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[This corrects the article DOI: 10.3389/fendo.2021.727628.].
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INTRODUCTION: Due to the early diagnosis of primary hyperparathyroidism the musculoskeletal manifestations of this disease are becoming less frequent. When this disease manifests secondary to a giant adenoma, it presents with more aggressive symptoms and can have important repercussions such as the hungry bone syndrome after parathyroidectomy. There are few reported cases of hyperparathyroidism secondary to a giant adenoma in the literature, as the presence of a brown tumor is often misinterpreted as a metastatic lesion from an unknown primary tumor. METHODS: We describe a case and performed a literature review to identify all case reports. A literature search was carried out on PubMed/MEDLINE and EMBASE bibliographic databases. All available studies from May 2009 to May 2021 were included. Data were tabulated, and outcomes were cumulatively analyzed. RESULTS: Twenty-four cases of primary hyperparathyroidism due to giant adenoma have been described; the majority were women, with a mean age of 52 years. They presented with heterogeneous symptoms such as palpable nodules (45%), bone pain (33%), brown tumor (12.5%), asymptomatic (12.5%), metabolic profile with a mean calcemia of 13.8 mg/dL, PTH 1109 ng/L, and mean tumor weight of 47.24 g. CONCLUSION: Primary hyperparathyroidism due to giant adenoma increases the risk of developing potentially serious postoperative complications such as hungry bone syndrome. This implies the need of implementing preventive measures comprising administration of intravenous zoledronic acid and early supplementation of oral calcium to prevent complications after resection.
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Endocrine tests are the cornerstone of diagnosing multiple diseases that primary care physicians are frequently faced with. Some of these tests can be affected by situations that affect the proper interpretation, leading to incorrect diagnoses and unnecessary treatment, such as the interference of biotin with thyroid function test, falsely elevated prolactin values in presence of macroprolactinemia or falsely normal due to the "hook effect" in macroprolactinomas. Recognizing these situations is essential for the clinician to make an adequate interpretation of these tests as well as an accurate diagnosis that guarantees the best outcomes for the patient.
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Interpretação Estatística de Dados , Técnicas de Diagnóstico Endócrino , Artefatos , Análise Química do Sangue/normas , Análise Química do Sangue/estatística & dados numéricos , Técnicas de Diagnóstico Endócrino/normas , Técnicas de Diagnóstico Endócrino/estatística & dados numéricos , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Prolactina/sangue , Prolactina/fisiologia , Prolactinoma/sangue , Padrões de Referência , Testes de Função Tireóidea/normas , Testes de Função Tireóidea/estatística & dados numéricosRESUMO
Resumen Introducción: Las masas cardiacas son una entidad heterogénea, que incluye lesiones neoplásicas y no neoplásicas y se clasifican en primarias y secundarias o metastásicas. Métodos: Estudio observacional analítico de tipo cohorte retrospectivo. Resultados: Se incluyeron un total de 73 individuos de los cuales se analizaron los datos de 66. Las masas cardiacas se diagnosticaron con mayor frecuencia en mujeres (53%). El síntoma más frecuente fue disnea (35%), seguido por dolor torácico (28%); otras manifestaciones comunes fueron fiebre (22%), pérdida de peso (22%) y focalización neurológica (22%). 44 pacientes fueron llevados a intervención quirúrgica o toma de biopsia de lesiones primarias encontrando como principal diagnóstico mixoma en 18 de ellos (27%); el resto de neoplasias primarias cardiacas fueron raras, fibroelastoma 2 casos (3%), al igual que rabdomioma y rabdomiosarcoma con solo un caso; el compromiso secundario fue frecuente con 18 casos (27%) representados principalmente por linfomas con 5 casos (8%), tumores primarios renales con 4 casos (6%) y cáncer de pulmón con 3 casos (5%). Dentro del seguimiento, el 77% estaban vivos en los siguientes seis meses del diagnóstico; la principal causa de muerte fue la progresión de la enfermedad oncológica (8 pacientes), seguida por ataque cerebrovascular (3 pacientes) y choque postoperatorio (2 pacientes). Conclusiones: Los pacientes con masas cardíacas con frecuencia tienen síntomas inespecíficos incluidos en tres ejes principales: insuficiencia cardíaca, síntomas generales y embolia sistémica. La frecuencia de mixoma auricular y las neoplasias secundarias fue similar.
Abstract Introduction: Cardiac masses are a heterogeneous condition, and include neoplastic and non-neoplastic lesions that can be classified as primary, secondary, or metastatic. Methods: An analytical observational study of a retrospective cohort. Results: A total of 74 subjects were included, of which the data of 66 of them were analysed. Cardiac masses were diagnosed more often in women (53%). The most frequent symptom was dyspnoea (35%), followed by chest pain (28%). Other common signs were fever (22%), weight loss (22%), and a neurological focus (22%). A total of 44 patients had surgery or a biopsy taken of the primary lesions found. The primary diagnosis was a myxoma in 18 (27%). The rest of the primary cardiac tumours were rare, with a fibroelastoma in 2 cases (3%), rhabdomyoma 2 cases (3%), and only one case of rhabdomyosarcoma. There was secondary involvement in 18 cases (27%), mainly as lymphomas in 5 cases (8%), primary renal tumours in 4 cases (6%), and lung cancer in 3 cases. During follow-up, 77% were alive in the six months following the diagnosis. The main cause of death was progression of the oncological disease (8 patients), followed a cerebrovascular attack (3 patients), and post-surgical shock (2 patients). Conclusions: Patients with cardiac masses of have non-specific symptoms included in three main groups: heart failure, general symptoms, and systemic embolisms. The frequency of atrial myxoma and secondary tumours was similar.