1
|
Broughton SE, O'Neill DG, Syme HM, Geddes RF. Ionized hypercalcemia in 238 cats from a referral hospital population (2009-2019). J Vet Intern Med 2023; 37:80-91. [PMID: 36645022 PMCID: PMC9889682 DOI: 10.1111/jvim.16627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/15/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ionized calcium concentration ([iCa]) is more sensitive for detecting calcium disturbances than serum total calcium concentration but literature on ionized hypercalcemia in cats is limited. Urolithiasis is a possible adverse consequence of hypercalcemia. HYPOTHESIS/OBJECTIVES To describe clinical details of diagnoses associated with ionized hypercalcemia in cats and association with urolithiasis. ANIMALS Cats (238) seen between 2009 and 2019 at a referral hospital with [iCa] above the normal reference interval. METHODS Observational cross-sectional study. Signalment, serum biochemical and imaging findings were reviewed for cats with ionized hypercalcemia considered to be clinically relevant (>1.41 mmol/L). Data were summarized by cause of hypercalcemia (i.e., diagnosis). RESULTS Diagnoses for the 238 cats with [iCa] >1.41 mmol/L included: acute kidney injury (AKI; 13%), malignancy-associated (10.1%), idiopathic hypercalcemia (IHC; 10.1%), chronic kidney disease/renal diet-associated (8.4%), iatrogenic (5.5%), primary hyperparathyroidism (2.1%), vitamin D toxicity (2.1%) and granulomatous disease (1.7%). In 112 cases (47.1%), no cause for ionized hypercalcemia could be determined (n = 95), hypercalcemia was transient (n = 12), or the cat was juvenile (<1 year; n = 5). Urolithiasis was identified in 83.3% of AKI, 72.7% of iatrogenic, 61.1% of CKD/renal diet-associated and 50% of IHC cases that were imaged (<50% for other diagnoses). Diagnoses with a high proportion of concurrent total hypercalcemia included primary hyperparathyroidism (100%), vitamin D toxicity (100%), malignancy-associated (71.4%), granulomatous disease (66.7%) and IHC (65.2%). CONCLUSIONS AND CLINICAL IMPORTANCE Ionized hypercalcemia was most commonly associated with kidney diseases, neoplasia or IHC. The proportion of urolithiasis cases varied by diagnosis.
Collapse
Affiliation(s)
- Sophie E. Broughton
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Dan G. O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary CollegeHertsUK
| | - Harriet M. Syme
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Rebecca F. Geddes
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonLondonUK
| |
Collapse
|
2
|
Cordella A, Bertaccini J, Rondena M, Zoia A, Bertolini G. Multidetector-Row CT Findings in Dogs with Different Primary Parathyroid Gland Diseases. Vet Sci 2022; 9:vetsci9060273. [PMID: 35737325 PMCID: PMC9228294 DOI: 10.3390/vetsci9060273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
Primary hyperparathyroidism in dogs is a possibly life-threatening condition, characterized by the excess of parathyroid hormone (PTH) secretion, which leads to an increase in serum ionized calcium level. The utility of computed tomography (CT) in the detection and characterization of parathyroid diseases in dogs has not been assessed to date. Therefore, the aim of this study was to describe the use of multidetector-row CT (MDCT) for the diagnosis of parathyroid disease in dogs. For this descriptive, single-center study, the database of the San Marco Veterinary Clinic was searched for dogs having a suspicion of parathyroid disease who underwent contrast-enhanced MDCT in the period from 2005 to 2021. Dogs with histopathology of the affected parathyroid gland were subsequently considered for inclusion. A total of 22 parathyroid glands were included: 12 adenomas, 8 adenocarcinomas, and two glands with hyperplasia. Several CT features were evaluated, including parathyroid gland affected, lateralization, shape, size, attenuation, and contrast-enhancement. Although the overlap between the appearance of different diseases exists, contrast-enhanced CT was a useful method for the diagnosis of parathyroid disease in dogs.
Collapse
Affiliation(s)
- Alessia Cordella
- Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, 35030 Veggiano, Italy; (A.C.); (J.B.)
| | - Jessica Bertaccini
- Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, 35030 Veggiano, Italy; (A.C.); (J.B.)
| | - Marco Rondena
- Pathology Division, San Marco Veterinary Clinic and Laboratory, 35030 Veggiano, Italy;
| | - Andrea Zoia
- Internal Medicine Division, San Marco Veterinary Clinic and Laboratory, 35030 Veggiano, Italy;
| | - Giovanna Bertolini
- Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, 35030 Veggiano, Italy; (A.C.); (J.B.)
- Correspondence:
| |
Collapse
|
3
|
Sumner JP, Espinheira Gomes FNCM, Flanders JA. Minimally invasive video-assisted parathyroidectomy in dogs: Technique description and feasibility study. Vet Surg 2022; 51 Suppl 1:O167-O173. [PMID: 35199354 DOI: 10.1111/vsu.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/15/2021] [Accepted: 12/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe a minimally invasive approach to the parathyroid gland for the treatment of primary hyperparathyroidism. STUDY DESIGN Surgical technique description and clinical case report. ANIMALS Five canine cadavers and 5 client-owned dogs with primary hyperparathyroidism. METHODS A surgical technique for minimally invasive video-assisted parathyroidectomy (MIVAP), described for humans, was adapted for dogs. With the dog in dorsal recumbency, a 15 mm incision was made on the midline, 1 finger width caudal to the cricoid cartilage of the larynx. A 5 mm 30° rigid endoscope was inserted into the peritracheal space with the aid of a blunt suction dissector, and fine elevators. The parathyroid was subsequently removed using electrocautery and blunt and sharp dissection. The technique was refined in 5 cadaver dogs to assess feasibility, and was subsequently performed in 5 clinical cases. RESULTS A minimally invasive approach to the parathyroid gland was possible and allowed successful removal of a parathyroid mass in 5 dogs without complication. The use of fluid ingress was trialed in 1 cadaver and not found to be helpful. The use of a blunt suction dissector greatly facilitated dissection of the peritracheal space. CONCLUSION Minimally invasive video-assisted parathyroidectomy is feasible in dogs and was not associated with complications in 5 clinical cases. CLINICAL SIGNIFICANCE Minimally invasive techniques tend to reduce morbidity and are popular with pet owners. This study demonstrates that a minimally invasive technique may be considered for parathyroidectomy in dogs.
Collapse
Affiliation(s)
- Julia P Sumner
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | | | - James A Flanders
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
4
|
Tremolada G, Schaffer P, Pitt K. Non‐secreting parathyroid carcinoma in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Giovanni Tremolada
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio State University Columbus Ohio USA
- Flint Animal Cancer Centre College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - Paula Schaffer
- Veterinary Diagnostic Laboratory Department of Microbiology, Immunology and Pathology College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - Kathryne Pitt
- Flint Animal Cancer Centre College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| |
Collapse
|
5
|
Erickson AK, Regier PJ, Watt MM, Ham KM, Marvel SJ, Wallace ML, Colopy SA, Scharf VF, Zheng J, Dugat DR, Sumner JP, Howard J, Skinner OT, Mickelson MA, Thieman-Mankin KM, Colee JC. Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010-2019). J Am Vet Med Assoc 2021; 259:1309-1317. [PMID: 34727057 DOI: 10.2460/javma.20.06.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate outcomes of dogs with parathyroid carcinoma (PTC) treated by surgical excision and to describe the incidence of postoperative hypocalcemia, degree of hypocalcemia, duration of hospitalization, duration of calcium supplementation, and survival time. ANIMALS 100 client-owned dogs with PTC admitted to academic, referral veterinary institutions. PROCEDURES In a retrospective multi-institutional study, medical records of dogs undergoing surgical excision of PTC between 2010 to 2019 were reviewed. Signalment, relevant medical history, clinical signs, clinicopathologic testing, imaging, surgical findings, intraoperative complications, histologic examination, and survival time were recorded. RESULTS 100 dogs with PTC were included, and 96 dogs had clinical or incidental hypercalcemia. Common clinical signs included polyuria (44%), polydipsia (43%), hind limb paresis (22%), lethargy (21%), and hyporexia (20%). Cervical ultrasonography detected a parathyroid nodule in 91 of 91 dogs, with a single nodule in 70.3% (64/91), 2 nodules in 25.3% (23/91), and ≥ 3 nodules in 4 (4/91)% of dogs. Hypercalcemia resolved in 89 of 96 dogs within 7 days after surgery. Thirty-four percent of dogs developed hypocalcemia, on the basis of individual analyzer ranges, within 1 week after surgery. One dog had metastatic PTC to the prescapular lymph node, and 3 dogs were euthanized for refractory postoperative hypocalcemia. Estimated 1-, 2-, and 3-year survival rates were 84%, 65%, and 51% respectively, with a median survival time of 2 years. CONCLUSIONS AND CLINICAL RELEVANCE Excision of PTC results in resolution of hypercalcemia and excellent long-term tumor control. Surgical excision of PTC is recommended because of resolution of hypercalcemia and a good long-term prognosis. Future prospective studies and long-term follow-up are needed to further assess primary tumor recurrence, metastasis, and incidence of postoperative hypocalcemia.
Collapse
|
6
|
Burkhardt SJ, Sumner JP, Mann S. Ambidirectional cohort study on the agreement of ultrasonography and surgery in the identification of parathyroid pathology, and predictors of postoperative hypocalcemia in 47 dogs undergoing parathyroidectomy due to primary hyperparathyroidism. Vet Surg 2021; 50:1379-1388. [PMID: 34365655 PMCID: PMC9290980 DOI: 10.1111/vsu.13707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 02/01/2023]
Abstract
Objective To investigate (1a) agreement of ultrasonographic, surgical, and histopathologic findings in the diagnosis of a neoplastic etiology underlying primary hyperparathyroidism (PHPT), (1b) the ability of ultrasonographically determined parathyroid gland size to distinguish between malignant (carcinoma) and non‐malignant (hyperplasia, adenoma) pathology, and (2) variables associated with postoperative hypocalcemia in dogs undergoing surgical treatment of PHPT. Study Design Ambidirectional cohort study. Animals Forty‐seven client owned dogs with PHPT (34 retrospective; 13 prospective). Methods Data were extracted from medical records. Method agreements were explored using Cohen's Kappa statistic. A receiver operating characteristic curve (ROC) was used to determine a cut‐off separating parathyroid pathologies. Univariable and multivariable models assessed associations between postoperative hypocalcemia and potential risk factors. Results Agreement of ultrasound and surgery for number and side of affected glands was 31/47 (65.9%) and 34/47 (72.3%), respectively. In 37/47 (78.7%) cases, parathyroid tissue was correctly assessed as pathologic by the surgeon. An ultrasonographic cut‐off of ≥8.0 mm (ROC AUC = 0.82) best distinguished malignant from benign pathologies. Dogs with a preoperative serum ionized calcium (iCa) concentration ≥1.75 mEq/L had 7.5 times greater odds of becoming hypocalcemic postoperatively. Conclusion A fair agreement existed between ultrasonographic and surgical findings in dogs with PHPT. A parathyroid mass ≥8.0 mm on ultrasonographic examination was suggestive of malignancy, while dogs with a preoperative serum iCa concentration ≥1.75 mEq/L were at increased risk for postoperative hypocalcemia in this study. Clinical significance This study supports the use of bilateral cervical surgical exploration to identify abnormal parathyroid glands for the treatment of PHPT.
Collapse
Affiliation(s)
- Samuel J Burkhardt
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, United States
| | - Julia P Sumner
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, United States
| | - Sabine Mann
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, United States
| |
Collapse
|
7
|
Lautscham E, von Klopmann C, Schaub S, Stengel C, Hartmann A. CT imaging features of the normal parathyroid gland in the dog. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2020; 48:313-320. [PMID: 33086408 DOI: 10.1055/a-1236-4542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Aim of our prospective pilot study was to assess the feasibility of computed tomography (CT) to visualize the normal parathyroid gland in dogs and provide a description of its CT appearance. MATERIAL AND METHODS A total of 25 dogs, which received CT imaging including the neck region for diseases unrelated to the thyroid or parathyroid glands, were enrolled. Inclusion criteria were a normal physical examination, an unremarkable complete blood count and serum chemistry profile. Pre and post contrast CT images were acquired using a 16-slice helical scanner with an 18 cm field of view, 1 mm slice thickness and a 512 × 512 matrix. Post contrast images were obtained 30-45 seconds following contrast medium injection (early venous phase). CT-images were independently reviewed by 2 radiologists. Visibility of the parathyroid gland was recorded and inter-observer agreement was calculated. For all visualized parathyroid glands the following parameters were assessed: size, density in Hounsfield units (HU) on pre and post contrast images, density of the thyroid gland and border definition (excellent, moderate, poor). RESULTS Only 20 respectively 25 parathyroid glands could be visualized by the 2 observers. The number did not vary between pre and post contrast images. The inter-observer agreement for the identification was fair (κ = 0.40). Length, width and height (mean ± standard deviation) of the parathyroid gland were 4.2 × 2.5 × 2.9 mm ± 1.3 × 0.8 × 1.0 mm. The density was 39.7 ± 20.6 HU on pre contrast images and 103.1 ± 47.1 HU on post contrast images, thus the organ was hypoattenuating compared to the thyroid gland on pre (166.7 ± 34.3 HU) and post contrast (234.0 ± 60.1 HU) images. CONCLUSION This study offers the first description of the CT appearance of the presumed normal canine parathyroid gland. However, the overall visibility was poor. CLINICAL RELEVANCE Despite the overall poor visibility of the parathyroid gland it was occasionally visible and its CT dimensions were larger as described for ultrasound in this group of dogs, which showed no clinical signs of hyperparathyroidism. Thus, visibility of the parathyroid gland on CT may not necessarily imply parathyroid disease. However, further research is necessary.
Collapse
Affiliation(s)
| | | | - Sebastian Schaub
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Justus-Liebig-University Giessen
| | | | | |
Collapse
|
8
|
Tørnqvist-Johnsen C, Schnabel T, Gow AG, Del-Pozo J, Milne E, Macklin V, Fisher C, Handel I, Mellanby RJ. Investigation of the relationship between ionised and total calcium in dogs with ionised hypercalcaemia. J Small Anim Pract 2020; 61:247-252. [PMID: 32043601 DOI: 10.1111/jsap.13109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 12/01/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the relationship between total and ionised calcium concentrations in dogs with ionised hypercalcaemia and to evaluate how albumin influences this relationship. METHODS Initially, a reference interval for ionised and total calcium was established using a large population of healthy adult dogs. Our teaching hospital clinical database was searched to identify adult dogs with ionised hypercalcaemia between 2012 and 2017, a time frame when the same sample handling and analysis protocols were in place as for the healthy reference interval population. The relationship between ionised and total calcium concentrations was then examined in the ionised hypercalcaemia population. RESULTS Based on biochemical analysis of 351 healthy adult dogs, a reference interval of 1.18 to 1.53 mmol/L for ionised calcium and 2.24 to 2.85 mmol/L for total calcium was established. Using these reference intervals, 63 dogs with ionised hypercalcaemia were identified, of which 23 did not have total hypercalcaemia. Only seven of the 23 dogs with ionised hypercalcaemia and total calcium below the upper limit of the reference interval had hypoalbuminemia. The majority of dogs with ionised hypercalcemia and normal total calcium had a modest increase in ionised calcium. CLINICAL SIGNIFICANCE If relying on total calcium alone, more than one third of dogs with ionised hypercalcaemia will be classified as normocalcaemic and the majority of these dogs had normal serum albumin.
Collapse
Affiliation(s)
- C Tørnqvist-Johnsen
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - T Schnabel
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - A G Gow
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - J Del-Pozo
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - E Milne
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - V Macklin
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - C Fisher
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - I Handel
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| | - R J Mellanby
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Division of Veterinary Clinical Studies, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Midlothian, UK
| |
Collapse
|
9
|
Secrest S, Grimes J. Ultrasonographic size of the canine parathyroid gland may not correlate with histopathology. Vet Radiol Ultrasound 2019; 60:729-733. [PMID: 31353771 DOI: 10.1111/vru.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/18/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022] Open
Abstract
Accurate ultrasonographic differentiation of normal versus abnormal parathyroid glands is important for clinical workup and presurgical screening in dogs with hypercalcemia. In previous published studies, size has been the only ultrasonographic criterion correlated with histologic diagnoses of abnormal parathyroid glands. In this retrospective, cross-sectional study, the medical records of dogs with ultrasonographic examinations of the parathyroid glands and histologic diagnoses of parathyroid gland hyperplasia, adenoma, and adenocarcinoma were evaluated. Ultrasonographic characteristics were recorded for each gland and compared among histologic diagnosis groups. A total of 49 dogs and 59 parathyroid glands were sampled and assigned to the following groups for analyses: adenoma (n = 24), hyperplastic (n = 20), and adenocarcinoma (n = 15). There were no associations with dog age, sex, weight, breed; or gland laterality, location, ultrasonographic shape, or echogenicity among histologic diagnosis groups (P > .05). Parathyroid gland adenocarcinomas were found to be less likely to have a homogeneous echotexture on ultrasonographic evaluation, with hyperplastic glands being smaller (P = .022) and adenocarcinomas being larger (P = .042). While 3 mm was the optimum cutoff for differentiating hyperplastic and neoplastic parathyroid glands in this sample of dogs, values varied widely within groups and there were overlapping values between groups. Therefore, authors caution against using ultrasonographic size as a sole criterion for differentiating hyperplasia from neoplasia and normal versus abnormal parathyroid glands.
Collapse
Affiliation(s)
- Scott Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Janet Grimes
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
| |
Collapse
|
10
|
Riehl V, Hartmann A, Rohrberg A, Neiger R. Percutaneous ultrasound-guided ethanol ablation for treatment of primary hyperparathyroidism in a cat. JFMS Open Rep 2019; 5:2055116919860276. [PMID: 31308957 PMCID: PMC6607573 DOI: 10.1177/2055116919860276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 9-year-old male neutered European Shorthair cat was presented owing to vomiting and mild weight loss. Clinical examination was normal, but biochemistry results showed increased concentrations of total calcium (4.05 mmol/l; reference interval [RI] 2.20-2.90 mmol/l) and ionised calcium (iCa) (2.19 mmol/l; RI 1.12-1.40 mmol/l), as well as hypophosphataemia (2.5 mg/dl; RI 3.1-7.5 mg/dl). Parathyroid hormone (PTH) concentration (>1000 pg/ml) was markedly increased, while parathyroid hormone-related protein concentration (<0.8 pmol/l) was normal. Neck ultrasound showed a large left parathyroid mass (13 × 7 × 6 mm). Under general anaesthesia and with ultrasonographic guidance, a fine-needle aspiration of the mass followed by chemical ablation with 2 ml 96% ethanol was performed. The cat was re-evaluated and iCa concentration measured 24 h, 72 h, 5 days, 4 weeks and 4 months post-ablation. Normocalcaemia was reached within 24 h, remained stable throughout the whole evaluation period and the concentration of PTH normalised 4 months later. Vomiting stopped promptly after chemical ablation and a slight change in voice, as well as a mild prolapse of the nictitating membrane, were the only side effects after the treatment but resolved some weeks later. Relevance and novel information To our knowledge, this is the first report of successful chemical ablation of a parathyroid mass in a cat with primary hyperparathyroidism. Chemical ablation might therefore be a possible alternative to parathyroidectomy in cats.
Collapse
Affiliation(s)
| | | | | | - Reto Neiger
- Veterinary Clinic Hofheim, Hofheim am Taunus, Germany
| |
Collapse
|
11
|
Gorenberg EB, Johnson AL, Magdesian KG, Bertin FR, Costa LRR, Theelen MJP, Durward-Akhurst SA, Cruz Villagrán C, Carslake H, Frank N, Tomlinson JE. Diagnosis and treatment of confirmed and suspected primary hyperparathyroidism in equids: 17 cases (1999-2016). Equine Vet J 2019; 52:83-90. [PMID: 30980730 DOI: 10.1111/evj.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is uncommon in equids. OBJECTIVES To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. STUDY DESIGN Retrospective case series describing 16 horses and one mule. METHODS Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH-related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. RESULTS The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. MAIN LIMITATIONS The small study size prohibited statistical analysis. CONCLUSIONS Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet.
Collapse
Affiliation(s)
- E B Gorenberg
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - A L Johnson
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - K G Magdesian
- University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - F-R Bertin
- The University of Queensland School of Veterinary Science, Gatton, Queensland, Australia
| | - L R R Costa
- University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - M J P Theelen
- Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands
| | - S A Durward-Akhurst
- Department of Veterinary Population Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - C Cruz Villagrán
- The University of Adelaide, Roseworthy, South Australia, Australia
| | - H Carslake
- School of Veterinary Science, University of Liverpool, Philip Leverhulme Equine Hospital, Cheshire, UK
| | - N Frank
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - J E Tomlinson
- Baker Institute for Animal Health, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
12
|
Singh A, Giuffrida MA, Thomson CB, Baum J, Kramek B, Liptak JM, Hyndman P, Ringwood B, Smeak D, Ham K, Berg J, Thieman-Mankin K, Blois SL, Boston SE. Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism. Vet Surg 2019; 48:367-374. [PMID: 30666680 DOI: 10.1111/vsu.13165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/08/2018] [Accepted: 12/24/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To report perioperative characteristics, complications, histopathologic diagnosis and outcome in cats undergoing surgical treatment for primary hyperparathyroidism (PHPT). STUDY DESIGN Multi-institutional, retrospective case series. ANIMALS Thirty-two client-owned cats. METHODS Medical records of cats treated with surgical removal of 1 or more parathyroid gland(s) with confirmed histopathologic evaluation were reviewed. Cats were divided into preoperative ionized calcium (iCa) groups corresponding to the 33rd, 67th, and 100th percentiles of the preoperative iCa results of the study population. Follow-up consisted of phone conversation with owners or primary veterinarian. RESULTS Ionized calcium was above reference range in all cats (median 1.8 mmol/L [interquartile range, 1.5-1.9]). Abnormal tissue was excised after cervical exploration in all cats. The most common histopathologic diagnoses were parathyroid adenoma in 20 of 32 (62.5%) cats and parathyroid carcinoma in 7 of 32 (21.9%) cats. At discharge, 6 of 32 (18.8%) cats had hypercalcemia, 5 of 32 (15.6%) had hypocalcemia, and 21 of 32 (65.6%) were normocalcemic. Preoperative iCa did not correlate with postoperative iCa. The median follow-up time was 332 days (range, 7-3156). Overall median survival time was 1109 days (95% CI, 856-1332). Survival time was not associated with preoperative iCa group, hypocalcemia at discharge, hypercalcemia at discharge, or diagnosis of carcinoma. CONCLUSION In this cohort of cats, parathyroid adenoma was the most common cause of PHPT, and surgical treatment resulted in very good median survival time. Preoperative iCa was not predictive of postoperative hypocalcemia. CLINICAL SIGNIFICANCE Surgical parathyroidectomy for treatment of PHPT in cats provides a favorable prognosis.
Collapse
Affiliation(s)
- Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Christopher B Thomson
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Jared Baum
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Betty Kramek
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Julius M Liptak
- Department of Surgery, VCA Canada-Alta Vista Animal Hospital, Ottawa, Ontario, Canada
| | - Philip Hyndman
- Department of Surgery, Veterinary Emergency Clinic, Toronto, Ontario, Canada
| | - Brendon Ringwood
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Daniel Smeak
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kathleen Ham
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - John Berg
- Department of Clinical Sciences, Tufts University, North Grafton, Massachusetts
| | - Kelley Thieman-Mankin
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Sarah E Boston
- VCA Canada-404 Veterinary Emergency and Referral, Newmarket, Ontario, Canada
| |
Collapse
|
13
|
Leal RO, Frau Pascual L, Hernandez J. The Use of Percutaneous Ultrasound-Guided Radiofrequency Heat Ablation for Treatment of Primary Hyperparathyroidism in Eight Dogs: Outcome and Complications. Vet Sci 2018; 5:vetsci5040091. [PMID: 30340351 PMCID: PMC6313915 DOI: 10.3390/vetsci5040091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/26/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
Percutaneous ultrasound-guided radiofrequency heat-ablation (UG-RHA) is a therapeutic option for dogs with primary hyperparathyroidism (PHPTH) but information about its outcome is still controversial. This retrospective study aimed to evaluate the outcome and complications of UG-RHA in dogs with PHPTH. The medical records of dogs with PHPTH submitted to UG-RHA between June 2012 and September 2015 in a French referral center were retrospectively reviewed. Eight cases were included. No sex predisposition was found. The median age at diagnosis was 12 years. The most common clinical sign was polyuria/polydipsia. All of the dogs were hypercalcaemic prior to UG-RHA, and all showed a parathyroid nodule identified upon cervical ultrasound. UG-RHA was uneventful, allowing a successful resolution of hypercalcemia in all dogs (8/8). Six out of eight dogs did not receive vitamin D supplementation either pre- or post-procedure. From these, three dogs developed biochemical hypocalcemia, but only one required therapy. Other short-term complications included Horner's syndrome (1/8) and aspiration bronchopneumonia, which led to cardio-respiratory arrest in one large-breed dog (1/8). Long-term complications were scarce, with no recurrence reported in all of the cases that were assessed in follow-up (4/7). This study demonstrates that UG-RHA has few short or long-term complications, and it is a good therapeutic alternative for dogs with PHPTH.
Collapse
Affiliation(s)
- Rodolfo Oliveira Leal
- Centre Hospitalier Vétérinaire Fregis, 43 Av. Aristide Briand, 94110 Arcueil, France.
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal.
- Hospital Escolar Veterinário-Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal.
| | - Laura Frau Pascual
- Centre Hospitalier Vétérinaire Fregis, 43 Av. Aristide Briand, 94110 Arcueil, France.
- Ciutat d'Inca Veterinary Hospital. Av. General Luque, 372, 07300 Inca, Spain.
| | - Juan Hernandez
- Centre Hospitalier Vétérinaire Fregis, 43 Av. Aristide Briand, 94110 Arcueil, France.
- Internal Medecine Unit of Oniris, Nantes-Atlantic College of Veterinary Medicine and Food Sciences, Atlanpole La Chantrerie, CS 40706, 44307 Nantes CEDEX 3, France.
| |
Collapse
|
14
|
Kaiser AM, Kempker L, Neiger R. Parathyroid immunohistochemistry in a 12-year-old mixed-breed dog with parathyroid adenocarcinoma. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
SummaryA 12-year-old, female, spayed, mixed-breed dog with acute lethargy, anorexia and weakness and markedly elevated total and ionised calcium concentration showed an enlarged left cranial parathyroid gland on ultrasonography of the ventral neck. Despite preoperative therapy with furosemide and calcitonin, there was no decline of plasma ionised calcium concentration. The dog deteriorated rapidly and was euthanased two days after initial presentation. Postmortem histopathology revealed parathyroid tissue with characteristics of malignancy as local and vascular invasion. Immunohistochemistry showed parathyroid hormone positive staining of these cells. Unusual clinical presentation and histopathological characteristics are discussed.
Collapse
|
15
|
Armstrong AJ, Hauptman JG, Stanley BJ, Klocke E, Burneko M, Holt DE, Runge JJ, Rubin JA. Effect of Prophylactic Calcitriol Administration on Serum Ionized Calcium Concentrations after Parathyroidectomy: 78 Cases (2005-2015). J Vet Intern Med 2017; 32:99-106. [PMID: 29280194 PMCID: PMC5787196 DOI: 10.1111/jvim.15028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/07/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
Background Prophylactic administration of calcitriol has been suggested to mitigate the risk of hypocalcemia after parathyroidectomy. The effect of calcitriol on postoperative serum ionized calcium concentrations has not been evaluated in dogs after parathyroidectomy. Hypothesis/Objectives To determine the effect of prophylactic calcitriol administration on postoperative serum ionized calcium (iCa) concentrations in dogs with primary hyperthyroidism (PHPTH) treated by parathyroidectomy. Animals Seventy‐eight dogs with primary hyperparathyroidism treated surgically. Methods Multi‐institutional retrospective case study. Medical records from 2005 to 2015 were evaluated. Dogs were included if they had a diagnosis of PHPTH and had surgery to remove parathyroid tissue. Serum iCa concentrations were monitored for a minimum of 2 days postoperatively. Two study groups were evaluated: calcitriol administration and no calcitriol administration. Results Serial postoperative iCa concentrations measured at 12‐hour time intervals for 2 days postoperatively were positively associated with preoperative iCa concentrations. This association was evident at each time interval, and the effect of preoperative iCa concentrations on postoperative iCa concentrations decreased as time elapsed (12 hours, P < 0.0001; 24 hours, P < 0.0001; 36 hours, P < 0.04; and 48 hours, P = 0.01). Prophylactic calcitriol administration was not found to be significantly associated with postoperative iCa concentrations or its rate of decrease after parathyroidectomy. Conclusion and Clinical Importance We found no protective value in administering calcitriol prophylactically to prevent hypocalcemia in the immediate postoperative period (48 hours) after parathyroidectomy. Preoperative iCa concentrations had a significant positive association with postoperative iCa concentrations throughout the monitoring period.
Collapse
Affiliation(s)
- A J Armstrong
- Department of Small Animal Clinical Studies, Michigan State University, East Lansing, MI
| | - J G Hauptman
- Department of Small Animal Clinical Studies, Michigan State University, East Lansing, MI
| | - B J Stanley
- Department of Small Animal Clinical Studies, Michigan State University, East Lansing, MI
| | - E Klocke
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - M Burneko
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - D E Holt
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J J Runge
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J A Rubin
- Department of Small Animal Clinical Studies, Michigan State University, East Lansing, MI
| |
Collapse
|
16
|
Dear J, Kass P, Della Maggiore A, Feldman E. Association of Hypercalcemia Before Treatment With Hypocalcemia After Treatment in Dogs With Primary Hyperparathyroidism. J Vet Intern Med 2017; 31:349-354. [PMID: 28213926 PMCID: PMC5354003 DOI: 10.1111/jvim.14644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/02/2016] [Accepted: 11/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Development of hypocalcemia after treatment of hyperparathyroidism results in increased costs and risk of poorer outcomes. Previous studies have shown conflicting data about predictors of hypocalcemia after these procedures. HYPOTHESIS/OBJECTIVES The objective of this study was to investigate whether ionized calcium (iCa) concentrations before treatment are predictive of hypocalcemia or its clinical signs after surgical removal or heat ablation in dogs with primary hyperparathyroidism. ANIMALS Fifty-four dogs with primary hyperparathyroidism (29 female, 25 male; 49 retrospective, 5 prospective). METHODS Dogs were enrolled if they met the inclusion criteria: persistent hypercalcemia (iCa >1.41 mmol/L) due to primary hyperparathyroidism and absence of preemptive calcitriol treatment. All dogs were treated with parathyroidectomy (n = 37) or percutaneous ultrasound-guided heat ablation (n = 17). After treatment, iCa was monitored twice daily until plateau or intervention. RESULTS There was a moderate correlation between before-treatment hypercalcemia and after-treatment hypocalcemia. The prospective study was terminated due to ethical concerns given findings in the retrospective section. All dogs were placed into groups according to their pretreatment iCa: 1.46-1.61 mmol/L, 1.62-1.71 mmol/L, iCa 1.72-1.81 mmol/L, or >1.81 mmol/L. After treatment, the mean lowest iCa for each group, respectively, was 1.19, 1.18, 1.13, and 1.01 mmol/L. There was a significant association between higher group and proportion of dogs with iCa <1.00 mmol/L (P = .014). CONCLUSIONS AND CLINICAL IMPORTANCE This study demonstrates a moderate correlation between iCa concentration before treatment and hypocalcemia after treatment. Dogs with higher initial iCa concentrations should be treated to prevent rapid decline and development of clinical hypocalcemia.
Collapse
Affiliation(s)
- J.D. Dear
- Department of Medicine and EpidemiologyUniversity of CaliforniaDavisCA
| | - P.H. Kass
- Department of Population Health and ReproductionUniversity of CaliforniaDavisCA
| | | | - E.C. Feldman
- Department of Medicine and EpidemiologyUniversity of CaliforniaDavisCA
| |
Collapse
|
17
|
Guttin T, Knox VW, Diroff JS. Outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules: 27 cases (2008–2011). J Am Vet Med Assoc 2015; 247:771-7. [DOI: 10.2460/javma.247.7.771] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Cardoso M, Melussi M, Costa F, Fagnani R, Holsback L, Zacarias Júnior A, Patelli T. Canine hypoparathyroidism: case report. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-6814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary hypoparathyroidism is an uncommon endocrinopathy in dogs, resulting from absolute or relative deficiency in the secretion of parathormone (PTH). The dog presented signs of hypocalcemia, including muscular spasms, tetany and cramps, evolving to tonic-clonic seizures and fever. Emergency therapy for hypocalcemia included glucose physiological solution at 0.45% and calcium gluconate administered intravenously. Diagnosis was confirmed by the presence of hypocalcemia, hyperphosphatemia and a decrease in parathormone (PTH).
Collapse
Affiliation(s)
| | | | - F.S. Costa
- Universidade Federal Rural de Pernambuco, Brasil
| | - R. Fagnani
- Universidade Estadual do Norte do Paraná, Brasil
| | - L. Holsback
- Universidade Estadual do Norte do Paraná, Brasil
| | | | | |
Collapse
|
19
|
Tomlinson JE, Johnson AL, Ross MW, Engiles JB, Levine DG, Wisner WA, Sweeney RW. Successful detection and removal of a functional parathyroid adenoma in a pony using technetium Tc 99m sestamibi scintigraphy. J Vet Intern Med 2014; 28:687-92. [PMID: 24417704 PMCID: PMC4858011 DOI: 10.1111/jvim.12285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/20/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- J E Tomlinson
- New Bolton Center, University of Pennsylvania, Kennett Square, PA
| | | | | | | | | | | | | |
Collapse
|
20
|
Milovancev M, Schmiedt CW. Preoperative factors associated with postoperative hypocalcemia in dogs with primary hyperparathyroidism that underwent parathyroidectomy: 62 cases (2004–2009). J Am Vet Med Assoc 2013; 242:507-15. [DOI: 10.2460/javma.242.4.507] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
|
22
|
Diagnosis and treatment of primary hyperparathyroidism in a bobcat (Lynx rufus). J Zoo Wildl Med 2012; 42:490-4. [PMID: 22950324 DOI: 10.1638/2010-0117.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An 18-yr-old male bobcat (Lynx rufus) presented with chronic moderate weight loss and acute onset of anorexia and lethargy. Hypercalcemia and azotemia were present on the serum chemistry panel. Abdominal ultrasound revealed hyperechoic renal cortices, but no evidence of neoplasia. Ionized calcium and 25-hydroxyvitamin D were mildly elevated, intact parathyroid hormone was severely elevated, and parathormone-related protein was undetected, suggesting primary hyperparathyroidism with possible renal dysfunction. Azotemia lessened in severity following diuresis, but hypercalcemia persisted; thus primary hyperparathyroidism was considered the most probable differential diagnosis. A second ultrasound including the cervical region revealed a solitary intraparenchymal left thyroid nodule. The nodule was surgically excised; histopathology confirmed a parathyroid adenoma. Although primary hyperparathyroidism was suspected, diagnosis was not achieved from serum chemistry values alone. This case emphasizes the importance of diagnostic imaging and histopathology in the investigation of persistently abnormal laboratory values.
Collapse
|
23
|
Arbaugh M, Smeak D, Monnet E. Evaluation of preoperative serum concentrations of ionized calcium and parathyroid hormone as predictors of hypocalcemia following parathyroidectomy in dogs with primary hyperparathyroidism: 17 cases (2001–2009). J Am Vet Med Assoc 2012; 241:233-6. [DOI: 10.2460/javma.241.2.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Graham KJ, Wilkinson M, Culvenor J, Dhand NK, Churcher RK. Intraoperative parathyroid hormone concentration to confirm removal of hypersecretory parathyroid tissue and time to postoperative normocalcaemia in nine dogs with primary hyperparathyroidism. Aust Vet J 2012; 90:203-9. [PMID: 22632282 DOI: 10.1111/j.1751-0813.2012.00918.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine (1) whether the intraoperative parathyroid hormone concentration ([PTH]) during parathyroidectomy (PTX) can be used to indicate cure in dogs with primary hyperparathyroidism and (2) the time taken for postoperative serum calcium concentration to normalise. DESIGN Retrospective study (2005-10) from a private referral hospital in Sydney, New South Wales, Australia. PROCEDURE Nine client-owned dogs underwent surgical PTX for naturally occurring primary hyperparathyroidism. [PTH] was measured from serum samples taken immediately post-induction (pre-PTX]) and at least 20 min after adenoma removal (post-PTX) for all dogs, and during parathyroid gland manipulation (intra-PTX) for six dogs. The concentration of ionised calcium (iCa) was measured at various time points postoperatively until it normalised, then stabilised or decreased below reference ranges. Statistical analysis compared the mean pre-, intra- and post-PTX [PTH] and the average rate of decline of iCa concentration postoperatively. RESULTS All dogs demonstrated a significant decrease from mean pre-PTX [PTH] (168.51 pg/mL) to mean post-PTX [PTH] (29.20 pg/mL). There was a significant increase in mean intra-PTX [PTH] (279.78 pg/mL). The average rate of decline of iCa concentration postoperatively to within the reference range (1.12-1.40 mmol/L) occurred after 24 h. CONCLUSION Intraoperative measurements of [PTH] can be used clinically to determine cure of primary hyperparathyroidism. Parathyroid hormone increases significantly during parathyroid gland manipulation. Plasma iCa concentration returns to within the reference range on average 24 h after successful PTX. Not all dogs require vitamin D or calcium supplementation pre- or postoperatively.
Collapse
Affiliation(s)
- K J Graham
- North Shore Veterinary Specialist Centre, 64 Atchison Street, Crows Nest, New South Wales 2065, Australia.
| | | | | | | | | |
Collapse
|
25
|
de Brito Galvao JF, Chew DJ. Metabolic complications of endocrine surgery in companion animals. Vet Clin North Am Small Anim Pract 2011; 41:847-68, v. [PMID: 21889689 DOI: 10.1016/j.cvsm.2011.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metabolic complications of endocrine surgery occur commonly and precautions should be taken to avoid potentially life-threatening situations and to lessen expense associated with a more extended hospital stay. Common complications of endocrine surgery as well as prevention strategies will be reviewed for pancreatic, parathyroid, and adrenal surgery.
Collapse
Affiliation(s)
- Joao Felipe de Brito Galvao
- Small Animal Internal Medicine, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA.
| | | |
Collapse
|
26
|
Sawyer ES, Northrup NC, Schmiedt CW, Culp WTN, Rassnick KM, Garrett LD, Selting KA, Saba CF, Howerth EW. Outcome of 19 dogs with parathyroid carcinoma after surgical excision*. Vet Comp Oncol 2011; 10:57-64. [DOI: 10.1111/j.1476-5829.2011.00276.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
Cortadellas O, Fernández del Palacio M, Talavera J, Bayón A. Calcium and Phosphorus Homeostasis in Dogs with Spontaneous Chronic Kidney Disease at Different Stages of Severity. J Vet Intern Med 2010; 24:73-9. [DOI: 10.1111/j.1939-1676.2009.0415.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
28
|
Benchekroun G, Desmyter A, Hidalgo A, Boulouis HJ, Gomes E, Garnier F, Escoffier L, Poujol L, de Fornel-Thibaud P, Maurey C, Rosenberg D. Primary Hyperparathyroidism and Monoclonal Gammopathy in a Dog. J Vet Intern Med 2009; 23:211-4. [DOI: 10.1111/j.1939-1676.2008.0223.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
29
|
Schropp DM, Kovacic J. Phosphorus and phosphate metabolism in veterinary patients. J Vet Emerg Crit Care (San Antonio) 2007. [DOI: 10.1111/j.1476-4431.2006.00217.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Abstract
The most common cause of primary hyperparathyroidism in dogs and cats is a solitary adenoma involving an extracapsular parathyroid gland. The prognosis is excellent if the affected parathyroid gland is removed. Nonsurgical methods are discussed, although there are no current data to support any benefit over conventional surgery. The common postoperative complication to consider is hypocalcemia. Hypocalcemia can be successfully managed in these animals if it is anticipated and treated promptly.
Collapse
|
31
|
Rasor L, Pollard R, Feldman EC. Retrospective Evaluation of Three Treatment Methods for Primary Hyperparathyroidism in Dogs. J Am Anim Hosp Assoc 2007; 43:70-7. [PMID: 17339283 DOI: 10.5326/0430070] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The medical records of 110 dogs treated for primary hyperparathyroidism were reviewed. Dogs were treated via parathyroidectomy (n=47), percutaneous ultrasound-guided ethanol ablation (n=15), or percutaneous ultrasound-guided heat ablation (n=48). Forty-five of 48 (94%) parathyroidectomies resulted in control of hypercalcemia for a median of 561 days. Thirteen of 18 (72%) ethanol ablation procedures resulted in control of hypercalcemia for a median of 540 days. Forty-four of 49 (90%) heat-ablation treatments resulted in control of hypercalcemia for a median of 581 days.
Collapse
Affiliation(s)
- Liberty Rasor
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California 95616, USA
| | | | | |
Collapse
|