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Results for “PARATHYROID DISEASES”

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PubMedDate not supplied

Psychiatric aspects of parathyroid disease.

Parathyroid diseases can present with psychiatric symptoms and can be recognized through determinations of serum electrolytes, especially the calcium level. Psychiatric evaluations should include a serum calcium concentration test, which is also essential in reassessment of patients poorly responsive to mental illness treatment. A magnesium and a phosphate assay may also be diagnostically helpful. Abnormality of divalent cation levels may provide evidence for consideration of, or ruling out, parathyroid disorders. Determinations of parathyroid hormone are performed if clinically indicated, and if abnormal divalent cation quantifications are confirmed. If parathyroid disease is identified, corrective endocrine therapies may diminish or even cure psychiatric aspects of parathyroid pathology. Failure to recognize a parathyroid disorder leaves an endocrine-induced mental dysfunction without proper treatment.

Adult↗
PubMedDate not supplied

Recent advances in parathyroid disease and parathyroid hormone assays.

Parathyroid hormone (PTH) regulates extracellular calcium. The physiology and pathology of PTH and the many circulating fragments of PTH are reviewed. Various PTH assays have been used, leading to the now standard intact PTH (iPTH). The recently discovered 7-84 fragment may have profound implications in PTH measurement and management, particularly in renal-failure patients. Newer assays measuring true PTH, exclusive of this fragment, are appearing on the market and may have use in monitoring calcitriol analogue therapy and other settings. Rapid PTH assays have application as intraoperative measures of success during excision of parathyroid adenomas.

Calcium↗
PubMed1993

Magnetic resonance imaging in preoperative localization of diseased parathyroid glands: a comparison with isotope scanning and ultrasonography.

The value of magnetic resonance imaging (MRI) in the preoperative localization of parathyroid glands was assessed through a comparison of the findings with those obtained by ultrasonography and isotope scanning. The localization findings in 37 patients with primary hyperparathyroidism were compared with the operative findings. The sensitivities of the three modalities as defined by the ability to detect a parathyroid adenoma were 67% (isotope scanning), 44% (ultrasonography) and 36% (MRI). The differences were not significant. The sensitivities as defined by the ability to predict the correct side of the lesion were 48% (isotope scanning) 33% (ultrasonography) and 36% (MRI). No correlation was found between the sensitivity of a given localization test and factors such as the presence of thyroid abnormalities, size of the lesion, type of lesion and preoperative calcium and parathormone levels. The low sensitivity and high cost of all three preoperative localization studies render them unnecessary in the management of uncomplicated parathyroid disease. However, if preoperative imaging is necessary, ultrasonography and isotope scanning are recommended, since MRI was not found to be superior.

Adult↗
PubMed1988

DNA patterns in parathyroid disease predict postoperative parathyroid hormone secretion.

Flow cytometric analysis of the nuclear deoxyribonucleic acid (DNA) content of parathyroid glands excised from patients with hypercalcemic hyperparathyroidism has identified three distinct DNA patterns. The most frequent pattern showed a high percentage of cells with tetraploid DNA, which indicated an increase in the G2 and M phase of the cell cycle. Thirty-four patients were found to have abnormal tetraploid DNA content. One patient had a normal diploid pattern, and seven were found to have an aneuploid DNA population in their excised parathyroid glands. This unexpected finding of aneuploid DNA appears to be an unique feature of these endocrine glands because they have no histologic or clinical characteristics of malignant change. All patients have remained normocalcemic and clinically well after excision of only grossly enlarged glands. Postoperative parathyroid hormone (PTH) levels were correlated in 17 patients with DNA analyses of biopsy specimens from 30 normal-sized glands which were left in situ. Seven patients with elevated PTH postoperatively had high tetraploid or aneuploid DNA in all 13 glands from which biopsy specimens had high tetraploid or aneuploid DNA in all 13 glands from which biopsy specimens had been taken. In 10 patients with normal PTH levels, six had normal diploid patterns, whereas four had high tetraploid DNA in their gland biopsy specimens. DNA content present in biopsy specimens of normal-sized, in situ glands was predictive (p less than 0.042) of parathyroid gland secretory activity. These findings suggest that the stimulus for parathyroid gland hyperfunction often affects more than a single enlarged gland and persists after clinical cure, as shown by a more rapid cell turnover in some remaining glands and continued hypersecretion of hormone.

DNA↗
PubMedDate not supplied

Parathyroid disease.

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Disease↗
PubMedDate not supplied

Parathyroid disease.

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Disease↗
PubMed1995

[Current status and problems in the classification of parathyroid diseases].

Abnormalities in serum calcium level usually lead to the diagnosis of parathyroid diseases. Therefore, parathyroid diseases can be classified according to serum calcium levels of the patients. However, the present classification of the diseases have several problems. First, the existence of some of the historically wellknown parathyroid diseases is still under controversy at present. Second, recent studies using molecular and cellular biological approaches have uncovered several genetic abnormalities in some parathyroid tumors, suggesting that parathyroid adenoma or cancer is not a homogeneous disease entity. Third, there remain many unanswered problems to explain the pathogenesis of various parathyroid diseases including pseudohypoparathyroidism. Further elucidation of the pathogenesis of parathyroid diseases should enable us to establish a better classification of these diseases.

Calcium↗
PubMed1982

Autotransplantation of fresh diseased parathyroid tissue in primary and radiation-induced hyperparathyroidism.

Thirty-five patients with primary or radiation-induced hyperparathyroidism underwent autotransplantation with fresh diseased parathyroid tissue. Due to previous neck surgery (34 percent), concomitant thyroid surgery (66 percent), and a high proportion of multiglandular parathyroid disease (43 percent), all patients ran a high risk of becoming hypoparathyroid, At follow-up , a mean of 28 months after operation, 32 patients had normal parathyroid function, 2 had hyper- and 1 had hypoparathyroid function. The amount of tissue used for transplantation was individually chosen by relating the serum calcium level to the total parathyroid mass. In patients with water-clear cell hyperplasia and thus low endocrine activity on a weight basis, large grafts were needed, whereas less than 120 mg was used in most other cases. In two of our three failures we did not follow these tactics. Our results show that autografting fresh diseased parathyroid tissue can minimize the occurrence of postoperative hypoparathyroidism in patients at high risk of this complication. In no case has recurrent or progressive hypercalcemia developed.

Aged↗
PubMed1989

The sites of hormone storage in normal and diseased parathyroid glands: a silver impregnation and immunohistochemical study.

The results of Grimelius' silver impregnation method and of two immunohistochemical methods for the demonstration of the sites of storage of parathyroid hormone (PTH) were compared in a series of parathyroid glands from 39 patients affected by either hyperplasia or adenoma and from 10 normal subjects. An indirect immunoperoxidase method using an anti-bovine PTH serum gave unsatisfactory results. In contrast a biotin-streptavidin immunoperoxidase method using an antibody against the 44-68 amino acid sequence of human PTH yielded similar results to those with Grimelius' silver impregnation method. This supports the view that argyrophil granules correspond to the secretory granules of PTH. The degree of silver impregnation, however, varied considerably in duplicate sections, probably because of difficulties in standardization of the Grimelius' method. The biotin-streptavidin method appeared more sensitive and was reproducible. The immunohistochemical demonstration of PTH may prove useful in defining the sites of hormone storage in normal and pathological conditions.

Adenoma↗
PubMed2002

Video-assisted neck surgery for thyroid and parathyroid diseases.

BACKGROUND: Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases. METHODS: From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves' diseases, 17 parathyroid adenomas and three thyroid cancers. RESULTS: The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful. CONCLUSIONS: VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.

Adolescent↗
PubMed2002

Endoscopic neck surgery: current status for thyroid and parathyroid diseases.

During the last 3 years, 59 patients underwent endoscopic neck surgery. We started the video-assisted neck surgery with the gasless skin-lifting method for benign thyroid and parathyroid diseases to avoid complications of carbon dioxide (CO2) insufflation. Hemithyroidectomy was performed for benign thyroid tumors and subtotal thyroidectomy was selected for Graves' disease. Parathyroid adenomas were extirpated for primary hyperparathyroidism with precise preoperative localization by imaging modalities. In order to obtain a better visual field and to improve the cosmetic results, we have adopted the complete endoscopic method via breast approach with low CO2 insufflation pressure since August 2001. An intraoperative parathormone assay was introduced recently to confirm the complete removal of parathyroid adenomas. Both gasless and insufflation methods are feasible for endoscopic neck surgery with excellent cosmetic results.

Adolescent↗
PubMed1998

Radionuclide scanning in parathyroid diseases.

BACKGROUND: New radionuclide agents and scanning procedures have markedly improved preoperative parathyroid gland localization. The aim of this review was to evaluate the results of parathyroid scanning and to clarify its current place in the clinical management of parathyroid diseases. METHODS: The literature describing the different radioisotopes and available scanning techniques was analysed and their clinical outcome in various parathyroid diseases was evaluated. RESULTS: Using 99mTc-radiolabelled sestamibi or other 9mTc-labelled cationic complexes, parathyroid scintigraphy detects 87 per cent of solitary adenomas (n=894), 55 per cent of abnormal glands in patients with multiglandular disease (n=303) and 75 per cent of persistent or recurrent lesions in patients with previous neck surgery (n=240). If necessary, three-dimensional imaging techniques can clarify the spatial localization of an ectopic uptake focus. The positive predictive value of the available scanning procedures is over 95 per cent, but false-positive uptake may be encountered. CONCLUSION: Radionuclide parathyroid gland scanning with 99mTc-labelled cationic complexes is the initial non-invasive method of choice for preoperative parathyroid gland localization in patients at special risk and/or with previous neck exploration. While scanning has also been proposed to facilitate parathyroidectomy, there is no objective evidence to support its routine use before a first-time surgical procedure.

False Positive Reactions↗
PubMed1995

Histopathological diagnosis of parathyroid diseases.

Hyperparathyroidism is the predominant disease of the parathyroid gland. This disease is nowadays quite common and is often diagnosed at an earlier stage, mainly by means of serum calcium determinations on wide indications. This means that when detected, the glandular abnormalities may be less advanced, which could hamper differentiation of adenoma from chief cell hyperplasia, and of normal glands from slightly hyperplastic ones. Normal glands and pathological glands both show wide variations in size, cellular composition and arrangement, as described in this article. The usefulness of applying fat staining to distinguish between normal and abnormal glands is also reported. It is important to bear in mind that the parathyroid diagnosis is in fact an indirect diagnosis based on the assessment of an associated gland or glands.

Humans↗
PubMed1998

Use of a rapid intraoperative parathyroid hormone assay in the surgical management of parathyroid disease.

OBJECTIVE: To evaluate the utility of a rapid intraoperative parathyroid hormone (PTH) immunoradiometric assay in the surgical management of parathyroid disease, particularly with reference to limiting extent of cervical exploration. DESIGN: Nonrandomized prospective study. SETTING: Academic tertiary care center. PATIENTS: Forty-three consecutive patients undergoing parathyroid exploration for adenoma or hyperplasia had rapid PTH assays performed from blood drawn at induction and 7 minutes after resection of all hyperfunctioning parathyroid tissue. OUTCOME MEASURES: Excision of all hyperfunctioning parathyroid tissue as assessed by bilateral neck exploration, postoperative normalization of serum calcium and PTH levels, and resolution of clinical symptoms. RESULTS: The intraoperative rapid PTH assay accurately reflected whether all hyperfunctioning parathyroid tissue was excised in every patient. In 41 patients, all hyperfunctioning parathyroid tissue was resected at the time of surgery and confirmed by a corresponding decrease in the intraoperative postexcision rapid PTH determination as well as by subsequent normalization of postoperative serum calcium and PTH levels and resolution of clinical symptoms. In 2 patients, the postexcision rapid PTH assay determination was not consistent with removal of all hyperfunctioning parathyroid disease and both patients demonstrated persistent hyperparathyroidism postoperatively. CONCLUSIONS: The intraoperative rapid PTH assay may be of significant benefit in permitting directed unilateral parathyroid explorations for adenoma when combined with preoperative localization with a technetium-99m sestamibi scan. Additionally, the rapid PTH assay has proved to be of benefit in confirming excision of all hyperfunctioning parathyroid tissue in patients with multiple gland hyperplasia, particularly those who may harbor ectopic parathyroid tissue.

Adenoma↗