Presentation
Methods: We present a case series of parathyroid lipoadenomas. [mayoclinic.pure.elsevier.com]
Even though this is a rare diagnosis, its presence should be considered in any patient with Turner’s syndrome presenting with severe osteoporosis and a rise in serum calcium during treatment. [journals.viamedica.pl]
Our days nephrocalcinosis is a very rare presentation of hyperparathyroidism due to the modern diagnostic technics and also the non-limitation in analyzing the phospho-calcic balance. [umbalk.org]
Case presentation A 12 year old Sri Lankan girl presented with progressive difficulty in walking since 1 year. On examination she had bilateral genu valgum. [bmcendocrdisord.biomedcentral.com]
This case highlights the rare presentation of cystic parathyroid adenoma with hypercalcemic crisis. [ijpmonline.org]
Entire Body System
- Malaise
She presented history of malaise, fatigue, myalgias, cramps and paresthesia. She denied diarrhea, recent treatment with diuretics or laxatives. Her physical exam was normal. [endocrine-abstracts.org]
Other symptoms include fatigue, loss of concentration, malaise, bone pain, polydipsia, polyuria, and depression. [shifrinmd.com]
A complete review of systems was unremarkable, with absence of any symptoms of hypercalcaemia such as fatigue, malaise, joint pain, polyuria, or abdominal discomfort. She did not give any history suggestive of renal failure or bone. [medcraveonline.com]
- Malnutrition
Other causes of hypomagnesemia include malnutrition, malabsorption, diabetes, chronic diarrhea, certain kidney disorders, and the use of certain medications. [rarediseases.org]
Musculoskeletal
- Osteopenia
CT chest demonstrated diffuse osteopenia with brown tumor on the left fourth rib. [shmabstracts.com]
Skeletal x-rays showed widespread lytic lesions with osteopenia and subperiosteal erosions, illustrated here by x-ray of the right hand ( Figure, B) where marked subperiosteal bone resorption can be seen; note the ill-defined phalangeal cortex (thick [mja.com.au]
Radiographs revealed fracture middle one-third of right femur, osteopenia and with subperiosteal resorption (figure 2a) Figure 2a. severe osteopenia with pathological fracture of right femur. [bjmp.org]
This loss of calcium from the bones can lead to weak, brittle bones (osteopenia and osteoporosis) and bone fractures. When the blood with this high calcium goes through the kidneys, the calcium may be filtered into the urine. [cedars-sinai.edu]
Treatment with antiresorptive agents may be indicated in patients with osteopenia or osteoporosis. [enotes.tripod.com]
- Muscle Cramp
The symptoms can be similar to hypercalcemia and include tingling in the extremities, muscle cramps, and even convulsions. [thyroid-parathyroid.com]
Hypoparathyroidism Symptoms Symptoms can range from quite mild (tingling in the hands, fingers, and around the mouth) to more severe forms of muscle cramps. [endocrineweb.com]
Symptoms of Hypoparathyroidism Patients with hypoparathyroidism very often complain of the following symptoms: Tingling of the lips and hands (due to muscle spasms and overactive nerves), muscle cramps, and pain in face, legs, feet Dry hair, brittle nails [hypopara.org]
The symptoms of hypoparathyroidism are synonymous with hypocalcemia and can range from quite mild (tingling in the hands, fingers, and around the mouth) to more severe forms of muscle cramps leading all the way to tetany (severe muscle cramping of the [parathyroid.com]
Hypocalcemia can cause a variety of symptoms including weakness, muscle cramps, excessive nervousness, headaches, and/or uncontrollable twitching and cramping spasms of certain muscles such as those of the hands, feet, arms, legs, and/or face (tetany) [rarediseases.org]
- Severe Osteoporosis
Even though this is a rare diagnosis, its presence should be considered in any patient with Turner’s syndrome presenting with severe osteoporosis and a rise in serum calcium during treatment. [journals.viamedica.pl]
She was referred to endocrinology after DEXA scan showed severe osteoporosis with T score of -4.1. She also had elevated calcium and parathyroid hormone (PTH) and undetectable Vitamin D levels. [shmabstracts.com]
However, in this age group the emphasis is often on the health of the bones (severe osteoporosis) or the health of the mind. Osteoporosis will occur in ALL patients with parathyroid disease given enough time (a few years). [parathyroid.com]
- Hip Dislocation
Seizure associated trauma was reported to occur in the shoulder region causing posterior dislocation, in the spine causing compression fractures of the vertebrae and in the pelvis causing hip dislocation and femoral neck fracture; its incidence was estimated [ispub.com]
- Back Pain
He was suffering from thoracic back pain for 3 months without any specific medical investigation such as NSAIDs or steroids. [edmcasereports.com]
Workup
Diagnostic workup includes physical examination, laboratory confirmation, neck Ultrasound (US), Tc-Sestamibi scintigraphy, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and Fine-Needle Aspiration (FNA) biopsy. [omicsonline.org]
Workup Laboratory studies Total serum calcium and albumin levels or ionized calcium levels should be measured. Hypercalcemia should be documented on more than one occasion before a diagnostic workup is undertaken. [emedicine.medscape.com]
X-Ray
- X-Ray Abnormal
such as: + Elevated alkaline phosphatase, + Hypophosphatemia, + Hypercalciuria Shortened QT interval on electrocardiogram X-ray abnormalities, including: + Brown tumors, + Resorption of distal phalanges, + Resorption of distal clavicles, + “Salt and [enotes.tripod.com]
Treatment
A 77-year-old man, 11 years under chronic hemodialysis treatment for chronic renal failure of unknown origin, presented with anterior chest pain, dyspnea with paradoxical breathing, and sternal instability after a simple fall from a standing height. [ncbi.nlm.nih.gov]
After primary evaluation, she underwent treatment with calcium and vitamin D supplement with the diagnosis of osteomalacia in Turner’s syndrome. [journals.viamedica.pl]
You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments. [rarediseases.info.nih.gov]
Chemotherapy and external beam radiation treatments have been generally ineffective in the treatment of parathyroid carcinoma. [scienceopen.com]
The treatment of brown tumor varies from case to case. However, the treatment of choice in a patient with primary hyperparathyroidism is most commonly surgical excision of offending parathyroid glands. [edmcasereports.com]
Prognosis
Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: Whether the calcium level in the blood can be controlled. The stage of the cancer. [rarecancers.org.au]
Prognosis The regular monitoring required to ensure appropriate calcium levels means that the prognosis is challenging for many people. This may improve if synthetic PTH becomes widely available. [patient.info]
The patient's prognosis is favourable, but the possibility of renal transplantation to prevent relapse and the development of further BT will have to be considered. References [1] H. Ito, E. [revistanefrologia.com]
Outlook for Hyperparathyroidism In most cases, if primary hyperparathyroidism is diagnosed early and treated effectively, the prognosis is positive. However, the outlook for secondary and tertiary hyperparathyroidism is not as good. [medic8.com]
Prognosis The reported survival rate is less than 50% to 85% at 10 years. [shifrinmd.com]
Etiology
Here, we present the case of a 51-year-old woman who began hemodialysis in 1986 due to chronic kidney disease of unknown etiology and developed SHPT in 1999. [ncbi.nlm.nih.gov]
Like in our patient hypercalcemia’s etiology should be prompt diagnosed and reversed. [endocrine-abstracts.org]
Surawicz Role of electrolytes in etiology and management of cardiac arrhythmias Prog Cardiovasc Dis, 8 (1966), pp. 364-385 [9] E. Bogin, S.G. Massry, I. [elsevier.pt]
Most of these patients had genu valgum at presentation indicating an etiological link. All these patients had solitary parathyroid adenoma and none were reported vitamin D deficient. [bmcendocrdisord.biomedcentral.com]
In less than 1% of cases of hyperparathyroidism, the etiology is parathyroid carcinoma. The hyperparathyroidism seen in parathyroid carcinoma is usually severe, with high serum calcium levels, severe bone disease, and renal stones. [rarecancers.org.au]
Epidemiology
"Primary hyperparathyroidism: Epidemiology and clinical consequences". Clinical Reviews in Bone and Mineral Metabolism. 1 (1): 25–34. doi : 10.1385/BMM:1:1:25. ^ Bolland, M. J.; Grey, A. B.; Gamble, G. D.; Reid, I. R. (2004). [en.wikipedia.org]
This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT. [nature.com]
Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016 Jun;101:2284-99. Ferre EM, Rose SR, Rosenzweig SD, et al. [rarediseases.org]
Primary hyperparathyroidism Epidemiology Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder. [ 1 ] it is most common in postmenopausal women. [ 1 ] Causes Excess PTH is produced by one or more of the parathyroid glands, due [patient.info]
Pathophysiology
Eschbach JW: The anemia of chronic renal failure: Pathophysiology and the effects of recombinant erythropoietin. Kidney Int 1989;35:134–148. [karger.com]
Lithium-Associated Hypercalcemia: Pathophysiology, Prevalence, Management. World J Surg. 2018; 42(2):415-24 [ Links ] 24. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr. [scielo.isciii.es]
[…] differential diagnosis of hypercalcemia Diagnosis of primary, secondary, and tertiary hyperparathyroidism Diagnosis of hypoparathyroidism Monitoring end-stage renal failure patients for possible renal osteodystrophy Clinical Information Discusses physiology, pathophysiology [mayomedicallaboratories.com]
Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target organ involvement, treatment and challenges for future research. J Bone Min Res. 2011; 26: 2317-37. Khan MI, Waguespack SG, Hu MI. [rarediseases.org]
Pathophysiology In primary hyperparathyroidism due to adenomas, the normal feedback on parathyroid hormone production by extracellular calcium seems to be lost, resulting in a change in the set point. [emedicine.medscape.com]
Prevention
The inherited forms tend to arise from abnormal genes that may: encode abnormal forms of PTH or its receptor prevent normal conduction of cell signals from the PTH receptor to the nucleus prevent normal gland development before birth. [endocrineweb.com]
Secondary Hyperthyroidism It is important for secondary hyperparathyroidism to be treated early to prevent damage to the bones. The underlying cause of the condition will be treated as a priority. [medic8.com]
The patient's prognosis is favourable, but the possibility of renal transplantation to prevent relapse and the development of further BT will have to be considered. References [1] H. Ito, E. [revistanefrologia.com]
Another alternative is to treat the patient with a bisphosphonate drug to prevent or decrease the rate of bone loss. [britannica.com]
Usually a parathyroidectomy is necessary within the first few weeks of life to prevent death. Of note, there have been milder, transient cases reported with a lack of family history of FHH or secondary hyperparathyroidism. [genedx.com]