The disease of hyperparathyroidism is diverse. The causes of it are very different. As a simplification there’s primary, secondary and tertiary hyperparathyroidism:
All three of these involves increased PTH (parathyroid hormone)
Primary: elevated calcium, low phosphorus in blood stream. Usually caused by a parathyroid adenoma.
Secondary: normal or low calcium, usually caused by renal failure.
Tertiary: failure of treatment of secondary hyperparathyroidism to correct increased PTH.
More details on hyperparathyroidism
Primary hyperparathyroidism is most commonly caused by adenomas, greater than 85%. Next most common cause would be hyperplasia which is 10% of the causes, and there is a 1% possibility that primary hyperparathyroidism is caused by a carcinoma.
Risk factor for primary hyperparathyroidism includes family history, MEN I and MEN IIa, and also radiation. Major difference between MEN IIA and IIB: MEN IIA has Hyperparathyroidism – hyperplasia, MEN IIB does not. More on MEN syndromes.
Sestamibi scan is a method of detecting hyperparathyroidism.
Carcinomas which are commonly associated with hypercalcemia:
- Breast Cancer Metastasis
- Postate Cancer
- Kidney Cancer
- Lung Cancer
Another cause of hypercalcemia: FHH – Familial hypocalciuric hypercalcemia
- autosomal dominant
- asymptomatic hypercalcemia and low urine calcium
- with or without elevated PTH
- No treatment is generally required for FHH
Pancreas NeoEndocrine/Islet cell Tumors
Sometimes associated with MEN I (multiple endocrine neoplasia)
- tumor of the delta cells of the endocrine pancreas
- triad of: Diabetes Mellitus, Steatorrhea, and Gallstones
- Most are malignant and have metastasized
- Necrolytic Migratory Erythema (NME). found in 70%
- Diabetes Mellitus
- Most are malignant and have metastasized
- Vasoactive Intestinal Polypeptide tumor
- Verner Morrison syndrome
- Causes WDHHA: Watery Diarrhea, Hypokalemia, Hypochlorhydria, Achlorhydria
- Activation of cellular adenylate cyclase and cAMP production
- 50% malignant
- 10% malignant
- Whipple’s triad of pancreatic insulinoma – Hypoglycemia, symptoms of hypoglycemia, relief of symptoms when glucose is given.
- Zollinger-Ellison Syndrome
- Excess gastric acid production
- Can arise in the duodenum or pancreas
- 60% malignant
When is a Carotid Endarterectomy Performed
- A Carotid Endarterectomy is indicated in patients with stenosis greater than 60%
- A Carotid Endarterectomy is indicated in symptomatic patients with stenosis greater than 70%
- If there are multiple episodes of TIAs, then operate when the stenosis is greater than 50%
Disclaimer: These are notes only. Every patient and condition is different and requires a in person consultation with a medical doctor. No medical advice is contained here, just academic discussion which may be very different from real life. There’s always ongoing trials and the information here may be out of date.
What is subclinical cushing’s syndrome?
- subclinical hypercortisolism / may be observed with adrenal incidentaloma
- autonomous clucocorticoid production without specific signs and symptoms of Cushing’s syndrome.
- Much more common than classic Cushing’s syndrome
- Patients have a high prevalence of obesity, hypertension, and type 2 diabetes.
- Patients with incidentally detected adrenal masses who are about to undergo surgery should have testing for subclinical Cushing’s to avoid postoperative adrenal crisis..
- Best test is short dexamethasone suppression test.
What is Cushing’s syndrome?
- exaggerated facial roundness,
- weight gain around the midsection and upper back
- thinning of arms and legs.
- stretch marks
- Cushing’s syndrome occurs when exposed to high levels of the hormone cortisol for an extended period of time.
- this can either occur with taking too much corticosteroid medication or when the body makes too much cortisol.
- Pituitary adenoma – secreting excess ACTH which stimulates the adrenal glands to make more cortisol
- Ectopic ACTH secreting tumor (ie. Lungs, pancreas, thyroid or thymus gland)
- Primary Adrenal Gland disease
- Familial Cushing syndrome
Diabetes type 1 vs. type 2
Type 1 = immune disorder. Body attacks and destroys insulin producing beta cells in the pancreas. Must take insulin. Sometimes called insulin dependent or juvenile onset diabetes.
Type 2 = either the body doesn’t produce enough insulin or the cells ignore the insulin (resistant). Sometimes called adult onset diabetes. Obesity is the strongest risk factor for type 2 diabetes.
Adrenalectomy for subclinical Cushing’s Syndrome?
Adrenalectomy may lead to cure or better control of diseases associated with subclinical Cushing’s syndrome such as diabetes and hypertension
Most pose no clinical problems.
Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!