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At least 19 recordsLinked to original sources
PubMed1991

Usefulness and limits of quick intraoperative measurements of intact (1-84) parathyroid hormone in the surgical management of hyperparathyroidism: sequential measurements in patients with multiglandular disease.

This study was designed to assess whether reliability of quick intraoperative assay of intact (1-84) immunoreactive parathyroid hormone (iPTH) could allow us to quit after removing one (or several) enlarged parathyroid gland(s) and obtaining a normal iPTH level. Intact iPTH was assayed during surgery before removal of enlarged parathyroid gland(s) and 5, 10, and 20 minutes afterward. Forty-seven patients entered the study: 40 with primary hyperparathyroidism (32 with uniglandular disease and eight with multiglandular disease) and seven with secondary hyperparathyroidism; all underwent bilateral neck exploration. Among 32 patients with uniglandular disease, five had normal basal intraoperative levels, 25 demonstrated a clear-cut drop from supranormal to normal levels, and two had elevated levels. Among the eight patients with multiglandular disease, two had undetectable levels and two had normal levels after removal of the first enlarged gland. The seven patients with secondary hyperparathyroidism demonstrated a decline in PTH levels, suggesting hormone clearance similar to that of patients with primary hyperparathyroidism. In conclusion, quick intraoperative assay with intact (1-84) iPTH (1) is not hampered by renal insufficiency, (2) may overlook a second enlarged gland after removal of a first adenoma and obtaining normal iPTH levels, and (3) should not be used as a substitute for bilateral neck exploration.

Humans↗
PubMed1990

Diagnosis of the multiglandular endocrine neoplasias.

Multiglandular endocrine neoplasia syndromes are disorders characterized by autosomal dominant inheritance patterns and by the striking patterns of clinical presentation of these endocrine tumors, which are often hormonally active. Not every patient with adenomas of more than one endocrine gland has one of these classical familial syndromes. This paper will deal with the specific diseases known as multiglandular endocrine neoplasia Types 1, 2A, and 2B. Types 2A and 2B are also known as Types II and III.

Humans↗
PubMed1992

Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? A plea against unilateral parathyroid exploration.

BACKGROUND: Most of the available data on multiglandular disease (MGD) originate from long-term series. The spectrum of the disease has changed now because of earlier diagnosis. We decided to assess the current frequency of MGD in seemingly sporadic primary hyperparathyroidism. METHODS: MGD was defined as the finding that more than one grossly enlarged gland weighed more than 50 mg and the rim of normal parathyroid tissue was diagnostic of adenoma. Nine hundred eight consecutive neck explorations for hyperparathyroidism were performed, 624 before 1989 and 284 between 1989 and 1991, and studied retrospectively. Since 1989, oil Red O staining has been done to assess hyperfunction. RESULTS: When multiple endocrine neoplasia and non-multiple endocrine neoplasia familial cases of hyperparathyroidism are excluded, the frequency of MGD in seemingly sporadic primary hyperparathyroidism, 17.7% before 1989, is still 14% since then, including a 3% frequency of true multiple adenomas. With more restrictive criteria, which exclude the second enlarged gland if it weighed less than 100 mg, if it had no rim, and if oil Red O staining was negative, the frequency of MGD in sporadic hyperparathyroidism has remained 11% since 1989. Unilateral exploration had missed 78% of second enlarged glands, and preoperative imaging studies, when performed, showed more than one gland in only two of 22 cases. CONCLUSIONS: Routine bilateral neck exploration is recommended in primary hyperparathyroidism because of a current frequency of MGD of at least 11%.

Adenoma↗
PubMed1992

Results of surgery in primary hyperparathyroidism.

In a prospective study 92 consecutive patients with biochemically proved primary hyperparathyroidism underwent initial neck exploration at Oulu University Hospital. The incidence of multiglandular disease was 34%. 23 patients (25%) underwent a simultaneous thyroidectomy. The cure rate after initial exploration was 91.3%, ectopic parathyroid glands and multiglandular disease being the most common causes of failure. Simultaneous thyroidectomy increased somewhat but not significantly the complication risk. There was a slight tendency for serum calcium concentrations to increase during the mean follow-up of 2.3 +/- 1.5 years. Four patients with persistent hypercalcaemia underwent a successful reoperation during that time. Thus the overall cure rate was 95.6%, but 5.4% of the patients required permanent medication for hypocalcaemia. We conclude that the most common causes for failed initial exploration were ectopic parathyroid glands and multiglandular disease. The incidence of multiglandular disease was unusually high in this series. Because simultaneous thyroidectomy increased somewhat the complication risk of initial neck exploration, the indications for this additional procedure should be carefully considered. The results of parathyroid surgery were good and dependent on how many patients underwent reoperation during the follow-up. A consequence of tendency for serum calcium concentrations to increase during the follow-up could be that a definite cure cannot always be attained in cases of primary hyperparathyroidism.

Adenoma↗
PubMed1987

Causes of failure in operations for hyperparathyroidism.

After a mean follow-up period of 6.1 years, a series of 862 patients who had undergone surgery for suspected hyperparathyroidism were evaluated to determine the reasons treatment failed. Incorrect diagnosis was found to be the cause of failure in 27 cases (3%). In 89 patients who required reoperation to achieve euparathyroidism, the three major reasons for failure were inexperience with the surgical procedure (n = 37), abnormal localization (n = 36), and multiglandular disease (n = 39). In patients with monoglandular involvement, the disease never recurred. However, of the 41 patients with more than one enlarged parathyroid gland, 20 had persistent disease and 21 others had recurrent disease with a normocalcemic interval of 1.2 to 17 years. In general, recurrent hyperparathyroidism occurs more frequently than is usually realized and thus patients with multiglandular involvement require very long follow-up periods. Persistent monoglandular disease is largely avoidable.

Clinical Competence↗
PubMed2025

Approach to the Patient With Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary disorder in which patients develop multiple endocrine tumors simultaneously. Among these, primary hyperparathyroidism is the most common and often the earliest manifestation. All patients with MEN1 and hypercalcemia should have surgery, with most patients requiring surgical treatment before the age of 50 years. The timing of parathyroid surgery mainly depends on hypercalcemia and the presence of renal or skeletal complications. The goals of treatment are to correct hypercalcemia, prevent target organ damage, and minimize the risk of postoperative hypoparathyroidism as much as possible. Currently, the most widely recommended surgical approach is subtotal parathyroidectomy via the cervical approach (removal of 3 or 3.5 glands). With advances in imaging technology, patients with clearly localized lesions-particularly younger patients-may be candidates for individualized unilateral resection (ie, removal of both glands on the affected side). In addition, recurrent hypercalcemia after surgery is relatively common in patients with MEN1. The management of the remaining glands remains challenging, such patients usually need reoperation, calcimimetic therapy, or clinical observation. For patients requiring repeated parathyroid surgeries, in addition to searching for multifocal lesions, the possibility of ectopic parathyroid glands should also be taken into account. Ectopic parathyroid adenoma, caused by abnormal embryonic migration, complicates surgery in both sporadic and MEN1-related primary hyperparathyroidism. However, in MEN1, their higher frequency and multiglandular distribution make localization even more challenging, often leading to incomplete resection and recurrence.

Humans↗
PubMed1989

Primary hyperparathyroidism associated with two enlarged parathyroid glands.

An increasingly recognized although small percentage of patients with primary hyperparathyroidism have enlargement of two parathyroid glands. We have treated nine patients with primary hyperparathyroidism associated with such double parathyroid gland enlargement. In four of these patients, marked asymmetry of the two enlarged glands was noted and the failure to recognize and excise a second enlarged parathyroid gland resulted in persistent or recurrent hyperparathyroidism. In one of these patients, the second enlargement was present in a super-numerary mediastinal gland. The subsequent excision of the second enlarged parathyroid gland resulted in normocalcemia in each instance. This contrasts with five patients in whom initial excision of two enlarged glands resulted in normocalcemia with no recurrence of hypercalcemia. Only three patients fulfilled the histologic criteria of true double adenomas. The remainder showed multiglandular hypercellularity. This experience supports identifying all parathyroid glands and recognizing that even minimal enlargement of a gland may be important pathophysiologically, regardless of its histopathologic classification. Excision of both enlarged glands, even if asymmetric, is appropriate.

Adult↗
PubMed1992

Continuing evolution in the operative management of primary hyperparathyroidism.

During the past several decades the operation for primary hyperparathyroidism at The University of Chicago, Ill, has changed from subtotal parathyroidectomy for all patients to removal of an adenoma with performance of biopsies of all other glands to bilateral neck exploration, resection of the adenoma, and performance of fewer biopsies of normal glands. During the 1980s, 308 operations were performed; 288 patients underwent first operations. Two hundred forty-five (85.1%) of these patients had an adenoma and forty-three (14.9%) had hyperplasia (multiglandular disease); none had a carcinoma. Resolution of hypercalcemia was achieved in 281 patients (97.5%); seven patients experienced failed explorations. The early cure was the same whether or not preoperative localization studies were performed. Nineteen patients underwent 20 reoperative parathyroidectomies during this period. Preoperative localization studies, done in 16 (80%) of 20 cases, were very helpful. Ninety percent of patients with abnormal parathyroid glands in their neck or mediastinum were cured with their initial reoperation.

Adenoma↗
PubMed1989

Catalase activity in human spermatozoa and seminal plasma.

Catalase activity was determined in human semen by measuring the oxygen burst with a Clark electrode, after H2O2 addition. Significant catalase activities (mean +/- SD) were found in migrated, motile spermatozoa (44 +/- 17 nmoles O2/min/10(8) cells) and in seminal plasma of normozoospermic men (129 +/- 59 nmoles O2/min/ml). It has been demonstrated that seminal catalase originated from prostate; however, its activity was not correlated with the usual prostatic markers (such as citric acid and zinc). Our data suggest a multiglandular function secreted by this organ. The catalase activities measured in seminal samples from asthenozoospermic, infertile men were found lower than those from normozoospermic subjects. The understanding of the relative contribution of the different enzyme systems against O2 toxicity (superoxide dismutase, catalase, glutathione peroxidase) seem to be a priority area of research to understand disturbances of sperm function.

Biomarkers↗
PubMed1991

Chromogranin A and B in parathyroid tissue of cases of primary hyperparathyroidism: an immunohistochemical study.

Routinely processed parathyroid tissues from 26 cases with primary hyperparathyroidism (19 adenomas, 7 multiglandular hyperplasia) and 8 normal human parathyroid glands were investigated with antibodies against chromogranin A and B and parathyroid hormone (PTH). Normal parathyroids were immunohistochemically positive for PTH and chromogranin A but negative for chromogranin B. Hyperplastic glands showed a focal staining for PTH and chromogranin A without correlation of the staining pattern on serial sections. Adenomas were either uniformly positive for both PTH and chromogranin A or showed a staining pattern similar to that seen in hyperplastic glands. Focal chromogranin B positivity (less than 10% of cells) was found in 3 cases (1 hyperplastic gland and 2 cases of parathyroid adenoma with an immunohistochemical staining pattern similar to hyperplastic glands). Our immunohistochemical results may support previously published findings that most parathyroid adenomas are monoclonal neoplasms whereas hyperplastic glands are of polyclonal origin.

Adenoma↗
PubMedDate not supplied

Parathyroid adenomectomy under local anesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH.

Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1987

Natural history of treated primary hyperparathyroidism.

A follow-up study of patients operated on for primary hyperparathyroidism revealed that recurrent hypercalcemia is uncommon in patients with solitary adenoma, but common in patients with multiglandular disease. The result of parathyroidectomy on the different symptoms of primary hyperparathyroidism is good. On the other hand, even after successful surgery, patients with primary hyperparathyroidism have poorer health than controls, and they also have a higher mortality rate. Most of the deaths in the primary hyperparathyroidism group are caused by cardiovascular disease. The effect of the preoperative serum calcium level on the later state of health is evident.

Adult↗
PubMedDate not supplied

Levels of trimethoprim and sulphamethoxazole in human seminal plasma.

An oral dose of the combination trimethophim/sulphamethoxazole (160 and 800 mg, respectively) gave concentrations of trimethoprim in seminal plasma that were equal to or higher than that in blood plasma 2--4 hours after intake. Trimethoprim was excreted by both the prostate and seminal vesicles. With a trimethoprim resistant strain it was possible to demonstrate in three patients with subclinical prostatitis that the concentrations of sulphamethoxazole two hours after the oral intake were 20, 26, and 74 microgram/ml in the blood plasma, respectively. This study was carried out on patients who had been on treatment for 2--5 days prior to investigation. In view of published reports on the pH of the fluids from the human prostate and seminal vesicles, respectively, and the importance of the hydrogen ion concentrations for the excretion of lipid soluble substances into the prostatic fluid it was unexpected to find similar concentrations of trimethoprim in both the "prostatic" and "vesicular" fluids. Preliminary studies on the pH of these fluids indicated, however, that they were in the same order of magnitude, i.e. 7.5 to 8.0. The multiglandular origin of the human seminal plasma must be considered in all studied concerning the excretion of drugs into the semen. Many problems related to the excretion of drugs, e.g. organ specificity, kinetics, and influence on organ and spermatozoal functions remain to be investigated.

Administration, Oral↗
PubMed1977

Diagnosis of hyperparathyroidism.

States of hypersecretion of PTH may occur primarily, or in response to other physiologic abnormalities. Primary hyperparathyroidism must be considered in the differential diagnosis of hypercalcemia, nephrolithiasis, metabolic bone disease, and pancreatitis and peptic-ulcer disease. The clinical manifestations of this disease have become more subtle with improved detection. The serum calcium level is almost always elevated, and when it it accompanied by relatively high serum PTH levels or increased urinary cAMP excretion, the diagnosis is usually secure. Findings of hypophosphatemia, decreased renal tubular reabsorption of phosphorus, hypercalciuria, and characteristic roentgenographic changes support the diagnosis of hyperparathyroidism, but are not prerequisites for that diagnosis. Most cases will come to operation, and experienced intraoperative assessment is necessary for the correct distinction between multiglandular disease and that involving only a single gland. We expect that a clearer understanding of the histopathologic features of these diseases, and improvement in the methods for measurement of PTH will be the main areas of advancement in the diagnosis of hyperparathyroidism in the next few years.

Bone Diseases↗
PubMed1992

Tertiary hyperparathyroidism during high phosphate therapy of familial hypophosphatemic rickets.

We report the development of severe tertiary hyperparathyroidism in three girls treated for familial hypophosphatemic rickets and characterize parathyroid function in vivo and in vitro. All patients had been previously treated with relatively large doses of inorganic phosphorus (125 mm/day) and ergocalciferol or calcitriol for several years and had radiographic evidence of long-standing hyperparathyroidism. Even in the presence of extremely elevated PTH levels, oral phosphate lowered serum calcium levels in vivo and further stimulated PTH secretion. Profound multiglandular parathyroid hyperplasia was found in each patient at surgery. Examination of the secretory characteristics of the excised parathyroid tissue revealed that either relatively high calcium concentrations were generally needed to suppress PTH secretion or PTH secretion was not suppressible. Caution is recommended when relatively large doses of phosphate are used to treat familial hypophosphatemic rickets.

Calcitriol↗