Donald A. Scholz

Primary hyperparathyroidism: A prospective clinical study

Abstract The results of the first thirty months of a long-term prospective study of primary hyperparathyroidism are presented. This study was designed to evaluate the course of asymptomatic patients without complications for whom surgical treatment is deferred as well as the effects of successful surgical treatment on the complications of the disease. Included in the last fifteen months of the study was the measurement of serum immunoreactive parathyroid hormone (IPTH). The majority of the patients without symptoms or complications did well without surgical treatment. Operation eventually was required in 13.8 per cent of these patients. There was no trend in serial serum IPTH values in the thirty patients for whom they were available. Removal of the parathyroid lesion does not ensure cure of primary hyperparathyroidism. Four patients had persistent hyperparathyroidism and three had recurrent hyperparathyroidism among the 171 patients with proved hyperparathyroidism. In patients with significant renal impairment prior to parathyroid surgery further renal deterioration may develop after the removal of an adenoma, but so far this has been reversible. The serum calcium was less than 11 mg/100 ml in fifty-one (31 per cent) of the patients with proved hyperparathyroidism. Serum IPTH values correlated positively with serum calcium values and tumor weights, differing from normal in which there is a negative correlation with serum calcium. Serum IPTH values have been most useful in the evaluation of hypercalcemia when the etiology is not clear. Renal lithiasis was present in 51 per cent of the patients with proved hyperparathyroidism but was thought to be metabolically active in only 10.5 per cent. Roentgenographic bone disease, occurring in 24 per cent of patients with proved hyperparathyroidism, appeared to represent a subpopulation with higher serum calcium, alkaline phosphatase and IPTH values as well as larger tumors. Primary hyperparathyroidism may be much more common than previously suspected, occurring frequently in an asymptomatic form without complications and detected by screening technics. As yet, it is not clear which of these patients should have surgical treatment.

Renal insufficiency, renal calculi and nephrocalcinosis in sarcoidosis: Report of eight cases

Abstract In eight cases of sarcoidosis in which renal complications were present, renal calculi were demonstrable in five cases, nephrocalcinosis in one case and renal insufficiency in two cases. Hypercalcemia was present in six of the cases. The possible mechanisms for the hypercalcemia are discussed. Renal insufficiency may be secondary to widespread granulomatous infiltration, nephrocalcinosis, or a combination of both processes.

SPONTANEOUS HYPOGLYCEMIA ASSOCIATED WITH FIBROGENIC TUMOR: REPORT OF TWO CASES

Excerpt The clinical signs and symptoms associated with hypoglycemia are well documented in recent clinical reviews.1-3The common causes of organic hypoglycemia include (1) hyperinsulinism due to a...

Lipoadenoma of the parathyroid gland.

An unusual parathyroid adenoma containing abundant adipose tissue is described in four patients. In one patient, hyperparathyroidism was documented; in another, studies were incomplete but the adenoma was probably functioning. Prior reports of similar lesions have been called “parathyroid hamartoma or parathyroid adenoma with myxoid stroma,” and some of these also have been shown to be functional. They may create diagnostic difficulties because of the presence of adipose tissue, a feature associated with normal parathyroid glands.