Hiperparatiroidismo primario por adenoma paratiroideo gigante; presentación de caso clínico
Fecha
2020
Tipo
tesis
Autores
Rodríguez Barrantes, Wendell José
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Resumen
El hiperparatiroidismo primario es la causa principal de hipercalcemia que afecta principalmente a personas mayores y mujeres, su diagnóstico se basa en los hallazgos de laboratorio con elevaciones del calcio y PTH sérica. El adenoma paratiroideo es la causa más frecuente del hiperparatiroidismo primario y en especial afecta a las glándulas paratiroideas inferiores, las cuales por su embriología, en ocasiones, tienen ubicaciones ectópicas en el ser humano. Por lo tanto, un amplio conocimiento de su anatomía es imperativo para el manejo adecuado quirúrgico, ya que la mayoría de los pacientes se encuentran asintomáticos en el momento del diagnóstico, por lo que en la actualidad son muy raras las manifestaciones óseas y renales clásicas del hiperparatiroidismo primario.
El tratamiento estándar es el manejo quirúrgico, clásicamente se les realizaba exploración de cuello, sin embargo, con el avance en los estudios de localización prequirúrgica, la cirugía ha evolucionado a procedimientos menos invasivos y con menor morbilidad y beneficio para el paciente.
El siguiente caso corresponde a una femenina de 49 años, quien se presenta con hiperparatiroidismo primario y enfermedad ósea avanzada, con estudios de localización negativos por adenoma y con hallazgo intraoperatorio de un adenoma paratiroideo gigante y posterior descenso en los niveles de la PTH al resecarlo.
Primary hyperparathyroidism is the main cause of hypercalcemia, which mainly affects older people and women. The diagnosis is based on laboratory findings with elevations of calcium and serum PTH. Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism, affecting mainly the lower parathyroid glands. Due to their embryology, it’s not uncommon for them to have ectopic locations in humans, therefore it’s imperative to have a broad knowledge of its anatomy for proper surgical management. Most patients are asymptomatic at the time of diagnosis, and the classic bone and kidney manifestations of primary hyperparathyroidism are currently very rare. The standard treatment is surgical management, classically a cervical exploration was performed, a rather morbid procedure. However, with the advancement in localization studies, surgery has evolved to less invasive procedures with less morbidity and benefit for the patient. The following case corresponds to a 49-year-old female, who presents with primary hyperparathyroidism and advanced bone disease, with negative location studies for adenoma, and with intraoperative findings of a giant parathyroid adenoma and subsequent decrease in PTH levels upon resection.
Primary hyperparathyroidism is the main cause of hypercalcemia, which mainly affects older people and women. The diagnosis is based on laboratory findings with elevations of calcium and serum PTH. Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism, affecting mainly the lower parathyroid glands. Due to their embryology, it’s not uncommon for them to have ectopic locations in humans, therefore it’s imperative to have a broad knowledge of its anatomy for proper surgical management. Most patients are asymptomatic at the time of diagnosis, and the classic bone and kidney manifestations of primary hyperparathyroidism are currently very rare. The standard treatment is surgical management, classically a cervical exploration was performed, a rather morbid procedure. However, with the advancement in localization studies, surgery has evolved to less invasive procedures with less morbidity and benefit for the patient. The following case corresponds to a 49-year-old female, who presents with primary hyperparathyroidism and advanced bone disease, with negative location studies for adenoma, and with intraoperative findings of a giant parathyroid adenoma and subsequent decrease in PTH levels upon resection.
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Cirugía