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Excerpt Thyroid imaging with iodine-131 (131I) and technetium pertechnetate (99mTc04) have proved to be useful procedures in delineating thyroid nodules (1). The two techniques usually yield identi...

A father and son each presented with severe watery diarrhea. The son was found to have a pancreatic islet-cell tumor associated with the pancreatic cholera syndrome, as well as a parathyroid adenoma. The father was found to have multiple islet-cell adenomas and the Zollinger-Ellison syndrome. Pancreatic tumor tissue from each patient contained detectable gastrin and vasoactive intestinal peptide; however, a much higher gastrin concentration was found in the tumor tissue from the father and a much higher vasoactive intestinal peptide content in the tumor tissue from the son. Thus, watery diarrhea may be mediated by different hormones in families having multiple endocrine neoplasia; the precise cause of the diarrheal syndrome should be defined to ensure the proper therapy.

Excerpt The association of tumors of the head and neck with previous radiation exposure has been well documented. Both benign and malignant neoplasms of the thyroid, brain, larynx, facial bones, sc...

Intractable hypercalcemia is the major cause of morbidity and mortality in patients with parathyroid carcinoma. Because gallium nitrate previously was shown to inhibit the bone resorptive activity of parathyroid hormone (PTH) in vitro, we used it to treat two patients with parathyroid carcinoma and resistant hypercalcemia. In both patients, total serum calcium levels were reduced from initial values of 3.62 and 3.77 mmol/L to posttreatment values of 2.32 and 1.45 mmol/L, respectively. Urinary excretion of calcium and hydroxyproline also declined significantly. Serum PTH levels were lower in both patients after therapy, although all levels remained markedly elevated. Nephrogenous cyclic adenosine monophosphate and tubular reabsorption of phosphate remained unchanged. These data indicate that treatment with gallium nitrate can control hypercalcemia in patients with high circulating levels of PTH. Gallium nitrate antagonizes the bone resorptive activity of PTH without altering renal effects of the hormone.

Transvenous digital subtraction angiography was used before surgery to evaluate seven patients with chemical evidence of hyperparathyroidism. Digital subtraction angiography identified parathyroid adenomas in six of the seven patients. This technique is a sensitive, although not specific, method to identify small vascular tumors.

Hypercalcaemic hyperparathyroidism has been diagnosed more commonly in recent years. This reflects an increasing awareness of and a growing interest in the disease. In the search for possible aetiologic mechanisms behind the development of parathyroid adenomata, certain environmental factors have been suggested. This study indicates that a significantly (p less than 0.01) greater number of patients who had parathyroid adenomata had previously undergone radiation therapy involving the neck region compared with normocalcaemic control subjects. The observed and controlled cases originate from a medical screening programme done as part of a health check-up including almost 16 000 persons in the Stockholm area. It is recommended that special attention to a past history of possible neck irradiation be paid in subjects suspected of suffering from hyperparathyroidism.

The chemoprotective and hypocalcemic agent WR-2721, S-2-(3-aminopropylamino) ethyl-phosphorothioic acid, inhibits parathyroid hormone secretion in vivo and in vitro. We report the first clinical use of WR-2721 in refractory hypercalcemia secondary to parathyroid cancer. After several days of saline diuresis the patient received WR-2721, 740 mg/m2 over 15 minutes, resulting in a fall in serum calcium from 11.76 to 9.06 mg/dL within 24 hours. Serum parathyroid hormone levels decreased from 675 to 140 microLeq/mL 2 hours after the infusion was complete. When hypercalcemia recurred the patient was retreated with differing doses and infusion rates to determine the optimal method of drug administration to provide a satisfactory hypocalcemic response without adverse effects. In this patient, WR-2721 in intravenous boluses of 150 mg/m2 was effective without adverse effects. Using high-pressure liquid chromatography with electrochemical detection, plasma pharmacokinetic studies showed that WR-2721's distribution half-life is 0.55 minutes.

Profound acute hypocalcemia was associated with a histologically proved infarcted parathyroid adenoma in the patient reported. The hypocalcemia was presumed to be the result of rapid skele...

Calcitonin concentrations in serum were measured by radioimmunoassay during calcium infusion in 76 members of 3 kindreds with known familial medullary thyroid carcinoma. Results were posit...

A 62-year-old woman with a 10-year history of repeated pathologic fractures was found at autopsy to have a parathyroid adenoma and osteitis fibrosa. Unusual features were normocalcemia and...

Postoperative observation for 44 patients with primary hyperparathyroidism (parathyroidal), reported in 1966, further supports the contention that partial parathyroidectomy is effective tr...

Excerpt Acute parathyroid intoxication in man has been reported but 10 times1, 2, 3 4, 5, 6and, except in one instance in which the intoxication was caused by the injection of parathormone,2has alw...

Excerpt The introduction of chromatographic methods for the determination of amino-acids led to the discovery of numerous conditions associated with increased urinary excretion of amino acids in va...

An additional family is reported with the association of bilateral pheochromocytoma, bilateral medullary carcinoma of the thyroid with amyloid stroma, and bilateral parathyroid adenomas. T...

Three patients with hypercalcemia had serum IgG monoclonal gammopathies. In none of the cases could a diagnosis of multiple myeloma be established, and other clinical findings were most co...

Excerpt Although osteomalacia and osteitis fibrosa resulting from primary kidney disease are found relatively frequently at autopsy (1), symptomatic bone disease during the course of renal insuffic...

Excerpt Primary hyperparathyroidism was seldom diagnosed during life prior to 1925. Twenty-six of 27 recorded cases from 1903 to 1925 were diagnosed at autopsy.1The pioneer work of Mandl2in 1926, c...

Excerpt Various methods for the insufflation of gases into the anterior mediastinum as contrast media have been described (1). Some of these have been in use in Europe for many years (2). After the...

Excerpt A 44-year-old woman was examined whose first symptom of hyperparathyroidism was nephrolithiasis. This was resolved by ureteromeatotomy and passage of the calculus. The calculus was composed...

Sixty-nine out of a kindred of 100 members covering five generations were examined and studied, and 34 were hypercalcemic. Sixteen subjects were believed, on the basis of laboratory and clinical observations, to have primary hyperparathyroidism. Eight patients were subjected to exhaustive study to identify polyendocrine involvement before neck exploration. No coexisting endocrine abnormalities were found; operation showed multiparathyroid gland involvement in most instances. Measurement of immunoassayable calcitonin and assessment of renal and gut function were carried out in 37 subjects to search out possible causes of "reactive" parathyroid gland hyperfunction. While no such cause-effect relationship was noted for this kindred, 16 of the subjects so tested had serum calcitonin content below the assay limits of sensitivity. What role this apparent lack of calcitonin played in the development of hyperparathyroidism (or vis versa) needs clarification.

Three patients with carcinoid tumor associated with hyperparathyroidism are described. All patients showed a high circulating immunoreactive calcitonin level with no differential increase in the neck venous catheterization specimens, suggesting that the high concentrations of circulating immunoreactive calcitonin may have come from the carcinoid tumor. We think that the hyperparathyroidism in these patients was primary and that the association with carcinoid tumor represents another form of multiple endocrine tumor formation. Hyperparathyroidism should be investigated in patients with carcinoid tumor.

Excerpt In 1936 Goldman and Smyth (1) reported the first cases of hyperparathyroidism in siblings. It is now generally accepted that familial hyperparathyroidism can occur both with (2) and without...

Members of five families, in whom at least one member was known to have multiple endocrine tumors, were screened for involvement with multiple endocrine adenomatosis. Of 27 family members ...

Excerpt The association of enlarged parathyroid glands and bone disease has long been recognized, but it has frequently been found difficult to distinguish between hyperplasia of the glands and neo...

Excerpt In a search for more effective forms of therapy for hypercalcemia, Goldsmith and Ingbar (1) have recently focused on the use of oral or parenteral phosphate. They reported a series of 20 hy...

The fifth reported case of exocrine pancreatic insufficiency in association with a parathyroid adenoma is described. The patient presented with severe malabsorption syndrome in which diarr...

Excerpt To the editor: We read with great interest the editorial by Drs. Gordan and Roof, "Humors from Tumors": "Diagnostic Potential of Peptides" (1). Some recent observations from our laboratorie...