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Clinical and histop...
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Starker, Lee FUppsala universitet,Experimentell kirurgi,Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
(författare)
Clinical and histopathological characteristics of hyperparathyroidism-induced hypercalcemic crisis
- Artikel/kapitelEngelska2011
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2010-11-02
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Springer Science and Business Media LLC,2011
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printrdacarrier
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LIBRIS-ID:oai:DiVA.org:uu-197676
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197676URI
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https://doi.org/10.1007/s00268-010-0840-6DOI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:art swepub-publicationtype
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BACKGROUND:The clinical and pathological characteristics of hyperparathyroidism-induced hypercalcemic crisis (HIHC) are incompletely described. The present study was designed to elucidate the nature and effects of HIHC in patients undergoing parathyroidectomy in our unit.METHODS:A prospective database of 1,754 consecutive patients with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy from 1991-2009 identified 67 (41 women) patients presenting with HIHC. Hyperparathyroidism-induced hypercalcemic crisis was defined as symptoms and signs of acute calcium intoxication with a concomitant total albumin corrected calcium level>13.5 mg/dl (range: 8.8-10.2 mg/dl). Clinical and pathological characteristics were evaluated. Data are expressed as mean±SEM.RESULTS:Mean age at presentation was 56.7±2.2 years. Twenty-four of 67 patients (35%) required preoperative in-hospital management. Of these, all were treated with saline resuscitation, whereas 20/24 (83%) were treated pharmacologically. Neurocognitive derangements and nephrolithiasis with associated hematuria were the most common presenting symptoms and signs. Preoperative serum calcium and the intact parathyroid hormone level (PTH) were 14.0±0.19 mg/dl and 393±43 pg/ml (reference range: 12-65 pg/ml), respectively. Minimally invasive parathyroidectomy under local cervical block was performed in 28/67 patients (42%); the remainder underwent standard cervical exploration. All patients had postoperative normalization of serum calcium and intact PTH. Hyperparathyroidism-induced hypercalcemic crisis was due to parathyroid carcinoma in 3/67 patients (4.5%), whereas the remainder of patients displayed a single parathyroid adenoma (n=57) or multiglandular hyperplasia (n=7). Histopathological evaluation from HIHC patients revealed a chief cell microcystic pattern in 15/21 (71.4%) of examined parathyroid tumors.CONCLUSIONS:Hyperparathyroidism-induced hypercalcemic crisis is most commonly due to a single parathyroid adenoma, often associated with a microcystic histopathological pattern. The condition is optimally managed with saline hydration and urgent parathyroidectomy.
Biuppslag (personer, institutioner, konferenser, titlar ...)
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Björklund, PeymanUppsala universitet,Experimentell kirurgi(Swepub:uu)pebjo957
(författare)
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Theoharis, Constantine
(författare)
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Long, William D
(författare)
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Carling, Tobias
(författare)
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Udelsman, Robert
(författare)
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Uppsala universitetExperimentell kirurgi
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:World Journal of Surgery: Springer Science and Business Media LLC35:2, s. 331-3350364-23131432-2323
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