Images
Presentation
We summarize the clinical presentation and pathophysiology of pseudogout following parathyroidectomy. We present a case of a 71-year-old woman who developed pseudogout following removal of a parathyroid adenoma. [ncbi.nlm.nih.gov]
Entire Body System
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HELLP Syndrome
CASE: A 27-year-old primigravida at 32 3 weeks' gestation had a serum calcium level in excess of 2.75 mmol/L and evidence of HELLP syndrome. She underwent concurrent parathyroidectomy and Caesarean section. [ncbi.nlm.nih.gov]
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Amyloidosis
Histology of the lesions revealed that the patient was in fact suffering from amyloidosis. [ncbi.nlm.nih.gov]
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Medication Noncompliance
Initially, severe hypocalcemia (corrected Ca: 4.8-5.6mg/dL; nadir ionized Ca: 0.57-0.69mmol/L) was attributed solely to medical noncompliance with oral Ca carbonate (3750mg, 3 /day between meals) and calcitriol (2-4mcg/day). [ncbi.nlm.nih.gov]
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Noncompliance
Initially, severe hypocalcemia (corrected Ca: 4.8-5.6mg/dL; nadir ionized Ca: 0.57-0.69mmol/L) was attributed solely to medical noncompliance with oral Ca carbonate (3750mg, 3 /day between meals) and calcitriol (2-4mcg/day). [ncbi.nlm.nih.gov]
Gastrointestinal
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Left Flank Pain
Our patient is a 16-yr-old male presenting with gross hematuria, left flank pain, and right foot pain. A biochemical evaluation revealed hypercalcemia and elevated parathyroid hormone levels. [ncbi.nlm.nih.gov]
Eyes
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Abnormal Eye Movement
Postoperatively, she demonstrated symptoms and signs of serotonin syndrome; specifically tachycardia, agitation, dystonia and abnormal eye movements. These clinical findings spontaneously resolved themselves over the subsequent 48 hr. [ncbi.nlm.nih.gov]
Musculoskeletal
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Foot Pain
Our patient is a 16-yr-old male presenting with gross hematuria, left flank pain, and right foot pain. A biochemical evaluation revealed hypercalcemia and elevated parathyroid hormone levels. [ncbi.nlm.nih.gov]
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Elbow Pain
On the first post-operative day, she complained of left elbow painful swelling with redness and warmth. Arthrocentesis of left elbow was done due to suspicion of septic arthritis. [ncbi.nlm.nih.gov]
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Elbow Swelling
Her left elbow swelling and pain resolved. Pseudogout flare is a rare but known sequelae after parathyroidectomy. Early recognition and expeditious treatment is essential. [ncbi.nlm.nih.gov]
Face, Head & Neck
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Neck Mass
Although rare, chylomas can present as a neck mass, especially in the post-operative setting. Here, we present a case of a persistent cervical chyloma following parathyroidectomy and propose a management algorithm for this clinical entity. [ncbi.nlm.nih.gov]
Psychiatrical
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Compulsive Disorder
The patient had a background of obsessive compulsive disorder treated with paroxetine. Postoperatively, she demonstrated symptoms and signs of serotonin syndrome; specifically tachycardia, agitation, dystonia and abnormal eye movements. [ncbi.nlm.nih.gov]
Neurologic
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Altered Mental Status
The lengths of stay for patients experiencing post-operative altered mental status (18.7d), post-operative infection (15.5d), respiratory complications (19d), and cardiac complications (13d) were significantly increased compared to individuals without [ncbi.nlm.nih.gov]
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Dystonia
Postoperatively, she demonstrated symptoms and signs of serotonin syndrome; specifically tachycardia, agitation, dystonia and abnormal eye movements. These clinical findings spontaneously resolved themselves over the subsequent 48 hr. [ncbi.nlm.nih.gov]
Workup
We present a review of the literature and discuss elements of the history and physical examination suggestive of occult CVS, with additional workup proposed for appropriate cases. [ncbi.nlm.nih.gov]
Workup for hyperparathyroidism includes an intact PTH level with a serum calcium level, 24 hour urine calcium, sestimibi-parathyroid scan, and ultrasound of the thyroid and parathyroid. Dr. Alfred Simental and Dr. Paul D. [medical-center.lomalindahealth.org]
This results in a workup to exclude a multitude of other causes of Hypercalcemia, and ensure the diagnosis is correct. A thorough history is obtained to exclude drug induced Hypercalcemia, or other medical conditions causing Hypercalcemia. [ent.uci.edu]
In my pre-surgical workup, I weighed 102 lbs, pretty standard for me. The surgery was necessary and beneficial, but I now weigh 135 lbs. This is more than I weighed when I was pregnant and overdue! [steadyhealth.com]
X-Ray
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Soft Tissue Calcification
We believe that this is due to a decreased PTH level and decreasing bone turnover which resulted in more circulating calcium facilitating vascular and soft tissue calcification. [ncbi.nlm.nih.gov]
We also noted muscular weakness (18 patients, 62.1%), pruritus (12 patients, 41.4%), high blood pressure (12 patients, 41.4%), soft tissue calcification (4 patients, 13.8%). [cyberleninka.org]
Calcimimetics not only control serum calcium, phosphorus and parathyroid hormone in patients with calciphylaxis secondary to hyperparathyroidism, but also help in regression of soft tissue calcification. [sjkdt.org]
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Pericardial Effusion
Other past medical history included atrial fibrillation, type II diabetes mellitus, hypertension, gout, pericardial effusion needing pericardial window, deep vein thrombosis, mitral insufficiency, and cardiomyopathy with implantable cardioversion device [ncbi.nlm.nih.gov]
Serum
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Calcium Decreased
Patient 1 received oral alendronate, 30 mg/day for four weeks; his calcium decreased from 14 to 11.6 mg/dL, and his UDPD from 342 to 160 nmol/mmol Cr. [ncbi.nlm.nih.gov]
By negative feed back, raised serum ionised calcium decreases PTH secretion to maintain adequate serum calcium levels [ 3 ]. [omicsonline.org]
After 4 weeks of cinacalcet HCl therapy in our patient, predose calcium decreased by 0.15 mmol/L. [clinchem.aaccjnls.org]
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Potassium Increased
RESULTS: Serum potassium level increased in 108 patients after surgery (P CONCLUSIONS: Preoperative serum potassium increased after parathyroidectomy with autotransplantation in patients with secondary hyperparathyroidism. [ncbi.nlm.nih.gov]
Treatment
The existing CSs indicate PTX-treatment versus non-PTX-treatment might reduce the risk of fracture in PHPT patients. [ncbi.nlm.nih.gov]
Prognosis
Most microcarcinomas are slow growing and have a favorable prognosis. Lymph node metastasis caused by thyroid microcarcinoma is uncommon, and distant metastasis to lung or bone is even rarer. [ncbi.nlm.nih.gov]
Etiology
The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study. [ncbi.nlm.nih.gov]
No associated variations were identified, and the diagnosis remained persistent primary hyperparathyroidism of unknown etiology. [clinchem.aaccjnls.org]
[…] controls matched for age, gender, and ethnic group) Neuromuscular symptoms: documented proximal weakness, atrophy, hyper-reflexia, and agait distubance Hereditary Hyperparathyroidism: Although cases of sporadic hyperparathyroidism are idiopathic and the etiology [medicine.uiowa.edu]
Epidemiology
The effect of PTx on fractures has been evaluated in only one epidemiological study from the United States, which demonstrated a significant association of PTx and lower hip and combined fractures. [ncbi.nlm.nih.gov]
Immortal time bias in pharmaco-epidemiology. Am. J. Epidemiol. 167, 492–499 (2008). [nature.com]
Several recent studies have reported on the epidemiology of pHPT [ 1, 13 – 17 ], yet few reported on parathyroidectomy rates [ 14, 15 ]. [journals.plos.org]
Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the GFR [ 10 ]. [karger.com]
Adami S, Marcocci C, Gatti D (2002) Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 17 Suppl 2: N18-23. Khan A, Bilezikian J (2000) Primary hyperparathyroidism: pathophysiology and impact on bone. CMAJ 163: 184-187. [omicsonline.org]
Pathophysiology
We summarize the clinical presentation and pathophysiology of pseudogout following parathyroidectomy. We present a case of a 71-year-old woman who developed pseudogout following removal of a parathyroid adenoma. [ncbi.nlm.nih.gov]
Khan A, Bilezikian J (2000) Primary hyperparathyroidism: pathophysiology and impact on bone. CMAJ 163: 184-187. Camanni F, Ghigo E Eds (2011) Malattie del sistema endocrino e del metabolismo - IV ed. Edi.Ermes, Milano. [omicsonline.org]
Safe and effective parathyroidectomy requires mastery of the anatomical and pathophysiologic features of pHPT (eAppendix in the Supplement ). [doi.org]
Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol. 1997;13(2):78–86. CrossRef PubMed 9. Li S, Chen YW, Peng Y, et al. [springermedizin.at]
Prevention
He had been administered calcium carbonate 6.0 g daily to prevent reabsorption of phosphorus and alfacalcidol 1.0 microg three times weekly at the end of hemodialysis. [ncbi.nlm.nih.gov]
Calcium supplements are therefore often required to prevent symptoms of hypocalcemia and to restore lost bone mass. [en.wikipedia.org]