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1.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 832-836, 2023.
Article in Chinese | WPRIM | ID: wpr-1011053

ABSTRACT

Objective:To investigate the application value of near-infrared autofluorescence imaging in identifying and protecting parathyroid glands in endoscopic thyroid surgery. Methods:From May 2022 to February 2023, 158 patients who underwent endoscopic thyroid surgery in the Department of Thyroid and Breast Vascular Surgery of Guilin People's Hospital were selected. The endoscopic fluorescence camera system was used to monitor the parathyroid glands under autofluorescence during endoscopic thyroid surgery. A total of 214 pieces were collected, among which the first 15 cases that could not be preserved in situ during the operation needed to be autotransplanted or the tissue clamped parts that could not be clearly identified as parathyroid glands were sent to fast-frozen pathology to determine whether they were parathyroid glands. Results:Among the first 15 patients who could not be preserved in situ during the operation or whose anatomy could not be clearly defined, 23 parathyroid glands were detected by autofluorescence imaging, 21 parathyroid glands were confirmed by pathology, and 2 were adipose tissue, with an accuracy rate of 91.30%; 158 patients underwent surgery Blood calcium decreased 2 hours after operation compared with preoperative blood calcium(P<0.05), decreased blood calcium 5 days after operation compared with preoperative blood calcium(P<0.01), and increased slightly 5 days after the operation compared to blood calcium 2 hours after the operation, but the difference was not statistically significant(P>0.05); while comparing parathyroid hormone(PTH), PTH at 2 hours after operation decreased significantly compared with PTH before operation(P<0.01), and PTH at 5 days after operation compared with PTH before operation PTH also decreased(P<0.01), but increased compared with PTH 2 hours after operation(P=0.001). Conclusion:In laparoscopic thyroid surgery, the application of near-infrared autofluorescence imaging technology can help surgeons quickly identify and protect parathyroid glands, and reduce the incidence of permanent hypoparathyroidism. Combining autofluorescence imaging, visual anatomy recognition under magnification of laparoscope, and intraoperative frozen pathological examination "trinity" method can improve the success rate of parathyroid gland recognition.


Subject(s)
Humans , Parathyroid Glands/transplantation , Thyroid Gland/surgery , Calcium , Parathyroid Hormone , Optical Imaging/methods , Laparoscopy , Thyroidectomy/methods
2.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 365-369, 2023.
Article in Chinese | WPRIM | ID: wpr-982750

ABSTRACT

Objective:To investigate the relationship between parathyroid hormone(PTH) level and permanent hypoparathyroidism(PHPP) on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day(OR=14.534, 95%CI: 2.377-88.858, P=0.004) was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874(95%CI: 0.790-0.958, P<0.001), the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.


Subject(s)
Humans , Calcium , Hypoparathyroidism/surgery , Parathyroid Glands , Parathyroid Hormone , Postoperative Complications/surgery , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/complications , Thyroidectomy
3.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 282-287, 2023.
Article in Chinese | WPRIM | ID: wpr-982733

ABSTRACT

Objective:To quantitatively evaluate the risk of recurrence in patients with secondary hyperparathyroidism after parathyroidectomy. Methods:The clinical data of 168 patients who underwent parathyroidectomy(PTX) from June 2017 to May 2019 were collected. The prediction model was constructed by using Akaike information criterion(AIC) to screen factors. A total of 158 patients treated with PTX from June 2019 to September 2021 were included in the validation set to conduct external validation of the model in three aspects of differentiation, consistency and clinical utility. Results:The prediction model we constructed includes different dialysis methods, ectopic parathyroid gland, the iPTH level at one day and one month after surgery, the number of excisional parathyroid and postoperative blood phosphorus. The C index of external validation of this model is 0.992 and the P value of the Calibration curve is 0.886[KG0.5mm]1. The decision curve analysis also shows that the evaluation effect of this model is perfect. Conclusion:The prediction model constructed in this study is useful for individualized prediction of recurrence after PTX in patients with secondary hyperparathyroidism.


Subject(s)
Humans , Parathyroidectomy/methods , Parathyroid Hormone , Retrospective Studies , Hyperparathyroidism, Secondary/surgery , Parathyroid Glands , Recurrence , Calcium
4.
Journal of Southern Medical University ; (12): 238-243, 2022.
Article in Chinese | WPRIM | ID: wpr-936307

ABSTRACT

OBJECTIVE@#To establish an cell model of hyperparathyroidism by isolation, in vitro culture, and identification of parathyroid cells from patients with secondary hyperparathyroidism (SHPT).@*METHODS@#The parathyroid gland tissues obtained from 10 patients with SHPT were dissociated by collagenase digestion for primary culture of the parathyroid cells. Morphological changes and growth characteristics of the cells were assessed by microscopic imaging and cell counting. The mRNA and protein expression levels of parathyroid hormone (PTH), calcium-sensing receptor (CaSR), and glial cells missing 2 (GCM2) in the primary and passaged cells were determined by immunofluorescence, qRT-PCR, and Western blotting.@*RESULTS@#Primary cultures of parathyroid cells were successfully obtained. The cells exhibited a high expression of PTH shown by immunofluorescence assay and had a population doubling time of approximately 71.61 h. PTH secretion in the second-passage (P2) cells was significantly lower than that in the primary (P0) and first-passage (P1) cells (P < 0.001). Despite a significant downregulation of CaSR mRNA (P=0.017) and protein (P=0.006) in P1 cells as compared with P0 cells, no significant differences were found in mRNA and protein expressions of PTH or GCM2 between the two cell generations.@*CONCLUSION@#Primary cultures of parathyroid cells isolated from SHPT patients by collagenase digestion show similar biological properties to the cells in vivo.


Subject(s)
Humans , Hyperparathyroidism, Secondary/metabolism , Parathyroid Glands/metabolism , Parathyroid Hormone , RNA, Messenger/metabolism , Receptors, Calcium-Sensing/metabolism
6.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 377-382, Mar.-Apr. 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1248933

ABSTRACT

The function and protection of the parathyroid glands are increasingly popular research topics. New Zealand white rabbits are the most commonly used animal model of parathyroid ischemia. However, information on the vasculature of their parathyroid glands is limited. We used 94 healthy New Zealand white rabbits, 3-4 months of age and 2-3kg in weight, for exploration of the parathyroid glands, which were stained using hematoxylin and eosin (HE) after removal. The following types were classified according to the relationship between the position of the inferior parathyroid gland and the thyroid: Type A, Close Type, Type B, and Distant Type. There were 188 cases, 4 where the inferior parathyroid glands were located near the dorsal side of thyroid (2.13%), 8 where the inferior parathyroid glands were located superior to the upper pole of the thyroid (4.26%), 20 where the inferior parathyroid glands were located parallel to the thyroid (10.64%), and 155 cases where the inferior parathyroid glands were located inferior to the lower pole of thyroid (82.45%). Identifying the location and classifying the vasculature of the parathyroid glands in New Zealand white rabbits will provide an anatomical model to assist in future research.(AU)


A função e proteção das glândulas paratireoidianas é um tópico de pesquisa cada vez mais popular. Coelhos brancos da Nova Zelândia são o modelo animal mais comumente usada para isquemia da paratireóide. Porém, informação sobre a vasculatura de suas glândulas paratireóides é limitada. Foram usados 94 coelhos brancos da Nova Zelândia saudáveis, com 3-4 meses de idade, 2-3kg de peso, para exploração das glândulas paratireóides, que foram coradas com hematoxilina e eosina (HE) após a remoção. Os seguintes tipos foram classificados de acordo com a relação entre a posição da glândula paratireoidiana inferior e a tireoide: Tipo A, Tipo Próximo, Tipo B e Tipo Distante. Houve 188 casos, 4 em que as glândulas paratireoidianas inferiores estavam localizadas próximas ao lado dorsal da tireoide (2.13%), 8 onde as glândulas paratireoidianas inferiores estavam localizadas superiores ao polo superior da tireoide (4.26%), 20 onde as glândulas paratireoidianas inferiores estavam localizadas paralelo à tireoide (10.64%) e 155 casos em que as glândulas paratireoidianas inferiores estavam localizadas inferiores ao polo inferior da tireoide (82.45%). A identificação da localização e a classificação da vasculatura das glândulas paratireóides em coelhos brancos da Nova Zelândia fornecerão um modelo anatômico para auxiliar em pesquisas futuras.(AU)


Subject(s)
Animals , Rabbits , Parathyroid Glands/anatomy & histology , Parathyroid Glands/blood supply
8.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 67(2): 230-234, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287806

ABSTRACT

SUMMARY OBJECTIVE: The parathormone level after parathyroidectomy in dialysis patients are of interest. Low levels may require cryopreserved tissue implantation; however, the resection is necessary in case of recurrence. We analyzed post parathyroidectomy parathormone levels in renal hyperparathyroidism. METHODS: Prospective observation of postoperative parathormone levels over defined periods in a cohort of dialysis patients that underwent total parathyroidectomy and immediate forearm autograft from 2008 to 2010, at a single tertiary care hospital. RESULTS: Of 33 patients, parathormone levels until 36 months could be divided into four patterns. Patients with stable function (Pattern 1) show relatively constant levels after two months (67% of the cases). Early function and later failure (Pattern 2) were an initial function with marked parathormone reduction before one year (18%). Graft recurrence (Pattern 3) showed a progressive increase of parathormone in four cases (12%). Complete graft failure (Pattern 4) was a nonfunctioning implant at any period, which was observed in one patient (3%). Parathormone levels of Pattern 3 became statistically different of Pattern 1 at 36 months. CONCLUSIONS: Patients that underwent the total parathyroidectomy and autograft present four different graft function patterns with a possible varied therapeutic management.


Subject(s)
Humans , Parathyroidectomy , Hyperparathyroidism, Secondary/surgery , Hyperparathyroidism, Secondary/etiology , Parathyroid Hormone , Parathyroid Glands , Recurrence , Transplantation, Autologous , Prospective Studies
9.
Rev. colomb. cir ; 36(1): 110-119, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1150525

ABSTRACT

Durante las últimas décadas, la incidencia del hiperparatiroidismo primario ha venido en aumento, muy probablemente relacionado con la mayor accesibilidad a los estudios diagnósticos; sin embargo, la forma más común de presentación clínica del hiperparatiroidismo primario es asintomática, en más del 80 % de los pacientes. En la actualidad, es menos frecuente el diagnóstico por las complicaciones renales (urolitiasis) u óseas (osteítis fibrosa quística) asociadas. Un tumor benigno de la glándula paratiroides (adenoma único), es la principal causa de esta enfermedad. Por tanto, su tratamiento usualmente es quirúrgico. A pesar de ello, no es frecuente el manejo de esta patología por el cirujano general. En este artículo se revisan conceptos claves para el diagnóstico y manejo de esta enfermedad para el médico residente y especialista en Cirugía general


During the last decades, the incidence of primary hyperparathyroidism has been increasing, most probably related to the greater accessibility to diagnostic studies; however, the most common form of clinical presentation of primary hyperparathyroidism is asymptomatic in more than 80% of patients. Diagnosis is less frequent due to associated renal (urolithiasis) or bone (osteitis fibrosa cystica) complications. A benign tumor of the parathyroid gland (single adenoma) is the main cause of this disease. Therefore, its treatment is usually surgical. Despite this, the management of this pathology by the general surgeon is not frequent. This article reviews key concepts for the diagnosis and management of this disease for the resident physician and specialist in General Surgery


Subject(s)
Humans , Parathyroid Glands , Parathyroid Neoplasms , Parathyroidectomy , Hyperparathyroidism, Primary
10.
Chinese Journal of Otorhinolaryngology Head and Neck Surgery ; (12): 844-847, 2021.
Article in Chinese | WPRIM | ID: wpr-942533

ABSTRACT

Objective: To explore the values of intraoperative fine-needle aspiration (IFNA) and parathyroid hormone (PTH) detection in the eluate of aspirated tissue during parathyroidectomy. Methods: Fifty-four patients with secondary hyperparathyroidism (SHPT) including 24 males and 30 females, aged 20-83 years, admitted to Zhongnan Hospital of Wuhan University from January 2019 to October 2019, were included. All patients received subtotal parathyroidectomy with autologous transplantation, during surgery, IFNA and PTH detection in the eluate of aspirated tissue were performed, and also routine postoperative pathological examination was performed. The results of PTH detection in the eluate of aspirated tissue and postoperative pathological examinations were compared and analyzed by SPSS and R software for evaluating of the sensitivity, specificity, positive predictive value, negative predictive value, misdiagnosis rate, missed diagnosis and accuracy. Results: Surgery was completed successfully in all patients. After surgery, the symptoms were improved in the patients except two who were asymptomatic. None had any serious postoperative complications such as hypocalcaemia or hoarseness. A total of 231 aspirated tissue samples were tested, of which 216 were identified as parathyroid and 15 non-parathyroid based on intraoperative PTH detection in tissue eluate; while 217 were confirmed as parathyroid tissues and 14 non-parathyroid tissues with postoperative pathological examinations. The specificity and sensitivity of intraoperative IFNA and PTH detection in tissue eluate for identifying parathyroid tissues were 99.5% and 100.0%, respectively. Conclusion: The IFNA and PTH detection in tissue eluate is a rapid, simple, and accurate procedure, which helps the surgeon to identify parathyroid tissue and to ensure the endocrine activity of preserved or autografted parathyroid tissue during parathyroidectomy.


Subject(s)
Female , Humans , Male , Hyperparathyroidism, Secondary/surgery , Parathyroid Glands/surgery , Parathyroid Hormone , Parathyroidectomy , Predictive Value of Tests
11.
Journal of Central South University(Medical Sciences) ; (12): 368-372, 2021.
Article in English | WPRIM | ID: wpr-880668

ABSTRACT

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


Subject(s)
Humans , Calcium , China/epidemiology , Hyperparathyroidism, Primary/epidemiology , Parathyroid Glands , Parathyroid Hormone , Retrospective Studies
12.
Arch. endocrinol. metab. (Online) ; 64(4): 427-435, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131116

ABSTRACT

ABSTRACT Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.


Subject(s)
Humans , Parathyroid Glands , Thyroid Gland/surgery , Postoperative Complications , Thyroidectomy , Fluorescein Angiography , Hypoparathyroidism , Indocyanine Green
13.
Medicina (B.Aires) ; 80(1): 39-47, feb. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1125036

ABSTRACT

El tejido paratiroideo ectópico es una causa frecuente de recurrencia del hiperparatiroidismo (HPT) siendo de 16% en primarios y 14% en secundarios. La localización intratorácica representa el 20-35%, pero solo un 2% requiere una cirugía torácica. El objetivo fue analizar una cohorte de pacientes con diagnóstico de HPT mediastinal operados en un hospital de alta complejidad de Argentina. Se realizó un estudio retrospectivo de todos los operados por HPT entre enero de 2006 y julio 2019 en ese hospital. Se incluyeron aquellos que requirieron acceso torácico por HPT ectópico. En este período se trataron 728 pacientes con HPT primario y secundario. Seis con primario y 3 con secundario requirieron cirugía torácica. Se realizaron 6 videotoracoscopias (VATS) y 3 esternotomías, sin complicaciones graves. Se utilizó biopsia por congelación en todos y dosaje de paratohormona intraoperatoria (PTHi) en 8 casos, que descendió en promedio 65% respecto al valor basal. Se confirmaron 5 adenomas y 4 hiperplasias. La enfermedad paratiroi dea mediastinal representó el 1.65% (12/728), mientras que recibieron tratamiento quirúrgico en nuestra institución 1.24% (9/728). La biopsia por congelación y el descenso de PTHi resultan útiles para confirmar el foco y eventualmente disminuir el riesgo de recurrencia. La VATS es segura pero depende del entrenamiento y de la disponibilidad en el medio asistencial. Si bien el sestamibi es el método con mayor sensibilidad, se propone el uso de 18F-colina PET/TC ante la sospecha de HPT ectópico. La posibilidad de obtener conclusiones basadas en la evidencia requiere de estudios con mayor número de pacientes.


The ectopic parathyroid tissue is a frequent cause of recurrent hyperparathyroidism (HPT), accounting 16% in primary HPT and 14% in secondary cases. Although intrathoracic ectopic glands represent 25-35% of all ectopic cases, only 2% requires thoracic surgery. The aim of this study is to report a case series of patients with ectopic mediastinal HPT treated by thoracic approach in a private institution in Argentina. This is a retrospective analysis from January 2006 to June 2019. All patients diagnosed with ectopic hyperparathyroidism who required a thoracic surgical approach were included. During this period, 728 patients with primary HPT and secondary HPT were treated. Six with primary HPT and 3 with secondary HPT required a thoracic approach. Six video-assisted thoracoscopy surgeries (VATS) and 3 sternotomies were performed. None of them presented serious posoperative complications. Frozen section biopsy was used in all cases. iPTH was measured in 8 cases, with a mean drop of 65% after 15 minutes. Final pathology reports confirmed 5 adenomas and 4 hyperplasias. Our case series reported an incidence of 1.65% (12/728) mediastinal parathyroids, while 1.24% (9/728) received surgical treatment at our institution. Intraoperative frozen section and PTHi are useful to confirm the diagnosis and to avoid recurrences. Although VATS is a safe and efficient treatment option, it depends on surgical training and availability. In terms of diagnostic imaging resources, sestamibi remains the current gold standard. However, 18F-choline PET/CT may arise as a new diagnostic tool. The possibility of obtaining evidence-based conclusions requires studies with higher number of patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Parathyroid Glands/pathology , Hyperparathyroidism/pathology , Argentina/epidemiology , Recurrence , Biopsy , Retrospective Studies , Sex Distribution , Age Distribution , Positron Emission Tomography Computed Tomography , Hyperparathyroidism/therapy , Hyperparathyroidism/epidemiology
14.
Endocrinology and Metabolism ; : 64-70, 2020.
Article in English | WPRIM | ID: wpr-816628

ABSTRACT

Since parathyroid hormone (PTH) was first isolated and its gene (PTH) was sequenced, only eight PTH mutations have been discovered. The C18R mutation in PTH, discovered in 1990, was the first to be reported. This autosomal dominant mutation induces endoplasmic reticulum stress and subsequent apoptosis in parathyroid cells. The next mutation, which was reported in 1992, is associated with exon skipping. The substitution of G with C in the first nucleotide of the second intron results in the exclusion of the second exon; since this exon includes the initiation codon, translation initiation is prevented. An S23P mutation and an S23X mutation at the same residue were reported in 1999 and 2012, respectively. Both mutations resulted in hypoparathyroidism. In 2008, a somatic R83X mutation was detected in a parathyroid adenoma tissue sample collected from a patient with hyperparathyroidism. In 2013, a heterozygous p.Met1_Asp6del mutation was incidentally discovered in a case-control study. Two years later, the R56C mutation was reported; this is the only reported hypoparathyroidism-causing mutation in the mature bioactive part of PTH. In 2017, another heterozygous mutation, M14K, was detected. The discovery of these eight mutations in the PTH gene has provided insights into its function and broadened our understanding of the molecular mechanisms underlying mutation progression. Further attempts to detect other such mutations will help elucidate the functions of PTH in a more sophisticated manner.


Subject(s)
Humans , Apoptosis , Case-Control Studies , Codon, Initiator , Endoplasmic Reticulum Stress , Exons , Hyperparathyroidism , Hypoparathyroidism , Introns , Parathyroid Diseases , Parathyroid Glands , Parathyroid Hormone , Parathyroid Neoplasms
17.
Rev. colomb. psiquiatr ; 48(1): 35-43, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1013958

ABSTRACT

RESUMEN La prescripción de carbonato de litio es común en la actividad psiquiátrica cotidiana. El objetivo es identificar las alteraciones endocrinas secundarias y sus bases fisiopatológicas. La revisión de la literatura se realizó en Psycinfo, EMBASE, PubMed y Scopus. Se efectuó una búsqueda computarizada de información utilizando la estrategia PICO. Las alteraciones más comunes están en riñones, tiroides, paratiroides, páncreas y vías neuroendocrinas. Los mecanismos fisiopatológicos subyacentes son diversos, y destacan la inhibición de la adenilato ciclasa tiroidea sensible a tirotropina como causa de hipotiroidismo, la expresión reducida de acuaporina 2 como causa de diabetes insípida nefrogénica, la pérdida del equilibrio iónico del calcio y la presencia de hiperparatiroidismo e hipercalcemia. En el eje hipotálamo-hipófiso-adrenal, se documenta una disminución en la producción de catecolaminas. Finalmente, se documenta la desregulación en el control de la glucemia al aumentar la resistencia a la insulina. Es necesario conocer estas eventualidades e identificarlas tempranamente a través de evaluaciones periódicas. Se propone un esquema de evaluación integral, sin que implique un algoritmo de tratamiento.


ABSTRACT The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lithium Carbonate , Kidney , Lithium , Parathyroid Glands , Thyroid Gland , Adrenal Glands , Diabetes Insipidus, Nephrogenic
18.
International Journal of Thyroidology ; : 54-57, 2019.
Article in Korean | WPRIM | ID: wpr-764087

ABSTRACT

Secondary hyperparathyroidism (HPT) usually result from parathyroid gland hyperplasia that produces excess parathyroid hormone (PTH). Decreased renal function leads to elevate serum phosphate levels and reduce vitamin D production, which results in hypocalcemia. Skeletal resistance to PTH results in persistently and frequently extremely elevated PTH levels and renal osteopathy. Treatment of choice for secondary HPT is medical management including calcitriol and vitamin D. However, for some cases in calciphylaxis and the failure including PTH >800 pg/mL or osteoporosis under maximal medical management surgical intervention could be an alternative option. We described a case of 47-year-old woman with surgical intervention for secondary hyperparathyroidism.


Subject(s)
Female , Humans , Middle Aged , Autografts , Calciphylaxis , Calcitriol , Hyperparathyroidism, Secondary , Hyperplasia , Hypocalcemia , Osteoporosis , Parathyroid Glands , Parathyroid Hormone , Parathyroidectomy , Transplantation, Autologous , Vitamin D
19.
The Korean Journal of Helicobacter and Upper Gastrointestinal Research ; : 65-70, 2019.
Article in Korean | WPRIM | ID: wpr-738991

ABSTRACT

Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant hereditary disorder caused by germline mutation of the MEN1 gene. It is characterized by tumors of the anterior pituitary gland, parathyroid glands, and endocrine pancreas. Thymic carcinoid tumor is uncommon and associated with a high mortality, but its natural history has not been investigated yet. We report a case of asymptomatic MEN 1 with a thymic carcinoid tumor. A 37-year-old man underwent a routine medical checkup and upper gastrointestinal endoscopy revealed a duodenal neuroendocrine tumor (NET). Further studies showed the coexistence of pancreatic tumor, parathyroid hyperplasia, pituitary adenoma, and thymoma. The patient underwent duodenal endoscopic mucosal resection, distal pancreatectomy, subtotal parathyroidectomy, and thymectomy. The pathological test revealed a duodenal NET, pancreatic NET, parathyroid hyperplasia, and thymic carcinoid tumor. He was treated for MEN 1. We report this asymptomatic case of MEN 1 with a literature review.


Subject(s)
Adult , Humans , Carcinoid Tumor , Endoscopy, Gastrointestinal , Germ-Line Mutation , Hyperparathyroidism , Hyperplasia , Islets of Langerhans , Mortality , Multiple Endocrine Neoplasia Type 1 , Multiple Endocrine Neoplasia , Natural History , Neuroendocrine Tumors , Pancreatectomy , Parathyroid Glands , Parathyroidectomy , Pituitary Gland, Anterior , Pituitary Neoplasms , Thymectomy , Thymoma
20.
Osteoporosis and Sarcopenia ; : 2-5, 2019.
Article in English | WPRIM | ID: wpr-760726

ABSTRACT

Aluminum (Al) is the third most abundant element in the earth's crust and is omnipresent in our environment, including our food. However, with normal renal function, oral and enteral ingestion of substances contaminated with Al, such as antacids and infant formulae, do not cause problems. The intestine, skin, and respiratory tract are barriers to Al entry into the blood. However, contamination of fluids given parenterally, such as parenteral nutrition solutions, or hemodialysis, peritoneal dialysis or even oral Al-containing substances to patients with impaired renal function could result in accumulation in bone, parathyroids, liver, spleen, and kidney. The toxic effects of Al to the skeleton include fractures accompanying a painful osteomalacia, hypoparathyroidism, microcytic anemia, cholestatic hepatotoxicity, and suppression of the renal enzyme 25-hydroxyvitamin D-1 alpha hydroxylase. The sources of Al include contamination of calcium and phosphate salts, albumin and heparin. Contamination occurs either from inability to remove the naturally accumulating Al or from leeching from glass columns used in compound purification processes. Awareness of this long-standing problem should allow physicians to choose pharmaceutical products with lower quantities of Al listed on the label as long as this practice is mandated by specific national drug regulatory agencies.


Subject(s)
Humans , Aluminum , Anemia , Antacids , Calcium , Eating , Glass , Heparin , Hypoparathyroidism , Infant Formula , Intestines , Kidney , Leeching , Liver , Osteomalacia , Parathyroid Glands , Parenteral Nutrition Solutions , Peritoneal Dialysis , Pharmaceutical Preparations , Renal Dialysis , Respiratory System , Salts , Skeleton , Skin , Spleen
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