- MeSH
- Diuretics * adverse effects therapeutic use MeSH
- Hydrochlorothiazide * adverse effects therapeutic use MeSH
- Hypercalcemia * drug therapy blood urine MeSH
- Hyperparathyroidism * drug therapy blood urine MeSH
- Middle Aged MeSH
- Humans MeSH
- Parathyroid Hormone urine MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Calcium * blood metabolism urine MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Overall MeSH
Je popsán případ 40leté ženy s hyperkalcemií a silnými trvajícími bolestmi hlavy s negativním neurologickým nálezem. Podezření na primární hyperparatyreózu bylo vysloveno na základě pozitivního scintigrafického vyšetřením s Tc-MIBI (methoxyisobutylisonitril) a diagnóza potvrzena histologickým nálezem: paratyreoidální tumor s měnlivou úpravou solidně trabekulární i alveolární, ložiskově i s tvorbou naznačeně rozetovitých formací z menších nápadně monomorfních buněk. Při vyšetřování tumoru přištítného tělíska nebyl testován průkaz parathormonu, protože byla uvedena normalizace hladin kalcemie po jeho odstranění. Ve vyšetřovaném tumoru je vzhledem ke klonální monomorfnější proliferaci s pozitivitou MIB 1 dosahující až 40 % biologická povaha nejistá i při neprokázané angioinvazi a perineurální invazi. Je potřeba pacientku kontrolovat s ohledem na riziko recidivy. Po úspěšné paratyreoidektomii cefalea zcela ustoupila. Kauzální vztah adenomu paratyreoidey a hyperkalcemie je zatím hypotetický.
The case report describes a case of a 40-year-old female patient with chronic hypercalcemia and severe chronic cephalea with negative neurologic finding (examination). Diagnosis of parathyroid gland adenoma was estimated by Tc scintigraphy (MIBI). Parathyroid tumor with variable rate adjustment of solid, trabecular and alveolar bearing is indicated by the formation of rosette-like formations of smaller strikingly monomorphic cells. When investigating tumor of the parathyroid gland parathyroid card has not been tested since it was shown normalization of blood after removal. In the investigation of the tumor due to the clonal proliferation monomorphic with positive MIB 1 reaching up to 40% biological nature uncertain and unproven at angioinvasion and perineural invasion. The patient should be monitored with regard to the risk of tumor recurrence. After successful parathyroidectomy, cefalea completely disappeared. Causal association between cefalea and hypercalcemia remains to be confirmed.
- Keywords
- paratyreoidální tumor,
- MeSH
- Headache * etiology MeSH
- Diagnosis, Differential MeSH
- Adult MeSH
- Hypercalcemia * etiology blood urine MeSH
- Humans MeSH
- Parathyroid Neoplasms * surgery pathology MeSH
- Parathyroid Hormone blood MeSH
- Parathyroidectomy MeSH
- Hyperparathyroidism, Primary * diagnosis etiology physiopathology MeSH
- Radionuclide Imaging MeSH
- Muscle Fatigue MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3. RESULTS: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling. CONCLUSIONS: Our data indicate that both hypo- and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.
- MeSH
- Biomarkers blood MeSH
- Time Factors MeSH
- Adult MeSH
- Phosphorus blood MeSH
- Hypercalcemia etiology blood urine MeSH
- Hypocalcemia etiology blood urine MeSH
- Calcifediol blood MeSH
- Calcitriol blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Parathyroid Hormone blood MeSH
- Postoperative Period MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Aged MeSH
- Case-Control Studies MeSH
- Kidney Transplantation adverse effects MeSH
- Calcium blood metabolism urine MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- MeSH
- Diagnosis, Differential MeSH
- Child MeSH
- Hypercalcemia drug therapy genetics urine MeSH
- Hypocalcemia diagnosis drug therapy genetics MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Membrane Proteins genetics MeSH
- Magnesium Deficiency MeSH
- Nephrocalcinosis drug therapy genetics ultrasonography MeSH
- Renal Insufficiency etiology prevention & control MeSH
- Calcium metabolism adverse effects MeSH
- Metabolism, Inborn Errors drug therapy genetics classification MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Acetylglucosaminidase diagnostic use metabolism urine MeSH
- Child MeSH
- Hypercalcemia complications urine MeSH
- Humans MeSH
- Urinary Calculi diagnosis etiology MeSH
- Nephrocalcinosis diagnosis etiology MeSH
- Renal Tubular Transport, Inborn Errors diagnosis complications MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- MeSH
- Adult MeSH
- Calcium Phosphates metabolism adverse effects MeSH
- Hormones therapeutic use MeSH
- Hypercalcemia metabolism urine prevention & control MeSH
- Bone Density physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Ovariectomy adverse effects MeSH
- Osteoporosis, Postmenopausal diagnosis complications MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
