI, Allan CA, et al.

Am J Hum Genet, 2024 Mar 07;111(3):487-508.

PMID: 38325380 DOI: 10.1016/j.ajhg.2024.01.007

Pathogenic variants in multiple genes on the X chromosome have been implicated in syndromic and non-syndromic intellectual disability disorders. ZFX on Xp22.11 encodes a transcription factor that has been linked to diverse processes including oncogenesis and development, but germline variants have not been characterized in association with disease. Here, we present clinical and molecular characterization of 18 individuals with germline ZFX variants. Exome or genome sequencing revealed 11 variants in 18 subjects (14 males and 4 females) from 16 unrelated families. Four missense variants were identified in 11 subjects, with seven truncation variants in the remaining individuals. Clinical findings included developmental delay/intellectual disability, behavioral abnormalities, hypotonia, and congenital anomalies. Overlapping and recurrent facial features were identified in all subjects, including thickening and medial broadening of eyebrows, variations in the shape of the face, external eye abnormalities, smooth and/or long philtrum, and ear abnormalities. Hyperparathyroidism was found in four families with missense variants, and enrichment of different tumor types was observed. In molecular studies, DNA-binding domain variants elicited differential expression of a small set of target genes relative to wild-type ZFX in cultured cells, suggesting a gain or loss of transcriptional activity. Additionally, a zebrafish model of ZFX loss displayed an altered behavioral phenotype, providing additional evidence for the functional significance of ZFX. Our clinical and experimental data support that variants in ZFX are associated with an X-linked intellectual disability syndrome characterized by a recurrent facial gestalt, neurocognitive and behavioral abnormalities, and an increased risk for congenital anomalies and hyperparathyroidism.

Matched MeSH terms: Hyperparathyroidism*

International evaluation of unrecognizably uglifying human faces in late and severe secondary hyperparathyroidism in chronic kidney disease. Sagliker syndrome. A unique catastrophic entity, cytogenetic studies for chromosomal abnormalities, calcium-sensing receptor gene and GNAS1 mutations. Striking and promising missense mutations on the GNAS1 gene exons 1, 4, 10, 4

Yildiz I, Sagliker Y, Demirhan O, Tunc E, Inandiklioglu N, Tasdemir D, et al.

J Ren Nutr, 2012 Jan;22(1):157-61.

PMID: 22200434 DOI: 10.1053/j.jrn.2011.10.030

Hypotheses explaining pathogenesis of secondary hyperparathyroidism (SH) in late and severe CKD as a unique entity called Sagliker syndrome (SS) are still unclear. This international study contains 60 patients from Turkey, India, Malaysia, China, Romania, Egypt, Tunisia, Taiwan, Mexico, Algeria, Poland, Russia, and Iran. We examined patients and first degree relatives for cytogenetic chromosomal abnormalities, calcium sensing receptor (Ca SR) genes in exons 2 and 3 abnormalities and GNAS1 genes mutations in exons 1, 4, 5, 7, 10, 13. Our syndrome could be a new syndrome in between SH, CKD, and hereditary bone dystrophies. We could not find chromosomal abnormalities in cytogenetics and on Ca SR gene exons 2 and 3. Interestingly, we did find promising missense mutations on the GNAS1 gene exons 1, 4, 10, 4. We finally thought that those catastrophic bone diseases were severe SH and its late treatments due to monetary deficiencies and iatrogenic mistreatments not started as early as possible. This was a sine qua non humanity task. Those brand new striking GNAS1 genes missense mutations have to be considered from now on for the genesis of SS.

Matched MeSH terms: Hyperparathyroidism, Secondary/genetics*; Hyperparathyroidism, Secondary/pathology; Hyperparathyroidism, Secondary/physiopathology

Fulltext Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism

Cheong YT, Taib NA, Normayah K, Hisham AN

Asian J Surg, 2009 Jan;32(1):51-4.

PMID: 19321403 DOI: 10.1016/S1015-9584(09)60009-9

Renal hyperparathyroidism with attendant osteodystrophy is a frequent and severe morbidity affecting the quality of life of end stage renal failure patients surviving on long-term renal replacement therapy. A small subgroup of these patients with severe cardiorespiratory dysfunction was deemed at very high risk for general anaesthesia (GA). We report on a series of total parathyroidectomy under local anaesthesia (LA) for these patients.

Matched MeSH terms: Hyperparathyroidism, Secondary/etiology; Hyperparathyroidism, Secondary/surgery*

Hypercalcaemic crisis: immediate parathyroidectomy and intraoperative intravenous calcium infusion improves outcome

Harjit K, Zanariah H, Hisham AN

Asian J Surg, 2007 Jul;30(3):173-7.

PMID: 17638635

The hypercalcaemic crisis of hyperparathyroidism is an endocrine emergency that is invariably fatal if untreated. Despite emergency parathyroidectomies to treat hypercalcaemic crisis, mortality rates remain high. The rapid decline of serum calcium levels after removal of an adenoma and its adverse effect on the heart contributes to the development of postoperative complications and death. The cornerstone of surgical treatment for hypercalcaemic crisis is to begin infusion of high doses of calcium immediately after successful removal of parathyroid adenomas to allow gradual and well-controlled decline of serum calcium to avoid fatal myocardial complications.

Matched MeSH terms: Hyperparathyroidism, Primary/complications; Hyperparathyroidism, Primary/therapy

Effect of vitamin D replacement in primary hyperparathyroidism with concurrent vitamin D deficiency: a systematic review and meta-analysis

Loh HH, Lim LL, Yee A, Loh HS, Vethakkan SR

Minerva Endocrinol., 2019 Jun;44(2):221-231.

PMID: 28294593 DOI: 10.23736/S0391-1977.17.02584-6

INTRODUCTION: We conducted a meta-analysis to assess the effects of vitamin D replacement on biochemical and skeletal parameters in subjects with mild primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency.

EVIDENCE ACQUISITION: A systematic search of all English-language medical literature published from 1980 till May 2016 using PubMed, Embase and Ovid was performed. Nine observational studies were evaluated after fulfilling the inclusion and exclusion criteria.

EVIDENCE SYNTHESIS: A total of 547 patients were examined. All studies used vitamin D2/D3 or calcifediol (25-hydroxyvitamin D3), There was significant improvement of serum 25(OH)D with unchanged serum iPTH level after vitamin D replacement, with pooled d+: 3.10 (95% CI 2.25 to 3.95), P<0.01 and pooled d+: 0.82 (95% CI -0.35 to 1.98), P=0.16 respectively. There was neither worsening of the pre-existing hypercalcemia (pooled d+: -0.27 [95% CI -1.09 to 0.64, P=0.56]) nor hypercalciuria (pooled d+: 3.64 [95% CI -0.55 to 7.83, P=0.09]). Two studies assessed in this meta-analysis reported unchanged bone density with vitamin D replacement.

CONCLUSIONS: Vitamin D replacement in subjects with mild PHPT and coexistent vitamin D deficiency improved serum 25(OH)D level without worsening of pre-existing hypercalcemia or hypercalciuria. Well-designed multicenter randomized controlled trials examining pre- and postoperative outcomes of vitamin D therapy in patients with different severities of PHPT and vitamin D inadequacy are warranted to elucidate the most appropriate vitamin D treatment protocol and determine the long-term safety concerns.

Matched MeSH terms: Hyperparathyroidism, Primary/complications*; Hyperparathyroidism, Primary/drug therapy*

Is survival enough for quality of life in Sagliker Syndrome-uglifying human face appearances in chronic kidney disease?

Sagliker Y, Acharya V, Golea O, Sabry A, Bali M, Eyupoglu K, et al.

J Nephrol, 2008 Mar-Apr;21 Suppl 13:S134-8.

PMID: 18446747

It is known that secondary hyperparathyroidism (SH) and particularly skeletal changes is a severe condition in chronic kidney disease (CKD). Sagliker syndrome (SS) is a very prominent feature in CKD including uglifying human face appearances, short stature, extremely severe maxillary and mandibulary changes, soft tissues in the mouth, teeth-dental abnormalities, finger tip changes and severe psychological problems.

Matched MeSH terms: Hyperparathyroidism, Secondary/complications; Hyperparathyroidism, Secondary/etiology*; Hyperparathyroidism, Secondary/pathology; Hyperparathyroidism, Secondary/psychology

Intravenous calcitriol versus paricalcitol in haemodialysis patients with severe secondary hyperparathyroidism

Abdul Gafor AH, Saidin R, Loo CY, Mohd R, Zainudin S, Shah SA, et al.

Nephrology (Carlton), 2009 Aug;14(5):488-92.

PMID: 19298641 DOI: 10.1111/j.1440-1797.2008.01058.x

Secondary hyperparathyroidism (SHPT) is common among haemodialysis patients. Intensive treatment with calcitriol is often complicated by hypercalcaemia, hyperphosphataemia and elevated calcium phosphorus (Ca X PO(4)) product. Paricalcitol is a vitamin D analogue developed to overcome some of the limitations of calcitriol therapy. The study objectives were to compare the response of intact parathyroid hormone (iPTH) and the incidence of hypercalcaemia, hyperphosphataemia and elevated Ca X PO(4) product in patients with severe SHPT treated with either i.v. calcitriol or i.v. paricalcitol.

Matched MeSH terms: Hyperparathyroidism, Secondary/blood; Hyperparathyroidism, Secondary/drug therapy*

Primary hyperparathyroidism presenting with pathological fracture

Deshmukh RG, Alsagoff SA, Krishnan S, Dhillon KS, Khir AS

J R Coll Surg Edinb, 1998 Dec;43(6):424-7.

PMID: 9990797

Primary hyperparathyroidism (PHPT) is an intriguing condition. Routine automated biochemical screening has made the diagnosis commonplace in developed countries and the disease is diagnosed early in its course when it is often asymptomatic. In developing countries or in recent immigrants from these countries, PHPT is often seen in an advanced stage with bone involvement. Associated dietary deficiencies may alter the biochemical profile and cause a diagnostic dilemma. It is important to include it in the differential diagnosis of pathological fractures. We report three cases of PHPT presenting with pathological fractures and discuss their diagnosis and management.

Matched MeSH terms: Hyperparathyroidism/complications*; Hyperparathyroidism/diagnosis

Resolution of rare palatal brown tumour after parathyroidectomy

Lim CT, Thevandran TK

Clin Exp Nephrol, 2017 Apr;21(2):352-353.

PMID: 27339441 DOI: 10.1007/s10157-016-1292-6

Matched MeSH terms: Hyperparathyroidism, Secondary/diagnosis; Hyperparathyroidism, Secondary/etiology; Hyperparathyroidism, Secondary/surgery*

Fulltext Bilateral Genu Valgum in an Adolescent with Primary Hyperparathyroidism: A Case Report and Review of Literature

Lee SP, Chai ST, Loh LT, Ali NM

J ASEAN Fed Endocr Soc, 2020;35(2):220-223.

PMID: 33442194 DOI: 10.15605/jafes.035.02.07

Primary hyperparathyroidism in children and adolescents is rare and often symptomatic at presentation. A 15-year-old bo presented with bilateral genu valgum for two years. Biochemical results were consistent with primary hyperparathyroidism Calcium levels normalized two months after removal of a left inferior parathyroid adenoma.

Matched MeSH terms: Hyperparathyroidism, Primary

Fulltext Communicating Hydrocephalus in a Case of Long-Term Primary Hyperparathyroidism

Ooi CP, Mustafa N, Kew TY

J ASEAN Fed Endocr Soc, 2018;33(1):49-52.

PMID: 33442110 DOI: 10.15605/jafes.033.01.08

We present the rare case of a 47-year-old woman with protracted primary hyperparathyroidism complicated by communicating hydrocephalus and cerebellar tonsillar herniation secondary to calvarial thickening. The parathyroid glands remained elusive, despite the use of advanced preoperative imaging modalities and three neck explorations. The serum calcium was optimally controlled with cinacalcet and alfacalcidol. Awareness of this rare complication is essential for early diagnosis and prompt intervention to prevent fatal posterior brain herniation.

Matched MeSH terms: Hyperparathyroidism, Primary

Large retrosternal parathyroid carcinoma with primary hyperparathyroidism

Tan GC, Shiran MS, Swaminathan M, Phang KS, Rohaizak M

Asian J Surg, 2007 Oct;30(4):286-9.

PMID: 17962134

Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcaemia, accounting for less than 1% of all cases of hyperparathyroidism. Parathyroid carcinoma is an indolent tumour with rather low malignant potential. Consideration of parathyroid carcinoma in the differential diagnosis of hypercalcaemic disorders is important because the morbidity and mortality are substantial and the best prognosis is associated with early recognition and surgical resection. Clinical indicators favouring parathyroid carcinoma over benign disease include markedly raised serum calcium levels, PTH and alkaline phosphatase. A palpable neck mass with both kidney and skeletal manifestations also give a high index of suspicion of parathyroid carcinoma. Histopathology alone is not sufficient to diagnose parathyroid cancer; it has to be correlated with the clinical findings. The initial and most effective treatment for parathyroid carcinoma is complete resection of the primary lesion, and repeated operations for recurrence are useful. The prognosis of parathyroid carcinomas is quite variable; 5-year survival rates vary from 40% to 86%, while the 10-year survival rate is approximately 49%. We report a case of parathyroid carcinoma occurring in a 55-year-old woman who presented with bone pain and hypercalcaemia.

Matched MeSH terms: Hyperparathyroidism, Primary/etiology*

Primary hyperparathyroidism: a rare cause of genu valgus in adolescence

Ratnasingam J, Tan AT, Vethakkan SR, Paramasivam SS, Ibrahim L, Lim LL, et al.

J Clin Endocrinol Metab, 2013 Mar;98(3):869-70.

PMID: 23337722 DOI: 10.1210/jc.2012-3839

Matched MeSH terms: Hyperparathyroidism, Primary/complications*

Displaying publications 1 - 20 of 34 in total