Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are two types of hyperparathyroidism, primary and
secondary. The most common disorder of the parathyroid glands and one that
causes primary hyperparathyroidism, is a small, tumor called a
parathyroid adenoma. A parathyroid
adenoma is a benign condition in which one parathyroid gland increases
in size and produces PTH in excess. (As opposed to parathyroid adenoma,
it should be noted that malignant tumors of the parathyroid glands, that
is, cancer, is very rare.) In most situations patients are unaware
of the adenoma, and they are found when routine blood test
results show an elevated blood calcium and PTH level. Less
commonly, primary hyperparathyroidism may be caused by overactivity of
all of the parathyroid glands, referred to as parathyroid hyperplasia.
With secondary hyperparathyroidism, the secretion of PTH is caused by a
nonparathyroid disease, usually kidney failure.
Parathyroidectomy is necessary
when calcium levels are elevated, if there is a complication of
hyperparathyroidism, or if a patient is relatively young. During a parathyroidectomy, the
surgeon delicately removes one or more of the tiny parathyroid glands. In some
situations, both sides of the neck are explored, while in other cases a direct
approach is made through a small incision (referred to as a minimally invasive
parathyroidectomy). Tests such as a high-resolution ultrasound or a nuclear
medicine scan (called a sestamibi scan) help to direct the approach preoperatively or intra-operatively by
identifying the location of the overactive, enlarged
gland. In rare situations, the offending gland cannot be found. (A portion of a
gland also may be transplanted to another site in the neck or the arm to preserve parathyroid
function.)
Whereas preoperative
tests help to identify hyperparathyroidism and to direct the surgical
approach, PTH levels obtained during parathyroidectiomy help to guarantee the successful
resection
of the abnormal gland by demonstrating a return of the PTH levels to normal after
the suspected parathyroid adenoma is removed. Using this method, a PTH
determination is obtained immediately prior to the resection and
compared to a PTH determination done ten minutes after the resection.
Hyperparathyroidism is a disorder of the parathyroid glands. There are two types of hyperparathyroidism, primary and secondary. When the parathyroid glands produce too much hormone, hyperparathyroidism is the resulting condition. Most cases of hyperparathyroidism have no evident cause. Symptoms include fatigue, weakness, depression, loss of appetite, nausea, vomiting, constipation, or confusion. Increased calcium and phosphorous excretion may cause kidney stones. The main treatment of hyperparathyroidism is parathyroidectomy.
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
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