Hypercalcemic crisis as a presentation of primary hyperparathyroidism / Crisis hipercalcémica como presentación de hiperpara-tiroidismo primario

Abstract Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is an unusual state of marked progressive pri mary hyperparathyroidism (PHPT). Patients have severe hypercalcemia and may have severe symptoms such as kidney failure, acute pancreatitis, and mental changes. PHPT is due to the presence of a single gland adenoma/ disease in 80 to 85%; parathyroid carcinoma is reported in <1%. Among patients with adenoma, atypical parathy roid tumor can be found infrequently. Parathyroidectomy is the only curative approach for PHPT. In this report we present three cases of HIHC due to giant parathyroid adenomas (GPAs), one of them with histopathological characteristics of an atypical parathyroid tumor, with satisfactory evolution after parathyroidectomy.

Resumen La crisis hipercalcémica inducida por hiperparatiroi dismo (HIHC) es un estado inusual de hiperparatiroidis mo primario progresivo y marcado (HPTP). Los pacientes tienen hipercalcemia grave y pueden tener síntomas graves como insuficiencia renal, pancreatitis aguda y cambios mentales. El HPTP se debe a la presencia de un adenoma/enfermedad de una sola glándula en 80 a 85%; el carcinoma de paratiroides se informa en <1%. Entre los pacientes con adenoma, el tumor paratiroideo atípico se puede encontrar con baja frecuencia. La paratiroidec tomía es el único abordaje curativo del HPTP. En este reporte presentamos tres casos de HIHC por adenomas paratiroideos gigantes (APGs), uno de ellos con características histopatológicas de tumor paratiroideo atípico, con evolución satisfactoria luego de paratiroidectomía.

Pancreatitis aguda en el escenario de hipercalcemia por hiperparatiroidismo primario / Acute pancreatitis in the setting of hypercalcemia due to primary hyperparathyroidism

Introducción: describir el caso de un paciente con pancreatitis aguda secundaria a hipercalcemia por hiperparatiroidismo prImario. Esta es una causa poco frecuente de pancreatitis, asociada a morbimortalidad significativa en caso de no ser diagnosticada oportunamente Caso clínico: un hombre de 44 años, con antecedente de pancreatitis de presunto origen biliar que había requerido previamente colecistectomía, consultó por dolor abdominal y náuseas. Los estudios complementarios fueron compatibles con un nuevo episodio de pancreatitis aguda. Presentaba hipercalcemia y hormona paratiroidea (PTH) elevada, configurando hiperparatiroidismo primario. La gammagrafía informó hallazgos compatibles con adenoma paratiroideo. Se inició tratamiento con reanimación hídrica y analgesia con adecuada disminución de calcio sérico y resolución de dolor abdominal. Después de la paratiroidectomía se logró normalizar los niveles de calcio y PTH. Discusión: la pancreatitis aguda es una condición potencialmente fatal, por lo que la sospecha de causas poco frecuentes como la hipercalcemia debe tenerse en cuenta. El tratamiento de la hipercalcemia por adenoma paratiroideo se basa en reanimación hídrica adecuada y manejo quirúrgico del adenoma, con el fin de evitar recurrencia de pancreatitis y mortalidad. (AU)

Introduction: we describe the case of a patient with acute pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism. This is a rare cause of pancreatitis associated with significant morbidity and mortality if not diagnosed in time. Clinical case: a 44-year-old man with a history of pancreatitis of presumed biliary origin, which had previously required cholecystectomy, consulted for abdominal pain and nausea. The laboratory findings were compatible with a new episode of acute pancreatitis. He presented hypercalcemia and an elevated parathyroid hormone (PTH), configuring primary hyperparathyroidism. Scintigraphy was performed, yielding findings compatible with parathyroid adenoma. Treatment with fluid resuscitation and analgesia was started, resulting in an adequate decrease in serum calcium and resolution of abdominal pain. After parathyroidectomy, calcium and PTH levels were normalized. Discussion: acute pancreatitis is a potentially fatal condition; therefore the suspicion of rare causes, such as hypercalcemia, should be considered. The treatment of hypercalcemia due to parathyroid adenoma is based on adequate fluid resuscitation and surgical management of the adenoma, to avoid recurrence of pancreatitis and death. (AU)

Hipercalcemia asociada a hiperparatiroidismo primario: enfoque y manejo a partir de un caso clínico

Introducción: el calcio es el electrolito más abundante del cuerpo humano y la hipercalcemia es el trastorno común causado normalmente por el hiperparatiroidismo primario o malignidad, su manejo depende de la presentación y causa subyacente. Además, una proporción de casos se presentan como una emergencia, lo que conlleva a una mortalidad significativa. Objetivo: mostrar un caso inusual de presentación clínica de hipercalcemia asociada a hiperparatiroidismo primario y, asimismo, dar una breve revisión acerca del enfoque y el manejo de esta patología. Presentación del caso: paciente femenina de 32 años, antecedente de adenoma paratiroideo no resecado y pancreatitis, asiste por tres días de dolor abdominal de tipo cólico y de moderada intensidad, acompañado de episodios eméticos de contenido alimentario, paraclínicos iniciales con hipercalcemia severa, electrocardiograma con bloqueo auriculoventricular grado I, gases arteriales con alcalosis respiratoria aguda e hiperlactatemia. También se le practicó un TAC de abdomen donde este apareció con tumores pardos. Se ingresó a la UCI para la administración de líquidos endovenosos, diuréticos de asa y cinacalcet, pero no presentó mejoría, por lo que se indicó terapia de hemodiálisis. Discusión y conclusión: la hipercalcemia es un hallazgo frecuente. El hiperparatiroidismo primario y la neoplasia maligna son las dos causas más frecuentes de aumento de los niveles de calcio sérico y, en conjunto, representan alrededor del 90 % de todos los casos, donde los valores en suero varían entre el calcio total (8,5 y 10,5 mg/dl) y el iónico (1,16-1,31). La concentración sérica de Ca 2+ está estrechamente relacionada por las acciones de la hormona paratiroidea y el calcitriol, donde el hiperparatiroidismo primario ocurre como resultado de adenomas, hiperplasias y carcinoma. Las manifestaciones clínicas y la severidad van a estar correlacionadas con el tiempo de duración de la enfermedad, los niveles de calcio y de PTH. Dentro del tratamiento, este será guiado por su causa, sin embargo, es posible clasificarlo en tratamiento urgente y no urgente. Además, el enfoque de la hipercalcemia aguda severa es un reto diagnóstico dadas las múltiples causas que pueden llevar a este trastorno hidroelectrolítico y la rápida instauración de tratamiento que se requiere cuando es detectada.

Background: Calcium is the most abundant electrolyte in the human body, hypercalcemia is a common disorder usually caused by primary hyperparathyroidism or malignancy. A proportion of cases presenting as an emergency, leading to significant mortality. The management of hypercalcemia depends on the presentation and underlying cause. Purpose: to present an unusual case of clinical presentation of hypercalcemia associated with primary hyperparathyroidism, as well as to give a brief review about the approach and management of this pathology. Case presentation: A 32-year-old female patient, with a history of unresected parathyroid adenoma and pancreatitis, attended for 3 days of abdominal pain, moderate intensity, accompanied by emetic episodes of food content, initial paraclinical findings showed severe hypercalcemia, electrocardiogram with block grade I atrioventricular, arterial gases with acute respiratory alkalosis and hyperlactatemia. CT of the abdomen with brown tumors. She was admitted to the ICU for administration of intravenous fluids, loop diuretics, and cinacalcet without showing any improvement, so hemodialysis therapy was indicated. Discussion and conclusion: hypercalcemia is a frequent finding. Primary hyperparathyroidism and malignancy are the two most common causes of elevated serum calcium levels, together accounting for about 90 % of all cases. Serum values vary between total calcium 8.5 and 10.5 mg/dl and ionic 1.16- 1.31. Serum Ca 2+ concentration is closely related by the actions of parathyroid hormone and calcitriol. Primary hyperparathyroidism occurs as a result of adenomas, hyperplasias, or carcinoma. The clinical manifestations and severity will be correlated with the duration of the disease, calcium and PTH levels. Within the treatment, this will be guided by its cause, however, it is possible to classify it into urgent and non-urgent treatment. The approach to severe acute hypercalcemia is a diagnostic challenge given the multiple causes that can lead to this hydroelectrolyte disorder and the rapid establishment of treatment that is required when it is detected.

Don’t pin it all on a stereotype

Hypercalcemia is one of the most frequently encountered problems in endocrinology OPD. Although the evaluation may not always be straightforward in all scenarios. Common factors affecting calcium levels such as dehydration, improper sample collection, and vitamin D supplementation may mask a serious underlying disorder. Here, we discuss a case of an elderly female who had symptoms of myelopathy and hypercalcemia whose etiology was initially attributed to excessive sup

One case report of recurrent primary hyperparathyroidism caused by iatrogenic implant ectopic parathyroid adenoma / 中华内分泌外科杂志

Parathyroid adenoma (PTA) is an important cause of hyperparathyroidism (HPT) . The author reported a case of HPT caused by proliferation of parathyroid cells caused by implantation during surgery, and the formation of adenoma in sternocleidomastoid muscle was detected. The understanding of primary hyperparathyroidism (PHPT) caused by ectopic PTA was analyzed from clinical symptoms, laboratory examination, the neck Doppler ultrasound, imaging ( 99TC m-MIBI SPECT/CT fusion imaging, CT) and pathological examination results, combined with the parathyroidism of the patient during the first operation.

Persistent primary hyperparathyroidism secondary to an ectopic mediastinal adenoma in a young adult: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Primary hyperparathyroidism commonly affects elderly women. When present in the young population, it is usually asymptomatic, most frequently due to a parathyroid adenoma and the definitive management is surgical excision. Uncommonly, 5-10% of patients fail to achieve long-term cure after initial parathyroidectomy and 6-16% of them is due to an ectopic parathyroid adenoma that will require focused diagnostic and surgical approaches. We report a 21-year-old male who had bilateral thigh pain. Work-up revealed bilateral femoral fractures, brown tumors on the arms and multiple lytic lesions on the skull. Serum studies showed hypercalcemia (1.83 mmol/L), elevated parathyroid hormone [(PTH) 2025.10 pg/mL], elevated alkaline phosphatase (830 U/L), normal phosphorus (0.92 mmol/L) and low vitamin D levels (18.50 ng/mL). Bone densitometry showed osteoporotic findings. Sestamibi scan showed uptake on the left superior mediastinal region consistent with an ectopic parathyroid adenoma. Vitamin D supplementation was started pre-operatively. Patient underwent parathyroidectomy with neck exploration; however, the pathologic adenoma was not visualized and PTH levels remained elevated post-operatively. Chest computed tomography with intravenous contrast was performed revealing a mediastinal location of the adenoma. A repeat parathyroidectomy was done, with successful identification of the adenoma resulting in a significant drop in PTH and calcium levels. Patient experienced hungry bone syndrome post-operatively and was managed with calcium and magnesium supplementation. A high index of suspicion for an ectopic adenoma is warranted for patients presenting with hypercalcemia and secondary osteoporosis if there is persistent PTH elevation after initial surgical intervention. Adequate follow-up and monitoring is also needed starting immediately in the post-operative period to manage possible complications such as hungry bone syndrome.

Hypercalcemic crisis caused by a parathyroid adenoma with hemorrhage and cystic degeneration: A case report / 中华内分泌代谢杂志

This paper reported a rare case of hypercalcemic crisis caused by a parathyroid adenoma with hemorrhage and cystic degeneration. Preoperative imaging examination of the patient was unable to determine the histological origin of the cervical cystic lesion. Despite aggressive medical treatment and hemodialysis, hypercalcemic crisis could not be relieved. Therefore, surgical exploration and excision of the cervical lesion were performed, and final diagnosis of parathyroid adenoma with hemorrhage and cystic degeneration was confirmed by pathology. Blood calcium level and renal function returned to normal after the surgery.

A giant parathyroid adenoma mimicking a thyroid swelling: A case report

Giant parathyroid adenomas are uncommon. Its clinical management is challenging. Our study抯 goal is to share our experience with pre-operative localization of parathyroid adenomas while emphasizing the importance of intraoperative parathyroid hormone (IOPTH) assays in such situations. Here, we present the case of a 46-year-old woman who was diagnosed with parathyroid adenoma. The clinical aspects, pre-operative management, and surgical procedure have all been examined. Parathyroid hormone levels were reduced by 90% following surgical removal of the tumor and an IOPTH assay. IOPTH significantly improves surgical success rates in patients with only one positive imaging test result and adds significant value to surgical decision-making.

PARATHYROID ADENOMA: A RARE TUMOUR CASE REPORT

Parathyroid adenoma is a rare tumour and are generally small size (< 2 cm) and <1gm weight. Giant adenomas are infrequent, are mostly elucidated as > 3.5 gm weight, along with few reports weights up to 110 gm. Parathyroid adenoma are usually found with primary hyperparathyroidism syndrome which is common, seen as third most common endocrine disorder. In this study a case of 52-year-old lady was refereed with complain of neck swelling, lethargy and generalized drowsiness. The results obtained from laboratory revealed increased serum calcium and increased parathyroid hormone. There is no significant history of renal stone, renal dysfunction or any family history of endocrinal tumours. Ultrasonography revealed a composite nodule with cystic and solid elements. Focused surgical neck exploration was performed with removal of 4 gm adenoma . Microscopic examination showed, encapsulated lesion formed of chief cells of parathyroid organized within network of capillaries. The most exact mechanism for localizing a Parathyroid Adenoma is altogether MIBI scan along with neck ultrasonography. Surgical excision with monitoring of parathyroid hormone screening during operation is the recommended conductance. Need for the intraoperative Parathyroid hormone monitoring is debatable in Parathyroid adenoma due to accuracy of preoperative imaging.

Paraganglioma del cuerpo carotídeo asociado a un adenoma paratiroideo: reporte de caso

Introducción: Los paragangliomas son tumores raros, y más raros aun cuando se presentan con otros tumores endocrinos. Objetivo: Presentar el caso de un paraganglioma del cuerpo carotídeo asociado con adenomas paratiroideos. Materiales y Método: Se presenta la evaluación clínica, imagenológica y fotográfica del caso. Resultados: Se presenta el caso de una paciente de 34 años con una masa cervical en región cervical de un año de evolución y que, durante los estudios de extensión, se encontró que correspondía a un paraganglioma en la bifurcación carotídea izquierda, asociada además con dos adenomas paratiroideos, que fueron resecados sin complicaciones. Discusión: Se discute la fisiopatología, el diagnóstico y manejo en relación con el caso presentado. Conclusión: La presentación de paragangliomas del cuerpo carotídeo asociadas con adenomas paratiroideos es rara, y su evaluación clínica deberá ser individualizada, dado que, si bien el manejo será en su mayoría quirúrgico, el abordaje dependerá de cada caso.

Introduction: Paragangliomas are rare tumors, and they are even rarer when they present with other endocrine tumors. Aim: To present a clinical case of a carotid body paraganglioma associated with parathyroid adenomas. Materials and Method: There are shown the clinical evaluation, images, and photos of the case. Results: We present the case of a 34 years old female patient with a cervical mass, which has grown for a year, and, after extension studies, it was found that the mass corresponded to a paraganglioma located in the left carotid bifurcation, and it was associated with two parathyroid adenomas, all the neoplasms were resected with no complications. Discussion: It is discussed physiopathology, diagnosis and management based on the presented case Conclusion: Carotid body paragangliomas associated with parathyroid adenomas are rare, and the clinical evaluation must be individual, given that, most of the management is surgical, however, the approach will depend on each case.

Adenoma paratiroideo mediastínico gigante. Abordaje cervical y toracoscópico. Caso clínico / Gigant Mediastinal Parathyroid Adenoma. Cervical and Thoracoscopic Approach. Case Report

El hiperparatiroidismo primario es el tercer trastorno endocrino más común, alrededor del 85% de los casos se debe a adenomas paratiroideos. El tratamiento definitivo es la paratiroidectomía, siendo la causa más común de fracaso la resección inadecuada y la localización de tejido ectópico, representando un desafío para el cirujano. En el presente trabajo se presenta el caso de un paciente con diagnóstico de adenoma paratiroideo mediastínico gigante, siendo este el de mayor longitud descrito en la literatura en los últimos 10 años. Caso clínico: Paciente masculino de 70 años de edad quien consulta por presentar convulsiones, polidipsia y poliuria. Se determinan niveles elevados de PTH, hipercalcemia e hipofosfatemia. Estudios de imagen describen lesión alargada localizada en espacio paratraqueal derecho extendiéndose hasta el polo inferior de lóbulo tiroideo derecho. Se decide resolución quirúrgica, mediante la realización de cervicotomía y toracoscopia con evolución satisfactoria del paciente. Conclusión: Los adenomas paratiroideos ectópicos constituyen una causa común de falla quirúrgica e hiperparatiroidismo persistente, su sospecha es de gran importancia. El tratamiento definitivo es la cirugía. La localización preoperatoria por pruebas de imagen es fundamental para seleccionar correctamente la técnica quirúrgica y garantizar el éxito de la cirugía. El abordaje cervical y toracoscópico es una alternativa segura y eficaz(AU)

Primary hyperparathyroidism is the third most common endocrine disorder, about 85% of cases are due to parathyroid adenomas. The definitive treatment is parathyroidectomy, being the most frequent cause of failure the inadequate resection and the location of ectopic tissue. The ectopic parathyroid adenomas represent a challenge for the surgeon. In this paper a case of a patient diagnosed with giant mediastinal parathyroid adenoma is presented, and is the largest reported in the literature in the last 10 years. Clinical case: 70-year-old male patient presented with seizures, polydipsia and polyuria, reason for which he consults. Elevated PTH levels, hypercalcemia, and hypophosphatemia are determined. Imaging studies report an elongated lesion located in the right paratracheal space that extends to the lower pole of the right thyroid lobe. Surgical resolution was decided, by performing cervicotomy and thoracoscopy with satisfactory recovery of the patient. Conclusion: Ectopic parathyroid adenomas are a common cause of surgical failure and persistent hyperparathyroidism; their suspicion is of great importance. The definitive treatment is surgery. Preoperative localization through imaging tests is essential to correctly select the surgical technique and guarantee the success of the surgery, the cervical and thoracoscopic approach is a safe and effective alternative(AU)

Gastric outlet obstruction following recurrent Pancreatitis uncovers a Giant Parathyroid Adenoma: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent pancreatitis with a pancreatic pseudocyst. Elevated serum calcium levels provided an etiologic link between hypercalcemia and pancreatitis. On examination, a nodule was found in the left side of her neck which was later diagnosed as a giant left inferior parathyroid adenoma. This report highlights the critical analysis of history, examination, and investigations to reach an ultimate diagnosis. Pseudocyst drainage and parathyroidectomy resolved her symptoms.

Application of endoscopic complete areola approach in the resection of parathyroid adenoma / 中华内分泌外科杂志

The most common cause of primary hyperparathyroidism (PHPT) is parathyroid adenoma. Surgery is the most effective method to treat PHTP. The data of 10 patients who underwent endoscopic complete areola approach for parathyroid adenoma resection in our hospital from Jan. 2018 to Oct. 2021 were reviewed. It is considered that this method is feasible and has certain advantages compared with traditional surgery.

One case of recurrent parathyroid carcinoma complicated with lung metastasis after parathyroid adenoma operation and literature review / 中华内分泌外科杂志

This paper reports the clinical data of a patient with recurrent metastatic parathyroid carcinoma. The causes, clinical manifestation, diagnose, treatment and prognosis of parathyroid carcinoma were discussed in order to perfect the experience of diagnosis and treatment and improve the survival rate of such patients.

Escisión transcervical de un adenoma paratiroideo mediastínico gigante / Transcervical Excision of a Giant Mediastinal Parathyroid Adenoma

Resumen El hiperparatiroidismo primario (HPTP) es el tercer trastorno neuroendocrino más común, cuya principal causa es el adenoma paratiroideo. Dentro de la clasificación aquellos adenomas que pesan más de 3.5 g se clasifican como adenomas paratiroideos gigantes (APG), se asocian a una peor evolución y malignidad. El propósito de este artículo es presentar nuestro enfoque diagnóstico y terapéutico, en el abordaje de una paciente con HPTP asociado a un APG mediastínico. Una búsqueda en la literatura internacional de los últimos 10 años reveló que solo otros 8 centros han informado la extracción de un APG de localización y dimensiones similares al nuestro. Presentación del caso: Mujer de 66 años con antecedente de bocio multinodular, se solicitan perfil tiroideo y medición de parathormona (PTH) con reporte de 350.60 pg/mL. Se decidió realizar una gammagrafía tiroidea/paratiroidea con 99mTc sestaMIBI que reportó persistencia de una zona focal de la concentración localizada en topografía de polo inferior del lóbulo tiroideo derecho. Se complementó dicho estudio con SPECT-CT, donde se reportó imagen de paratiroides inferior derecha hiperfuncionante compatible con adenoma y se diagnosticó a la paciente con HPTP. Finalmente, se realizó resección obteniendo tumoración de 7.0 × 4.5 × 2.0 cm, con un peso de 24.5 g. Conclusiones: Nuestro caso destacó el uso de los estudios de imagen para facilitar la localización y lograr el diagnóstico aunado a la presentación clínica y el perfil bioquímico. El tratamiento selectivo se logró de manera segura a través de una técnica transcervical mínimamente invasiva, combinada con la medición de los niveles de PTH.

Abstract Primary hyperparathyroidism (HPTP) is the third most com- mon neuroendocrine disorder, its main cause is parathyroid adenoma. Within the classification, those adenomas that weigh more than 3.5 g are classified as giant parathyroid adenomas (APG), and are associated with a worse evolution and malignancy. The purpose of this article is to present our diagnostic and therapeutic approach of a patient with HPTP associated with a mediastinal APG. A search in the international literature of the last 10 years revealed that only 8 other centers have reported the extraction of an APG of similar dimensions to ours and in a similar location. Case presentation: A 66-year-old woman with a history of multinodular goiter, thyroid profile and parathormone (PTH) measurement were requested, with a report of 350.60 pg/ mL. A thyroid/parathyroid scintigraphy was performed with 99mTc sestaMIBI which reported persistence of a focal area of the concentration located in the topography of the lower pole of the right thyroid lobe. This study was complemented with SPECT-CT, which reported an image of hyperfunctioning right inferior parathyroid compatible with adenoma and the patient was diagnosed with PTH. Finally, resection was performed, obtaining a tumor measuring 7.0 × 4.5 × 2.0 cm, with a weight of 24.5 g. Conclusions: Our case highlights the use of imaging studies to facilitate localization and achieve diagnosis together with clinical presentation and biochemical profile. Selective treatment was achieved safely through a minimally invasive transcervical technique, combined with the measurement of PTH.

Paciente con fractura patológica de cúbito lado derecho

RESUMEN El hiperparatiroidismo es una enfermedad eminentemente clínica que se presenta cuando existe un aumento en la producción de hormona paratiroidea, superior a las necesidades que el organismo requiere, dando lugar a hipercalcemia, trastornos óseos y renales en un grado variable. Se presenta el caso de un paciente de 64 años con hiperparatiroidismo secundario a un adenoma paratiroideo que fue diagnosticado por hallazgo casual, posterior a que el paciente venía presentando dolores óseos frecuentes de más de un año de evolución. Durante su internación se obtuvo el diagnóstico de adenoma paratiroideo por lo que fue intervenido quirúrgicamente con exéresis y tratamiento ambulatorio.

ABSTRACT Hyperparathyroidism is an eminently clinical disease that occurs when there is an increase in the production of parathyroid hormone, greater than the needs that the body requires, leading to hypercalcemia, bone and kidney disorders to a variable degree. We present the case of a 64-year-old patient with hyperparathyroidism secondary to a parathyroid adenoma that was diagnosed by chance finding, after the patient had been presenting frequent bone pain of more than a year of evolution. During his hospitalization, a diagnosis of parathyroid adenoma was obtained, for which he underwent surgery with excision and outpatient treatment.

Hiperparatiroidismo primario por adenoma gigante de paratiroides. Abordaje quirúrgico selectivo / Primary hyperparathyroidism caused by giant parathyroid adenoma. Selective surgical approach / Hiperparatireoidismo primário devido a um adenoma gigante da paratireoide. Abordagem cirúrgica seletiva

Resumen: Introducción: el hiperparatiroidismo primario por un adenoma gigante de paratiroides es infrecuente. Los adenomas de mayor tamaño reportados ocurrieron sobre paratiroides ectópicas (mediastinales). Comparte con el carcinoma su gran tamaño y elevadas cifras de calcemia y de hormona paratiroidea, hecho que dificulta el diagnóstico. Su tratamiento quirúrgico es la paratiroidectomía mediante una cervicotomía transversa centrada en la región infrahioidea. Objetivo: presentar un caso clínico de hiperparatiroidismo primario por un adenoma gigante de paratiroides tratado quirúrgicamente mediante un abordaje selectivo. Caso clínico: paciente de 53 años, sexo femenino, con antecedentes de litiasis ureteral, dolores óseos y tumoración infrahiodea de 4 cm de diámetro que imagenológicamente presentó las características de un adenoma paratiroideo inferior izquierdo. La valoración funcional confirmó hiperparatiroidismo. Con diagnóstico de hiperparatiroidismo primario por adenoma gigante se trató quirúrgicamente a través de una incisión pequeña y centrada en la tumoración, realizándose la paratiroidectomía inferior izquierda con la cual remitió la sintomatología y normalizó la funcionalidad paratiroidea. Discusión: el hiperparatiroidismo primario por adenoma gigante de paratiroides tiene indicación quirúrgica y es curativo. El caso presentado demuestra la factibilidad y seguridad de un abordaje selectivo a lo que suma una menor afectación cosmética, dejando indemne la logia tiroidea contralateral ante futuras cirugías sobre ésta.

Summary: Introduction: primary hyperparathyroidism caused by giant parathyroid adenoma is a rather unusual condition. Reported large adenomas occurred in ectopic parathyroid glands (mediastinal). Just like carcinomas, they are large, present high calcemia and parathyroid hormone values, what complicates diagnosis. Surgical treatment consists in parathyroidectomy by means of transversal cervicotomy around the infrahyoid region. Objective: the study presents the clinical case of primary hyperparathyroidism caused by giant parathyroid adenoma that was treated by selective surgery approach. Clinical case: 53 year-old female patient with a history of uretheral lithiasis, bone pain and 4-cm-diameter infrahyoid tumor. Imagenology studies revealed the characteristics of lower left parathyroid adenoma. Functional assessment confirmed hyperparathyroidism. Upon the diagnosis of primary hyperparathyroidism caused by giant parathyroid adenoma it was surgically addressed by means of a small cut around the tumour and performing a lower left parathyroidectomy, what resulted in the remission of symptoms and normalized parathyroid functionality. Discussion: primary hyperparathyroidism caused by giant parathyroid adenoma has an indication for surgery and is therapeutic. The case presented shows the feasibility and safety of a selective approach, as well as its smaller cosmetic harm, managing to keep the contralateral thyroid loggia intact, in view of future surgeries involving it.

Resumo: Introdução: o hiperparatireoidismo primário devido a adenoma de paratireoide gigante é raro. Os maiores adenomas relatados ocorreram em paratireoides ectópicas (mediastinais). Compartilha com o carcinoma seu grande tamanho e altos níveis de cálcio e hormônio da paratireoide, o que torna o diagnóstico difícil. Seu tratamento cirúrgico é a paratireoidectomia por meio de cervicotomia transversa com foco na região infra-hióidea. Objetivo: apresentar um caso clínico de hiperparatireoidismo primário por adenoma gigante da paratireoide tratado cirurgicamente por abordagem seletiva. Caso clínico: paciente do sexo feminino, 53 anos, com história de litíase ureteral, dor óssea e tumor infra-hióideo de 4 cm de diâmetro que apresentava características de imagem de adenoma de paratireoide inferior esquerdo. A avaliação funcional confirmou hiperparatireoidismo. Com diagnóstico de hiperparatireoidismo primário por adenoma gigante, foi tratada cirurgicamente por meio de pequena incisão focada no tumor, realizando paratireoidectomia inferior esquerda com remissão dos sintomas e normalização da funcionalidade da paratireoide. Discussão: o hiperparatireoidismo primário devido ao adenoma gigante da paratireoide tem indicação cirúrgica e é curativo. O caso apresentado demonstra a viabilidade e segurança de uma abordagem seletiva que apresenta um menor envolvimento estético, deixando o espaço contralateral da tireoide sem danos para futuras cirurgias.

Tumor pardo del paladar, presentación atípica de hiperparatiroidismo primario en adolescente: buena evolución y normalización de la masa ósea tras paratiroidectomía / Brown tumor of the palate, atypical presentation of primary hyperparathyroidism in an adolescent: good evolution and bone mass normalization after parathyroidectomy

El hiperparatiroidismo primario (HPTP) es poco frecuente en niños y adolescentes. Hay escasos datos para el manejo de estos pacientes en pediatría. Las glándulas paratiroideas son glándulas endocrinas que secretan hormona paratiroidea (PTH) y regulan el metabolismo del calcio y del fósforo. La sobreexpresión de PTH se llama hiperparatiroidismo, que se clasifica en primario, secundario y terciario. En los adolescentes, 80 a 92% de los hiperparatiroidismos primarios se deben a adenoma paratiroideo. Presentamos el caso clínico de una adolescente con una primera manifestación atípica de HPTP, la presencia de un tumor pardo del paladar, presentación rara de adenoma paratiroideo, acompañado de hipercalcemia, marcada elevación de PTH y varias lesiones óseas. (AU)

Primary hyperparathyroidism (PHPT) in children and adolescents is uncommon. Guidelines for management in pediatric patients are limited. Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calciumphosphate metabolism. The overexpression of PTH is called hyperparathyroidism, and is classified as primary, secondary, and tertiary. In adolescents, 80 to 92% of PHPT cases are due to a parathyroid adenoma. We present here a case report of an adolescent with a brown tumor of the palate as the first manifestation of the disease, atypical and rare presentation of parathyroid adenoma in an adolescent. She had hypercalcemia, marked elevation of PTH and bone lesions. (AU)

A comparative study of Da Vinci robot and open surgery in primary hyperparathyroidism / 中华内分泌外科杂志

Objective:To investigate the safety and efficacy of da Vinci surgical system in surgical treatment of primary hyperparathyroidism.Methods:The clinical data of 19 patients with primary hyperparathyroidism who received the Da Vinci robot surgical system (the da Vinci surgery group) from Feb. 2016 to May. 2020 and 23 patients undergoing open parathyroid surgery (the open surgery group) were retrospectively analyzed and compared. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, postoperative serum calcium and phosphorus, parathyroid hormone, postoperative pain visual analog score, and surgical complications rate and beauty effect of the two groups were statistically compared. The postoperative clinical symptoms and recurrence were followed up in a duration 3 to 84 months.Results:All patients completed the operation successfully, there was no conversion to open operation in the da Vinci surgery group. The operation time (65.5±9.9 vs 54.3±8.3) min ( t=6.231, P=0.015) and postoperative drainage volume (109.7±50.6 vs 97.2±45.2) ml ( t=3.132, P=0.016) in the da Vinci surgery group were more than those in the open surgery group, while the cosmetic effect (9.1±0.6 vs 8.3±0.7) ( t=3.628, P=0.031) was better in the da Vinci surgery group than in the open surgery group. There was no significant difference in intraoperative blood loss (44.3±19.4 vs 39.1±15.4) ml, hospital stay (7.4±1.4 vs 7.9±2.8) days, incidence of complications (15.8% vs 8.7%) , visual analogue scale of postoperative pain (6.9±0.6 vs 6.4±0.8) , clinical symptom relief during the follow-up (100.0% vs 100.0%) , postoperative serum calcium (2.48±0.30 vs 2.43±0.26) mmol/L, serum phosphorus (0.75±0.07 vs 1.37±0.31) mmol/L or parathyroid hormone (36.5±4.7 vs 40.4±5.3) ng/L between the da Vinci surgery group and the open surgery group ( P>0.05) . Conclusion:Leonardo da Vinci robot-assisted surgical treatment for primary hyperparathyroidism with strict surgical indications is similar to traditional open surgery in safety and efficacy, while its cosmetic effect is better.

Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism / 中南大学学报(医学版)

OBJECTIVES@#The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT.@*METHODS@#Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group (@*RESULTS@#The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, @*CONCLUSIONS@#Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L