Bijschildklieren / hyperparathyreoïdie

ineke
Berichten: 360
Lid geworden op: 08 nov 2014, 17:53

Bijschildklieren / hyperparathyreoïdie

Bericht door ineke » 14 apr 2017, 15:01

Onderstaand info via het Schildkliernetwerk.

(In het Schildklier Netwerk werken dokters van verschillende specialismen en uit verschillende ziekenhuizen nauw met elkaar samen rondom de zorg aan en het onderzoek naar (bij)schildklierziekten)


Impact trial

IMPlementation of a symptom based Algorithm for Calcium management after total Thyroidectomy (IMPACT-trial)

Achtergrond:
Hypocalciëmie is een veel voorkomende complicatie na totale thyreoïdectomie. Ongeveer een kwart van de patiënten heeft postoperatief een verlaagd serum calcium. Resectie van één of meerdere bijschildklieren, maar ook (tijdelijke) ischemie of oedeem in het operatiegebied zijn mogelijke oorzaken van postoperatieve hypocalciëmie. Een evidence based richtlijn voor de behandeling van dit veelvoorkomende probleem bestaat helaas niet. De behandeling wordt doorgaans gebaseerd op het serum calcium en soms ook het parathormoon (PTH). Recent onderzoek suggereert echter dat dit in veel gevallen resulteert in overbehandeling en dat behandeling van alleen symptomatische patiënten efficiënt en veilig is. Naar aanleiding van deze observatie is voor de Nederlandse praktijk een behandelalgoritme ontwikkeld voornamelijk gebaseerd op symptomen. De verwachting is dat dit algoritme zal leiden tot optimalisatie van diagnostiek en onnodige behandeling kan voorkomen. Het aantal bloedafnames en polikliniekbezoeken en daarmee de belasting voor de patiënt zullen hierdoor afnemen.

Doel:
Het doel van deze studie is het onderzoeken van de effectiviteit en veiligheid van een nieuw behandelalgoritme voor de behandeling van hypocalciëmie na totale thyreoïdectomie. Dit zal worden onderzocht in een prospectieve multicenter trial in tien ziekenhuizen in de regio Rotterdam.

Inclusiecriteria:
1. Geplande totale of totaliserende thyreoïdectomie
2. Leeftijd ≥ 18 jaar

Exclusiecriteria:
1. Preoperatief afwijkend gecorrigeerd serum calcium
(referentiewaarden 2.20 -2.65 mmol/L)
2. Hyperparathyreoïdie
3. Epilepsie in de voorgeschiedenis
4. Zwangerschap
5. Onvoldoende beheersing van de Nederlandse taal
6. Wilsonbekwaam


Behandelalgoritme
http://www.schildkliernetwerk.nl/docume ... oritme.pdf

Dagboek
http://www.schildkliernetwerk.nl/documenten/Dagboek.pdf

Tijdschema IMPACT-trial
http://www.schildkliernetwerk.nl/docume ... nisch).pdf

Zakkaartje > Implementation of a symptom based algorithm for calcium management after total thyroidectomy (IMPACT-trial)
http://www.schildkliernetwerk.nl/docume ... aartje.pdf


Website:
http://www.schildkliernetwerk.nl/in-beeld/


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ineke
Berichten: 360
Lid geworden op: 08 nov 2014, 17:53

Bijschildklieren / hyperparathyreoïdie

Bericht door ineke » 16 apr 2017, 12:23

Volledig artikel in Journaal van de European Society of Endocrinology


Published online before print March 3, 2017, doi: 10.1530/EJE-16-1065
Eur J Endocrinol June 1, 2017 176 R269-R282

Review
DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

Abstract
Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic–pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma.
A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders.

Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis.
The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.

Figure 1
(A and B) A 57-year-old woman presenting with headache, dyplopia and ptosis. Sellar MRI ((A) sagittal and (B) coronal views) shows an invasive sellar mass with propagation to the sphenoid sinus and clivus. Pathology report: Pituitary plasmacytoma IgA kappa+.

Figure 2
A 62-year-old woman with euthyroid multinodular goiter presenting with bitemporal hemianopsia and moderate hypeprolactinemia. (B) Sellar MRI shows a large suprasellar mass. (C) Pathology report: Metastasis from papillary carcinoma of thyroid not previously diagnosed. From: Stojanovic M et al. European Thyroid Journal 2013 1 277–284. (reproduced with permission).

Figure 3
(A and B) A 10-year-old boy developed a sudden onset of diabetes insipidus, somnolence and visual field impairment. Sellar MRI (A sagittal and B coronal views) shows a large suprasellar mass. Pathology report: non-Langerhans cell histiocytosis WHO grade III.

en meer figuren zie:
http://www.eje-online.org/content/176/6 ... gures-only


Conclusion
The less common and unusual causes of hypopituitarism are always challenging, and there is a long delay in arriving at the diagnosis.
However, a high index of suspicion is needed when patients present with a history of cranial irradiation, head trauma, vascular injury, cancer treated with specific immune therapy causing hypophysitis, history of systemic diseases and bacterial, tuberculosis, viral, fungal and parasitic infections.
Once suspected, the diagnosis can be confirmed with pituitary function tests and imaging.

The pattern of pituitary hormone deficiencies depends on the nature of the underlying pathological process. Hypopituitarism may be permanent in some instances or transitory in other necessitating repeated assessment. It is unclear who and how often to screen, but certainly, a lengthy follow-up is needed. Some of the so-called uncommon causes of hypopituitarism, such as traumatic brain injury, may in the near future be a common cause, as the number of people sustaining head trauma is increasing.


Volledig artikel:
http://www.eje-online.org/content/176/6/R269.full

NB
Je kan het artikel lezen in het Nederlands - zie knop vertalen bovenin de balk > Google.



Als pdf:
http://www.eje-online.org/content/176/6 ... l.pdf+html


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ineke
Berichten: 360
Lid geworden op: 08 nov 2014, 17:53

Bijschildklieren / hyperparathyreoïdie

Bericht door ineke » 16 dec 2017, 15:41

Volledig artikel.


IMAJ 2017; 19: 731–735
Intraoperative Parathyroid Aspiration and Parathyroid
Hormone Assay During Parathyroidectomy for Primary Hyperparathyroidism


Miki Paker MD1, Shani Fisher RN2, Salim Mazzawi MD1, Raul Kolodner PhD3 and Dror Ashkenazi MD1
1Department of Ear, Nose and Throat, 2Department of Dermatology and Venereology and 3Laboratory Unit, Emek Medical Center, Afula, Israel

Abstract
Background:
Direct aspiration from suspected pathological tissue and rapid parathyroid hormone analysis may offer
a reliable, cost effective alternative to currently used “gold standard” tests.

Objectives:
To validate the accuracy of intraoperative measurements of parathyroid hormone levels in parathyroid adenomas.

Methods:
A prospective study included 22 patients diagnosed with primary hyperparathyroidism who underwent parathyroidectomy due to an adenoma or hyperplasia.
Aspirations of tissues extracted from three adjacent areas (the pathological parathyroid, thyroid, and muscle tissues) were sent for rapid parathyroid hormone analysis.
The assay values of these tissue aspirates were compared to the results of the pathology report based on frozen section analysis and the final pathology report.

Results:
All assay results were significantly higher for parathyroid tissue 16,800 to 1,097,986 pmol/L (median 26,600), than for either thyroid 1.7 to 415 pmol/L (median 6.5), P < 0.001, or muscle tissue 1.1 to 1230 pmol/L, (median 11.3), P < 0.001.

All tissues showing high parathyroid assay values were also verified by pathology examinations:
7 had adenomas and 15 had a differential diagnosis of adenoma or hyperplasia.
The frozen section identified all but one (false negative).
Rapid intraoperative parathyroid levels > 1500 predicted parathyroid tissue with a 99% level of confidence, while levels between 1000 and 1500 predicted it with 95% confidence.
The intraoperative parathyroid hormone assay showed > 70% decrease in 15/21 cases.

Conclusions:
Rapid intraoperative parathyroid hormone analysis is a reliable and precise technique, equally accurate for
frozen section analysis in predicting with high certainty intraoperative parathyroid tissue.

Table 1.
Patient details

Figure 1.
Mean log transformed results per group, parathyroid vs.thyroid: P < 0.05,
parathyroid vs. muscle: P < 0.05, muscle vs. thyroid:
NS. Standard error reflects a confidence interval of 95%

Table 2.
Descriptive statistics of the parathyroid hormone measurements


Volledig:
https://www.ima.org.il/FilesUpload/IMAJ ... 131862.pdf

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