vitamin-d-2 and Parathyroid-Neoplasms

Topics: Adenoma; Alkaline Phosphatase; Calcitonin; Calcium; Dihydrotachysterol; Diuretics; Ergocalciferols; Female; Homeostasis; Humans; Hydroxyproline; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Osteitis Deformans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Phosphates; Sulfonamides; Thiadiazines

Topics: Acidosis, Renal Tubular; Adenoma; Adult; Alkaline Phosphatase; Anuria; Bicarbonates; Bone Diseases; Calcium; Ergocalciferols; Female; Glomerulonephritis; Glycosuria; Humans; Hypercalcemia; Hyperparathyroidism; Hypertension, Renal; Kidney Failure, Chronic; Kidney Transplantation; Parathyroid Glands; Parathyroid Neoplasms; Phosphates; Renal Dialysis; Sodium; Transplantation, Homologous

Calcific uremic arteriolopathy, or calciphylaxis, is a serious and life-threatening complication of end-stage renal disease. Its pathogenesis is not yet fully elucidated and treatment is controversial. In the presence of severe hyperparathyroidism, parathyroidectomy should be considered. We report a case of a woman on maintenance hemodialysis therapy with calciphylaxis and parathyroid adenoma who refused to undergo parathyroidectomy. She was treated successfully with a combination of noncalcium phosphate binders, cinacalcet, and paricalcitol. Subcutaneous plaques disappeared, and the necrotic lesion was healed. Discontinuation of paricalcitol led to an increase in serum parathyroid hormone levels and reappearance of the patient's symptoms, whereas its reintroduction resulted in complete remission of the clinical picture. Paricalcitol, a less calcemic vitamin D analogue, is also a selective vitamin D receptor activator with a number of nonclassic actions (such as inhibition of inflammation and ossification-calcification) that could prove beneficial in cases of calciphylaxis.

Topics: Adenoma; Arterial Occlusive Diseases; Arterioles; Biopsy; Bone Density Conservation Agents; Calcinosis; Ergocalciferols; Female; Follow-Up Studies; Humans; Middle Aged; Parathyroid Neoplasms; Positron-Emission Tomography; Uremia

Sixteen patients with primary hyperparathyroidism presenting as rickets have so far been reported in the English literature. However, no report of an ectopic thymic parathyroid adenoma presenting as rickets has been published. We report a 14-year-old Caucasian American, wheelchair-ridden male who presented with signs and symptoms suggestive of vitamin D deficiency rickets subsequently confirmed by laboratory and radiological findings. Following the intramuscular administration of 125,000 U ergocalciferol (vitamin D2), he developed hypercalcemia with persistently elevated parathyroid hormone (PTH) levels suggestive of primary hyperparathyroidism. Sestamibi scan demonstrated significant uptake in the superior chest, without uptake at the normal parathyroid glands location. Surgical exploration revealed normal parathyroid glands and a thymic mass, which was removed and confirmed by pathology to be a parathyroid adenoma. With subsequent oral ergocalciferol solution and calcium carbonate therapies, the patient's symptoms resolved, blood chemistries normalized, and radiological evidence of rickets significantly improved. To our knowledge, this is the first case of an ectopic thymic parathyroid adenoma in a patient presenting with rickets. Our patient demonstrates that hyperparathyroidism-induced hypercalcemia may be masked by severe vitamin D deficiency. Prolonged treatment with ergocalciferol after removal of the parathyroid adenoma was necessary to normalize iPTH and replenish vitamin D store.

Topics: Adolescent; Calcium; Ergocalciferols; Follow-Up Studies; Humans; Male; Parathyroid Neoplasms; Radiography; Rickets; Time Factors; Vitamin D Deficiency

Topics: Adenoma; Adult; Alkaline Phosphatase; Calcium; Cardiomegaly; Cardiomyopathies; Ergocalciferols; Female; Humans; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Infant, Newborn; Infant, Newborn, Diseases; Parathyroid Hormone; Parathyroid Neoplasms; Perfusion; Phosphorus; Pregnancy; Pregnancy Complications

Topics: Adenoma; Adult; Aged; Calcium; Carcinoma, Papillary; Creatinine; Ergocalciferols; Female; Humans; Hypercalcemia; Hypoparathyroidism; Parathyroid Neoplasms; Pharmaceutical Vehicles; Postoperative Complications; Stimulation, Chemical; Thyroid Neoplasms; Thyroidectomy

Topics: Adenoma; Adult; Bone Resorption; Calcium; Ergocalciferols; Female; Hand; Humans; Hyperparathyroidism; Hyperthyroidism; Hypocalcemia; Osteoclasts; Parathyroid Neoplasms; Pelvis; Postoperative Complications; Radiography; Skull; Tetany

Topics: Adenoma; Bone Cysts; Calcium; Calcium, Dietary; Diagnosis, Differential; Ergocalciferols; Humerus; Lactates; Maxilla; Neoplasms; Parathyroid Neoplasms; Pathology; Radiography, Dental; Surgical Procedures, Operative

Topics: Bone Diseases; Ergocalciferols; Humans; Parathyroid Glands; Parathyroid Neoplasms; Paratyphoid Fever; Tetany