Hypercalcemia and Hyperparathyroidism

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Differential Diagnosis of Hypercalcemia:
    • Primary hyperparathyroidism:
      • Solitary adenoma:
        • 85% to 90% of the cases
      • Multigland hyperplasia:
        • 3% of the cases
      • Doble adenoma:
        • 6% to 9% of the cases
      • Triple adenoma:
        • 0.3% of the cases
    • Secondary hyperparathyroidism
    • Tertiary hyperparathyroidism
    • Familial hypocalciuric hypercalcemia
    • Medications:
      • Lithium
      • Hydrochlorothiazide
    • Malignancy:
      • Parathyroid carcinoma
      • Multiple myeloma
      • Tumors producing PTH-related peptide:
        • Ovarian cancer
        • Lung cancer
      • Acute or chronic leukemia
    • Sarcoidosis
    • Thyrotoxicosis
    • Paget disease
    • Increased intake:
      • Milk-alkali syndrome
      • Vitamin A toxicity
      • Vitamin D toxicity
  • Primary hyperparathyroidism (PHPT):
    • Is caused by an inappropriate, autonomous  secretion of parathyroid hormone (PTH) by the parathyroid gland (s), which leads to an elevated serum calcium concentration or wide variations of the serum calcium concentration.
    • Single gland disease:
      • Caused by a single, enlarged, overactive gland, is found in 85% to 90% of cases.
    • Multiple gland disease occurs in 10% to 15% of the cases:
      • Multiple gland disease may consist of:
        • Double adenomas (6% to 9% of the cases)
        • Four-gland hyperplasia (3% of the cases)
        • Three enlarged and one normal appearing gland (0.3% of the cases).
          • Because asymmetric hyperplasia is common, it is difficult to distinguish between multiple adenomas and hyperplasia and the term multiple gland disease is preferred.
    • PHPT in the United States usually presents quite early, often when hypercalcemia is noted during routine laboratory testing.
    • Signs may include:
      • Nephrolithiasis, decreased bone density, and fragility fractures, and subjective symptoms may include fatigue, cognitive changes, depression, constipation and other gastrointestinal complaints, musculoskeletal pain, nocturia, and rarely pruritus:
        • Many patients may appear asymptomatic:
          • A detailed history often uncovers symptoms:
            • 95% of the cases have symptoms when appropriate history is taken. 
              • The recently revised guidelines for asymptomatic PHPT include a more extensive evaluation of the skeletal and renal systems.
    • A family history of endocrine disorders should be investigated:
      • As hyperparathyroidism alone can be familial or can present as a component of multiple endocrine neoplasia (MEN) types 1 and 2A.

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Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello / cirugia endocrina miembro del equipo de Mount Sinai Medical Center experto en el manejo del hiperparatiroidismo primario.

Entrenamiento:

  • Cirugia general y gastrointestinal:

• Michigan State University:

• 2004 al 2010image-48

• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

image-39

• Maestria en ciencias (Clinical research for healthprofessionals):

• Drexel University (Filadelfia):

• 2010 al 2012image-50

• Cirugia de tumores de cabeza y cuello / cirugiaendocrina

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

image-51

#Arrangoiz

#CirugiadeTumoresdeCabezayCuello

#CirugiaEndocrina

#CirugiaOncologica

#HeadandNeckSurgery

#EndocrineSurgery

#SurgicalOncology

#Hiperparatiroidismo

#Hyperparathyroidsim

#MountSInaiMedicalCenter

#MSMC

#Mexico #Miami

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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