Hypercalcemia Pathophysiology & Treatment

Primary Hyperparathyroidism & Benign Diseases

Author(s): Franco Lumachi and Stefano M.M. Basso

Pp: 18-27 (10)

DOI: 10.2174/978160805107611001010018

* (Excluding Mailing and Handling)

Abstract

Primary hyperparathyroidism (HPT) is the most common cause of hypercalcemia in nonhospitalized patients. Benign sporadic primary HPT is caused by a solitary adenoma in 80-85%, by multiglandular disease (multiple adenoma, parathyroid hyperplasia) in 12-14%, and parathyroid carcinoma in 1-2% of the cases. Parathyroid carcinoma is an uncommon finding, and its etiology remains unclear. Primary HPT can also occur in familial syndromes, such as multiple endocrine neoplasia type 1 (MEN 1), MEN 2A, hyperparathyroidism-jaw tumor (HPT-JT) syndrome, and familial isolated primary HPT, which seems to be an early stage of MEN 1 or HPT-JT. Most of the patients with primary HPT are diagnosed because of asymptomatic hypercalcemia, and both signs and symptoms of the disease, when present, are nonspecific, mainly depending on serum calcium concentration. Some patients, however, are diagnosed because of having osteopenia, osteoporosis, or unjustified recurrent bilateral nephrolithiasis. Primary HPT can be discovered by a simultaneous increase of both serum calcium and parathyroid hormone (PTH) levels, and thus the diagnosis can be obtained by inclusion rather than by excluding all the other causes of hypercalcemia. Indeed, the PTH measurement represents the keystone for differential diagnosis between primary HPT and malignancy-associated hypercalcemia. Other benign causes of hypercalcemia are drug-induced (vitamins A & D intoxication, thiazides, lithium, estrogens), endocrine (thyrotoxicosis), posttransplant and tertiary HPT, and familial benign hypocalciuric hypercalcemia. Virtually, all symptomatic patients with confirmed primary HPT should be referred for surgery, while more restrictive criteria have been suggested for the management of those with asymptomatic HPT.

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      • 11. app/Models/ContentAccess.php:647
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      • 11. app/Models/ContentAccess.php:647
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      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271243 and j.to_ip >=51271243 )) and ((j.from_date <= 1739848329 and j.to_date >= 1739848329 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 878) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271243 and j.to_ip >=51271243 )) and ((j.from_date <= 1739848329 and j.to_date >= 1739848329 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 878) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271243 and j.to_ip >=51271243 )) and ((j.from_date <= 1739848329 and j.to_date >= 1739848329 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 878)
      590μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 856 and `b`.`banner_from_date` <= 1739848329 and `b`.`banner_to_date` >= 1739848329 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.53msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 856
      • 3: 1739848329
      • 4: 1739848329
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='39217d6ed60501c00f035e1f747200ac'
      430μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        Oi3yLjxYWWAByifs4KGltyESxWEgxUqgoxSku5uG
        uc_cart_id
        39217d6ed60501c00f035e1f747200ac
        _previous
        array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/878" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/878
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 18 Feb 2025 03:12:09 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InhOZUJoOXUrK0MwQ2lGd3pYQXFkTHc9PSIsInZhbHVlIjoiK2hlRGRlaGlpWGlUd1RsR09WR0VLblVCV0t1Wm1nS0ZxVlZ5WDRQUWw3T1RvZzRCZmNHQjduQ3Z4bjB4dXNoYjNjOFcwN1kxN1V3WTlaSnprQ1lEY0ZKbHBrNktRN09IekkxdFRPUXRxc1RuTUFUUW5WNHVwaDhlWGVXT0hsWnQiLCJtYWMiOiIzNWRiODI5MTZlNDhjYmZmNzk5OGY3MmM1OWI2MjIwNDdlNjQ5Mzg0Zjc4YjVhMTk2YjhiYzllNWZkOWY0MWEzIiwidGFnIjoiIn0%3D; expires=Thu, 20 Feb 2025 15:12:09 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6InhOZUJoOXUrK0MwQ2lGd3pYQXFkTHc9PSIsInZhbHVlIjoiK2hlRGRlaGlpWGlUd1RsR09WR0VLblVCV0t1Wm1nS0ZxVlZ5WDRQUWw3T1RvZzRCZmNHQjduQ3Z4bjB4dXNoYjNjOFcwN" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjQxZEZ2MlExYzN5bS9WWTJYSmdmN3c9PSIsInZhbHVlIjoiMmQyejlqbmhDNEtoWDdSWC9mYzNvQVdlbGlHbkhNQm4vQXRPQllLS21KWGlYWWI0T3MxS1ZBMTIzS2lSMms4dkNwUm9oY2lXYjB4VXQ2TEUrczE3aHl1NGdXKytJcXlyeCtLd2pzZkdzeHpUWkdjbzVBLzJ2ODQ5dFpFQURySjkiLCJtYWMiOiJiZTg2ZWE2MTFiNDJlNTA0NTdhZjQwODgxYWM5MDE5N2QyMDk4NmQzYzg2NzI0MDRkNDcwOTljYzU3MDZhNzc4IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IjQxZEZ2MlExYzN5bS9WWTJYSmdmN3c9PSIsInZhbHVlIjoiMmQyejlqbmhDNEtoWDdSWC9mYzNvQVdlbGlHbkhNQm4vQXRPQllLS21KWGlYWWI0T3MxS1ZBMTI" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InhOZUJoOXUrK0MwQ2lGd3pYQXFkTHc9PSIsInZhbHVlIjoiK2hlRGRlaGlpWGlUd1RsR09WR0VLblVCV0t1Wm1nS0ZxVlZ5WDRQUWw3T1RvZzRCZmNHQjduQ3Z4bjB4dXNoYjNjOFcwN1kxN1V3WTlaSnprQ1lEY0ZKbHBrNktRN09IekkxdFRPUXRxc1RuTUFUUW5WNHVwaDhlWGVXT0hsWnQiLCJtYWMiOiIzNWRiODI5MTZlNDhjYmZmNzk5OGY3MmM1OWI2MjIwNDdlNjQ5Mzg0Zjc4YjVhMTk2YjhiYzllNWZkOWY0MWEzIiwidGFnIjoiIn0%3D; expires=Thu, 20-Feb-2025 15:12:09 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6InhOZUJoOXUrK0MwQ2lGd3pYQXFkTHc9PSIsInZhbHVlIjoiK2hlRGRlaGlpWGlUd1RsR09WR0VLblVCV0t1Wm1nS0ZxVlZ5WDRQUWw3T1RvZzRCZmNHQjduQ3Z4bjB4dXNoYjNjOFcwN" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjQxZEZ2MlExYzN5bS9WWTJYSmdmN3c9PSIsInZhbHVlIjoiMmQyejlqbmhDNEtoWDdSWC9mYzNvQVdlbGlHbkhNQm4vQXRPQllLS21KWGlYWWI0T3MxS1ZBMTIzS2lSMms4dkNwUm9oY2lXYjB4VXQ2TEUrczE3aHl1NGdXKytJcXlyeCtLd2pzZkdzeHpUWkdjbzVBLzJ2ODQ5dFpFQURySjkiLCJtYWMiOiJiZTg2ZWE2MTFiNDJlNTA0NTdhZjQwODgxYWM5MDE5N2QyMDk4NmQzYzg2NzI0MDRkNDcwOTljYzU3MDZhNzc4IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IjQxZEZ2MlExYzN5bS9WWTJYSmdmN3c9PSIsInZhbHVlIjoiMmQyejlqbmhDNEtoWDdSWC9mYzNvQVdlbGlHbkhNQm4vQXRPQllLS21KWGlYWWI0T3MxS1ZBMTI" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "Oi3yLjxYWWAByifs4KGltyESxWEgxUqgoxSku5uG" "uc_cart_id" => "39217d6ed60501c00f035e1f747200ac" "_previous" => array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/878" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:12:09GET/chapter/878112192