G. D. Aurbach

Neuromuscular Disease in Primary Hyperparathyroidism

Abstract Fourteen of 16 patients with primary hyperparathyroidism studied prospectively had weakness, easy fatiguability, and atrophy of muscles—particularly of the lower extremities. Electromyogra...

Divalent cation metabolism: Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism

Abstract Twenty-three members of three families with a syndrome of hypercalcemia without hypercalciuria (familial hypocalciuric hypercalcemia) were compared to a group of 64 subjects with hypercalcemia due to typical primary hyperparathyroidism. Patients with familial hypocalciuric hypercalcemia had higher creatinine clearance values than those with primary hyperparathyrodism (115 ± 27 versus 87 ± 27 ml/min/1.73 m 2 (mean ± 1 standard deviation [SD] p p p p p p p

Parathyroid carcinoma in familial hyperparathyroidism

Abstract We present the first reported occurrence of parathyroid carcinoma in familial parathyroid hyperplasia or multiple endocrine adenomatosis, type I. The patients hypercalcemia persisted through 8 years even though abnormal parathyroid tissue was removed from three separate sites in the neck. The original clinical presentation and review of tissue removed initially from the left thyroid lobe suggested the possibility of parathyroid carcinoma; tissue from the second and third operations (on the right) was histologically benign, showing chief cell hyperplasia. A fourth operation then revealed implants of parathyroid carcinoma unilaterally in the left side of the neck. The patients brother and sister also had parathyroid hyperplasia, and his mother died of a pancreatic tumor of undocumented cell type. The patient himself had no evidence of pancreatic or pituitary tumor.

Hyperparathyroidism: Recent Studies

Abstract A review of 57 cases of primary hyperparathyroidism has delineated the changing clinical complex of the disease; its apparent prevalence increases with greater clinical awareness and more ...

PSEUDOGOUT AFTER PARATHYROIDECTOMY

Abstract Four cases of acute arthritis developed after parathyroidectomy, and pseudogout was suspected in each patient. All patients demonstrated typical chondrocalcinosis in radiographs of knees and wrists, and acute polyarticular arthritis developed in these affected joints. Intracellular rhomboidal crystals with weakly positive birefringence were characteristic of fluid obtained from the affected joints in two patients. The episode of acute pseudogout in these four cases, three of whom had no previous history of symptomatic joint diseases, indicates a possible relation between the changes in calcium metabolism after parathyroidectomy and the development of acute pseudogout.

Angiographic Ablation of Parathyroid Adenomas

Six mediastinal parathyroid adenomas were stained by infusing contrast agent through a catheter wedged in the feeding artery. Adenomas in the first three cases were stained unintentionally with small volumes of dilute contrast media and hypercalcemia recurred within 3 to 6 months. In the next three patients, adenomas were deliberately stained with larger doses of concentrated contrast media and these patients have remained normocalcemic from 2 to 18 months following staining. The permanency of parathyroid ablation following deliberate staining with contrast media has not been established.

The blood supply of mediastinal parathyroid adenomas.

Arteriography for parathyroid localization following unsuccessful neck surgery should include selective catheterization of the inferior thyroid and internal mammary arteries bilaterally. When the arterial supply to a mediastinal adenoma arises from the internal mammary artery, recovery from the neck may not be possible and an open mediastinal exploration (or embolization) should be considered.

Intraoperative urinary cyclic adenosine monophosphate as a guide to successful reoperative parathyroidectomy.

Sixty patients with persistent or recurrent primary hyperparathyroidism underwent reexploration during which urinary cyclic adenosine monophosphate (UcAMP) levels were determined at half-hour intervals by radioimmunoassay. Retrospective analysis of the data allowed us to develop UcAMP criteria for surgical success. Following removal of parathyroid tissue, if an individual UcAMP level dropped 50% from the median baseline level, or if elevated levels dropped to less than 4.0 nmol/dl glomerular filtrate, surgery was predicted to be successful. Eight unsuccessful procedures in seven patients produced no decline in UcAMP, and the intraoperative results accurately predicted surgical failure. Fifty-three patients underwent successful procedures and in every case UcAMP fell. Ninety-eight per cent of these successful procedures were predicted by our criteria. Levels of UcAMP fell 1.5 +/- 0.5 hours (means +/- SD) following abnormal parathyroidectomy. In 19 of 36 successful cases diagnosed before surgery as adenoma, the operative procedure was terminated before a significant drop in UcAMP. In 16 of 17 successful cases diagnosed before surgery as hyperplasia or uncertain histology, UcAMP fell during the operation. Intraoperative determination of UcAMP is helpful in reoperative parathyroid surgery. The criteria established allow intraoperative prediction of success with remarkable accuracy. Urinary cyclic AMP is especially helpful in reoperation for multigland disease; when enough pathologic tissue has been removed, the criteria will be met and the procedure may be terminated with confidence.

PARATHYROID FUNCTION AFTER PARATHYROIDECTOMY: EVALUATION BY MEASUREMENT OF URINARY cAMP

We measured urinary cyclic AMP (UcAMP) excretion after parathyroidectomy in order to assess postoperative parathyroid function. Patients undergoing successful treatment for primary hyperparathyroidism were divided into three groups based on therapy required to correct postoperative hypocalcaemia: 1 (n= 44) vitamin D not required; 2 (n= 17) vitamin D required temporarily (< 1 year); 3 (n= 10) vitamin D required permanently (> 1 year).

Preoperative Localization of Abnormal Parathyroid: Neck Massage versus Arteriography and Selective Venous Sampling

Excerpt Preoperative localization is desirable in patients with primary hyperparathyroidism who have had previous neck surgery (1-3). Arteriography and selective venous sampling, the most effective...