calcitonin and Parathyroid-Neoplasms

A patient with extremely high calcium level of 23.9 mg/dL (5.97 mmol/L) was admitted to our department unconscious with pathological ECG recording, demonstrating shortening of QT interval. The patient was treated by fluid resuscitation, bisphosphonates, salmon calcitonin and steroids. Haemodialysis with low calcium bath had been promptly provided with improvement of consciousness and calcium level. ECG changes disappeared. Subsequent investigations revealed hyperparathyroidism and a large parathyroid adenoma was then surgically removed. Extreme and rapid calcium elevation (parathyroid crisis) is rarely seen in primary hyperparathyroidism and usually is distinctive for malignancy. In the context of acute kidney injury and refractory hypercalcaemia with life-threatening complications (coma, ECG changes with impending danger of arrhythmia), haemodialysis may effectively decrease calcium levels. It should be pointed out that dialysis is an efficient method of treatment of refractory hypercalcaemia, parathyroid crisis, but it is rarely used due to its invasive nature.

Topics: Adenoma; Aged; Bone Density Conservation Agents; Calcitonin; Dexamethasone; Diphosphonates; Fluid Therapy; Glucocorticoids; Humans; Hypercalcemia; Male; Pamidronate; Parathyroid Neoplasms; Prednisone; Renal Dialysis; Severity of Illness Index; Tomography, X-Ray Computed

As primary hyperparathyroidism affects mainly middle-aged and elderly women, it is an infrequent finding during gestation and breastfeeding. To date, less than 200 pregnant patients with primary hyperparathyroidism diagnosed during pregnancy have been described. Like in other disorders of the parathyroid gland, the recognition of primary hyperparathyroidism during pregnancy and lactation may be difficult, as clinical symptoms are not specific, while laboratory findings may be masked by some typical pregnancy-induced changes in calcium and phosphate homeostasis. If remains untreated, the disease may result in serious clinical implications for the mother and fetus. Most authors consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients.. In our paper, we discuss the case of a 35-year-old female with a history of recurrent acute pancreatitis and recurrent abortions. As the patient declined surgery, conservative management with calcitonin was started and continued throughout the rest of pregnancy, and led to giving birth to the infant whose only health problem was transient hypocalcemia.. The described case shows that conservative management, if started respectively early and conducted on the basis of a patient's condition, may effectively reduce increased perinatal and maternal morbidity and mortality in pregnant women declining surgery.

Topics: Abortion, Habitual; Adenoma; Adult; Calcitonin; Calcium Gluconate; Female; Humans; Hypercalcemia; Hyperparathyroidism; Infant, Newborn; Pancreatitis; Parathyroid Neoplasms; Pregnancy; Pregnancy Complications; Recurrence

Topics: Adenoma; Adult; Aged; Calcitonin; Calcium; Female; Fluorescent Antibody Technique; Humans; Hypercalcemia; Hyperparathyroidism; Hyperplasia; In Vitro Techniques; Kidney Failure, Chronic; Luminescent Measurements; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms