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]

• Anorexia

  Most had symptoms of weakness, irritability, anorexia, and weight loss. Severe hypercalcemia (serum calcium>15 mg/ 100 ml) and radiologic evidence of bone changes were common findings, and suggested delayed diagnoses. [deepblue.lib.umich.edu]

  This condition presents with anorexia, nausea, vomiting, constipation, acute pancreatitis, shortened QT interval, apathy, drowsiness, and coma, and, if left untreated, it can lead to death. [shifrinmd.com]

  Anorexia; nausea and vomiting; constipation; abdominal pain; peptic ulcer disease (hypercalcaemia can increase gastric acid secretion); acute pancreatitis. Polyuria, polydipsia, dehydration. Renal colic, haematuria, hypertension. [patient.info]

  He had discontinued his medication in the previous five days due to financial difficulties, since when he had complained of anorexia, asthenia, constipation and dizziness. [elsevier.pt]

  Early diagnosis and aggressive treatment, including expeditious parathyroidectomy is required to avoid a lethal course. [4], [5] A 46-year-old female presented to the emergency room in September 2013 with generalized weakness and anorexia since 1-month [ijpmonline.org]

• Goiter

  Ultrasound neck revealed a multinodular goiter with suspicion of thyroid cyst/parathyroid cyst. [ijpmonline.org]

  Previous medical history included hypertension, dyslipidemia and toxic multinodular goiter. No signs were revealed from her clinical examination. [omicsonline.org]

  Surgery to treat cancer of the thyroid (nearby the parathyroid glands) or goiter (enlargement) of the thyroid gland may also cause hypoparathyroidism, usually through damage to the blood supply for the parathyroid glands or inadvertent removal of the [rarediseases.org]

• 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]

• Anemia

  Parathyroidectomy and improving anemia. Arch Surg. 2008;143(1):97-8. DOI: 10.1001/archsurg. 2007.26 34. Gasparri G, Camadona M, Abbona GC, Papotti M, Jeantet A, Radice E, et al. [degruyter.com]

  Eschbach JW: The anemia of chronic renal failure: Pathophysiology and the effects of recombinant erythropoietin. Kidney Int 1989;35:134–148. [karger.com]

• Chills

  […] aggressive treatment, including expeditious parathyroidectomy is required to avoid a lethal course. [4], [5] A 46-year-old female presented to the emergency room in September 2013 with generalized weakness and anorexia since 1-month, fever associated with chills [ijpmonline.org]

• Aspiration

  Fine-needle aspiration cytology of presumed thyroid swelling from one of the two sites aspirated yielded clear fluid but was not attributed to parathyroid pathology. [ijpmonline.org]

  However, PC may recur after aspiration. Sclerotherapy with tetracycline and alcohol can be effective in recurrent lesions, but it could result in fibrosis and recurrent laryngeal nerve palsy [ 5 ]. [omicsonline.org]

  Fine needle aspiration Fine needle aspiration is a method of obtaining a tissue sample from suspected parathyroid tumor. This is rarely necessary. Cleveland Clinic is a non-profit academic medical center. [my.clevelandclinic.org]

  Guided by high-resolution, small parts ultrasonography, fine-needle aspiration biopsy confirmed localization of parathyroid tissue in 3 patients. [link.springer.com]

  Fine needle aspiration (FNA) prior to initial operation is not recommended due to technical difficulty in differentiating benign and malignant disease on cytology specimens and the possible associated risk of tumor seeding from the needle track. [scienceopen.com]

• Hoarseness

  A rare symptom reported is hoarseness [ 11 ]. This was also noticed in our patient who suffered also among other symptoms from depression, anxiety and hoarseness. [ispub.com]

  Change in voice such as hoarseness. Trouble swallowing. Other conditions may cause the same symptoms as parathyroid cancer. A doctor should be consulted if any of these problems occur. [rarecancers.org.au]

  Hoarseness may develops as a result of recurrent laryngeal nerve palsy. Enlarged, palpable lymph nodes can also be a result of metastatic disease. [shifrinmd.com]

  Recurrent laryngeal nerve injury - suspect this if a patient develops new hoarseness postoperatively. Immediate laryngoscopy is indicated. [patient.info]

  Possible complications of both traditional and minimally invasive surgery include damage to the laryngeal nerve (which can cause hoarseness) and decreased parathyroid function. [health.harvard.edu]

• Loss of Appetite

  With more severe disease, a person may have a loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination. [rarediseases.info.nih.gov]

  There are also other patients who have nonspecific symptoms, such as fatigue, weakness, depression, and loss of appetite. [britannica.com]

  But these are the most common symptoms: Joint aches and pains Depression Belly (abdominal) pain Gastroesophageal reflux disease (GERD) Peptic ulcer disease Pancreatitis Tiredness (fatigue) Urinating more than normal Increased thirst Loss of appetite Confusion [cedars-sinai.edu]

  Loss of appetite. Weight loss for no known reason. Being much more thirsty than usual. Urinating much more than usual. Constipation. Trouble thinking clearly. [rarecancers.org.au]

• Hepatosplenomegaly

  PHP was diagnosed together with hepatosplenomegaly and pancytopenia. Bone marrow biopsy revealed grade 3–4 reticulin fibrosis. [degruyter.com]

• 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]

• Arthritis

  J Arthritis 2:107. doi:10.4172/2167-7921.1000107 Copyright: © 2013 Spyridon K, et al. [omicsonline.org]

  Systemic signs: renal (polyuria, hypercalciuria, nephrolithiasis) skeletal, neuromuscular (myopathy, chondrocalcinosis, arthritis), central nervous system (fatigue, cognitive changes), gastrointestinal (peptic ulcer, pancreatitis), cardiovascular (hypertension [iofbonehealth.org]

  'At first doctors said it was arthritis, but tests proved otherwise,' she told MailOnline. 'It got to the point where I couldn't hold a camera any more. I was devastated.' [dailymail.co.uk]

  J Arthritis 2013;2:2. Available from: http://www.omicsgroup.com/jarthritis/journal/2167-7921.1000107. [Last cited on 2014 Dec 14]. 4. Singh DN, Gupta SK, Kumari N, Krishnani N, Chand G, Mishra A, et al. [ijpmonline.org]

  Other bone diseases associated with hyperparathyroidism are osteoporosis, osteomalacia, and arthritis. "Abdominal groans" refers to gastrointestinal symptoms of constipation, indigestion, nausea and vomiting. [en.wikipedia.org]

• Neck Mass

  FNAC is an established test as afirst line investigation in the evaluation of neck masses. [ijpmonline.org]

  A palpable neck mass can be present in 30% to 75% of patients with parathyroid carcinoma, a finding that is quite rare in benign disease. Hoarseness may develops as a result of recurrent laryngeal nerve palsy. [shifrinmd.com]

  A palpable neck mass is not usually expected with hyperparathyroidism, although in rare cases, it may indicate parathyroid cancer. A previously undiagnosed thyroid nodule is much more commonly the source of a palpable nodule. [emedicine.medscape.com]

  mass o Pathologic fracture Physical findings — There are no specific physical findings of hyperparathyroidism. [enotes.tripod.com]

• Neck Swelling

  Abstract We discuss a case of primary hyperparathyroidism caused by a giant cystic parathyroid adenoma presenting with neck swelling and hypercalcemic crisis. [ijpmonline.org]

  There was no history of trauma, fractures, abdominal pain, vomiting constipation, neck swelling or renal calculi. She had been relatively healthy up to now taking part in athletic events in school until the development of these symptoms. [bmcendocrdisord.biomedcentral.com]

• Asthenia

  He had discontinued his medication in the previous five days due to financial difficulties, since when he had complained of anorexia, asthenia, constipation and dizziness. [elsevier.pt]

  An 88-year old male patient presented with severe anaemia, asthenia and melaena in the previous days. [giornalechirurgia.it]

• Uremia

  Rao SD, Shih M, Mohini R: Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 1993;328:171–175. [karger.com]

  Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 1993;328:171–5. Google Scholar 14. Bhadada SK, Bhansali A, Ahluwalia J, Chanukya GV, Behera A, et al. [degruyter.com]

  The patient was transferred to the "tidal" modality of peritoneal dialysis in order to increase the efficiency of uremia treatment, while waiting for AVF maturation for starting HD. [jbn.org.br]

• Frequency of Micturition

  […] of micturition since 15 days, vomiting since 10 days and puffiness of face and swelling of the lower limbs since 7 days. [ijpmonline.org]

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]

• Hypoalbuminemia

  Further evaluation revealed hypercalcemia (serum calcium of 16.9 mg/dl) (normal range: 8.5–10.2 mg/dl), hypoalbuminemia (serum albumin: 3.1 g/dl) and slightly elevated serum phosphorus of 4.8 mg/dl. [ijpmonline.org]

• Leukocytosis

  Hemogram revealed neutrophilic leukocytosis. Urine examination revealed plenty of pus cells per high power field. There was no evidence of nephrolithiasis or pyelonephritis. The urinary tract infection was treated with intravenous antibiotics. [ijpmonline.org]

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]

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]

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]

"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]

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]

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]