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Permanent hypoparathyroidism Permanent hypoparathyroidism is defined as the continuing need for calcium and/or vitamin D replacement at 1 year postoperatively . It is a rare complication when surgery is under taken for PHPT (0.5%), but in secondary hyperparathy...

Presentation PHPT is defined as hypercalcaemia in the presence of an unsuppressed and therefore relatively , or absolutely , elevated PTH level. Prevalence of the disease is reported to be 0.2–0.5%, with approximately 100 /uni00A0 000 new cases per year in th...

RECURRENT HYPERPARATHYROIDISM Recurrent hyperparathyroidism is defined as hypercalcaemia occurring 6 months after surgery but with an intervening period of normocalcaemia. Common causes include missed pathology at the first operation; hyperplasia in remaining o...

SECONDARY HYPERPARATHYROIDISM Secondary hyperparathyroidism is defined as a derangement in calcium homeostasis, which leads to a compensatory increase in PTH secretion. It occurs primarily as a result of chronic kidney disease and is therefore sometimes referr...

SPECIAL CASES Lithium-induced hyperparathyroidism Lithium-induced hyperparathyroidism occurs in 10–15% of patients treated with long-term lithium. It is generally associated with a mild elevation in calcium with failure to suppress PTH. The underlying aetiol...

TERTIARY HYPERPARATHYROIDISM Tertiary hyperparathyroidism is a persistent autonomous hypercalcaemic hyperparathyroidism occurring after kidney transplantation. A number of proposed factors may prevent involution of the hyperplastic parathyroid glands follow...

ADRENAL HAEMORRHAGE Definition Adrenal haemorrhage is a serious condition that can result in adrenal insu ffi ciency , shock, acute adrenal crisis and mortality if not managed with adequate treatment. The adrenal glands are, per weight of tissue, one of the mo...

ADRENAL INSUFFICIENCY Adrenal insu ffi ciency may be primary , secondary or tertiary . Primary insu ffi ciency (Addison’s disease) is due to adreno - cortical disease, whereas secondary and tertiary insu ffi ciency arise from pituitary and hypothalamic pathology , r...

ANATOMY Adrenal glands The weight of a normal adrenal gland is approximately 4 /uni00A0 g. The adrenal glands are paired and situated in the retroperi - - toneum, near the upper poles of the kidneys, within Gerota’s - capsule. They are not symmetrical. The r...

Acute adrenal insufficiency (adrenal or Addisonian crisis) This is a medical emergency . Owing to its non-specific features (shock with some or all of the following: fever, nausea, vomiting, abdominal pain, hypoglycaemia and electrolyte imbalance), it can be di...

Adrenocortical carcinoma Definition ACC is a rare aggressive malignancy that arises from the adrenal cortex. The prognosis is variable but is generally poor, in part owing to its tendency to present at a late stage. Although most ACCs are sporadic, a minority o...

Appendiceal carcinoid Incidence Appendiceal NETs are the commonest neoplasm in the appendix (30–80%). They are diagnosed in 3–5 in 1000 appendicectomies for acute appendicitis. - Pathology They are classified in the same way as other NETs. Staging is determined...

Chronic adrenal insufficiency Patients with chronic adrenal insu ffi ciency may also be di ffi cult to diagnose because symptoms appear insidiously over time. They may experience anorexia, weakness and nausea and, in the case of primary adrenal insu ffi ciency , hyp...

Congenital adrenal hyperplasia (adrenogenital syndrome) Virilisation and adrenal insu ffi ciency in children are pathog - nomonic of congenital adrenal hyperplasia (CAH). This is an autosomal recessive disorder caused by a variety of enzy - matic defects in th...

Conn’s syndrome (primary hyperaldosteronism) Definition First described in 1957 in a patient with hypertension and low serum potassium, primary hyperaldosteronism (PA) now comprises a heterogeneous group of disorders characterised by hypertension and inappropr...

Cushing’s syndrome Definition Hypercortisolism may arise as a result of excess ACTH secretion (termed pituitary dependent; Cushing’s disease), ectopic ACTH secretion from a non-pituitary tumour, exogenous corticosteroid therapy or autonomous secretion of endog...

DISORDERS OF THE ADRENAL MEDULLA AND DIFFUSE NEUROENDOCRINE SYSTEM Phaeochromocytoma and paraganglioma Definition Tumours that arise from the neuroectodermal tissue of the adrenal medulla are termed phaeochromocytomas (PCCs) and those arising from the extra-ad...

Duodenum Incidence These are exceptionally rare tumours, accounting for 1–3% of all GI-NETs. Pathology They are usually small (<20 /uni00A0 mm) and submucosal. They can be functional (gastrin, somatostatin) or non-secreting. Gastrinoma is often associated wit...