1/5. Polyglandular autoimmune syndrome type 1 without chronic mucocutaneous candidiasis in a 16 year-old male.A 16 year-old boy presented with adrenal crisis and was incidentally found to have features of latent tetany. Also detected were Hashimoto's thyroiditis, alopecia and subnormal T cell function, and he was diagnosed as having polyglandular autoimmune syndrome type 1 (PGA-1), although chronic mucocutaneous candidiasis, a hallmark of PGA-1, was absent. The presentation of several components of this disorder at one time and at this age is uncommon, and the features of overt hypoparathyroidism were probably masked by associated adrenal insufficiency.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/5. Case report: hypoparathyroidism with menses-associated hypocalcemia.For 18 years, a patient with idiopathic hypoparathyroidism has experienced stiffness or tetany chiefly at the time of menses. A significant decline (0.2 mmol/L) in her serum total and ionized calcium values was observed after the withdrawal of oral contraceptive and after spontaneous onset of menses. No increase in urinary calcium excretion or decline in serum magnesium or calcitriol occurred to explain the fall in serum calcium. In two hypoparathyroid women without the history of menses-associated tetany, serum calcium remained stable after withdrawal of oral contraceptive or conjugated estrogen. serum calcitriol levels unexpectedly increased in these controls, possibly helping sustain serum calcium. The author concludes the following: (1) some hypoparathyroid women show a significant and symptomatic decline in serum calcium at the time of menses; (2) serum calcium values obtained at the time of menses may not be a reliable guide to adjusting medication dosage for hypoparathyroidism; and (3) further investigation will be needed to determine the mechanism of the decline in serum calcium values and whether the effect of estrogens on serum calcitriol might be altered in the absence of the parathyroid glands.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
3/5. central nervous system magnesium deficiency.The central nervous system concentration of magnesium (Mg ) appears to have a critical level below which neurologic dysfunction occurs. Observations presented suggest that the interchange of the Mg ion between the cerebrospinal fluid, extracellular fluid, and bone is more rapid and dynamic than is usually believed. This is especially so when the hypertrophied parathyroid gland is associated with significant skeletal depletion of Mg as judged by history rather than serum level. Magnesium, much like calcium, has a large presence in bone and has a negative feedback relationship with the parathyroid gland. A decline in central nervous system Mg may occur when the skeletal buffer system orchestrated largely by the parathyroid glands is activated by an increase in serum calcium. Observations in veterinary medicine and obstetrics suggest that the transfer of Mg from the extracellular fluid into bone during mineralization processes may be extensive. If the inhibition of the hypertrophied parathyroid gland is prolonged and the skeletal depletion of Mg extreme, serious neurologic symptoms, including seizures, coma, and death, may occur. noise, excitement, and bodily contact appear to precipitate neurologic symptoms in Mg ( )-deficient human subjects as it has been documented to occur in Mg ( )-deficient experimental animals. The similarity of the acute central nervous system demyelinating syndromes with reactive central nervous system Mg deficiency is reviewed.- - - - - - - - - - ranking = 0.8keywords = gland (Clic here for more details about this article) |
4/5. hypoparathyroidism in Wilson's disease.An 11-year-old girl with Wilson's disease presented with mild hypocalcemia (8.0 mg per deciliter), hypophosphatemia (2.7 mg per deciliter), hypercalciuria (569 mg per day), and hyperphosphaturia (tubular reabsorption of phosphate, 67 per cent). The hyperphosphaturia and hypercalciuria were attributed to the fanconi syndrome, a known component of Wilson's disease. Circulating immunoreactive parathyroid hormone was usually undetectable or, occasionally, detectable at minimal levels in the presence of depressed blood levels of ionized calcium. Normal levels of ionized calcium were not maintained throughout a 24-hour monitoring period. The patient had tetany during a period of rapid reduction in ionized calcium levels, and an appropriate rise in circulating immunoreactive parathyroid levels was never demonstrated. Induced hypocalcemia during citrate infusion did not stimulate parathyroid secretion, nor did infusion of magnesium. We conclude that parathyroid insufficiency may be associated with Wilson's disease. We speculate that it is due to deposition of copper in the parathyroid glands.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
5/5. hyperparathyroidism during pregnancy.hyperparathyroidism during pregnancy is clearly associated with an increased incidence of neonatal morbidity and mortality. Although it is impossible to define the precise incidence of this entity, we believe that its occurrence will be seen more frequently with the increasing numbers of female patients who have successfully received renal transplants and with the routine determination of serum chemistries in the nontransplanted pregnant patient. A review of case reports since 1962 of women known to be hyperparathyroid during pregnancy revealed 80 per cent of these pregnancies to be complicated by neonatal tetany, death, or abortion. This review substantiates Ludwig's earlier report [1], which noted a 50 per cent incidence of neonatal complications despite the advances of prenatal and postnatal medical care. There have been only eight reported cases in which parathyroid resection was performed during pregnancy. Successful operation dramatically reduced the incidence of neonatal complications. An adaptive normocalcemic hyperparathyroidism occurs routinely during pregnancy. However, in the hypercalcemic hyperparathyroid pregnancy, transplacental passage of calcium leads to a profound hypercalcemia in the fetus. Since the fetal parathyroid glands are functionally responsive, parathyroid suppression is thought to occur in utero due to high calcium levels. This can lead to neonatal tetany or perhaps permanent neonatal hypoparathyroidism. When a patient presents with significant hypercalcemic hyperparathyroidism during pregnancy, we suggest that an explorative parathyroid operation be performed during the second trimester of pregnancy. After delivery, the baby's course should be carefully monitored with frequent calcium determinations. Cow's milk or other formula feedings high in phosphate content should be avoided in favor of feedings with a calcium:phosphorus ratio similar to that of human milk.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |