Diagnosis and management of asymptomatic primary hyperparathyroidism: Consensus Development Conference statement

Article Abstract:

Excess secretion of hormone by the parathyroid glands is known as hyperparathyroidism, and is being diagnosed more often than in years past, thanks to widespread testing of serum calcium levels. In hyperparathyroidism, the calcium level is increased, calcium in the urine (and therefore, the risk of kidney stones) is increased, and there is evidence of bone damage in many cases. The generally accepted treatment is removal of the parathyroid glands. However, as screening is detecting these patients much earlier in the course of their disease, a panel was convened to study whether there were any patients with hyperparathyroidism who could safely be monitored without surgical intervention. The most useful means of making the diagnosis of hyperthyroidism is through testing the serum calcium and parathyroid hormone levels. A subset of hyperparathyroid patients can be followed medically for some time, before being referred for surgery. Observation alone is acceptable in those who have no symptoms, and no important bone, kidney, gastrointestinal or neuromuscular symptoms. Every six months, those patients deemed suitable for observation should be examined, and blood tested for the factors mentioned above. Patients should be instructed to avoid dehydration, which can lead to abnormalities in their already high calcium levels. Any decline in bone, kidney or gastrointestinal function should prompt a referral to a surgeon. Thus far, the various imaging techniques are not particularly useful for visualizing the parathyroid glands. Further research is necessary to clarify which patients might be successfully monitored medically, and which need to be referred for early surgical intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Conferences, meetings and seminars, United States. National Institutes of Health, Hyperparathyroidism

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Diagnosis of gastrinoma: much ado about nothing?

Article Abstract:

A disease known as the Zollinger-Ellison syndrome is characterized by tumors called gastrinomas which secrete excessive amounts of the stomach hormone gastrin. High gastrin levels in turn create excessive amounts of hydrochloric acid and pepsin in the stomach, which often results in duodenal ulcers. Gastrinomas may go undetected because the patient's symptoms can resemble the more common duodenal ulcer disease. Also, effective drugs that are available for the long-term treatment of ulcers may mask Zollinger-Ellison syndrome. The early diagnosis of gastrinomas is important because of the high rate of malignancy of these tumors. This condition can be accurately diagnosed by measuring gastric acid secretions. The test for acid hypersecretion is valuable despite the discomfort for the patient and the high level of technical skill required to conduct it. Ambiguities concerning diagnosis still remain, and the use of this particular test may not always be indicated. High levels of serum gastrin can occur in patients without gastrinomas and some patients with the tumors do not have abnormally high gastrin levels. Serum gastrin levels are also measured using intravenous calcium infusion and intravenous secretin infusion tests. The high rate of false positive results for the calcium test makes the secretin infusion test the preferred diagnostic method. Frucht et al. reported on the results of a 10-year comparative study of these two diagnostic methods in the November 1, 1989 Annals of Internal Medicine. Their findings have indicated that the secretin injection test should be the initial test ordered for diagnosing Zollinger-Ellison syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Gastrin, column, Zollinger-Ellison syndrome

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Thoracoscopy for the diagnosis of pleural disease

Article Abstract:

Diseases that involve the pleura, which line the lungs, are frequently difficult to diagnose. Methods of evaluating pleural disease include thoracentesis, or needle sampling of pleural fluid collections, and pleural biopsy, but even after these have been tried, 21 to 27 percent of patients are still undiagnosed. A study was performed to assess the accuracy and safety of thoracoscopy in diagnosing pleural disease; thoracoscopy is the direct visualization of the pleura with a special endoscopic instrument, which has a flexible tube with an optical system. A total of 104 thoracoscopies were performed in 102 patients with pleural disease. In all but seven cases, a diagnosis was made. Malignancy was identified in 42 patients and benign disease in 53. Four patients who were diagnosed by thoracoscopy as having benign disease were later discovered to have malignant mesothelioma, giving an accuracy for thoracoscopic diagnosis of 91 percent. The procedure was generally safe, although two patients studied developed potentially life-threatening complications. Thoracoscopy required only local anesthesia to be performed, and the duration of the procedure lessened as the investigators gained experience, showing it to be a relatively safe, quick and accurate means of diagnosing pleural disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Lung diseases, Pleural diseases, Thoracoscopy

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