1/8. calciphylaxis: case report and literature review.Tissue calcification is a well-recognized common metabolic disease, but calciphylaxis still remains an enigmatic rarity. The latter may be induced experimentally and acquired naturally in human diseases. Although many chronic azotemic or end stage renal disease patients (ESRD) with hyperparathyroidism (HPT) are at risk of calciphylaxis not all of them do develop the disease, even non-renal, patients may also develop this disease. Out of a total of about 2000 hemodialysis, 15,000 dermatology and 26,000 medical patients seen over a three year period in a busy Saudi Arabian tertiary medical centre, we report a sentinel nephrology patient with sudden excruciatingly painful cutaneous calciphylaxis that necessitated acute dermatology emergency consultation, and present a review of the medical literature. In order to institute appropriate total quality management of this life-threatening, rare disease, it is advisable that a high index of suspicion should be entertained by dermatologists, general physicians, nephrologists, and pulmonologists in an appropriate clinical scenario.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Normocalcemic hyperparathyroidism presented with mandibular brown tumor: report of a case.Brown tumor is a rare clinical entity complicating hyperparathyroidism. It may occur in the head and neck, with the mandible being the most frequent site. hyperparathyroidism is usually associated with hypercalcemia. We report a case of madibular Brown tumor secondary to primary hyperparathyroidism. In this case in spite of hyperparathyroidism and the bony lesion the serum calcium level was within normal range. The case managed by surgical excision of the mandibular tumor with an en-bloc hemithyroidectomy with inclusion of the diseased parathyroid gland. This case demonstrates that in osteolytic bony lesions a hyperparathyroid complication can be expected even with normal serum calcium level. The presence of normocalcemia in primary hyperparathyroidism should prompt the physician to look for vitamin d deficiency.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Maternal primary hyperparathyroidism of pregnancy. Successful treatment by parathyroidectomy.Primary hyperparathyroidism of pregnancy may result in spontaneous abortion, neonatal hypocalcemia, or neonatal tetany if appropriate treatment is not instituted. Of great importance in prevention of these complications is an awareness by physicians that this disease exists and is of clinical importance. parathyroidectomy performed during the second trimester of pregnancy offers the best chance for fetal and neonatal survival. This operation results in little risk to either the mother or the fetus. Normal calcium homeostasis is restored to the fetus and the risk of hypocalcemia in the neonatal period is virtually eliminated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. carcinoma of the parathyroid gland: is it overdiagnosed? A report of three cases.The true incidence of carcinoma of the parathyroid gland is probably about 1 percent of cases of primary hyperparathyroidism. Overreporting may occur if the diagnosis is based on histologic appearances alone because the histologic criteria are less than definitive. carcinoma of the parathyroid gland, if diagnosed early and treated with adequate surgical excision, is associated with a satisfactory long-term prognosis. However, the possibility of distant metastases or locally recurrent disease is not necessarily excluded by a prolonged interval of disease-free status, and the physician should continue to follow the patient on a regular basis by physical examination and routine serum calcium analysis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Coexisting hyperthyroidism and primary hyperparathyroidism.The simultaneous occurrence of hyperthyroidism and primary hyperparathyroidism is rare in the absence of previous neck irradiation. We report two cases from our institution. hypercalcemia secondary to hyperthyroidism is common and may obfuscate the diagnosis of concomitant primary hyperparathyroidism. Therefore the continued presence of hypercalcemia in a patient with successfully treated hyperthyroidism should lead the physician to search for primary hyperparathyroidism. Treatment of these concomitant disease processes consists of combined thyroidectomy and parathyroidectomy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy.The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
7/8. osteomalacia secondary to celiac disease, primary hyperparathyroidism, and Graves' disease.Primary hyperparathyroidism is seldom associated with other autoimmune disorders. The presence of normocalcemia in primary hyperparathyroidism should prompt the physician to look for vitamin d deficiency. This observation concerns a 34-year-old vegetarian woman with combined primary hyperparathyroidism, Graves' disease, and celiac disease. The patient presented with severe bone deformities; she was unable to walk, and had severe muscular weakness and weight loss. Biochemical findings revealed severe hyperparathyroidism with normocalcemia, hypophosphatemia, very low urinary calcium, and low 25-hydroxy vitamin D level. Thyroid tests showed hyperthyroidism with positive thyroid receptor antibodies, confirming the presence of Graves' disease. Positive antigliadin and antireticulin antibodies and complete villous atrophy on duodenal biopsy established the presence of celiac disease. The patient underwent a near-total thyroidectomy, with the removal of a parathyroid adenoma. To our knowledge, this observation is the first finding of an association between celiac disease, Graves' disease, and primary hyperparathyroidism. It emphasizes the need to rule out intestinal malabsorption in the case of normocalcemic hyperparathyroidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Reversal of the histology of bone after parathyroidectomy in patients with hyperparathyroidism.hyperparathyroidism is commonly seen in patients with end-stage renal disease and less commonly in the primary form. The skeletal manifestations of hyperparathyroidism are the same in both forms and are well described in the literature. We treated a patient from each category. Multiple bony lesions and pathologic fractures were observed. The clinical presentations and radiologic and histologic findings confirmed the diagnosis of hyperparathyroidism and osteitis fibrosa cystica in both patients. Subtotal excisions of the parathyroid glands were done in both patients. Appropriate treatment of the bony lesions and pathologic fractures resulted in healing. Histologic evaluation of the bony lesions indicated an osteoblastic or healing response. The reversal of the histologic pattern in just 5 days and 16 days after parathyroidectomy was noted. In treating such patients, physicians should consider parathyroidectomy as an aid in the overall management of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |