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Yang L, Jing X, Pang H, Guan L, Li M. Primary hyperparathyroidism: predictors of sporadic multi-gland disease. Endocr Connect 2024; 13:e230492. [PMID: 38513354 PMCID: PMC11046330 DOI: 10.1530/ec-23-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
In this review, we discuss the definition, prevalence, and etiology of sporadic multiglandular disease (MGD), with an emphasis on its preoperative and intraoperative predictors. Primary hyperparathyroidism (PHPT) is the third-most common endocrine disorder, and multiglandular parathyroid disease (MGD) is a cause of PHPT. Hereditary MGD can be definitively diagnosed with detailed family history and genetic testing, whereas sporadic MGD presents a greater challenge in clinical practice, and parathyroidectomy for MGD is associated with a higher risk of surgical failure than single gland disease (SGD). Therefore, it is crucial to be able to predict the presence of sporadic MGD in a timely manner, either preoperatively or intraoperatively. Various predictive methods cannot accurately identify all cases of sporadic MGD, but they can greatly optimize the management of MGD diagnosis and treatment and optimize the cure rate. Future research will urge us to investigate more integrative predictive models as well as increase our understanding of MGD pathogenesis.
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Affiliation(s)
- Lu Yang
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingguo Jing
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Pang
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Guan
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengdan Li
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Bräutigam K, Nesti C, Riss P, Scheuba C, Niederle B, Grob T, Di Domenico A, Neuenschwander M, Mazal P, Köhn N, Trepp R, Perren A, Kaderli RM. Syndromic MEN1 parathyroid adenomas consist of both subclonal nodules and clonally independent tumors. Virchows Arch 2024; 484:789-798. [PMID: 38244045 PMCID: PMC11106174 DOI: 10.1007/s00428-023-03730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024]
Abstract
Primary hyperparathyroidism with parathyroid tumors is a typical manifestation of Multiple Endocrine Neoplasia Type 1 (MEN1) and is historically termed "primary hyperplasia". Whether these tumors represent a multi-glandular clonal disease or hyperplasia has not been robustly proven so far. Loss of Menin protein expression is associated with inactivation of both alleles and a good surrogate for a MEN1 gene mutation. The cyclin-dependent kinase inhibitor 1B (CDKN1B) gene is mutated in MEN4 and encodes for protein p27 whose expression is poorly studied in the syndromic MEN1 setting.Here, we analyzed histomorphology and protein expression of Menin and p27 in parathyroid adenomas of 25 patients of two independent, well-characterized MEN1 cohorts. The pattern of loss of heterozygosity (LOH) was assessed by fluorescence in situ hybridization (FISH) in one MEN1-associated parathyroid adenoma. Further, next-generation sequencing (NGS) was performed on eleven nodules of four MEN1 patients.Morphologically, the majority of MEN1 adenomas consisted of multiple distinct nodules, in which Menin expression was mostly lost and p27 protein expression reduced. FISH analysis revealed that most nodules exhibited MEN1 loss, with or without the loss of centromere 11. NGS demonstrated both subclonal evolution and the existence of clonally unrelated tumors.Syndromic MEN1 parathyroid adenomas therefore consist of multiple clones with subclones, which supports the current concept of the novel WHO classification of parathyroid tumors (2022). p27 expression was lost in a large fraction of MEN1 parathyroids and must therefore be used with caution in suggesting MEN4.
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Affiliation(s)
- Konstantin Bräutigam
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland.
| | - Cédric Nesti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Scheuba
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno Niederle
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Tobias Grob
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Annunziata Di Domenico
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Maja Neuenschwander
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Peter Mazal
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Nastassja Köhn
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aurel Perren
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Reto M Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Včelák J, Šerková Z, Zajíčková K. Molecular Genetic Aspects of Sporadic Multiglandular Primary Hyperparathyroidism. Physiol Res 2023; 72:S357-S363. [PMID: 38116772 PMCID: PMC10830163 DOI: 10.33549/physiolres.935253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Multiglandular primary hyperparathyroidism (MGD) represents a rare form of primary hyperparathyroidism (PHPT). MGD is associated with hereditary PHPT, but the sporadic MGD is more common and affects a similar patient profile as single gland parathyroid disease (SGD). The distinction between SGD and MGD is of great clinical importance, especially for the strategy of parathyroidectomy. Based on the limited knowledge available, MGD is likely to be a genetically heterogeneous disease resulting from the interaction of germline and somatic DNA mutations together with epigenetic alterations. Furthermore, these events may combine and occur independently in parathyroid tumors within the same individual with MGD. Gene expression profiling has shown that SGD and MGD may represent distinct entities in parathyroid tumorigenesis. We are waiting for studies to analyze exactly which genes are different in SGD and MGD in order to identify potential biomarkers that can distinguish between the two forms of the disease.
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Affiliation(s)
- J Včelák
- Institute of Endocrinology, Prague, Czech Republic.
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Jha S, Simonds WF. Molecular and Clinical Spectrum of Primary Hyperparathyroidism. Endocr Rev 2023; 44:779-818. [PMID: 36961765 PMCID: PMC10502601 DOI: 10.1210/endrev/bnad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
Recent data suggest an increase in the overall incidence of parathyroid disorders, with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder. PHPT is associated with morbidities (fractures, kidney stones, chronic kidney disease) and increased risk of death. The symptoms of PHPT can be nonspecific, potentially delaying the diagnosis. Approximately 15% of patients with PHPT have an underlying heritable form of PHPT that may be associated with extraparathyroidal manifestations, requiring active surveillance for these manifestations as seen in multiple endocrine neoplasia type 1 and 2A. Genetic testing for heritable forms should be offered to patients with multiglandular disease, recurrent PHPT, young onset PHPT (age ≤40 years), and those with a family history of parathyroid tumors. However, the underlying genetic cause for the majority of patients with heritable forms of PHPT remains unknown. Distinction between sporadic and heritable forms of PHPT is useful in surgical planning for parathyroidectomy and has implications for the family. The genes currently known to be associated with heritable forms of PHPT account for approximately half of sporadic parathyroid tumors. But the genetic cause in approximately half of the sporadic parathyroid tumors remains unknown. Furthermore, there is no systemic therapy for parathyroid carcinoma, a rare but potentially fatal cause of PHPT. Improved understanding of the molecular characteristics of parathyroid tumors will allow us to identify biomarkers for diagnosis and novel targets for therapy.
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Affiliation(s)
- Smita Jha
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
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Bouriez D, Gronnier C, Haissaguerre M, Tabarin A, Najah H. Less Than Subtotal Parathyroidectomy for Multiple Endocrine Neoplasia Type 1 Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:2666-2675. [PMID: 35767091 DOI: 10.1007/s00268-022-06633-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is classically associated with an asymmetric and asynchronous parathyroid involvement. Subtotal parathyroidectomy (STP), which is currently the recommended surgical treatment, carries a high risk of permanent hypoparathyroidism. The results of less than subtotal parathyroidectomy (LSTP) are conflicting, and its place in this setting is still a matter of debate. The aim of this study was to identify the place of LSTP in the surgical management of patients with MEN-associated pHPT. METHODS A systematic literature review was conducted in accordance with PRISMA and MOOSE guidelines, for studies comparing STP and LSTP for MEN1-associated pHPT. The results of the two techniques, regarding permanent hypoparathyroidism, persistent hyperparathyroidism and recurrent hyperparathyroidism were computed using pairwise random-effect meta-analysis. RESULTS Twenty-five studies comparing STP and LSTP qualified for inclusion in the quantitative synthesis. In total, 947 patients with MEN1-associated pHPT were allocated to STP (n = 569) or LSTP (n = 378). LSTP reduces the risk of permanent hypoparathyroidism [odds ratio (OR) 0.29, confidence interval (CI) 95% 0.17-0.49)], but exposes to higher rates of persistent hyperparathyroidism [OR 4.60, 95% CI 2.66-7.97]. Rates of recurrent hyperparathyroidism were not significantly different between the two groups [OR 1.26, CI 95% 0.83-1.91]. CONCLUSIONS LSTP should not be abandoned and should be considered as a suitable surgical option for selected patients with MEN1-associated pHPT. The increased risk of persistent hyperparathyroidism could improve with the emergence of more efficient preoperative localization imaging techniques and a more adequate patients selection.
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Affiliation(s)
- Damien Bouriez
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Magalie Haissaguerre
- Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Antoine Tabarin
- Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Haythem Najah
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
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Voronkova IA, Eremkina AK, Krupinova YA, Gurevich LE, Mokrysheva NG. [Neuroendocrine markers in parathyroid tumors]. Arkh Patol 2020; 82:70-78. [PMID: 33274631 DOI: 10.17116/patol20208206170] [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] [Indexed: 11/17/2022]
Abstract
The parathyroid glands (PTGs) are a key regulator of calcium and phosphorus metabolism in the human body. In terms of their, morphological and immunophenotypic characteristics, PTGs are neuroendocrine organs, and their neoplasms are neuroendocrine tumors. These neoplasms include adenoma and cancer; in addition, glandular hyperplasia may develop, which is most characteristic of multiple endocrine neoplasia (MEN1, MEN2a, and MEN4) syndromes. The morphological characteristics of pathologically altered PTGs in MEN syndromes are variable. The analysis and generalization of knowledge about the features and expression of various immunohistochemical markers in PTG tissue in health and in diseases are useful in the practical work of not only pathologists, but also clinicians of various specialties.
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Affiliation(s)
- I A Voronkova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia.,M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A K Eremkina
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - Yu A Krupinova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - L E Gurevich
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - N G Mokrysheva
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
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Montenegro FLDM, Brescia MDG, Lourenço DM, Arap SS, d'Alessandro AF, de Britto e Silva Filho G, Toledo SPDA. Could the Less-Than Subtotal Parathyroidectomy Be an Option for Treating Young Patients With Multiple Endocrine Neoplasia Type 1-Related Hyperparathyroidism? Front Endocrinol (Lausanne) 2019; 10:123. [PMID: 30899245 PMCID: PMC6417394 DOI: 10.3389/fendo.2019.00123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The surgical treatment of primary hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1 (MEN1) has evolved due the concern of permanent hypoparathyroidism. As the diagnosis has increased, the extent of operation has decreased. Most MEN1 patients requiring parathyroidectomy are younger than 50 years and they pose a difficult balance to achieve between persistent HPT and life-long hypoparathyroidism. The aim of the present study is to review our experience with a large series of patients with MEN1-related HPT (HPT/MEN1) treated at a single institution in order to find clues to a better treatment decision in these younger cases. Method: Retrospective analysis of consecutive HPT/MEN1 cases treated at a single institution with different operations: total parathyroidectomy and immediate forearm autograft (TPTX-AG), subtotal (STPTX), unintentional less than subtotal (U-LSTPTX) and intentional less than subtotal parathyroidectomy (I-LSTPTX). Results: Considering 84 initial cases operated on since 2011 (TPTX-AG, 39; STPTX, 22, U-LSTPTX, 13, and I-LSTPTX, 10), the rates of hypoparathyroidism were 30.8% (U-LSTPTX), 28.2% (TPTX-AG), 13.6% (STPTX), and 0% (I-LSTPTX). Two-thirds of them (68%; 57/84) were young (<50 years) or asdolescents. MIBI scan was more sensitive to show parathyroid glands and bilateral disease. Considering the concordance of MIBI and ultrasound for the possibility of unilateral clearance, it would be suitable to 22.6% of the cases. Intra-operative parathormone showed a significant decay even after unilateral exploration, but longer follow up is necessary. Overall, there were seven (4%) adolescents in 161 cases treated from 1987 to 2018, three underwent TPTX-AG and four had U-LSTPTX. Five are euparathyroid, one had mild recurrence, and one required a reoperation after 8 years due to the residual gland. Conclusions: Young patients are the most frequent candidates to parathyroidectomy. Less extensive procedures may be planned only if carefully reviewed preoperative imaging studies suggest a localized disease. Patients and their relatives should be fully informed of the risks and benefits during consent process. Future research with larger cohorts and long-term results are necessary to clarify if less than I-LSPTX or unilateral clearance are really adequate in selected groups of patients with HPT/MEN1 presenting lower volume of disease detected by preoperative imaging studies.
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Affiliation(s)
- Fabio Luiz de Menezes Montenegro
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Fabio Luiz de Menezes Montenegro
| | - Marilia D'Elboux Guimaraes Brescia
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Delmar Muniz Lourenço
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Endocrine Oncology Division, Institute of Cancer of the State of Sao Paulo, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Samir Arap
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Fernandes d'Alessandro
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto de Britto e Silva Filho
- Parathyroid Unit- LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Head and Neck Surgery, Department of Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Pereira de Almeida Toledo
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clinicas, University of Sao Paulo School of Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Kamilaris CDC, Stratakis CA. Multiple Endocrine Neoplasia Type 1 (MEN1): An Update and the Significance of Early Genetic and Clinical Diagnosis. Front Endocrinol (Lausanne) 2019; 10:339. [PMID: 31263451 PMCID: PMC6584804 DOI: 10.3389/fendo.2019.00339] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/10/2019] [Indexed: 12/21/2022] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, enteropancreatic, and anterior pituitary origin, as well as nonendocrine neoplasms. Other endocrine tumors in MEN1 include foregut carcinoid tumors, adrenocortical tumors, and rarely pheochromocytoma. Nonendocrine manifestations include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas. MEN1 is caused by inactivating mutations of the tumor suppressor gene MEN1 which encodes the protein menin. This syndrome can affect all age groups, with 17% of patients developing MEN1-associated tumors before 21 years of age. Despite advances in the diagnosis and treatment of MEN1-associated tumors, patients with MEN1 continue to have decreased life expectancy primarily due to malignant neuroendocrine tumors. The most recent clinical practice guidelines for MEN1, published in 2012, highlight the need for early genetic and clinical diagnosis of MEN1 and recommend an intensive surveillance approach for both patients with this syndrome and asymptomatic carriers starting at the age of 5 years with the goal of timely detection and management of MEN1-associated neoplasms and ultimately decreased disease-specific morbidity and mortality. Unfortunately, there is no clear genotype-phenotype correlation and individual mutation-dependent surveillance is not possible currently.
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Marx SJ, Lourenço DM. Questions and Controversies About Parathyroid Pathophysiology in Children With Multiple Endocrine Neoplasia Type 1. Front Endocrinol (Lausanne) 2018; 9:359. [PMID: 30065698 PMCID: PMC6057055 DOI: 10.3389/fendo.2018.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/18/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Stephen J. Marx
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- *Correspondence: Stephen J. Marx
| | - Delmar M. Lourenço
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Endocrine Oncology Division, Institute of Cancer of the State of São Paulo, University of São Paulo School of Medicine, São Paulo, Brazil
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Marini F, Giusti F, Tonelli F, Brandi ML. Management impact: effects on quality of life and prognosis in MEN1. Endocr Relat Cancer 2017; 24:T227-T242. [PMID: 28733468 DOI: 10.1530/erc-17-0203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 12/25/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant endocrine tumor syndrome, caused by inactivating mutations of the MEN1 tumor suppressor gene at 11q13 locus, which predisposes to develop tumors in target neuroendocrine tissues. As the positional cloning and identification of the causative gene in 1997, genetic diagnosis, by the sequencing-based research of gene mutations, has become an important tool in the early and differential diagnosis of the disease. Application of the genetic test, in MEN1 index cases and in first-degree relatives of mutated patients, has been constantly increasing during the last two decades, also thanks to the establishment of multidisciplinary referral centers and specific genetic counseling, and thanks to the wide availability of high throughput instruments for gene sequencing and gene mutation identification. The MEN1 genetic test helps the specific diagnosis of probands, and allows the early identification of asymptomatic carriers, strongly contributing, together with progressions in tumor diagnostic techniques and in pharmacological and surgical therapeutic approaches, to the reduction of morbidity and mortality associated with the syndrome. International clinical guidelines for MEN1 have been drafted by panels of specialists in the field, with the main goal to improve the management of the disease and grant patients a better quality of life. Here, we review main recommendations and suggestions derived by the last published general guidelines in 2012, and by most recent published studies about MEN1 syndrome diagnosis, clinical management, therapeutic approaches and patients' quality of life.
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Affiliation(s)
- Francesca Marini
- Department of Surgery and Translational MedicineUniversity of Florence, Viale Pieraccini 6, Florence, Italy
| | - Francesca Giusti
- Department of Surgery and Translational MedicineUniversity of Florence, Largo Palagi 1, Florence, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational MedicineUniversity of Florence, Largo Palagi 1, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational MedicineUniversity of Florence, Largo Palagi 1, Florence, Italy
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De Gregorio L, Lubitz CC, Hodin RA, Gaz RD, Parangi S, Phitayakorn R, Stephen AE. The Truth about Double Adenomas: Incidence, Localization, and Intraoperative Parathyroid Hormone. J Am Coll Surg 2016; 222:1044-52. [DOI: 10.1016/j.jamcollsurg.2015.12.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/02/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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12
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Lee F, Lee JJ, Jan WC, Wu CJ, Chen HH, Cheng SP. Molecular pathways associated with transcriptional alterations in hyperparathyroidism. Oncol Lett 2016; 12:621-626. [PMID: 27347190 DOI: 10.3892/ol.2016.4623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 05/12/2016] [Indexed: 12/11/2022] Open
Abstract
Hyperparathyroidism is characterized by the oversecretion of parathyroid hormone biochemically and increased cell proliferation histologically. Primary and secondary hyperparathyroidism exhibit distinct pathophysiology but share certain common microscopic features. The present study performed the first genome-wide expression analysis directly comparing the expression profile of primary and secondary hyperparathyroidism. Microarray gene expression analyses were performed in parathyroid tissues from 2 primary hyperparathyroidism patients and 3 secondary hyperparathyroidism patients. Unsupervised hierarchical clustering analysis identified two natural subgroups containing different types of hyperparathyroidism. Combined with additional data extracted from a publicly available database, a meta-signature was constructed to represent an intersection of two sets of differential expression profile. Multiple pathways were identified that are aberrantly regulated in hyperparathyroidism. In primary hyperparathyroidism, dysregulated pathways included cell adhesion molecules, peroxisome proliferator-activated receptor signaling pathway, and neuroactive ligand-receptor interaction. Pathways implicated in secondary hyperparathyroidism included tryptophan metabolism, tight junctions, renin-angiotensin system, steroid hormone biosynthesis, and O-glycan biosynthesis. The present study demonstrates that different pathophysiology is associated with differential gene profiling in hyperparathyroidism. Several pathways are involved in parathyroid dysregulation and may be future targets for therapeutic intervention.
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Affiliation(s)
- Fang Lee
- Department of Surgery, MacKay Memorial Hospital and MacKay Medical College, Taipei 10449, Taiwan, R.O.C
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and MacKay Medical College, Taipei 10449, Taiwan, R.O.C.; Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Tapei 11260, Taiwan, R.O.C.; Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Woan-Ching Jan
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Tapei 11260, Taiwan, R.O.C
| | - Chih-Jen Wu
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; Department of Nephrology, MacKay Memorial Hospital and Mackay Medical College, Taipei 10449, Taiwan, R.O.C
| | - Han-Hsiang Chen
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; Department of Nephrology, MacKay Memorial Hospital and Mackay Medical College, Taipei 10449, Taiwan, R.O.C
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and MacKay Medical College, Taipei 10449, Taiwan, R.O.C.; Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
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Angiogenesis in primary hyperparathyroidism. Ann Diagn Pathol 2015; 19:91-8. [DOI: 10.1016/j.anndiagpath.2015.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 12/03/2014] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
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14
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Segiet OA, Deska M, Michalski M, Gawrychowski J, Wojnicz R. Molecular profiling in primary hyperparathyroidism. Head Neck 2014; 37:299-307. [DOI: 10.1002/hed.23656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 12/19/2022] Open
Affiliation(s)
- Oliwia Anna Segiet
- Department of Histology and Embryology, Zabrze; Medical University of Silesia; Katowice Poland
| | - Mariusz Deska
- Chair and Clinical Department of General Surgery, Bytom; Medical University of Silesia; Katowice Poland
| | - Marek Michalski
- Department of Histology and Embryology, Zabrze; Medical University of Silesia; Katowice Poland
| | - Jacek Gawrychowski
- Chair and Clinical Department of General Surgery, Bytom; Medical University of Silesia; Katowice Poland
| | - Romuald Wojnicz
- Department of Histology and Embryology, Zabrze; Medical University of Silesia; Katowice Poland
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15
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The parathyroid glands. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sulaiman L, Nilsson IL, Juhlin CC, Haglund F, Höög A, Larsson C, Hashemi J. Genetic characterization of large parathyroid adenomas. Endocr Relat Cancer 2012; 19:389-407. [PMID: 22454399 PMCID: PMC3359501 DOI: 10.1530/erc-11-0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, we genetically characterized parathyroid adenomas with large glandular weights, for which independent observations suggest pronounced clinical manifestations. Large parathyroid adenomas (LPTAs) were defined as the 5% largest sporadic parathyroid adenomas identified among the 590 cases operated in our institution during 2005-2009. The LPTA group showed a higher relative number of male cases and significantly higher levels of total plasma and ionized serum calcium (P<0.001). Further analysis of 21 LPTAs revealed low MIB1 proliferation index (0.1-1.5%), MEN1 mutations in five cases, and one HRPT2 (CDC73) mutation. Total or partial loss of parafibromin expression was observed in ten tumors, two of which also showed loss of APC expression. Using array CGH, we demonstrated recurrent copy number alterations most frequently involving loss in 1p (29%), gain in 5 (38%), and loss in 11q (33%). Totally, 21 minimal overlapping regions were defined for losses in 1p, 7q, 9p, 11, and 15q and gains in 3q, 5, 7p, 8p, 16q, 17p, and 19q. In addition, 12 tumors showed gross alterations of entire or almost entire chromosomes most frequently gain of 5 and loss of chromosome 11. While gain of 5 was the most frequent alteration observed in LPTAs, it was only detected in a small proportion (4/58 cases, 7%) of parathyroid adenomas. A significant positive correlation was observed between parathyroid hormone level and total copy number gain (r=0.48, P=0.031). These results support that LPTAs represent a group of patients with pronounced parathyroid hyperfunction and associated with specific genomic features.
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Affiliation(s)
- Luqman Sulaiman
- Medical Genetics Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital CMM L8:01SE-171 76, StockholmSweden
- Center for Molecular MedicineKarolinska University HospitalStockholmSweden
| | - Inga-Lena Nilsson
- Endocrine Surgery Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital P9:03SE-171 76, StockholmSweden
| | - C Christofer Juhlin
- Medical Genetics Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital CMM L8:01SE-171 76, StockholmSweden
- Center for Molecular MedicineKarolinska University HospitalStockholmSweden
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital P1:02SE-171 76, StockholmSweden
| | - Felix Haglund
- Medical Genetics Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital CMM L8:01SE-171 76, StockholmSweden
- Center for Molecular MedicineKarolinska University HospitalStockholmSweden
| | - Anders Höög
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital P1:02SE-171 76, StockholmSweden
| | - Catharina Larsson
- Medical Genetics Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital CMM L8:01SE-171 76, StockholmSweden
- Center for Molecular MedicineKarolinska University HospitalStockholmSweden
- (Correspondence should be addressed to C Larsson at Medical Genetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital CMM L8:01; )
| | - Jamileh Hashemi
- Medical Genetics Unit, Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital CMM L8:01SE-171 76, StockholmSweden
- Center for Molecular MedicineKarolinska University HospitalStockholmSweden
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Abstract
Primary hyperparathyroidism (HPT) results from the excessive secretion of parathyroid hormone from parathyroid tumours. While most HPT is sporadic, it is associated with a familial syndrome in a minority of cases. The study of these syndromes has helped define the pathophysiology of both familial and sporadic parathyroid neoplasms. Investigation of kindred with multiple endocrine neoplasia type 1 (MEN1) and the hyperparathyroidism-jaw tumour syndrome (HPT-JT) led to the discovery of the tumour suppressor genes MEN1 and HRPT2. We now recognise that somatic mutations in MEN1 and HRPT2 tumour suppressor genes are frequent events in sporadic parathyroid adenomas and carcinomas, respectively. Parathyroid tumours in the MEN2A syndrome result from mutational activation of the RET oncogene. The CCND1/PRAD1 oncogene was discovered by analysis of sporadic parathyroid tumours. Studies of familial isolated HPT and analysis of chromosomal loss and gain in parathyroid tumours suggest that other genes relevant to parathyroid neoplasia await identification.
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Affiliation(s)
- John M Sharretts
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 10 Room 8C-101, 10 Center Dr. MSC 1752 Bethesda, MD 20892-1752, USA.
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19
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Abstract
Thyroid and parathyroid diseases are fairly common and can be either hereditary or sporadic in nature. Tumors and tumor-like processes account for the majority of surgical pathology specimens in both of these endocrine organs. Molecular alterations are well known to occur in both the hereditary and the sporadic settings, and include alterations in tumor suppressor genes and oncogenes. The genetic pathways of tumors of parathyroid and thyroid are beginning to be well understood and are proving to be useful diagnostic, prognostic, and potential therapeutic targets. The molecular alterations in parathyroid and thyroid tumors and tumor-like processes are reviewed, with a focus on the potentially clinically useful diagnostic markers.
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20
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Doherty GM, Lairmore TC, DeBenedetti MK. Multiple endocrine neoplasia type 1 parathyroid adenoma development over time. World J Surg 2005; 28:1139-42. [PMID: 15490065 DOI: 10.1007/s00268-004-7560-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Multiple gland parathyroid disease is one of the hallmarks of multiple endocrine neoplasia (MEN) type 1. Often mislabeled parathyroid hyperplasia, the process is actually the development of multiple adenomas. Some clinicians have reported results of selective parathyroidectomy in this group, removing only grossly enlarged glands. We argue that all the glands are at risk and should be addressed at any planned parathyroid intervention. Our hypothesis is that, given sufficient time, patients would all develop adenomas in each of the parathyroid glands. Our available data to address this issue are the parathyroidectomy results from a single institution series. Patients who had initial parathyroid exploration for hyperparathyroidism in the setting of MEN-1 were reviewed. This study includes those patients who had the weights of the resected glands documented; 23 men and 21 women met the criteria. The total weight of the parathyroid glands did not vary with the age of the patient at operation. However, the number of normal glands identified did vary significantly with age (p < 0.02), with older patients being less likely to have any normal parathyroid glands. Although total parathyroid weight may correlate with development of hypercalcemia and indications for operation, the involvement of multiple parathyroid glands in MEN-1 is a function of time, as independent events in each gland must occur. Given time, MEN-1 patients all develop multiple gland disease, and this reality must be used in planning operative management for patients with this syndrome.
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Affiliation(s)
- Gerard M Doherty
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109-0331, USA.
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21
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Scarpelli D, D'Aloiso L, Arturi F, Scillitani A, Presta I, Bisceglia M, Cristofaro C, Russo D, Filetti S. Novel somatic MEN1 gene alterations in sporadic primary hyperparathyroidism and correlation with clinical characteristics. J Endocrinol Invest 2004; 27:1015-21. [PMID: 15754732 DOI: 10.1007/bf03345303] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Primary hyperparathyroidism (pHPT) is a common endocrine disease that in more than 95% of cases is sporadic and only in some cases is caused by inherited disorders, isolated or as part of multiple endocrine neoplasia (MEN1 and 2). Somatic mutations of MEN1 gene have also been described in sporadic parathyroid tumors. In our study, we examined the presence of alterations in MEN1 gene in a series of 39 patients who had undergone surgery for sporadic pHPT (35 with parathyroid adenoma or hyperplasia, 4 with a carcinoma). A genotype-phenotype correlation was also analysed. After DNA extraction from paraffin-embedded tissues, we amplified by PCR and sequenced the exons 2-10 of the MEN1 gene. Somatic MEN1 mutations were detected in 6 of the 35 patients with a benign parathyroid lesion examined (17.1%), whereas no alterations were found in the carcinomas. Four novel MEN1 gene mutations were identified as follows: one frameshift mutation (222insT, exon 2), one frameshift deletion (912delTA, exon 5), one in-frame deletion (835del18, exon 4) and one missense mutation (P291A, exon 6). In addition, one missense mutation (L89R, exon 2) and one nonsense mutation (Q536X, exon 10) were previously reported. Moreover, two polymorphisms were also found: one allele carried a R171Q polymorphism (1/39 tumors), while a D418D polymorphism (GAC/GAT) was found in 15 and 8 tumors in hetero (CT) and homozygosity (TT), respectively. In no case (mutations and/or polymorphisms) did we find a genotype-phenotype correlation. In conclusion, our data demonstrate the presence of somatic alterations of the MEN1 tumor suppressor gene in about one fifth of benign sporadic parathyroid tumors. The absence of a genotype-phenotype correlation, however, suggests the involvement of other genetic/epigenetic factors for the full expression of the disease.
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Affiliation(s)
- D Scarpelli
- Department of Clinical and Experimental Medicine G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Milas M, Wagner K, Easley KA, Siperstein A, Weber CJ. Double adenomas revisited: nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease). Surgery 2004; 134:995-1003; discussion 1003-4. [PMID: 14668733 DOI: 10.1016/j.surg.2003.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A double adenoma (DA) is a recognized clinical entity of primary hyperparathyroidism (HPT) and is presumed to have uniform location distribution. We reviewed our experience with 2-gland parathyroid disease to identify anatomic patterns and implications for surgical management. METHODS Clinical characteristics were reviewed for 828 consecutive patients with HPT at 2 endocrine referral centers that practice bilateral neck exploration with intraoperative parathyroid hormone (IOPTH) measurement. RESULTS Fifteen percent (127 of 828) of HPT patients demonstrated 2 enlarged glands; 13% (107 of 828), 3- or 4-gland hyperplasia; and 71% (592 of 828), single adenomas. DAs in superior parathyroids affected 57 of 127 (45%) patients, an observed frequency 3-fold higher than expected (P<.001, chi-square test). DAs were larger than normal glands (240+/-575 mg vs 28+/-23 mg, P<.001), and superior parathyroid adenomas were larger than adenomas at other sites (421+/-983 mg vs 202+/-353 mg, P=.002). Technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH identified DAs correctly in only 5 of 84 (6%) and 19 of 75 (25%) of patients tested, respectively. CONCLUSIONS DAs have nonuniform anatomic distribution with predilection for abnormal growth in bilateral superior parathyroids-embryologic remnants of the fourth branchial pouch. Since additional abnormal glands were detected by observation with technetium 99 metastable (Tc99m)-sestamibi imaging and IOPTH rarely aiding detection, unilateral neck exploration may predispose to persistent or recurrent HPT.
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Affiliation(s)
- Mira Milas
- Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue/A80, Cleveland, OH 44195, USA
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Abstract
PURPOSE OF REVIEW This contribution presents research progress concerning primary hyperparathyroidism (pHPT), and the background for recent notable changes in treatment policy. RECENT FINDINGS Research has clarified that most patients with pHPT require surgery due to risk for osteoporosis, renal stones, and possibly silent complications of renal impairment, cardiovascular disease, and common psychiatric disability. Genetic studies have advanced, but the cause of the disease remains unclear for most patients. Localization methods for parathyroid tumors have improved and increased the interest for less invasive operative methods with shorter hospital stays and reduced costs for the patient. It is important to delineate when this really will imply progress and to use the new diagnostic methods in discussions of appropriate treatment strategies. It has also become evident that older pHPT patients especially could benefit from medical treatment of bone mineral deficit, and they may also need vitamin D or vitamin D analogues to prevent progress of the disease. SUMMARY pHPT is a common disorder among postmenopausal women, in whom most commonly applied surgical treatment has proven markedly efficient. There is now increased interest to better understand possible causes of the disease and schedule the most efficient surgical and medical treatment and discuss possible prophylaxis.
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Affiliation(s)
- Göran Akerström
- Department of Surgery, University Hospital, Uppsala, Sweden.
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Broughan TA. Review of parathyroid surgery. CURRENT SURGERY 2003; 60:572-7. [PMID: 14972192 DOI: 10.1016/s0149-7944(03)00108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thomas A Broughan
- University of Oklahoma College of Medicine, Tulsa, Tulsa, Oklahoma, USA
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