Sandbox : anmol
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Hyperparathyroidism Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Classification
| Classification of hyperparathyridism | |||
|---|---|---|---|
| Features | Primary hyperparathyroidism | Secondary hyperparathyroidism | Tertiary hyperparathyroidism |
| Pathology | Hyperfunction of parathyroid cells due to hyperplasia, adenoma or carcinoma. | Physiological stimulation of parathyroid in response to hypocalcaemia. | Following long term physiological stimulation leading to hyperplasia. |
| Cause | |||
| Associations | May be associated with multiple endocrine neoplasia. | Usually due to chronic renal failure or other causes of Vitamin D deficiency. | Seen in chronic renal failure. |
| Serum calcium | High | Low/Normal | High |
| Serum phosphate | Low/Normal | High | High |
| Management | Usually surgery if symptomatic. Cincacalcet can be considered in those not fit for surgery. | Treatment of underlying cause. | Usually cinacalcet or surgery in those that don't respond. |
Epidemiology PE & DVT
Incidence
- The incidence of VTE increases with age, ranging from less than 5 cases per 100,000 people in childhood to 500 cases per 100,000 people in the elderly.[1]
- Subjects who are more than 65 years of age are at three times higher risk for VTE compared to those who are 45-54 years old.[2]
- In the United States, the annual incidence of VTE is estimated to be approximately 100 per 100,000 persons.[1]
Age
- The incidence of VTE increases with age, ranging from less than 5 cases per 100,000 people in childhood to 500 cases per 100,000 people in the elderly.[1]
- Subjects who are more than 65 years of age are at three times higher risk for VTE compared to those who are 45-54 years old.[2]
Gender
- Studies about differences in the incidence of VTE by gender have mixed results.
- In addition, the risk for DVT was reported to consistently increase with age across both genders.[2]
Race
- There is a significant difference in the incidence of DVT as it relates to race. African Americans characteristically have the highest incidence of DVT while Caucasians rank as the second highest incidence of DVT.[1]
- When compared to African Americans and Caucasians, the incidence of DVT is noted to be two to four times lower in Hispanics and Asian-Pacific Islanders.[1]
- Lower thrombosis incidences in non-Caucasians may be related to a lower prevalence of disorders like Factor V Leiden or Prothrombin 20210A mutation.[6][7]
Recurrence of VTE
- The risk of recurrence of VTE in patients diagnosed with first-time VTE is estimated to be around 7-8 percent per year during an average follow up period of 2.2 years of subsequent observation of 265 patients.[2]
- Among patients with a first episode of VTE, the risk of recurrence of VTE is particularly elevated in the first 6 to 12 months following the first episode of VTE. The risk of recurrent VTE remains up to 10 years, with a estimated cumulative incidence of first overall VTE recurrence of 30 %. Predictors for recurrence of VTE include malignancy, neurological diseases, and paresis.[10]
- In recent years, the increase in thrombosis incidence may be related to improved diagnostic modalities and increased awareness by clinicians.[1]
Complications of VTE
- Estimates suggest that 60,000-100,000 Americans die of VTE, 10 to 30% of which will die within one month of diagnosis.[8][9]
- Among people who have had a DVT, one-half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb.[8][9]
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References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 White RH (2003). "The epidemiology of venous thromboembolism". Circulation. 107 (23 Suppl 1): I4–8. doi:10.1161/01.CIR.0000078468.11849.66. PMID 12814979.
- ↑ 2.0 2.1 2.2 2.3 2.4 Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P; et al. (2004). "Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology". Am J Med. 117 (1): 19–25. doi:10.1016/j.amjmed.2004.01.018. PMID 15210384.
- ↑ Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ (1998). "Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study". Arch Intern Med. 158 (6): 585–93. PMID 9521222.
- ↑ Kniffin WD, Baron JA, Barrett J, Birkmeyer JD, Anderson FA (1994). "The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly". Arch Intern Med. 154 (8): 861–6. PMID 8154949.
- ↑ "Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009". Retrieved 2012-10-06.
- ↑ Ridker PM, Miletich JP, Hennekens CH, Buring JE (1997). "Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening". JAMA. 277 (16): 1305–7. PMID 9109469.
- ↑ Gregg JP, Yamane AJ, Grody WW (1997). "Prevalence of the factor V-Leiden mutation in four distinct American ethnic populations". Am J Med Genet. 73 (3): 334–6. PMID 9415695.
- ↑ 8.0 8.1 8.2 Beckman MG, Hooper WC, Critchley SE, Ortel TL (2010). "Venous thromboembolism: a public health concern". Am J Prev Med. 38 (4 Suppl): S495–501. doi:10.1016/j.amepre.2009.12.017. PMID 20331949.
- ↑ 9.0 9.1 9.2 CDC- Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) — Blood Clot Forming in a Vein
- ↑ Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ (2000). "Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study". Arch Intern Med. 160 (6): 761–8. PMID 10737275.