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Ultima Vez Modificado: 1 de abril del 2002
UI - 11889154
AU - Burski K; Torjussen B; Paulsen AQ; Boman H; Bollerslev J
TI - Parathyroid adenoma in a subject with familial hypocalciuric hypercalcemia: coincidence or causality?
SO - J Clin Endocrinol Metab 2002 Mar;87(3):1015-6
AD - Section of Endocrinology, Department of Medicine, National University Hospital, N-0027 Oslo, Norway.
A middle-aged woman presented with a history of constipation, easy fatigue, depressive mood, lassitude, polydipsia, and polyuria. The patient posed a challenging diagnostic dilemma due to the presence of persistent severe hypercalcemia and relative lack of clinically manifested symptoms. Clinical, biochemical, and genetic examinations confirmed the diagnosis of familial hypocalciuric hypercalcemia as a result of C562Y calcium-sensing receptor mutation, and a coexisting parathyroid adenoma. After adenectomy, the patient's clinical situation improved markedly, and a modest equilibrium hypercalcemia persisted. This case presents an unusual combination of two relatively common endocrine disorders.
UI - 11891946
AU - Absher KJ; Truong LD; Khurana KK; Ramzy I
TI - Parathyroid cytology: avoiding diagnostic pitfalls.
SO - Head Neck 2002 Feb;24(2):157-64
AD - Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. email@example.com
BACKGROUND: Interpretation of parathyroid fine-needle aspirates (FNA) remains problematic not only because this type of specimen is rare but also because the pertinent literature is very limited. We systematically reviewed parathyroid FNAs in our files and sought to delineate additional diagnostic criteria. DESIGN: Review of all thyroid and parathyroid lesions. The final diagnoses included four parathyroid adenomas, one intrathyroidal hyperplastic parathyroid, one intrathyroidal parathyroid adenoma, one atypical parathyroid adenoma (all confirmed by histologic screening or immunocytochemistry), and five parathyroid cysts (all confirmed by immunoassay). Papanicolaou and Diff Quik-stained smears of the parathyroid FNAs were reviewed. The cytologic features were compared and contrasted with those of thyroid FNAs to establish criteria for differential diagnoses. RESULTS: The FNAs of the five parathyroid cysts yielded virtually acellular fluid with a characteristic water-clear appearance and markedly elevated levels of parathyroid hormone. The remaining seven aspirates consisted of moderately cellular smears that showed an admixture of architectural features. Common patterns included cohesive three-dimensional groups, disorganized sheets, papillary fragments, microfollicles, and a single case showing lymphoidlike smears. Although the cells were generally small and round to oval, all cases demonstrated mild to moderate anisokaryosis. The nuclei were hyperchromatic E with coarsely granular chromatin reminiscent of that of small lymphocytes. Occasional nucleoli were noted. Although the cytoplasm was usually pale blue and finely granular with ill-defined borders, two cases showed well-delineated cytoplasmic membranes. Less common findings included cytoplasmic granulation, vacuolization, and rare oxyphilic cells. Naked nuclei were noted in the background of all of the aspirates to varying degrees. Other background findings included the presence of colloidlike material, macrophages, and lymphocytes. One interesting finding that to date has not been reported is the presence of nuclear overlapping (100%) and nuclear molding (71%), which is an uncommon finding in thyroid aspirates. CONCLUSIONS: FNAs of the parathyroid can be easily confused with that of the thyroid, not only because of the clinical similarity between these two types of lesions but also because of the overlap in cytomorphologic features of the aspirated cells. Although no one single cytomorphologic feature is diagnostic, a combination of cytologic parameters noted earlier should raise the possibility of a parathyroid lesion. Aspirates of parathyroid cysts show acellular water-clear fluid with elevated parathyroid hormone measurements. Copyright 2002 John Wiley & Sons, Inc.
UI - 11870476
AU - Berczi C; Mezosi E; Galuska L; Varga J; Bajnok L; Lukacs G; Balazs G
TI - Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism.
SO - Eur Radiol 2002 Mar;12(3):605-9
AD - First Department of Surgery, P.O. Box 27, University of Debrecen, Hungary 1, Nagyerdei str. 98, 4012 Debrecen, Hungary. firstname.lastname@example.org
A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.
UI - 11680065
AU - Emmelot-Vonk MH; Samson MM; Raymakers JA
TI - [Cognitive deterioration in elderly due to primary hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2001 Oct 13;145(41):1961-4
AD - Universitair Medisch Centrum, afd. Geriatrie, Postbus 85.500, 3805 GA Utrecht. email@example.com
Three patients, two women aged 79 and 80 and a man aged 84, showed symptoms of cognitive impairment caused by primary hyperparathyroidism. Parathyroidectomy lead to a marked improvement in the symptoms. The incidence of primary hyperparathyroidism increases with age. Most patients only show slight symptoms. In addition, clinical symptoms in elderly patients differ from those in younger patients with mental changes, general tiredness and reduced muscular strength being prevalent. In accordance with the literature, which shows high cure rates with low morbidity and mortality, we recommend that parathyroid surgery be considered in elderly patients who exhibit only slight or mental symptoms of primary hyperparathyroidism.
UI - 11845573
AU - Mannesse CK; van Ouwerkerk BM; Willemse AP
TI - [Cognitive deterioration in the elderly due to primary hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2002 Jan 26;146(4):188
UI - 11852306
AU - Rubello D; Casara D; Fiore D; Muzzio P; Zonzin G; Shapiro B
TI - An ectopic mediastinal parathyroid adenoma accurately located by a single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction scintigraphy and MIBI-SPECT-computed tomographic image fusion.
SO - Clin Nucl Med 2002 Mar;27(3):186-90
AD - Service of Nuclear Medicine 2, Department of Radiotherapy, General Hospital of Padova, Italy. firstname.lastname@example.org
PURPOSE: Because ectopic parathyroid adenoma (PA) is a frequent cause of failed initial surgery, an imaging approach with accurate preoperative localization is recommended by some authors in patients with primary hyperparathyroidism (HPT). METHODS: The authors describe a 52-year-old woman in whom primary HPT was diagnosed incidentally during a screening program for osteoporosis. The peculiarity of this case is that the patient was examined before operation in a single-day multimodal imaging protocol based on the combination of high-resolution cervical ultrasound, planar Tc-99m pertechnetate-MIBI scans, and an MIBI-SPECT-computed tomographic (CT) image fusion study. An ectopic PA was accurately located in the upper middle mediastinum, close to the lower margin of the sternal notch. RESULTS: Guided by the MIBI-SPECT-CT fusion images, the surgeon performed a limited median sternotomy and easily removed the PA that was revealed before operation. To confirm the completeness of resection, a bilateral neck exploration was performed through the same incision, with identification of three normally sized parathyroid glands. CONCLUSIONS: Our experience suggests the utility of multimodality imaging procedures for the accurate preoperative localization of PAs, particularly when they are present in ectopic mediastinal locations. Such procedures, including the MIBI-SPECT-CT image fusion study, can be performed in a single day.
UI - 11852320
AU - Arslan N; Rydzewski B
TI - Detection of a recurrent parathyroid carcinoma with FDG positron emission tomography.
SO - Clin Nucl Med 2002 Mar;27(3):221-2
AD - Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA. email@example.com
UI - 11933634
AU - Lalanne-Mistrih ML; Ognois-Ausse P; Goudet P; Cougard P
TI - [Giant parathyroid tumors: characterization of 26 glands weighing more than 3.5 grams]
SO - Ann Chir 2002 Mar;127(3):198-202
AD - Service d'endocrinologie-nutrition, hopital du Bocage, CHU de Dijon, 21000 Dijon, France.
AIM OF THE STUDY: To determine the characteristics of giant lesions of the parathyroid glands weighting more than 3.5 g. PATIENTS AND METHOD: Twenty-six patients operated on between 1989 to 2001 were included in this retrospective study. Anatomical, biological, clinical and histological parameters were analyzed. Data were compared both with a personnal series of the last 220 patients with hyperparathyroidism operated on in our department and with the results of a primary hyperparathyroidism multicentric study conducted by the French Association of Surgery (AFC). RESULTS: They were 14 females and 12 males with a mean age of 58.57 +/- 13.72 years (ranged: 26-80). Mean weight of the parathyroid glands was 9.87 +/- 9.76 g (ranged: 3.5-40). The diagnosis of parathyroid disease was suspected by symptoms and incidentally discovered hypercalcemia in 17 and 8 cases respectively. In one case, the adenoma was misdiagnosed as a thyroid nodule. Mean calcemia was 125.42 +/- 19.6 mg/L, mean phosphoremia was 21.6 +/- 6.9 mg/L, mean seric parathormone concentration was 451.44 +/- 530.18 ng/L. Comparing with our personnel 220 HPT-series, they was no statistically difference concerning the mean age, but number of males and biological measurements were significantly higher in presence of a giant adenoma. Comparing with the study of the AFC group, there was no statistically difference concerning the symptoms, especially in regard to the asymptomatic forms discovered by hypercalcemia and to the acute hypercalcemia forms. Minor ectopic localizations were found in half of the cases. All the glands were considered as beginnings. After surgery, one patient had a severe hypocalcemia in relation to a hungry bone syndrome. CONCLUSION: Giant adenomas have no specific symptoms even if functional status seems to be more active. Diagnosis is made during the sixth decade as usual. Male people are more often concerned. At surgery ectopic localizations are present in 50% of the cases. In our study their size is not a sign of malignancy. After surgery severe hypocalcemia can occur if a long past of bone disease exists.
UI - 11914679
AU - Boulahdour H; Bertrand AM; Klingelschmitt S; Rudenko B; Loboguerrero A;
TI - Bidet AC; Mantion G; Cardot JC Parathyroid adenoma visualization on octreotide scintigraphy.
SO - Clin Nucl Med 2002 Apr;27(4):304-5
AD - Department of Nuclear Medicine, CHU Jean Minjoz, Boulevard Alexandre Fleming, 25000 Besancon, France. firstname.lastname@example.org
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