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Khan EA, Cheddani L, Saint-Jacques C, Vargas-Poussou R, Frochot V, Chieze R, Letavernier E, Avellino V, Lionnet F, Haymann JP. Primary Hyperparathyroidism in Homozygous Sickle Cell Patients: A Hemolysis-Mediated Hypocalciuric Hypercalcemia Phenotype? J Clin Med 2021; 10:jcm10215179. [PMID: 34768698 PMCID: PMC8584729 DOI: 10.3390/jcm10215179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Primary hyperparathyroidism (pHPT) has been reported to have a higher prevalence in sickle cell disease (SCD) patients, including a high rate of recurrence following surgery. However, most patients are asymptomatic at the time of diagnosis, with surprisingly infrequent hypercalciuria, raising the issue of renal calcium handling in SCD patients. We conducted a retrospective study including (1) 64 hypercalcemic pHPT non-SCD patients; (2) 177 SCD patients, divided into two groups of 12 hypercalcemic pHPT and 165 non-pHPT; (3) eight patients with a diagnosis of familial hypocalciuric hypercalcemia (FHH). Demographic and biological parameters at the time of diagnosis were collected and compared between the different groups. Determinants of fasting fractional excretion of calcium (FeCa2+) were also analyzed in non-pHPT SCD patients. Compared to non-SCD pHPT patients, our data show a similar ionized calcium and PTH concentration, with a lower plasmatic calcitriol concentration and a lower daily urinary calcium excretion in pHPT SCD patients (p < 0.0001 in both cases). Fasting FeCa2+ is also surprisingly low in pHPT SCD patients, and thus inadequate to be considered hypercalcemia, recalling the FHH phenotype. FeCa2+ is also low in the non-pHPT SCD control group, and negatively associated with PTH and hemolytic biomarkers such as LDH and low hemoglobin. Our data suggest that the pHPT biochemical phenotype in SCD patients resembles the FHH phenotype, and the fasting FeCa2+ association with chronic hemolysis biomarkers strengthens the view of a potential pharmacological link between hemolytic by-products and calcium reabsorption, potentially through a decreased calcium-sensing receptor (CaSR) activity.
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Affiliation(s)
- Edmat Akhtar Khan
- Service de Néphrologie, Université de Lorraine, CHRU-Nancy, 54500 Vandœuvre-lès-Nancy, France;
| | - Lynda Cheddani
- Unité HTA, Prévention et Thérapeutique Cardiovasculaires, Assistance Publique—Hôpitaux de Paris, Hôpital Hôtel Dieu, 75004 Paris, France;
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Université de Paris, 75006 Paris, France
| | - Camille Saint-Jacques
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Rosa Vargas-Poussou
- Centre d’Investigation Clinique, Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Assistance Publique—Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France;
| | - Vincent Frochot
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Remi Chieze
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Emmanuel Letavernier
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Virginie Avellino
- Service de Médecine Interne, Centre de Référence de la Drépanocytose, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (V.A.); (F.L.)
| | - Francois Lionnet
- Service de Médecine Interne, Centre de Référence de la Drépanocytose, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (V.A.); (F.L.)
| | - Jean-Philippe Haymann
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
- Correspondence: ; Tel.: +33-1-5601-6771; Fax: +33-1-5601-7003
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Szulc P. Biochemical bone turnover markers in hormonal disorders in adults: a narrative review. J Endocrinol Invest 2020; 43:1409-1427. [PMID: 32335857 DOI: 10.1007/s40618-020-01269-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hormonal disorders are often associated with abnormal levels of bone turnover markers (BTMs). N-terminal propeptide of type I procollagen (PINP) and serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) are the reference markers of bone formation and bone resorption, respectively. METHODS A comprehensive literature search within the MEDLINE and Web of Science databases was performed. RESULTS Acromegaly is associated with higher BTM levels, which decrease during the remission after treatment. Adult-onset growth hormone deficiency is often associated with decreased BTM levels. Growth hormone replacement therapy stimulates bone turnover and increases BTM levels. Hypothyroidism is characterized by general slowing of bone metabolism which is reflected by lower BTM levels. The replacement thyroid hormone therapy increases the bone turnover rate and BTM levels increase. Patients with thyroid cancer receive a suppressive dose of thyroid hormones and may have slightly elevated BTM levels. Patients with overt hyperthyroidism had higher BTM levels and anti-thyroid therapy induces a rapid decrease in the BTM levels. Patients with overt primary hyperparathyroidism have higher BTM levels, whereas those with asymptomatic and normocalcemic hyperparathyroidism usually have normal BTM levels. Hypoparathyroidism is characterized by slightly decreased BTM levels. Cushing's syndrome is characterized consistently by markedly decreased osteocalcin concentration, whereas data on other BTMs are discordant. CONCLUSIONS BTMs help us to better understand mechanisms of the impact of hormonal disorders and their treatment on bone metabolism. However, it is unknown whether BTMs may be used to monitor the effect of their treatments on bone in the clinical practice.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Quilao RJ, Greer M, Stack BC. Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences. Laryngoscope Investig Otolaryngol 2020; 5:773-777. [PMID: 32864451 PMCID: PMC7444768 DOI: 10.1002/lio2.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a condition in which one or more parathyroid glands secrete excess amounts of parathyroid hormone (PTH). In short, PHPT is characterized by hypercalcemia/hypercalciuria with concurrent elevated PTH levels. This condition is known to increase the risk of cardiovascular disease, osteoporosis, psychiatric disturbances, and renal complications. As of now, the disease typically runs a long course before being identified and treated. At present, surgery is the only viable treatment option for patients with this disease. Publications from other tertiary centers have identified a large-scale underdiagnosis of PHPT. The aim of this study is to determine if similar trends exist at the University of Arkansas for Medical Sciences (UAMS). Moreover, this study was seen as a first step to developing a machine learning strategy to diagnose PHPT in large clinical data sets. METHODS To evaluate for potential underdiagnosis of PHPT at UAMS, all patients from 2006 to 2018 with hypercalcemia and/or hypercalciuria (excluding those with known malignancies or other possible causes of excess serum calcium) were identified in electronic medical records. Then, it was evaluated whether these hypercalcemic/hypercalciuric patients received subsequent measurement of PTH levels necessary to confirm the diagnosis of HPT. RESULTS At UAMS between 2006 and 2018, 28 831 patients were identified as having hypercalcemia and/or hypercalciuria. Of these patients, only 7984 ever had subsequent PTH levels tested. Therefore, 20 847 (72.3%) of these patients never had PTH labs drawn. CONCLUSIONS These findings may represent a significant patient population in which PHPT remains undiagnosed due to lack of follow-up. PHPT is often a silent disease with an insidious onset. At the point of diagnosis, typically the treatment is surgical removal of the offending parathyroid gland(s) (parathyroidectomy). Identification of underdiagnosis is the first step for subsequent improvement in the diagnosis of PHPT. Detection of this disease in its earlier stages may open the door for medical and lifestyle interventions, thereby decreasing long-term sequelae of the disease, such as osteoporosis, myocardial infarction, or stroke.
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Affiliation(s)
- Raymond J. Quilao
- University of Arkansas for Medical Sciences, Class of 2020, College of MedicineLittle RockArkansasUSA
| | - Melody Greer
- Department of Biomedical InformaticsUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Brendan C. Stack
- Department of Otolaryngology – Head and Neck SurgerySouthern Illinois University School of MedicineSpringfieldIllinoisUSA
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Duskin-Bitan H, Nemirovsky N, Slutzky-Shraga I, Gorshtein A, Masri-Iraqi H, Robenshtok E, Diker-Cohen T, Singer J, Shimon I, Hirsch D, Tsvetov G. Hyperparathyroidism in patients over 75: Clinical characteristics and outcome. Is conservative treatment a safe alternative? Maturitas 2020; 135:47-52. [PMID: 32252964 DOI: 10.1016/j.maturitas.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE With the current aging of the world's population, primary hyperparathyroidism (PHPT) is increasingly detected in the elderly. Yet data on the presentation and outcome of PHPT in this group are scarce. The objective was to describe a cohort of patients aged 75 years or more with PHPT observed in our endocrine clinic. STUDY DESIGN A retrospective analysis of medical records in an endocrine clinic at a tertiary hospital. We evaluated 182 patients with PHPT, aged 75 years or more at their last follow-up, all diagnosed at age 65 or more. Laboratory data were compared at diagnosis and last follow-up. RESULTS Mean age at diagnosis was 73 ± 4 years, last follow-up was at 83 ± 4 years, and mean follow-up was 11.3 ± 5.5 years. Osteoporosis, fractures, and nephrolithiasis were diagnosed in 114(63 %), 84(46 %), and 43(24 %) patients, respectively. Overall, 150 patients had an indication for surgery; of them, the 29 who underwent parathyroidectomy were younger than the non-operated patients and had higher rates of hypercalciuria. During the follow-up of the 141 patients who did not undergo operation, serum and urinary calcium levels significantly had decreased, and vitamin D level had increased at last visit (10.4 ± 0.5 mg/dl, 161 ± 70 mg/24 h, 69 ± 17 nmol/l, p < 0.01 respectively) compared with levels at diagnosis (10.6 ± 0.2 mg/dl, 223 ± 95 mg/24 h, 53 ± 15 nmol/l, respectively, p = 0.001). Overall, 38 of the 182 patients (20 %) died during follow-up; these patients were significantly older at diagnosis (76 ± 5 vs. 72 ± 4 years) but there were no differences in laboratory variables. CONCLUSIONS While most patients had a formal indication for surgery, few underwent parathyroidectomy. Serum and urinary calcium significantly decreased during follow-up in patients who did not undergo surgery. Our data are reassuring and support at least the consideration of conservative treatment for these patients.
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Affiliation(s)
- Hadar Duskin-Bitan
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Ilana Slutzky-Shraga
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gorshtein
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Masri-Iraqi
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robenshtok
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Diker-Cohen
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Medicine A, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joelle Singer
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dania Hirsch
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gloria Tsvetov
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yadav SK, Johri G, Bichoo RA, Jha CK, Kintu-Luwaga R, Mishra SK. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:105-110. [PMID: 32236309 PMCID: PMC10118947 DOI: 10.20945/2359-3997000000211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/26/2019] [Indexed: 11/23/2022]
Abstract
While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.
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Affiliation(s)
- Sanjay Kumar Yadav
- Department of Breast and Endocrine Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Goonj Johri
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Raouef Ahmed Bichoo
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Saroj Kanta Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Gracia-Marco L, García-Fontana B, Ubago-Guisado E, Vlachopoulos D, García-Martín A, Muñoz-Torres M. Analysis of Bone Impairment by 3D DXA Hip Measures in Patients With Primary Hyperparathyroidism: A Pilot Study. J Clin Endocrinol Metab 2020; 105:5582038. [PMID: 31588503 DOI: 10.1210/clinem/dgz060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/07/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy x-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed three-dimensional (3D)-DXA software might overcome this issue. OBJECTIVE To examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group. DESIGN Cross-sectional pilot study. SETTING Hospital. PATIENTS 80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 age- and sex-matched healthy controls. MEASURES aBMD (g/cm2) of the femoral neck, trochanter, shaft, and total hip was assessed using DXA. Cortical surface (sBMD, mg/cm2), cortical volumetric BMD (vBMD, mg/cm3), trabecular vBMD (mg/cm3), integral vBMD (mg/cm3) and cortical thickness (mm) was assessed using 3D-DXA software. RESULTS Mean-adjusted values showed lower aBMD (7.5%-12.2%, effect size: 0.51-1.01) in the PHPT group compared with the control group (all P < 0.05). 3D-DXA revealed bone impairment (3.7%-8.5%, effect size: 0.47-0.65) in patients with PHPT, mainly in cortical parameters (all P < 0.05). However, differences in trabecular vBMD were not statistically significant (P = 0.055). The 3D mapping showed lower cortical sBMD, cortical vBMD, and cortical thickness at the trochanter and diaphysis in the PHPT group (P < 0.05) compared with the control group. In both groups, the presence of osteopenia or osteoporosis is related to lower cortical bone. CONCLUSIONS aBMD and cortical 3D parameters are impaired in patients with PHPT versus healthy controls. The vBMD of the trabecular compartment seems to be affected, although to a lesser extent.
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Affiliation(s)
- Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - Beatriz García-Fontana
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
| | - Esther Ubago-Guisado
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Antonia García-Martín
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division. Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Granada, Spain
- CIBERFES, Instituto de Salud Carlos III. Madrid, Spain
- Department of Medicine. Universidad de Granada, Granada, Spain
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Abstract
Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes. Hypercalcaemia is the biochemical hallmark of PHPT. Usually, the concentration of PTH is frankly increased but can remain within the normal range, which is abnormal in the setting of hypercalcaemia. Normocalcaemic PHPT, a variant in which the serum calcium level is persistently normal but PTH levels are increased in the absence of an obvious inciting stimulus, is now recognized. The clinical presentation of PHPT varies from asymptomatic disease (seen in countries where biochemical screening is routine) to classic symptomatic disease in which renal and/or skeletal complications are observed. Management guidelines have recently been revised to help the clinician to decide on the merits of a parathyroidectomy or a non-surgical course. This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT.
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Santa Maria C, Cheng Z, Li A, Wang J, Shoback D, Tu CL, Chang W. Interplay between CaSR and PTH1R signaling in skeletal development and osteoanabolism. Semin Cell Dev Biol 2016; 49:11-23. [PMID: 26688334 PMCID: PMC4761456 DOI: 10.1016/j.semcdb.2015.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/05/2015] [Indexed: 12/01/2022]
Abstract
Parathyroid hormone (PTH)-related peptide (PTHrP) controls the pace of pre- and post-natal growth plate development by activating the PTH1R in chondrocytes, while PTH maintains mineral and skeletal homeostasis by modulating calciotropic activities in kidneys, gut, and bone. The extracellular calcium-sensing receptor (CaSR) is a member of family C, G protein-coupled receptor, which regulates mineral and skeletal homeostasis by controlling PTH secretion in parathyroid glands and Ca(2+) excretion in kidneys. Recent studies showed the expression of CaSR in chondrocytes, osteoblasts, and osteoclasts and confirmed its non-redundant roles in modulating the recruitment, proliferation, survival, and differentiation of the cells. This review emphasizes the actions of CaSR and PTH1R signaling responses in cartilage and bone and discusses how these two signaling cascades interact to control growth plate development and maintain skeletal metabolism in physiological and pathological conditions. Lastly, novel therapeutic regimens that exploit interrelationship between the CaSR and PTH1R are proposed to produce more robust osteoanabolism.
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Affiliation(s)
- Christian Santa Maria
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Zhiqiang Cheng
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alfred Li
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jiali Wang
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Dolores Shoback
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Chia-Ling Tu
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Wenhan Chang
- Endocrine Research Unit, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA.
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Eufrazino C, Veras A, Bandeira F. Epidemiology of Primary Hyperparathyroidism and its Non-classical Manifestations in the City of Recife, Brazil. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2013; 6:69-74. [PMID: 24348080 PMCID: PMC3864738 DOI: 10.4137/cmed.s13147] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Before the introduction of routine measurements of serum calcium in ambulatory services, PHTP (primary hyperparathyroidism) was symptomatic with classic bone disease (known as osteitis fibrosa cystica) nephrolithiasis, and acute neuropsychiatric syndrome with severe hypercalcemia. Currently, PHPT presents few unspecific symptoms. This cross-sectional study was conducted from December 1, 2007, through August 31, 2008 to estimate the prevalence of primary hyperparathyroidism and to describe the clinical and laboratory characteristics of patients receiving ambulatory care. From 4207 patients, we found a prevalence of PHTP of 0.78 (95% confidence interval [CI], 0.52–1.04) of which 81.8% were asymptomatic and 18.2% symptomatic. The female:male ratio was 7.2:1, and 89.7% of the women were postmenopausal. Mean age was 61.12 ± 15.73 years, mean serum calcium was 10.63 ± 1.33 mg/dL, and mean serum parathyroid hormone (PTH) was 182.48 ± 326.51 pg/mL. We found a high prevalence of PHTP at reference centers and a high prevalence of hypertension and type 2 diabetes.
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Affiliation(s)
- Cátia Eufrazino
- Division of Endocrinology and Diabetes of Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Andreia Veras
- Division of Endocrinology and Diabetes of Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Francisco Bandeira
- Division of Endocrinology and Diabetes of Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
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Romagnoli E, Del Fiacco R, Russo S, Piemonte S, Fidanza F, Colapietro F, Diacinti D, Cipriani C, Minisola S. Secondary osteoporosis in men and women: clinical challenge of an unresolved issue. J Rheumatol 2011; 38:1671-9. [PMID: 21632675 DOI: 10.3899/jrheum.110030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the clinical and etiological factors of osteoporosis. We also tested the FRAX algorithm to compare the assessment of fracture risk in patients with primary or secondary osteoporosis. METHODS A prospective study carried out in a large sample of 123 men and 246 women. All subjects had a biochemical, densitometric, and radiological examination of thoracic and lumbar spine. RESULTS The prevalence of primary (men 52.9% vs women 50%; p = nonsignificant) and secondary (men 21.1% vs women 17.5%; p = nonsignificant) osteoporosis did not differ between the sexes. In contrast, the prevalence of primary osteoporosis was significantly higher than secondary causes (p < 0.0001) in both men and women. While women came to our attention for prevention of osteoporosis, men sought help because of clinical symptoms or disease-related complications, such as fractures. As evaluated by the FRAX tool, patients with osteopenia do not need treatment, in agreement with Italian guidelines. The estimated risk of major osteoporotic and hip fractures was significantly higher in women with secondary osteoporosis compared to men and also compared to women with primary osteoporosis. CONCLUSION The prevalence of secondary osteoporosis in men is similar to that in women and it is less frequent than commonly reported. In patients with secondary osteoporosis, FRAX calculation may provide an estimate of a particularly high fracture risk in patients whose bone fragility is usually attributed to another disease.
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Affiliation(s)
- Elisabetta Romagnoli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
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Siilin H, Lundgren E, Mallmin H, Mellström D, Ohlsson C, Karlsson M, Orwoll E, Ljunggren Ö. Prevalence of Primary Hyperparathyroidism and Impact on Bone Mineral Density in Elderly Men: MrOs Sweden. World J Surg 2011; 35:1266-72. [DOI: 10.1007/s00268-011-1062-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Isidro ML, Ruano B. Biochemical effects of calcifediol supplementation in mild, asymptomatic, hyperparathyroidism with concomitant vitamin D deficiency. Endocrine 2009; 36:305-10. [PMID: 19598008 DOI: 10.1007/s12020-009-9211-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 06/18/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
Abstract
It has been proposed to cautiously supplement with vitamin D to any patient with asymptomatic primary hyperparathyroidism (PHTP) and a plasma 25-hydroxyvitamin D [25(OH)D] concentration <50 nmol/l. Evidence about the safeness of this intervention is limited to two studies. Our aim was to prospectively assess the biochemical effects of one-year 25(OH)D supplementation in this context. Twenty-seven patients were included in this study. Calcifediol was started at a dose of 480-960 IU/24 h (8-16 microg/24 h) and adjusted up to a maximum of 960 IU/24 h (16 microg/24 h). Basal calcium, phosphate, albumin, total alkaline phosphatase (ALP), creatinine, 24 h calcium urinary excretion, intact PTH (iPTH) and 25(OH)D were measured before and during vitamin D supplementation. The mean basal 25(OH)D was 28.7 +/- 8.0 nmol/l, and at 12 months was 71.5 +/- 32.5 nmol/l (P = 0.00 vs. baseline). After 3, 6 and 12 months iPTH levels were 141.7 +/- 108.4 ng/l (P = 0.00 vs. baseline), 131.1 +/- 95.7 ng/l (P = 0.03 vs. baseline) and 162.2 +/- 139.3 ng/l (P = ns vs. baseline). Mean calcium did not change. Mean urinary calcium excretion increased significantly (basal: 5.7 +/- 2.9 mmol/24 h, 12 months: 7.9 +/- 4.9 mmol/24 h, P = 0.02). Cautious calcifediol supplementation significantly increased mean 25(OH)D and temporarily reduced mean iPTH. It did not change mean serum calcium, but urinary calcium excretion increased significantly. We suggest that serum calcium and 24 h calciuria be measured at regular intervals in patients with PHTP, while on calcifediol supplementation.
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Affiliation(s)
- M Luisa Isidro
- Endocrine Department, Complejo Hospitalario Universitario, As Xubias 84, A Coruña, 15006, Spain.
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