ABSTRACT
Primary hyperparathyroidism presenting first time with severe hypercalcemia is rare in pregnancy. We report a case of primary hyperparathyroidism due to a cystic parathyroid adenoma presenting as severe hypercalcemia with acute pancreatitis in second trimester of pregnancy. Acute pancreatitis was managed by conservative treatment. Hypercalcemia failed to respond to medical management and ultimately responded to ultrasound-guided ethanol ablation of parathyroid adenoma. The delivery was uneventful and patient continues to remain normocalcemic during follow up. As such, ethanol ablation of parathyroid adenoma may be considered during pregnancy in case of failure of response to medical management and when surgical removal of parathyroid adenoma is not safe.
Subject(s)
Adenoma/diagnostic imaging , Hypercalcemia/etiology , Hyperparathyroidism, Primary/complications , Pancreatitis/etiology , Parathyroid Neoplasms/diagnostic imaging , Pregnancy Complications/etiology , Ablation Techniques , Adenoma/complications , Adenoma/surgery , Adult , Ethanol , Female , Humans , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/surgery , Pregnancy , Ultrasonography, InterventionalABSTRACT
A young adult female with restricted water intake during the postpartum period presented with history of progressive weakness, dizziness and tendency to fall with generalized slowing of movement. On examination, patient was anaemic, febrile and stuporous. Investigations revealed hypernatremia, delta waves in electroencephalogram (EEG) and features suggestive of extra-pontine myelinolysis on magnetic resonance imaging (MRI) of brain. After correcting hypernatremia and instituting anti-cholinergic therapy, there was a gradual but steady improvement in neurological symptoms of the patient over a period of one week and the patient was discharged in a conscious, oriented and ambulant state. As such, neuroimaging findings can be crucial in diagnosing hypernatremic encephalopathy in the postpartum period.
Subject(s)
Hypernatremia/etiology , Myelinolysis, Central Pontine/etiology , Postpartum Period , Water Deprivation , Electroencephalography , Female , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Middle Cerebellar Peduncle/diagnostic imaging , Myelinolysis, Central Pontine/diagnostic imaging , Neural Pathways/diagnostic imaging , Young AdultABSTRACT
Although visceral leishmaniasis (VL) is endemic in various parts of India, mainly Bihar, West Bengal and Orissa, and neighbouring countries such as Nepal and Bangladesh, it is rarely reported from the hilly areas of India. We report on nine male VL cases from the non-endemic Garhwal region of Uttarakhand who were treated successfully with sodium stibogluconate. We conclude that sodium stibogluconate-sensitive VL is emerging in this region and that urgent and effective vector control measures may be warranted to prevent the disease from becoming a major health problem and to ensure that resistance to sodium stibogluconate does not emerge.
