Hypercalcemia and Hyperparathyroidism

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Differential Diagnosis of Hypercalcemia:
    • Primary hyperparathyroidism:
      • Solitary adenoma:
        • 85% to 90% of the cases
      • Multigland Disease:
        • 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
    • Granulomatous diseases:
      • Sarcoidosis, histioplasmosis, tuberculosis
    • 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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