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1.
Rev. méd. Urug ; 37(1): e702, mar. 2021. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1180966

ABSTRACT

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.


Subject(s)
Parathyroid Neoplasms , Adenoma , Parathyroidectomy , Hyperparathyroidism, Primary/surgery
2.
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
3.
Actual. osteol ; 17(1): 45-56, 2021. ilus, graf, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1292122

ABSTRACT

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)


Subject(s)
Humans , Female , Child , Parathyroid Neoplasms/diagnosis , Palatal Neoplasms/etiology , Adenoma/diagnosis , Hyperparathyroidism, Primary/complications , Parathyroid Neoplasms/surgery , Palatal Neoplasms/diagnostic imaging , Adenoma/surgery , Hyperparathyroidism, Primary/etiology
4.
Autops. Case Rep ; 11: e2021270, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249033

ABSTRACT

Background Hemangiomas are benign neoplasms of capillary proliferation that arise from a developmental anomaly where angioblastic mesenchyme fails to form canals. Most hemangiomas arise in the head and neck region, either superficially in the skin or deeper within endocrine organs such as the parotid gland. Parathyroid hemangiomas, however, are extremely rare, with only five cases previously reported in the literature. Case presentation Herein, we present a case of a 68-year-old man with a hemangioma almost completely replacing the right upper parathyroid gland, grossly measuring 1.3 × 1.3 × 1.2 cm and weighing 700 mg, associated with primary hyperparathyroidism. Conclusions Parathyroid gland enlargement due to vascular neoplasms such as hemangiomas can mimic, both clinically and radiographically, hyperplasias and/or adenomas. Surgeons need to be aware of the presence of this entity and should consider it in the differential diagnosis of hyperparathyroidism or parathyroid gland enlargement.


Subject(s)
Humans , Male , Aged , Parathyroid Neoplasms/pathology , Adenoma/pathology , Hemangioma/pathology , Parathyroid Diseases/complications , Diagnosis, Differential
5.
Actual. osteol ; 17(2): 92-103, 2021. ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1370258

ABSTRACT

El carcinoma paratiroideo (CP) es una neoplasia maligna con una incidencia de 0,015 cada 100.000 habitantes por año. Representa el 1% de los diagnósticos de hiperparatiroidismo primario y se manifiesta entre la 4.a y 5.a década de la vida, con una incidencia similar entre hombres y mujeres. La etiología del CP es incierta, ha sido asociada a formas esporádicas o familiares. Está caracterizado por altos niveles séricos de calcio y PTH y el desafío clínico-quirúrgico es el diagnóstico diferencial con otras entidades benignas como el adenoma o la hiperplasia de paratiroides. Aunque el diagnóstico de certeza es anatomopatológico, la sospecha clínica y el uso de métodos de baja complejidad (ecografía) con operadores avezados permite una correcta localización y abordaje pertinente del paciente para dirigir el tratamiento quirúrgico adecuado (resección en bloque) evitando persistencias y recurrencias de enfermedad. Se presenta el caso clínico de un paciente masculino que ingresa por síndrome de impregnación asociado a hipercalcemia, su abordaje diagnóstico, tratamiento y manejo interdisciplinario con discusión y revisión bibliográfica. (AU)


Parathyroid carcinoma (CP) is a malignant disease with an incidence of 0.015 per 100,000 inhabitants per year. It accounts for 1% of primary hyperparathyroidism diagnoses and occurs between the 4th and 5th decade of life, with a similar incidence between men and women. The etiology of CP is uncertain and has been associated with sporadic or family forms. CP is characterized by high serum calcium and PTH levels and the clinical-surgical challenge is the differential diagnosis with other benign entities such as parathyroid adenoma or hyperplasia. Although the diagnosis of certainty is achieved by pathological anatomy examination, the clinical suspicion and the use of low complexity methods (ultrasound) by experienced operators allows a correct localization and a patient-specific approach to direct the appropriate surgical treatment (block resection), avoiding persistence and recurrences of disease. The clinical case of a male patient admitted for severe hypercalcemia with multiple organ disfunction, the diagnostic approaches, treatment, and interdisciplinary management, together with review and discussion of the current literature are presented. (AU)


Subject(s)
Humans , Male , Middle Aged , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/etiology , Parathyroid Neoplasms/diagnostic imaging , Hyperparathyroidism, Primary/complications , Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/etiology , Parathyroid Hormone/blood , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/pathology , Calcitriol/administration & dosage , Calcium Gluconate/administration & dosage , Radiography , Tomography , Calcium/administration & dosage , Ultrasonography , Diagnosis, Differential , Hypercalcemia/blood
6.
Rev. bras. ginecol. obstet ; 42(12): 841-844, Dec. 2020.
Article in English | LILACS | ID: biblio-1156070

ABSTRACT

Abstract Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsiamotivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.


Resumo O hiperparatiroidismo primário é umdistúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Pancreatitis/diagnosis , Parathyroid Neoplasms/diagnosis , Pre-Eclampsia/diagnosis , Prenatal Diagnosis , Adenoma/diagnosis , Hyperparathyroidism, Primary/diagnosis , Pancreatitis/complications , Parathyroid Neoplasms/complications , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Trimester, Third , Adenoma/complications , Diagnosis, Differential , Hyperparathyroidism, Primary/complications
8.
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)
Apoptosis , Case-Control Studies , Codon, Initiator , Endoplasmic Reticulum Stress , Exons , Humans , Hyperparathyroidism , Hypoparathyroidism , Introns , Parathyroid Diseases , Parathyroid Glands , Parathyroid Hormone , Parathyroid Neoplasms
9.
Rev. colomb. radiol ; 31(2): 5354-5359, jun. 2020. imag, ilus
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1343461

ABSTRACT

El carcinoma de paratiroides es una causa excepcional de hiperparatiroidismo primario. Los tumores pardos se desarrollan como manifestaciones esqueléticas de hiperparatiroidismo primario en el contexto de una enfermedad avanzada. Son lesiones óseas líticas, altamente vasculares con un proceso celular reparador en lugar de un proceso neoplásico. Pueden identificarse en las formas secundarias de la enfermedad; sin embargo, son más frecuentes en el hiperparatiroidismo primario. Se presenta el caso de múltiples tumores pardos secundarios a un carcinoma de paratiroides. La manifestación inicial del hiperparatiroidismo primario fue una fractura patológica secundaria a tumor pardo asociado con hipercalcemia y niveles elevados de hormona paratiroidea (PTH), lo cual es infrecuente debido a que en las últimas décadas la incorporación del calcio sérico en las pruebas de rutina de laboratorio detecta esta enfermedad en estadios asintomáticos o mínimamente sintomáticos. Por ultrasonido se detectó lesión sólida vascularizada en sitio anatómico de paratiroides inferior izquierda y nefrocalcinosis. Se sometió a resección quirúrgica de la lesión en hemicuello izquierdo y la biopsia reportó carcinoma de paratiroides. Los tumores pardos son lesiones no neoplásicas que no tienen potencial maligno por lo que se consideran granulomas reparadores.


Parathyroid carcinoma is an exceptional cause of primary hyperparathyroidism. Brown tumors develop as skeletal manifestations of primary hyperparathyroidism in the context of advanced disease. They are highly vascular, lytic bone lesions with a reparative cellular process instead of a neoplastic process. They can be identified in the secondary forms of the disease, however, they are more frequent in primary hyperparathyroidism. We present a case of multiple brown tumors secondary to parathyroid carcinoma. The initial manifestation of primary hyperparathyroidism was a pathological fracture secondary to brown tumor associated with hypercalcemia and elevated levels of parathyroid hormone (PTH), which is rare due to the fact that in recent decades the incorporation of serum calcium in routine laboratory tests detects this disease in asymptomatic or minimally symptomatic stages. Ultrasound detected a vascularized solid lesion in the anatomical site of the left lower parathyroid and nephrocalcinosis. The lesion was surgically resected in the left hemicolumn and the biopsy reported parathyroid carcinoma. Brown tumors are non-neoplastic lesions that do not have malignant potential and are therefore considered repairing granulomas.


Subject(s)
Osteitis Fibrosa Cystica , Parathyroid Neoplasms , Radiography , Hyperparathyroidism, Primary
10.
Article in English | WPRIM | ID: wpr-876112

ABSTRACT

@#Primary hyperparathyroidism in children and adolescents is rare and often symptomatic at presentation. A 15-year-old boy presented with bilateral genu valgum for two years. Biochemical results were consistent with primary hyperparathyroidism. Calcium levels normalized two months after removal of a left inferior parathyroid adenoma.


Subject(s)
Parathyroid Neoplasms , Genu Valgum , Adolescent , Hyperparathyroidism, Primary
11.
Rev. méd. hondur ; 87(2): 76-70, abr.-dic. 2019. ilus
Article in Spanish | LILACS, BIMENA | ID: biblio-1097735

ABSTRACT

Antecedentes: El hiperparatiroidismo primario, tercer trastorno metabólico más común a nivel mundial, provoca un aumento del calcio sérico y de la hormona paratiroidea, causado por una hiperactividad de las glándulas paratiroideas. En el 85% de los casos, se debe a un adenoma paratiroideo. Es predominantemente asintomático (>80%), pero sus manifestaciones pueden ser musculo-esqueléticas, neurológicas, psiquiátricas, renales, cardiovasculares, y gastrointestinales. Descripción del Caso Clínico: Paciente femenina de 53 años de edad, con antecedente de hipercolesterolemia familiar heterocigoto e hipertensión arterial; presenta insomnio, náuseas, pérdida de peso, mialgias, astenia, relujo gastroesofágico e irritabilidad. Ante indicación de exámenes de labo-ratorio muestra hipercalcemia leve. Se comprueba un adenoma paratiroideo derecho y nódulos tiroideos coloides benignos en lóbulo izquierdo mediante gammagrafía Tc99m MIBI, siendo sometida a su resección con posterior evolución satisfactoria. Conclusiones: Considerando la predilección asintomática del hiperparatiroidismo primario y su preferencia de presentación como adenoma, resulta indispensable su sospecha ante toda hipercalcemia. Requiere entonces una concientización amplia no solo en el ámbito médico sino también en la comunidad, ampliando esfuerzos entre el clínico, cirujano, y patólogo. Se recomienda medir el calcio y fósforo sérico de forma rutinaria en la evaluación clínica cotidiana de cada paciente para su detección...(AU)


Subject(s)
Humans , Male , Middle Aged , Parathyroid Neoplasms/complications , Thyroid Gland/surgery , Hyperparathyroidism, Primary/diagnosis , Hypercalcemia
12.
Prensa méd. argent ; 105(8): 431-435, sept 2019. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1023142

ABSTRACT

Introducción: La monitorización con hormona tiroidea intraoperatoria (IOPTH) es utilizada en la práctica médica para predecir la cura bioquímica durante la paratiroidectomía del hiperparatiroidismo primario. Sin embargo, existen diversos criterios utilizados para predecir la normocalcémica luego de una paratiroidectomía. El propósito de este estudio es determinar cuál criterio es aquel que se corresponde con el menor riesgo de presentar un hiperparatiroidismo persistente luego de una paratiroidectomía por hiperparatiroidismo primario. Material y métodos: Se han analizado publicaciones realizadas en los últimos 10 años tomando como fuente de recopilación la base de datos de Pub-Med, trabajos publicados en Journal of the American Medical Associatiion y World Journal of Surgery. Conclusión: El criterio de IOPTH final en valores por debajo de los 65 pg/mL, y en especial, por debajo de los 40 pg/mL parece comportarse como mejor predictor de bajo riesgo de enfermedad persistente en comparación con el criterio de disminución de IOPTH por debajo del 50% del valor basal (AU)


Introduction: Monitoring with intraoperative thyroid hormone (IOPTH) is used in medical practice to predict the biochemical cure during the parathyroidectomy of primary hyperparathyroidism. However, there are several criteria used to predict normocalcemia after a parathyroidectomy. The purpose of this study is to determine which criterion is the one that correspons to the lowest risk of presenting a persistent hyperparathyroidism after a parathyroidectomy due to primary hyperparathyroidism. Materials and methods: Publications made in the last 10 years have been analyzed taking as a source of compilations the PubMed database, works published in Journal of the American Medical Association and World Journal of Surgery. Conclusiion: The final IOPTH criterion in values below 65 pg/mL, and especially below 40 pg/mL, seems to be the best predictor of low risk of persistent disease compared to the IOPTH decrease criterior Below 50% of the basal value (AU)


Subject(s)
Humans , Parathyroid Hormone , Parathyroid Neoplasms/surgery , Risk Assessment , Hyperparathyroidism, Primary/surgery , Feasibility Studies
13.
Int. j. odontostomatol. (Print) ; 13(3): 266-270, set. 2019. graf
Article in Spanish | LILACS | ID: biblio-1012420

ABSTRACT

RESUMEN: Se presenta el caso de un paciente sexo femenino 31 años, insuficienciente renal crónica en hemodiálisis, hipertensa secundaria, consulta por aumento de volumen oral en relación a encía marginal vestibular izquierda, 6 meses de evolución. Al examen se observa aumento de volumen de 15 mm en relación a piezas. 3.6 y 3.7. Radiografía muestra compromiso periodontal pieza 3.7. Se realiza biopsia excisional y exodoncia pieza 3.7. Histopatología informa granuloma periférico de células gigantes. Se solicitan exámenes de laboratorio para estudio de hiperparatiroidismo (PTH elevada, calcemia fosfatemia normales). Evoluciona favorablemente. Sin signos de recidiva a los 3 meses. El diagnóstico histopatológico de lesión de células gigantes debe ser complementado con la clínica, exámenes de laboratorio e imagenología, el objetivo final es definir si tal diagnóstico corresponde a un tumor pardo, a un granuloma central de células gigantes o a un granuloma periférico de células gigantes. En la literatura los reportes de asociación entre granuloma periférico de células gigantes e hiperparatiroidismo son escasos. Este caso corresponde a granuloma periférico células gigantes, asociado a hipersecreción de paratohormona.


ABSTRACT: A 31-year-old female patient with chronic renal insufficiency in hemodialysis and secondary hypertension consulted due to an enlarging intraoral lesion in relation to the left marginal vestibular gingival, with 6 months of evolution. A 15mm mass in relation to mandibular left molars was noted. Radiograph showed periodontal involvement of mandibular left second molar. Excisional biopsy and tooth 3.7 extraction were performed. Histopathology reported a peripheral giant cell granuloma. Laboratory tests were requested for suspected hyperparathyroidism (aiding in the diagnosis) (high PTH, normal phosphatemia and calcemia). Evolution was favorable, without signs of reappearance after 3 months. The histopathological diagnosis of giant cell lesions should be complemented with clinical, laboratory and imaging tests. The final objective is to make the differential diagnosis between brown tumor, central giant cell granuloma and peripheral giant cell granuloma because the treatment varies considerably. There are few reports in the literature about the association between peripheral giant cell granuloma and hyperparathyroidism. This case corresponds to peripheral giant cell granuloma, possibly associated with parathormone hypersecretion.


Subject(s)
Humans , Female , Adult , Parathyroid Neoplasms/surgery , Granuloma, Giant Cell/diagnosis , Granuloma, Giant Cell/pathology , Hyperparathyroidism, Primary/surgery , Gingival Diseases/etiology , Gingival Diseases/pathology , Radiography, Panoramic , Oral Surgical Procedures/methods , Gingival Diseases/surgery
14.
Rev. méd. Chile ; 147(8): 1078-1081, ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058646

ABSTRACT

Acute pancreatitis during pregnancy is uncommon and usually associated with gallstones. However other etiologies must be considered. We report a 24 years old woman with a 32 weeks pregnancy consulting for abdominal pain, nausea and vomiting. She had elevated lipase and amylase levels, a corrected serum calcium of 13.1 mg/dl and a serum phosphate of 1.6 mg/dl. A magnetic resonance colangiopancreatography showed an enlarged pancreas with inflammatory changes and a normal Wirsung duct. A parathyroid nodule was found on cervical ultrasonography. The patient was treated initially with cinacalcet with partial response. A parathyroidectomy was performed at 39 weeks of pregnancy with a good maternal and fetal evolution.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pancreatitis/etiology , Pregnancy Complications/etiology , Hypercalcemia/complications , Pancreatitis/surgery , Pancreatitis/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Pregnancy Complications/surgery , Adenoma/diagnostic imaging , Abdominal Pain/etiology , Parathyroidectomy/methods , Treatment Outcome , Cholangiopancreatography, Magnetic Resonance/methods
15.
Article in Korean | WPRIM | ID: wpr-787535

ABSTRACT

Parathyroid adenoma can cause extracapsular bleeding. In 1934, Capps first reported a case of massive hemorrhage secondary to rupture of a parathyroid adenoma. Recently, we experienced a 73-year-old female presented with pharyngeal discomfort and extensive ecchymosis over the neck without history of trauma. Endoscopic investigation revealed submucosal hemorrhage in the posterior wall of the hypopharynx. CT scan and ultrasonography demonstrated the presence of a mass below the left thyroid lobe. Serum calcium level was normal and PTH level was elevated. We underwent left thyroidectomy and parathyroidectomy 2 weeks later from first visit. During the operation, hypopharyngeal mucosa was teared and it was treated with pharyngostoma formation and L-tube feeding. We report a rare case of normocalcemic parathyroid adenoma with spontaneous hemorrhage and propose the proper management period with a literature review


Subject(s)
Aged , Calcium , Ecchymosis , Female , Hematoma , Hemorrhage , Humans , Hypopharynx , Mucous Membrane , Neck , Parathyroid Neoplasms , Parathyroidectomy , Rupture , Tears , Thyroid Gland , Thyroidectomy , Tomography, X-Ray Computed , Ultrasonography
16.
Article in Chinese | WPRIM | ID: wpr-813046

ABSTRACT

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder. A 44-year-old man visited second Xiangya Hospital, Central South University due to hypoglycemia. He was eventually diagnosed as MEN1. A novel homozygous frameshift for c.640-643delCAGA (p.V215Mfs*13) of MEN1 gene was identified in the patient. After MDT (Multiple Disciplinary Team), open bilateral exploration with total parathyroidectomy and autotransplantation as well as partial pancreatectomy excision of all the macroscopic pancreatic tumors were performed at the same time. The patient recovered well. Individualized diagnosis and treatment are important for MEN1 patients.


Subject(s)
Adult , Humans , Insulinoma , Male , Multiple Endocrine Neoplasia Type 1 , Pancreatic Neoplasms , Parathyroid Neoplasms , Parathyroidectomy
17.
Rev. chil. endocrinol. diabetes ; 12(4): 205-207, 2019.
Article in Spanish | LILACS | ID: biblio-1088026

ABSTRACT

INTRODUCCIÓN: El carcinoma de paratiroides es una enfermedad de difícil diagnóstico, siendo perentorio una detección precoz y un tratamiento oportuno para prevenir las complicaciones. CASO CLÍNICO: Se presenta paciente de 42 años que debuta con hipercalcemia de 16.1 mg/dl, PTH 1573 pg/mL y lesión sugerente de adenoma de paratiroides. Biopsia quirúrgica identifica carcinoma paratiroideo sin invasión, realizándose posteriormente lobectomía derecha con foco de 0,1 mm de carcinoma paratiroideo, con bordes libres. En comité oncológico se decide seguimiento estricto; sin embargo, a los seis meses requiere hospitalización nuevamente por hipercalcemia, a la ecografía cervical presenta dos nódulos hipoecogénicos menores a 1 cm en lecho quirúrgico. Tomografía computada sin evidencia de lesiones. Con estos antecedentes, se decide exploración cervical, encontrándose tumor de 2 cm, multilobulado, paraesofágico. Biopsia evidencia carcinoma paratiroideo con invasión en tejido graso y músculo estriado. Se descarta radioterapia paliativa y quimioterapia debido a escasa evidencia, quedando en cuidados paliativos. DISCUSIÓN: El cáncer de paratiroides es una enfermedad de difícil diagnóstico. En muchos casos se ha descrito la crisis hipercalcémica como presentación inicial. La resección en bloque de la lesión de paratiroides con hemitiroidectomía ipsilateral es el tratamiento estándar. Es un tumor radio resistente y la quimioterapia adyuvante no ha demostrado aumento en la sobrevida. En pacientes con enfermedad inoperable, el pronóstico es pobre, siendo fundamental el control de calcemia y PTH, las cuales son la causa principal de morbimortalidad. CONCLUSIONES: El carcinoma paratiroideo es una enfermedad rara, cuyo diagnóstico y tratamiento representan un verdadero desafío clínico, siendo crucial el alto índice de sospecha. Su curso es crónico y de mal pronóstico, por lo que para pacientes de alto riesgo debe considerarse una cirugía radical desde el inicio.


INTRODUCTION: Parathyroid carcinoma is a difficult diagnosis, with early detection and timely treatment to prevent complications being imperative. CLINICAL CASE: A 42-year-old patient presenting with hypercalcemia of 16.1 mg / dl, PTH 1573 pg / mL and suggestive lesion of parathyroid adenoma is presented. Surgical biopsy identifies parathyroid carcinoma without invasion, subsequently performing right lobectomy with 0.1 mm focus of parathyroid carcinoma, with free borders. Oncological committee, strict follow-up is decided; However, at six months he requires hospitalization again for hypercalcemia, at cervical ultrasound he presents two hypoechogenic nodules smaller than 1 cm in the surgical bed. CT scan without evidence of injuries. With this background, cervical exploration is decided, finding a 2 cm, multilobed, paraesophageal tumor. Biopsy shows parathyroid carcinoma with invasion of fatty tissue and striated muscle. Palliative radiotherapy and chemotherapy are ruled out due to limited evidence, remaining in palliative care. DISCUSSION: Parathyroid cancer is a difficult diagnosis disease. In many cases the hypercalcemic crisis has been described as an initial presentation. Block resection of the parathyroid lesion with ipsilateral hemitiroidectomy is the standard treatment. It is a radioresistant tumor and adjuvant chemotherapy has not shown an increase in survival. In patients with inoperable disease, the prognosis is poor, with the control of calcemia and PTH being essential, which are the main cause of morbidity and mortality. CONCLUSIONS: Parathyroid carcinoma is a rare disease, the diagnosis and treatment of which represent a real clinical challenge, the high index of suspicion being crucial. Its course is chronic and has a poor prognosis, so for high-risk patients, radical surgery should be considered from the beginning.


Subject(s)
Humans , Female , Middle Aged , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnosis , Adenoma/complications , Adenoma/diagnosis , Hypercalcemia/etiology , Parathyroid Neoplasms/surgery , Adenoma/surgery
18.
Article in English | WPRIM | ID: wpr-762612

ABSTRACT

Primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalcemia (FHH) have significantly different treatment approaches, so physicians must be careful to differentiate these 2 diseases. Herein, we report a 14-year-old female who presented with symptomatic hypercalcemia (12 mg/dL; reference range, 9.2–10.7 mg/dL), elevated intact parathyroid hormone (iPTH) (236 pg/mL; reference range, 9–69 pg/mL), and vitamin D deficiency (6 ng/mL; reference range, ≥ 20 ng/mL). On numerous occasions, her 24-hour urine calcium was more than 4 mg/kg/day, consistent with PHPT, but her fractional excretion of calcium on 24-hour urine collection was consistently below 1%, in line with FHH. ⁹⁹mTc-Sestamibi scan failed to detect any abnormalities. However, a 4-dimensional computed tomography scan of the neck revealed a right superior parathyroid adenoma which was excised with a focused parathyroidectomy. Although the patient’s calcium and iPTH levels normalized, her nonspecific symptoms persisted. This case illustrates both the challenges of differentiating PHPT from FHH and the limitations of a first-line imaging tool in identifying a parathyroid adenoma.


Subject(s)
Adolescent , Calcium , Female , Humans , Hypercalcemia , Hyperparathyroidism, Primary , Neck , Parathyroid Hormone , Parathyroid Neoplasms , Parathyroidectomy , Reference Values , Urine Specimen Collection , Vitamin D Deficiency
19.
Int. arch. otorhinolaryngol. (Impr.) ; 22(4): 382-386, Oct.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-975609

ABSTRACT

Abstract Introduction Intraoperative parathyroid hormone (ioPTH) testing is a widely accepted standard for assessing the parathyroid gland function. A decline of preoperative parathyroid hormone (PTH) levels by more than 50% is one accepted measure of parathyroid surgery adequacy. However, there may be a variation between preoperative PTH levels obtained at a clinic visit and pre-excisional ioPTH. Objective Our study explores the differences between preoperative PTH and pre-excisional ioPTH levels, and the potential impact this difference has on determining the adequacy of parathyroid surgery. Methods A retrospective study that consisted of 33 patients that had undergone parathyroid resection between September 2009 and March 2016 at a tertiary academic center was performed. Each subject's preoperative PTH levels were obtained from clinic visits and pre-excisional ioPTH levels were recorded along with the time interval between the measurements. Results There was a significant difference between the mean preoperative PTH and the pre-excisional ioPTH levels of 147 pg/mL (95% confidence interval [CI] 11.43 to 284.47; p= 0.0396). The exclusion of four outliers revealed a further significant difference with a mean of 35.09 pg/mL (95% CI 20.27 to 49.92; p< 0.0001). The average time interval between blood draws was 48 days + 32 days. A weak correlation between the change in PTH values and the time interval between preoperative and pre-excision blood draws was noted (r2 = 0.15). Conclusion Our study reveals a significant difference between the preoperative PTH levels obtained at clinic visits and the pre-excisional intraoperative PTH levels. We recommend routine pre-excisional intraoperative PTH levels, despite evidence of elevated preoperative PTH levels, in order to more accurately assess the adequacy of surgical resection.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Parathyroid Hormone/blood , Monitoring, Intraoperative , Parathyroidectomy , Parathyroid Neoplasms/surgery , Immunoassay , Medical Records , Retrospective Studies , Preoperative Period , Hyperparathyroidism/surgery , Intraoperative Period
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