| Clinical and histopathological characteristics of hyperparathyroidism-induced hypercalcemic crisis. | |
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MedLine Citation:
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PMID: 21042912 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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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. |
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Authors:
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Lee F Starker; Peyman Björklund; Constantine Theoharis; William D Long; Tobias Carling; Robert Udelsman |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World journal of surgery Volume: 35 ISSN: 1432-2323 ISO Abbreviation: World J Surg Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-07 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704052 Medline TA: World J Surg Country: United States |
Other Details:
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Languages: eng Pagination: 331-5 Citation Subset: IM |
Affiliation:
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Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT 06520-8062, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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