Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism.
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Adult↗
Biomedical subjects
J O Koehler
Publications and source records attributed to J O Koehler.
Dispersed cells prepared from human parathyroid glands: distinct calcium sensitivity of adenomas vs. primary hyperplasia.
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Adenoma↗
Urinary cAMP excretion during surgery: an index of successful parathyroidectomy in patients with primary hyperparathyroidism.
Urinary phosphate (Up) and urinary cAMP (UcAMP) excretion were determine in patients undergoing neck exploration for primary hyperparathyroidism in order to evaluate these parameters as indices of successful surgery. UcAMP fell below 1.5 micro mol/g creatinine in all 12 patients in whom single gland removal corrected hypercalcemia and in 0 of 3 patients in whom no parathyroid tissue was found. The mean time to drop below 1.5 was 2.0 +/- 0.8 h (mean /+- SD) from the time of parathyroidectomy. UcAMP fell below 1.5 in only 1 of 6 patients who had multiple enlarged parathyroid glands removed, irrespective of the outcome of surgery. Changes in Up excretion lagged behind UcAMP changes, so that within the time period studied Up fell to varying degrees in only 10 of 15 patients in whom hypercalcemia was corrected. A spurt in UcAMP excretion, possibly reflecting parathyroid hormone release due to manipulation of a parathyroid gland, occurred in 3 patients. The results suggest that an intraoperative fall in UcAMP below 1.5 predicts successful parathyroidectomy and that an intraoperative spurt in UcAMP may provide a clue to the location of abnormal parathyroid tissue.
Calcium↗
Computed tomography for parathyroid localization.
Computed tomography (CT) of the neck and mediastinum was performed in 10 patients with primary hyperparathyroidism. Nine had undergone previous surgery and were considered localization problems. Of four subsequently proven cervical adenomas, only one unusually large 19-g adenoma was visualized by CT. However, of two subsequently proven anterior mediastinal adenomas, CT scanning was positive in both; a single posterior mediastinal adenoma was not demonstrated. Of the remaining three patients, one was not operated on; in two others no adenoma was found at surgery. CT scanning is recommended prior to neck surgery in all patients with primary hyperparathyroidism to identify adenomas in the anterior mediastinum.
Adenoma↗