Secondary parathyromatosis in a patient with normal kidney function: review of diagnostic modalities and approaches to management.

OBJECTIVE: To present a patient with secondary parathyromatosis, a rare complication of parathyroidectomy, and to discuss issues currently pertinent to its diagnosis and management. METHODS: Data were derived from clinical and pathologic observations obtained during patient care. RESULTS: The index patient developed intractable hyperparathyroidism and hypercalcemia that has persisted after 4 surgical procedures and has remained largely resistant to medication, albeit with partial amelioration with combined bisphosphonate and cinacalcet. CONCLUSION: Despite the rarity of this difficult complication of parathyroidectomy, its iatrogenic basis emphasizes a need for heightened awareness and caution among surgeons and endocrinologists. Herein we report an instance of intractable secondary parathyromatosis in a patient with normal kidney function, and we review current approaches to diagnosis and management.

Pharmacotherapy for obese adolescents.

The pharmaceutical search to induce weight loss was precipitated by the United States Food and Drug Administration's (FDA) 1959 formal approval of phentermine for short-term weight loss despite limited research supporting its assertions of weight loss. In addition to sympathomimetic amine products like phentermine, other medications considered in this article include herbal products, sibutramine, orlistat, metformin, and rimonabant. The use of pharmacotherapy for morbidly obese adolescents should be part of a comprehensive weight-loss program that recommends diet, exercise, and behavioral modification. Side effects and the possibility of major adverse effects should be remembered when considering use of these products.

The metabolic syndrome: a gathering challenge in a time of abundance.

The metabolic syndrome (also known as dysmetabolic syndrome, MetS, Reaven syndrome, syndrome X, and insulin-resistance syndrome) is a well-recognized and all-too-frequently encountered fact of modern life, with staggering economic consequences. Various aspects of the metabolic syndrome are considered in this review, including such features as insulin resistance with glucose intolerance, hypertension, beta-cell failure, hyperinsulinemia, frank diabetes mellitus, dyslipidemia, and release of inflammatory and procoagulant factors into the circulation. Issues of management for the adolescent are considered also. Much can be accomplished for such youth by using the knowledge we currently have in hand, but many additional issues that are noted make the prospects for success extremely challenging for clinicians who deal with adolescent patients.