1.
Normocalcemic primary hyperparathyroidism-characteristics and clinical significance of an emerging entity.
Shlapack, MA, Rizvi, AA, Lopez, FA
The American journal of the medical sciences. 2012;(2):163-166
Abstract
The epidemiology and presentation of primary hyperparathyroidism (PHPT) is changing. Full-blown disease in its tertiary stage is rarely seen. Instead, asymptomatic hypercalcemia draws more attention because of the widespread use of screening laboratory tests. In recent years, clinicians have started ordering intact parathyroid hormone (iPTH) assays for a variety of reasons (eg, during the evaluation of fractures, nephrolithiasis, osteomalacia and low bone mass), even in individuals who have no evidence of hypercalcemia. The increased levels of iPTH without an underlying etiology may represent an early phase, or a distinct subtype, of PHPT, termed as normocalcemic primary hyperparathyroidism (NPH). The prevalence and clinical significance of NPH are unknown and are a matter of great debate. No guidelines regarding management of this entity exist. The authors describe a patient who had increased levels of iPTH, osteopenia and normal calcium and vitamin D. There was no discernible secondary cause for hyperparathyroidism (renal insufficiency, osteomalacia, vitamin D deficiency, lithium use, etc), and no intervention was offered aside from periodic monitoring of laboratory values and bone density. Analysis of data in patients with NPH should include elucidation of its natural history, temporal patterns in calcium level and prevalence of low bone mass, nephrolithiaisis and fragility fractures and could assist in devising evidence-based guidelines for management of the condition. Further characterization of NPH will be of benefit in defining its clinical impact and associated complications, to clarify the rationale behind the use of the iPTH assay as a screening test, and to assist in management of this entity.
2.
Fracture and fortified breast milk in an extremely preterm infant.
Sharp, MJ, Simmer, K
Journal of paediatrics and child health. 2003;(6):470-3
Abstract
Metabolic bone disease (MBD) in the newborn predominantly affects preterm infants. The risk of MBD is inversely proportional to gestational age and birthweight, and directly related to postnatal complications. Poor bone mineralization has been shown in 55% of infants born at less than 1000 g. Optimal nutrition for very preterm infants is thought to be mother's own milk but supplementation is required to meet dietary requirements. However, there is insufficient evidence to determine that supplementation of human milk with commercial fortifiers has an effect on bone mineral content. We report a case of severe MBD with fractures in an extremely preterm infant who was fed with fortified mother's milk.
3.
Thymic parathyroid carcinoma and postoperative hungry bone syndrome.
Chandran, M, Deftos, LJ, Stuenkel, CA, Haghighi, P, Orloff, LA
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003;(2):152-6
Abstract
OBJECTIVE To describe a case of parathyroid carcinoma localized to ectopic parathyroid tissue within the thymus and the development of hungry bone syndrome postoperatively. METHODS We present pertinent clinical, radiologic, pathologic, and laboratory details of the study patient and discuss the relevant literature. RESULTS A 33-year-old man who presented with only symptoms of fatigue and depression was found to have high serum calcium, parathyroid hormone, and alkaline phosphatase levels. A sestamibi scan revealed evidence of activity adjacent to the sternum. He underwent neck exploration after selective staining of the parathyroid glands with methylene blue dye. A mass was found in the thymic bed, and the pathologic features were consistent with parathyroid carcinoma. Postoperatively, symptoms and signs of hypocalcemia developed despite normal serum calcium levels. CONCLUSION Physicians should be aware that (1) parathyroid carcinoma may originate wherever ectopic parathyroid tissue is found and patients may have only nonspecific symptoms, (2) wide local excision is imperative if carcinoma is suspected, and (3) symptoms and signs of hypocalcemia may be evident even when the serum calcium concentration is normal, if it has rapidly declined from a high level.
4.
Rhabdomyolysis and severe haemolytic anaemia, hepatic dysfunction and intestinal osteopathy due to hypophosphataemia in a patient after Billroth II gastrectomy.
Altuntas, Y, Innice, M, Basturk, T, Seber, S, Serin, G, Ozturk, B
European journal of gastroenterology & hepatology. 2002;(5):555-7
Abstract
Hypophosphataemic syndromes lead to appreciable morbidity and mortality. A deficiency or lack of phosphate leads to tissue hypoxia and disruption of cellular function, which may cause severe clinical complications. We present various manifestations of hypophosphataemia; in all cases, diagnosis was delayed due to lack of follow-up. We present the case of a patient with rhabdomyolysis, severe haemolytic anaemia, hepatic dysfunction and intestinal osteopathy due to hypophosphataemia complicated by gastric Billroth II anastomosis surgery. We also review the literature concerning hypophosphataemic conditions. In conclusion, the determination of serum calcium and phosphate levels should be included in the routine follow-up of Billroth II anastomosed patients.