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di Filippo L, Bilezikian JP, Canalis E, Terenzi U, Giustina A. New insights into the vitamin D/PTH axis in endocrine-driven metabolic bone diseases. Endocrine 2024; 85:1007-1019. [PMID: 38632163 DOI: 10.1007/s12020-024-03784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Endocrine regulation of bone metabolisms is the focus of the "Skeletal Endocrinology" series of meetings. AIMS To report on the outcome of the discussion on the role of vitamin D/PTH axis in endocrine osteopathies held during the 10th Skeletal Endocrinology Meeting which took place in Stresa (Italy) in March 2023. OUTCOMES Vitamin D/PTH axis has relevant influence on several outcomes in the general population and in patients affected by endocrinopathies such as hypoparathyroidism and secreting pituitary adenomas. CONCLUSIONS Assessing the status of the vitamin D/PTH axis and using vitamin D and PTH as therapeutic agents is mandatory in several endocrine-related bone metabolic conditions.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
| | - Ernesto Canalis
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA; Department of Medicine, UConn Health, Farmington, Connecticut, USA; UConn Musculoskeletal Institute, UConn Health, Farmington, CT, USA
| | - Umberto Terenzi
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University and IRCCS San Raffaele Hospital, Milan, Italy.
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2
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Wu C, Gillis A, Lindeman B, Chen H, Fazendin J. Normocalcemic primary hyperparathyroidism: From pathophysiology to clinical management. Am J Surg 2024; 235:115812. [PMID: 39002253 DOI: 10.1016/j.amjsurg.2024.115812] [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: 03/27/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/15/2024]
Abstract
Normocalcemic primary hyperparathyroidism (NPHPT), a variant of primary hyperparathyroidism (PHPT) characterized by persistently elevated parathyroid hormone (PTH) levels and normal serum calcium, has gained recognition as a substantial subset of PHPT cases. Despite its increasing prevalence, the precise pathophysiology and natural progression of NPHPT remain enigmatic. This in-depth literature review explores recent advancements in our understanding of NPHPT, encompassing pathophysiology, clinical presentation, diagnostic approaches, medical and surgical management options. By synthesizing this wealth of information, this review aims to contribute to a more nuanced and informed approach to the treatment of patients grappling with NPHPT. As our understanding of the condition continues to evolve, the knowledge gathered from this review has the potential to significantly enhance the quality of care and outcomes for individuals afflicted with NPHPT, ultimately improving their overall well-being and prognosis.
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Affiliation(s)
- Christopher Wu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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3
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Poiană IR, Dobre R, Pițuru SM, Bucur A. The Value of Mandibular Indices on Cone Beam Computed Tomography in Secondary Causes of Low Bone Mass. J Clin Med 2024; 13:4854. [PMID: 39200996 PMCID: PMC11355527 DOI: 10.3390/jcm13164854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)-thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)-thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)-thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)-thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity.
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Affiliation(s)
- Ioana Ruxandra Poiană
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.-M.P.); (A.B.)
| | - Ramona Dobre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
| | - Silviu-Mirel Pițuru
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.-M.P.); (A.B.)
| | - Alexandru Bucur
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.-M.P.); (A.B.)
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Cieślewicz M, Andryszak N, Pełka K, Szczepanek-Parulska E, Ruchała M, Kunikowska J, Czepczyński R. Parathyroid Adenoma Detected in 68Ga-PSMA PET/CT but Not in the Dedicated Imaging Modalities. Diagnostics (Basel) 2024; 14:1690. [PMID: 39125566 PMCID: PMC11312185 DOI: 10.3390/diagnostics14151690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disorder characterised by excessive parathormone secretion that results in hypercalcemia, primarily caused by parathyroid adenoma. Accurate localisation of hyperfunctioning tissue is essential for curative surgical treatment. Although conventional imaging modalities like ultrasonography and 99mTc-MIBI scintigraphy (SPECT) along with 18F-fluorocholine PET/CT are commonly employed, there are cases with false-negative imaging results. CASE PRESENTATION This case report presents a patient with primary hyperparathyroidism and a parathyroid adenoma detected solely through 68Ga-PSMA-11 PET/CT, typically used for prostate cancer diagnosis. The lesion observed in the PET/CT was confirmed as a parathyroid adenoma through laboratory evaluation, while other imaging techniques failed to detect it. CONCLUSIONS This finding suggests that the PSMA ligands' particular affinity for neovascularisation in focal changes may facilitate the visualisation of parathyroid adenomas. The utilisation of 68Ga-PSMA-11 PET/CT in primary hyperparathyroidism could potentially improve the preoperative localization of parathyroid adenomas when conventional imaging methods are inconclusive.
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Affiliation(s)
- Maja Cieślewicz
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland (M.R.)
| | - Natalia Andryszak
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland (M.R.)
- Department of Nuclear Medicine, Affidea Poznan, 61-485 Poznan, Poland
| | - Kacper Pełka
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland (M.R.)
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland (M.R.)
| | - Jolanta Kunikowska
- Department of Nuclear Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland (M.R.)
- Department of Nuclear Medicine, Affidea Poznan, 61-485 Poznan, Poland
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5
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Salmon MK, Fritz CG, Barrette LX, Romeo D, Suresh NV, Ng JJ, Balar E, Prasad A, Moreira A, Rajasekaran K. Quality appraisal of clinical practice guidelines for the evaluation and management of primary hyperparathyroidism. Endocrine 2024; 85:864-872. [PMID: 38551756 PMCID: PMC11291579 DOI: 10.1007/s12020-024-03790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/17/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Multiple groups have created clinical practice guidelines (CPGs) for the management of primary hyperparathyroidism (PHPT). This report provides a rigorous quality assessment using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) to identify high-performing guidelines and areas for improvement. METHODS A systematic review was conducted to isolate CPGs addressing the management of PHPT. Guideline data was extracted and quality ratings were assigned by four independent reviewers. Intraclass correlation coefficients (ICC) were calculated to ensure interrater reliability. RESULTS Twelve guidelines were assessed. The American Association of Endocrine Surgeons (AAES) guideline had the highest mean scaled score across all domains (73.6 ± 31.4%). No other published guideline achieved a "high" quality designation. The highest scoring domain was "clarity of presentation" (mean 60.5 ± 26.5%). The lowest scoring domain was "applicability" (mean 19.8 ± 18.2%). Scoring reliability was excellent, with ICC ≥ 0.89 for all AGREE II 6 domains. CONCLUSION Although several working groups have developed guidelines to address PHPT management, only those published by the AAES meet all methodologic quality criteria necessary to ensure incorporation of recommendations into clinical practice. Future guidelines would benefit from the development of tools, resources, monitoring criteria that enhance applicability.
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Affiliation(s)
- Mandy K Salmon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Christian G Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Louis-Xavier Barrette
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Dominic Romeo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Neeraj V Suresh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jinggang J Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Eesha Balar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Aman Prasad
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Zhang Y, Wu H, Yang A, Y H Ng N, Zhang X, Lau ESH, Chow EWK, Kong APS, Chow EYK, Chan JCN, Luk AOY, Ma RCW. Higher risk of incident diabetes among patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2024. [PMID: 39038182 DOI: 10.1111/cen.15118] [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: 11/04/2023] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES There is relatively scarce data regarding the association between primary hyperparathyroidism (PHPT) and incident diabetes in large population-based longitudinal studies. We aimed to evaluate the risk of incident diabetes in individuals with and without PHPT and investigate the association between serum calcium concentrations and the risk of incident diabetes in patients with PHPT. METHODS We included 2749 PHPT patients and 13,745 age, sex and index year matched non-PHPT individuals during 2000-2019. We used Cox regression models to compare the risk of incident diabetes in individuals with and without PHPT, and the risk of incident diabetes in PHPT patients with serum calcium concentration above and below the median value. The association between serum calcium concentrations and the risk of incident diabetes was examined by restricted cubic spline analyses in patients with PHPT. RESULTS During a median follow-up time of 5.17 years (IQR 2.17, 9.58), 433 patients (15.75%) with PHPT and 2110 individuals (15.35%) without PHPT developed diabetes, respectively. Patients with PHPT had a higher incidence rate of diabetes compared to non-PHPT individuals (27.60 [95% CI 25.00, 30.30] vs. 23.90 [95% CI 22.80, 24.90] per 1000 person-years, log-rank test p = .007]. Crude Cox regression model showed PHPT was associated with a 15% higher risk of incident diabetes (HR 1.15, 95%CI 1.04, 1.28). In patients with PHPT, a 44% higher risk of incident diabetes was found in patients with serum calcium concentrations above the median value (2.63 mmol/L), compared to those below the median value (HR 1.44, 95%CI 1.08, 1.90). Restricted cubic spline analyses confirmed a positive linear association between serum calcium concentrations and the risk of incident diabetes in those with PHPT (p-value for nonlinear = .751) CONCLUSIONS: Patients with PHPT had a higher risk of incident diabetes compared to non-PHPT individuals. A positive linear association was found between serum calcium concentrations and the risk of incident diabetes in patients with PHPT.
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Affiliation(s)
- Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Noel Y H Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Xinge Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Edith W K Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Elaine Y K Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
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Tang J, Malshy K, Pareek G. Kidney Stone Risk in Normocalcemic Hyperparathyroidism before and after Parathyroid Surgery. Case Rep Endocrinol 2024; 2024:1252724. [PMID: 39055046 PMCID: PMC11272400 DOI: 10.1155/2024/1252724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/24/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
The higher risk for kidney stone in patients with primary hyperparathyroidism is well-documented; stone risk in patients with normocalcemic primary hyperparathyroidism (NPHPT) remains unclear. We present a case of recurrent calcium kidney stones in a patient with severe idiopathic hypercalciuria and NPHPT. The surgical resection of the parathyroid adenoma failed to reduce kidney stone risk (based on the 24-hr urine study) and kidney stone burden (based on ultrasound). This unique case examines the impact of surgical resection of an ectopic parathyroid adenoma on stone risk in a patient with NPHPT and recurrent calcium kidney stones.
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Affiliation(s)
- Jie Tang
- Division of Kidney Diseases and HypertensionAlpert Medical School of Brown University, Providence, RI, USA
| | - Kamil Malshy
- Division of UrologyAlpert Medical School of Brown University, Providence, RI, USA
| | - Gyan Pareek
- Division of UrologyAlpert Medical School of Brown University, Providence, RI, USA
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8
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Koh NYY, Miszkiewicz JJ, Fac ML, Wee NKY, Sims NA. Preclinical Rodent Models for Human Bone Disease, Including a Focus on Cortical Bone. Endocr Rev 2024; 45:493-520. [PMID: 38315213 PMCID: PMC11244217 DOI: 10.1210/endrev/bnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/22/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
Preclinical models (typically ovariectomized rats and genetically altered mice) have underpinned much of what we know about skeletal biology. They have been pivotal for developing therapies for osteoporosis and monogenic skeletal conditions, including osteogenesis imperfecta, achondroplasia, hypophosphatasia, and craniodysplasias. Further therapeutic advances, particularly to improve cortical strength, require improved understanding and more rigorous use and reporting. We describe here how trabecular and cortical bone structure develop, are maintained, and degenerate with aging in mice, rats, and humans, and how cortical bone structure is changed in some preclinical models of endocrine conditions (eg, postmenopausal osteoporosis, chronic kidney disease, hyperparathyroidism, diabetes). We provide examples of preclinical models used to identify and test current therapies for osteoporosis, and discuss common concerns raised when comparing rodent preclinical models to the human skeleton. We focus especially on cortical bone, because it differs between small and larger mammals in its organizational structure. We discuss mechanisms common to mouse and human controlling cortical bone strength and structure, including recent examples revealing genetic contributors to cortical porosity and osteocyte network configurations during growth, maturity, and aging. We conclude with guidelines for clear reporting on mouse models with a goal for better consistency in the use and interpretation of these models.
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Affiliation(s)
- Natalie Y Y Koh
- Bone Cell Biology & Disease Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC 3065, Australia
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia
| | - Justyna J Miszkiewicz
- School of Social Science, The University of Queensland, Brisbane, QLD 4072, Australia
- Vertebrate Evolution Development and Ecology, Naturalis Biodiversity Center, 2333 CR Leiden, The Netherlands
| | - Mary Louise Fac
- Bone Cell Biology & Disease Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC 3065, Australia
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia
| | - Natalie K Y Wee
- Bone Cell Biology & Disease Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC 3065, Australia
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia
| | - Natalie A Sims
- Bone Cell Biology & Disease Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC 3065, Australia
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia
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Caraway J, Ryan M, Yang A, Watson N, Allard R, Orestes M. PHQ-9 and GAD-7 Score Response After Parathyroidectomy for Primary Hyperparathyroidism: a Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 171:11-22. [PMID: 38415869 DOI: 10.1002/ohn.698] [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: 11/03/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Currently, the relationship between parathyroidectomy and objective neuropsychiatric outcomes are not clearly defined. The purpose of this study is to perform the first ever Meta-analysis of preoperative and postoperative PHQ-9 and GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy with the goal of identifying a specific psychometric score that could be used as an indication for surgical intervention. DATA SOURCES A comprehensive search of the literature was performed using PubMed, Embase, PsycINFO, Web of Science, and Ovid All EBM Reviews. REVIEW METHODS Studies met inclusion criteria if they evaluated preoperative and postoperative PHQ-9 and/or GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy. Random effects Meta-analyses were used to analyze the compiled data. RESULTS The literature search returned 1433 articles for initial review of which 6 (1105 participants) met criteria for inclusion and Meta-analysis. Meta-analysis revealed that primary hyperparathyroidism patients had significantly higher presurgical PHQ-9 scores when compared to control groups. Additionally, patients experienced a statistically significant and sustained decrease in PHQ-9 scores following parathyroidectomy. Notably, there was a dramatic decrease in the percentage of patients with PHQ-9 scores ≥10 (considered clinically significant for depression) following parathyroidectomy. CONCLUSION Patients with primary hyperparathyroidism experience a statistically significant and sustained improvement in PHQ-9 scores following parathyroidectomy. Additionally, symptoms of anxiety and suicidal ideation appear to decrease after parathyroidectomy. We propose that a PHQ-9 score ≥10 could potentially be used as an indication for parathyroidectomy in patients with asymptomatic primary hyperparathyroidism.
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Affiliation(s)
- John Caraway
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Matthew Ryan
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Alex Yang
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Nora Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rhonda Allard
- James A. Zimble Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Michael Orestes
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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10
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Abdul Khaleq SM, Nwayyir HA, Mansour AA. Outcome of Primary Hyperparathyroidism: Retrospective Tertiary Center Experience From Basrah, Iraq. Cureus 2024; 16:e65901. [PMID: 39219874 PMCID: PMC11364918 DOI: 10.7759/cureus.65901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Primary hyperparathyroidism is regarded as a common endocrine disorder that is biochemically identified and could be symptomatic or asymptomatic. A detailed history and a thorough evaluation with regular follow-ups are required until a definite diagnosis is made. The study aims to evaluate the characteristics of patients and the performance of a tertiary endocrine center in managing the disease in Basrah, Iraq. MATERIAL AND METHODS A retrospective study was conducted at the Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basrah, southern Iraq, on 106 patients diagnosed with primary hyperparathyroidism between 2012 and 2023. The patients' general characteristics were assessed, and those who underwent parathyroidectomy were evaluated post-surgery, and the cure rate was determined. RESULTS The mean age of presentation was 47.5 ± 14.6 years, with a median of 50 years. The highest occurrence is in the sixth decade. Females comprised 79 (75%) of the patients, and the female-to-male ratio was 3:1. Symptomatic patients were 84 (90%), 30 (70%) of the patients had nephrolithiasis, and 52 (68%) had osteoporosis. The cure rate was 15 (83%). CONCLUSION In our single-center study, the frequency of primary hyperparathyroidism has increased with time. The disease's highest occurrence was seen in the sixth decade. Females were substantially higher than males. Most patients were symptomatic. The cure rate was 83%.
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Affiliation(s)
- Suha M Abdul Khaleq
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) University of Basrah, Basrah, IRQ
| | - Hussein A Nwayyir
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) University of Basrah, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) University of Basrah, Basrah, IRQ
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Kim KJ, Baek S, Yu MH, Shin S, Cho S, Rhee Y, Hong N. Secular trends in the incidence and treatment patterns of primary hyperparathyroidism in Korea: a nationwide cohort study. JBMR Plus 2024; 8:ziae065. [PMID: 38868595 PMCID: PMC11166891 DOI: 10.1093/jbmrpl/ziae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Data on epidemiology and secular trend in primary hyperparathyroidism (PHPT) in adults are relatively limited in Asian countries. This study aims to provide an overview of the secular trends in incidence, clinical characteristics, and treatment patterns of PHPT in South Korea. We used Korea's National Health Insurance Claim database (2005-2020) to identify newly diagnosed PHPT cases. Individuals with age below 19, fewer than 2 E21.0 diagnoses, fewer than 2 PTH measurements, secondary hyperparathyroidism, undergoing dialysis or kidney transplantation within a year of diagnosis, parathyroidectomy (PTX) within a year prior to the diagnosis code, and diagnosis of multiple endocrine neoplasm or parathyroid carcinoma were excluded from the analysis. A total of 6837 patients with PHPT (PTX, n = 2989; non-surgery, n = 3848) were compared with 1:10 age- and sex-matched controls (n = 68 370). The mean age of patients with PHPT was 56.0 years, with 77.4% being women. The annual incidence of PHPT increased from 0.23/100 000 persons in 2005 to 1.75 in 2020, with higher rate in women than in men. Compared with 2005-2010 (n = 675), the number of newly diagnosed PHPT cases increased up to 3.1-fold (n = 2119) in 2011-2015 and 6.0-fold (n = 4043) in 2016-2020 periods. Among all patients with PHPT, 43.7% of patients underwent PTX, with decrement of proportion of bilateral surgery among PTX group across time (11.9% in 2005-2010 to 8.9% in 2016-2020, P for trend .033). Among all patients with PHPT, non-surgery group increased from 41.6% in 2005-2010 to 58.0% in 2016-2020 (P for trend <.001). Patients with PHPT had higher odds of osteoporosis (odds ratio [OR] 7.03), renal stones (OR 10.55), chronic kidney diseases (OR 7.42), and cardiovascular, metabolic, and neurological conditions after adjustment for comorbidity index. In summary, the incidence of PHPT increased from 2005 to 2020 with predominance of non-surgical treatment, which calls for research focus on improving non-surgical management.
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Affiliation(s)
- Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Seungjin Baek
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Min Heui Yu
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sungjae Shin
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Sungjoon Cho
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul 03722, South Korea
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Charoenngam N, Rittiphairoj T, Wannaphut C, Pangkanon W, Saowapa S. Risk of Malignant Neoplasm in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Calcif Tissue Int 2024; 115:1-13. [PMID: 38772934 PMCID: PMC11153283 DOI: 10.1007/s00223-024-01219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024]
Abstract
This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved from PubMed and Embase databases from inception to November 2023 using search strategy consisting of terms for "Primary hyperparathyroidism" and "Malignant neoplasm". Eligible study must report prevalence of malignant neoplasm among patients with PHPT or compare the risk of malignant neoplasm between patients with PHPT and comparators. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method.A total of 11,926 articles were identified. After two rounds of systematic review, 50 studies were included. The meta-analysis revealed that pooled prevalence rates of overall cancer was 0.19 (95%CI: 0.13-0.25; I2 94%). The two most prevalent types of malignancy among patients with PHPT ware papillary thyroid cancer (pooled prevalence: 0.07; 95%CI: 0.06-0.08; I2 85%) and breast cancer (pooled prevalence: 0.05; 95%CI: 0.03-0.07; I2 87%). Subgroup analysis of studies focusing on patients undergoing parathyroidectomy reported a fourfold higher prevalence of papillary thyroid cancer than the remaining studies (0.08 versus 0.02). The meta-analysis of cohort studies found a significant association between PHPT and overall cancer with the pooled risk ratio of 1.28 (95%CI: 1.23-1.33; I2 66.9%).We found that the pooled prevalence of malignant neoplasm in PHPT was 19%, with papillary thyroid cancer and breast cancer being the most prevalent types. The meta-analysis of cohort studies showed that patient with PHPT carried an approximately 28% increased risk of malignancy.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Harvard Medical School, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, 02138, USA.
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Thanitsara Rittiphairoj
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Health Systems Management, Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chalothorn Wannaphut
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Watsachon Pangkanon
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sakditat Saowapa
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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13
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Lupiáñez Seoane P, Muñoz Negro JE, Torres Parejo U, Gómez Jiménez FJ. [Predictive model and discriminant analysis of the development of dementia in patients with delirium in the emergency department]. Semergen 2024; 50:102283. [PMID: 38936098 DOI: 10.1016/j.semerg.2024.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The main aim of our study is to know the sociodemographic, clinical, analytical, and functional variables that predict the probability of developing dementia in patients with delirium who attend the emergency room. METHOD All patients with delirium (n=45) from the emergency room who were admitted to the Geriatrics service of the General University Hospital of Ciudad Real (HGUCR) in 2016-2018 and met the inclusion and exclusion criteria were included. Subsequently, we ran a bivariate and multivariate analysis of the variables that predicted a diagnosis of dementia at six months and a discriminant analysis. RESULTS 15.6% of patients presented dementia at six months of follow-up, 22.2% had developed cognitive impairment. We conducted a multivariate model (R2 Nagelkerke 0.459) for the probability of developing dementia, with elevated heart rate being the most crucial variable (OR=11.5). The model could excluded dementia with 100% accuracy. Finally, we achieved a discriminant function capable of correctly classifying 95.6% of the cases. It included the following variables of influence: pH, Lawton Brody index, calcium, urea, and heart rate. CONCLUSIONS A few clinical and analytical variables that are easily detectable in the emergency room, especially tachycardia, could help us better identify those patients with delirium at higher risk of developing dementia, as well as formulate hypotheses about the variables involved in the development of dementia in patients with delirium.
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Affiliation(s)
- P Lupiáñez Seoane
- Área de Urgencias, Hospital Universitario Virgen de las Nieves, Servicio Andaluz de Salud, Granada, España
| | - J E Muñoz Negro
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, España.
| | - U Torres Parejo
- Departamento de Estadística e Investigación Operativa, Facultad de Ciencias, Universidad de Granada, Granada, España
| | - F J Gómez Jiménez
- Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, España
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14
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Shan H, Jiang Z, Xu J, Li J, Zhu X. Ectopic parathyroid adenoma on sternocleidomastoid muscle: a case report. Front Oncol 2024; 14:1410057. [PMID: 38957316 PMCID: PMC11217165 DOI: 10.3389/fonc.2024.1410057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
A 54-year-old woman was admitted to the hospital with a left neck mass. Enhanced CT and ultrasound examinations revealed a lesion in the left sternocleidomastoid muscle. The patient undergone right thyroid lobe resection 8 years ago. Interestingly, the lesion on the sternocleidomastoid muscle, along with the left lobe of the patient's thyroid, visually appears to form a displaced and complete thyroid in the early Tc-99m-MIBI parathyroid scintigraphy. Combined with Tc-99m-MIBI scintigraphy and abnormal PTH and blood calcium levels, the consideration was given to the lesion in the sternocleidomastoid muscle as an ectopic parathyroid adenoma. Subsequent surgical pathology confirmed this suspicion.
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Affiliation(s)
- HuiMin Shan
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - ZhenPeng Jiang
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Jin Xu
- Department of Pathology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - JingFa Li
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - XuSheng Zhu
- Department of Nuclear Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Milanković V, Tasić T, Leskovac A, Petrović S, Mitić M, Lazarević-Pašti T, Novković M, Potkonjak N. Metals on the Menu-Analyzing the Presence, Importance, and Consequences. Foods 2024; 13:1890. [PMID: 38928831 PMCID: PMC11203375 DOI: 10.3390/foods13121890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Metals are integral components of the natural environment, and their presence in the food supply is inevitable and complex. While essential metals such as sodium, potassium, magnesium, calcium, iron, zinc, and copper are crucial for various physiological functions and must be consumed through the diet, others, like lead, mercury, and cadmium, are toxic even at low concentrations and pose serious health risks. This study comprehensively analyzes the presence, importance, and consequences of metals in the food chain. We explore the pathways through which metals enter the food supply, their distribution across different food types, and the associated health implications. By examining current regulatory standards for maximum allowable levels of various metals, we highlight the importance of ensuring food safety and protecting public health. Furthermore, this research underscores the need for continuous monitoring and management of metal content in food, especially as global agricultural and food production practices evolve. Our findings aim to inform dietary recommendations, food fortification strategies, and regulatory policies, ultimately contributing to safer and more nutritionally balanced diets.
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Affiliation(s)
- Vedran Milanković
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Tamara Tasić
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Andreja Leskovac
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Sandra Petrović
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Miloš Mitić
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Tamara Lazarević-Pašti
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
| | - Mirjana Novković
- Group for Muscle Cellular and Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444a, 11000 Belgrade, Serbia;
| | - Nebojša Potkonjak
- VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11000 Belgrade, Serbia; (V.M.); (T.T.); (A.L.); (S.P.); (M.M.); (T.L.-P.)
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16
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van Mossel S, Saing S, Appelman-Dijkstra N, Quak E, Schepers A, Smit F, de Geus-Oei LF, Vriens D. Cost-effectiveness of one-stop-shop [ 18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06771-1. [PMID: 38837058 DOI: 10.1007/s00259-024-06771-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE We conducted a cost-effectiveness analysis in which we compared a preoperative [18F]Fluorocholine PET/CT-based one-stop-shop imaging strategy with current best practice in which [18F]Fluorocholine PET/CT is only recommended after negative or inconclusive [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT for patients suffering from primary hyperparathyroidism. We investigated whether the one-stop-shop strategy performs as well as current best practice but at lower costs. METHODS We developed a cohort-level state transition model to evaluate both imaging strategies respecting an intraoperative parathyroid hormone monitored treatment setting as well as a traditional treatment setting. The model reflects patients' hospital journeys after biochemically diagnosed primary hyperparathyroidism. A cycle length of twelve months and a lifetime horizon were used. We conducted probabilistic analyses simulating 50,000 cohorts to assess joint parameter uncertainty. The incremental net monetary benefit and cost for each quality-adjusted life year were estimated. Furthermore, threshold analyses regarding the tariff of [18F]Fluorocholine PET/CT and the sensitivity of [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT were performed. RESULTS The simulated long-term health effects and costs were similar for both imaging strategies. Accordingly, there was no incremental net monetary benefit and the one-stop-shop strategy did not result in lower costs. These results applied to both treatment settings. The threshold analysis indicated that a tariff of €885 for [18F]Fluorocholine PET/CT was required to be cost-effective compared to current best practice. CONCLUSION Both preoperative imaging strategies can be used interchangeably. Daily clinical practice grounds such as available local resources and patient preferences should inform policy-making on whether a hospital should implement the one-stop-shop imaging strategy.
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Affiliation(s)
- Sietse van Mossel
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| | - Sopany Saing
- Faculty of Behavioural Management and Social Sciences, Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Natasha Appelman-Dijkstra
- Department of Internal Medicine, Division Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
- Centre for Bone Quality Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - Elske Quak
- Department of Nuclear Medicine, Centre François Baclesse, Caen, France
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frits Smit
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiology, Section Nuclear Medicine, Alrijne Medical Centre, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Radiation Sciences and Technology, Delft University of Technology, Delft, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Centre for Bone Quality Leiden, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Gossili F, Gauduseviciene S, Erentaite D, Iversen P, Almasi CE. Preoperative localization of water clear cell giant parathyroid adenoma: A case report. Radiol Case Rep 2024; 19:2492-2497. [PMID: 38585408 PMCID: PMC10997805 DOI: 10.1016/j.radcr.2024.03.026] [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: 01/23/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Primary hyperparathyroidism commonly results from a solitary parathyroid adenoma. A water clear cell parathyroid adenoma represents a rare histological variant. This report presents the challenges of preoperative detection of a giant parathyroid adenoma, which was of the water clear cell variant. A case of severe hypercalcemia in a patient without clinical symptoms and equivocal findings on standard imaging modalities, in which the use of [11C]C-Methionine PET/CT facilitated the preoperative detection of a giant parathyroid adenoma. Histopathological examination confirmed the diagnosis of a water clear cell giant parathyroid adenoma following surgical excision. These findings highlight the significance of advanced imaging techniques in the detection and management of a rare form of parathyroid adenoma.
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Affiliation(s)
- Farid Gossili
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Physiology, Viborg Regional Hospital, Viborg, Denmark
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Simona Gauduseviciene
- Department of Clinical Medicine, Aalborg University Hospital Thisted, Thisted, Denmark
| | - Daiva Erentaite
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte E. Almasi
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
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18
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Castellano E, Attanasio R, Boriano A, Gianotti L, Borretta G. Calcium/phosphate ratio: an additional tool for the clinical management of asymptomatic primary hyperparathyroidism? J Endocrinol Invest 2024; 47:1505-1511. [PMID: 38129742 DOI: 10.1007/s40618-023-02260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Serum calcium/phosphate ratio (Ca/P) has been recently proposed as an additional tool to identify primary hyperparathyroidism (PHPT), especially in patients with subclinical presentation, with a proposed cut-off of 3.3 when both values are expressed in mg/dL. No data are available on the relationship between Ca/P and the clinical presentation of PHPT. We thus evaluated this relationship in a large, single-center, unselected series. METHODS 515 consecutive PHPT patients (mean age 65 ± 13.15 years, 77.1% females) were retrospectively evaluated at diagnosis. RESULTS Mean Ca/P was 4.54 ± 1.5 (range 2.36-13.9), being higher than 3.3 in 88.5% of patients. Ca/P was significantly higher in (1) males, (2) symptomatic PHPT, (3) patients with 25-hydroxy vitamin D levels lower than 20 μg/L, (4) patients with osteitis fibrosa cystica, (5) patients with T score < - 2.5 at the radial site. In a multivariate regression analysis, Ca/P resulted significantly associated with PTH levels. After the exclusion of 57 patients with asymptomatic PHPT (aPHPT) patients and serum Ca higher than 1 mg/dL above the upper limit of normal range, no differences were found in Ca/P between aPHPT meeting or not surgical criteria. CONCLUSIONS In PHPT Ca/P ratio is associated with increased biochemical and clinical severity of disease and represents a direct indicator of clinical bone damage. However, it does not seem an additional tool to identify aPHPT patients reaching surgical indication.
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Affiliation(s)
- E Castellano
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy.
| | - R Attanasio
- Scientific Committee of the Italian Association of Clinical Endocrinologists, Milan, Italy
| | - A Boriano
- Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy
| | - L Gianotti
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - G Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
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19
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Harmantepe AT, Bas E, Akdeniz Y, Kucuk A, Bayhan Z, Kocer HB. A novel index to predict postoperative hypocalcemia in primary hyperparathyroidism. Ir J Med Sci 2024; 193:1261-1266. [PMID: 38253945 DOI: 10.1007/s11845-024-03613-9] [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: 07/13/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
BAKGROUND Vitamin D (Vit D) deficiency is common in patients with hyperparathyroidism, but the importance of replacement before surgery is controversial. It can be predicted that hypocalcemia risk will be higher in patients with high bone turnover. AIM In this study, the effect of preoperative ALP/Vit D ratio on postoperative hypocalcemia was investigated. METHODS Among the primary hyperparathyroidism cases who were operated between 2015 and 2022, 158 patients with complete data were included in the study. Preoperative laboratory results, radiological images, and pathology reports of the patients were evaluated retrospectively. The cross-sectional value of the ALP/Vit D value predicting hypocalcemia was calculated. The effect of these parameters on postoperative hypocalcemia was investigated. RESULTS The mean age of our patients was 54 (21-81 years). When factors affecting postoperative hypocalcemia were evaluated by univariable analysis, Vit D deficiency and insufficiency (p < 0.001), ALP (p < 0.001), ALP/Vit D ratio (p < 0.001), and T score (p = 0.026) found to be factors affecting postoperative hypocalcemia. In multivariate analysis, the ALP/Vit D ratio was found to be an independent variable in predicting hypocalcemia. It was found that hypocalcemia was 45 times more common in patients with ALP/Vit D > 6.34 (p < 0.001). ALP/Vit D ratio predicts patients who will develop postoperative hypocalcemia with 87.2% sensitivity and 87.1% specificity. CONCLUSIONS Vit D deficiency increases the risk of postoperative hypocalcemia, but it is not sufficient alone to predict it. The risk increases more in patients with high bone turnover. The preoperative ALP/Vit D ratio is the strongest predictor of postoperative hypocalcemia risk.
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Affiliation(s)
| | - Enes Bas
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Yesim Akdeniz
- Department of General Surgery, Bandirma Onyedi Eylul University Faculty of Medicine, Balikesir, Turkey
| | - Ali Kucuk
- Department of Surgical Oncology, Balikesir Ataturk City Hospital, Balikesir, Turkey
| | - Zulfu Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - Havva Belma Kocer
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Rikhotso RE, Khan F. Lytic brown tumour of the mandible as the initial presentation of hyperparathyroidism in a 7-year old girl: A case report. Int J Surg Case Rep 2024; 119:109735. [PMID: 38735218 PMCID: PMC11101889 DOI: 10.1016/j.ijscr.2024.109735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Maxillomandibular involvement with brown tumours is rare, especially in the paediatric population. We present a rare case of a young girl with brown tumour (BT) occurring in the mandible as the first manifestation of hyperparathyroidism. CASE PRESENTATION A 7-year-old black female, presented with a 6-month history of a swelling on the left mandible. Patient had a history of intractable gastrointestinal symptoms such as nausea, vomiting and abdominal cramps. Biopsy confirmed the lesion as a giant cell lesion. Elevated parathyroid hormone (PTH) levels confirmed the diagnosis of a BT of hyperparathyroidism. The patient underwent surgical intervention involving parathyroidectomy. This was followed by segmental resection of the mandibular tumour two years later. CLINICAL DISCUSSION Brown Tumour is a rare, non-neoplastic lesion resulting from abnormal bone metabolism secondary to hyperparathyroidism. BT predominantly arise in long bones and the axial skeleton. Maxillomandibular involvement is very rare. In the present case, after parathyroidectomy, normal PTH and calcium levels were restored, and there was relief of gastrointestinal tract hypercalcaemic symptoms. However, there was no spontaneous regression of the mandibular tumour over a 2-year observation period. Hemimandibulectomy followed by reconstruction with a plate and costochondral graft was then performed. CONCLUSION It is difficult to differentiate BT from other giant cell lesions without blood chemistry revealing hyperparathyroidism. The distinction is imperative to avoid mutilating and aggressive treatment for BTs. Although BTs are amenable for conservative treatment, the present case illustrates that for bigger tumours, in the absence of spontaneous regression, aggressive surgical treatment may be required.
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Affiliation(s)
- Risimati Ephraim Rikhotso
- Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Faheema Khan
- Department of Maxillofacial and Oral Surgery, Wits School of Oral Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa
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Lopez Fanas R, Fouad R, Swedish KA. Random Occurrence or Real Association? Primary Hyperparathyroidism in a Young Man With Sickle Cell Disease. JCEM CASE REPORTS 2024; 2:luae068. [PMID: 38841703 PMCID: PMC11151693 DOI: 10.1210/jcemcr/luae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Indexed: 06/07/2024]
Abstract
A 32-year-old man with sickle cell disease (SCD) was admitted to the hospital for sickle cell crisis, during which laboratory workup revealed primary hyperparathyroidism. His treatment regimen included hydration, calcitonin, and calcimimetics. A parathyroid nuclear scan revealed anomalous parathyroid tissue. The precise relationship between primary hyperparathyroidism (PHPT) and SCD remains incompletely understood but may involve factors such as vitamin D deficiency, elevated erythropoietin levels, and the influence of growth factors on the development of parathyroid adenomas. Furthermore, the concurrent occurrence of both PHPT and SCD at an earlier age may potentiate adverse long-term outcomes. Effective management of PHPT in SCD entails addressing hypercalcemia and treating the underlying cause of hyperparathyroidism. While a potential association between PHPT and SCD exists, further research is essential to better elucidate their interaction, prevalence, clinical presentations, and outcomes.
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Affiliation(s)
- Raul Lopez Fanas
- Wakefield Division, Montefiore Medical Center, Bronx, NY, 10466, USA
| | - Rateb Fouad
- Wakefield Division, Montefiore Medical Center, Bronx, NY, 10466, USA
| | - Kristin A Swedish
- Wakefield Division, Montefiore Medical Center, Bronx, NY, 10466, USA
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Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab 2024; 109:1494-1504. [PMID: 38152848 DOI: 10.1210/clinem/dgad718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 12/29/2023]
Abstract
CONTEXT Osteoporosis and/or bone fractures are indications of parathyroidectomy in primary hyperparathyroidism (PHPT), especially in women. However, the benefit of surgery in patients with osteopenia remains unclear. OBJECTIVE To evaluate bone mineral density (BMD) and bone remodeling biomarkers changes 1 year after parathyroidectomy in women with PHPT. DESIGN In the prospective, monocentric, observational prospective cohort with primary hyperparathyroidism patients (CoHPT) cohort, women operated for sporadic PHPT since 2016 with ≥1 year follow-up were included. BMD (dual-X ray absorptiometry) and bone remodeling biomarkers [cross-linked C-telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and bone-specific alkaline phosphatases] were assessed before and 1 year after parathyroidectomy. SETTING Referral center. PATIENTS A total of 177 women with PHPT (62.5 ± 13.3 years, 83.1% menopausal, 43.9% osteopenic, and 45.1% osteoporotic) were included. INTERVENTION Parathyroidectomy. MAIN OUTCOME MEASURE BMD change between before and 1 year after parathyroidectomy. RESULTS Parathyroidectomy resulted in significant increase in BMD and decrease in serum bone remodeling biomarker concentrations. In the 72 patients with baseline osteopenia, mean BMD significantly increased at the lumbar spine [+0.05 g/cm2 (95% confidence interval [CI], 0.03-0.07)], the femoral neck [+0.02 g/cm2 (95% CI 0.00-0.04)], the total hip [+0.02 g/cm2 (95% CI 0.01-0.02)], and the forearm [+0.01 (95% CI 0.00-0.02)], comparable to osteoporotic patients. Among osteopenic patients, those with individual BMD gain (>0.03 g/cm2) at ≥1 site had higher preoperative serum CTX, P1NP, and urine calcium concentrations than those without improvement. CONCLUSION Parathyroidectomy significantly improved BMD and remodeling biomarkers in women with osteopenia, thereby supporting the benefit of parathyroidectomy in these patients. Preoperative serum CTX and P1NP concentrations could be useful to predict expected BMD gain.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Maxime Gérard
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
| | - Pascale Guillot
- Nantes Université, CHU Nantes, Service de Rhumatologie, F-44000 Nantes, France
| | - Matthieu Wargny
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France
| | - Kalyane Bach-Ngohou
- Nantes Université, CHU Nantes, Department of Biochemistry and INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, F-4400 Nantes, France
| | - Edith Bigot-Corbel
- Nantes Université, CHU Nantes, Laboratoire de biochimie, Hôpital Guillaume et René Laennec, F-4400 Nantes, France
| | - Nelly Renaud Moreau
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
| | - Cécile Caillard
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
| | - Eric Mirallié
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Claire Blanchard
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, F-44000 Nantes, France
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
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23
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Misgar RA, Wani M, Qadir A, Chhabra A. Clinical, Biochemical and Surgical Outcomes of Primary Hyperparathyroidism in the Present Era: A Prospective Study From a Tertiary Care Hospital. Cureus 2024; 16:e60965. [PMID: 38910736 PMCID: PMC11193873 DOI: 10.7759/cureus.60965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Primary hyperparathyroidism (PHPT) has undergone a considerable change from being symptomatic to asymptomatic. This is the first large study from North India to study the clinical and biochemical features and surgical outcomes in the present era. Study design This is a cross-sectional study that was conducted in the Department of Endocrinology (SKIMS) from February 2021 to December 2022, in which 103 patients diagnosed with PHPT were included. Evaluation included measurement of total calcium, phosphorus, alkaline phosphate, intact parathyroid hormone, 25-hydroxy vitamin, 24-hour urinary calcium, radiological survey of hands and skull, Dual Energy X-ray absorptiometry, and ultrasonography (USG) of the abdomen. USG neck and technetium-99m sestamibi scans were used for preoperative localization; however, in cases of discordance between these investigations or suspicions of multi-glandular disease, four-dimensional computerized tomography of the neck was used. Patients were subjected to surgery according to the guidelines and monitored post-surgery for complications like hypocalcemia and hungry bone syndrome and to document the cure. Results The mean age of patients was 42.8±14.73 years, with a female-to-male ratio of 4.4:1. The mean eGFR of patients was 99.1±30.87 ml/min, with 55 (53.4%) of them having renal disease. Osteoporosis and fractures were present in 41 (39.8%) and 5 (4.8%) patients, respectively. Cholelithiasis and pancreatitis were present in 25 (24.3%) and 5 (4.9%) patients, respectively. Hypertension (HTN) and diabetes mellitus (DM) were the commonest comorbidities, which were present in 34 (33.1%) and 15 (14.5%) patients, respectively. Mean preoperative levels of calcium, phosphorus (PO4), alkaline phosphate (ALP), intact parathyroid hormone (iPTH), 25(OH)vitamin D, and 24-hour urinary calcium were 12.1 mg/dl, 2.35 mg/dl, 210.2 U/L, 332.9 pg/ml, 25.7 ng/ml, and 452.1 mg/day, respectively. The most common type was right inferior parathyroid adenoma, present in 45 cases (43.7%), followed by left inferior parathyroid adenoma in 31 cases (30.1%). A total of 75 patients (72.8%) underwent minimally invasive parathyroidectomy, with 68 patients (90.7%) achieving a biochemical cure. The mean adenoma weight was 3.19±2.25 g. There was no statistically significant correlation (r) between preoperative biochemical parameters and adenoma weight. Conclusion Despite improvements in imaging and the easy availability of immunoassays for early diagnosis, renal disease continued to be the most common presentation, followed by skeletal involvement in our population. In developing countries like India, any patient presenting with nephrolithiasis or nephrocalcinosis, low bone mass, or fragility fractures should be evaluated for PHPT.
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Affiliation(s)
- Raiz A Misgar
- Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Munir Wani
- General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ajaz Qadir
- Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Ankit Chhabra
- Endocrinology and Metabolism, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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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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25
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Viswanathan G, Mathew V, Jeeragi M, George B, Bantwal G, Ayyar V, Michael J. Emerging pattern of asymptomatic hyperparathyroidism in South India - a six-year retrospective study. Folia Med (Plovdiv) 2024; 66:221-226. [PMID: 38690817 DOI: 10.3897/folmed.66.e117637] [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: 12/20/2023] [Accepted: 03/30/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a common endocrine disease with a variable presentation. There is a recent increase in the number of asymptomatic cases due to the use of multichannel automated analyzers.
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Affiliation(s)
| | - Vivek Mathew
- VPS Lakeshore Hospital and Research Centre, Kochi, India
| | | | | | | | - Vageesh Ayyar
- St John's Medical College Hospital, Bengaluru, India
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26
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Govind K, Paruk IM, Motala AA. Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa. BMC Endocr Disord 2024; 24:53. [PMID: 38664758 PMCID: PMC11044279 DOI: 10.1186/s12902-024-01583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003-2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH. METHODS A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded. RESULTS Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008). CONCLUSIONS The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.
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Affiliation(s)
- Kamal Govind
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.
| | - Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
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27
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Kirstein E, Schaudien D, Wagner M, Diebolt CM, Bozzato A, Tschernig T, Englisch CN. TRPC3 Is Downregulated in Primary Hyperparathyroidism. Int J Mol Sci 2024; 25:4392. [PMID: 38673977 PMCID: PMC11049814 DOI: 10.3390/ijms25084392] [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: 03/02/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Transient receptor potential canonical sub-family channel 3 (TRPC3) is considered to play a critical role in calcium homeostasis. However, there are no established findings in this respect with regard to TRPC6. Although the parathyroid gland is a crucial organ in calcium household regulation, little is known about the protein distribution of TRPC channels-especially TRPC3 and TRPC6-in this organ. Our aim was therefore to investigate the protein expression profile of TRPC3 and TRPC6 in healthy and diseased human parathyroid glands. Surgery samples from patients with healthy parathyroid glands and from patients suffering from primary hyperparathyroidism (pHPT) were investigated by immunohistochemistry using knockout-validated antibodies against TRPC3 and TRPC6. A software-based analysis similar to an H-score was performed. For the first time, to our knowledge, TRPC3 and TRPC6 protein expression is described here in the parathyroid glands. It is found in both chief and oxyphilic cells. Furthermore, the TRPC3 staining score in diseased tissue (pHPT) was statistically significantly lower than that in healthy tissue. In conclusion, TRPC3 and TRPC6 proteins are expressed in the human parathyroid gland. Furthermore, there is strong evidence indicating that TRPC3 plays a role in pHPT and subsequently in parathyroid hormone secretion regulation. These findings ultimately require further research in order to not only confirm our results but also to further investigate the relevance of these channels and, in particular, that of TRPC3 in the aforementioned physiological functions and pathophysiological conditions.
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Affiliation(s)
- Emilie Kirstein
- Institute for Anatomy and Cell Biology, Saarland University, 66421 Homburg, Germany (C.N.E.)
| | - Dirk Schaudien
- Fraunhofer Institute for Toxicology and Experimental Medicine, 30625 Hanover, Germany
| | - Mathias Wagner
- Department of Pathology, Saarland University, 66421 Homburg, Germany
| | - Coline M. Diebolt
- Institute for Anatomy and Cell Biology, Saarland University, 66421 Homburg, Germany (C.N.E.)
| | - Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University, 66421 Homburg, Germany;
| | - Thomas Tschernig
- Institute for Anatomy and Cell Biology, Saarland University, 66421 Homburg, Germany (C.N.E.)
| | - Colya N. Englisch
- Institute for Anatomy and Cell Biology, Saarland University, 66421 Homburg, Germany (C.N.E.)
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28
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Verly E, Lapauw B, Verroken C. Evaluation of the thiazide challenge test to differentiate primary from hypercalciuria-related hyperparathyroidism. J Clin Endocrinol Metab 2024:dgae239. [PMID: 38605120 DOI: 10.1210/clinem/dgae239] [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: 12/07/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
CONTEXT treatment of primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism due to idiopathic hypercalciuria (SHPT-IH) is markedly different. Robust diagnostic tools to differentiate between both entities are however lacking. OBJECTIVE evaluate the thiazide challenge test (TCT) in clinical practice, its aid in clinical decision making, evaluate the accuracy (sensitivity, specificity) and potentially useful parameters of the TCT. DESIGN monocentric observational retrospective cohort study from January 2017 to November 2023. SETTING outpatient, Ghent University Hospital (Belgium). PATIENTS 25 adult patients with hypercalciuria, elevated parathyroid hormone (PTH), and high-normal or elevated serum calcium that underwent a TCT. INTERVENTION TCT. OUTCOME MEASURES serum, urinary biochemical parameters before and after testing, clinical and imaging outcomes, treatment, and follow-up. RESULTS patients with a TCT-based working diagnosis of PHPT show greater increases in albumin-adjusted calcium and total serum calcium concentration than patients with SHPT-IH (+0,11 ± 0,10 vs. + 0,0071 ± 0,10mmol/l; p = 0,025 and +0,14 ± 0,12 vs. + 0,012 ± 0,15mmol/l; p = 0,024 respectively). The TCT-based working diagnosis of PHPT has a sensitivity of 81,8%, a specificity of 77,8% and a likelihood ratio of 3,68 of estimating a correct final diagnosis.Urinary calcium excretion, PTH, calcium-phosphorous ratio, PTH-inhibition rate, and parathyroid function index do not differ significantly in patients with PHPT compared to those with SHPT-IH. CONCLUSION the TCT aids in discriminating patients with PHPT from those with SHPT-IH based on a rise in serum calcium. Other parameters are not different between both groups. Larger prospective trials are necessary to further define the diagnostic potential of the TCT, its most appropriate biochemical outcome variables, and decision cut-offs.
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Affiliation(s)
- Ewout Verly
- Ghent University Hospital (Department of Endocrinology, Unit for Osteoporosis and Metabolic Bone Diseases)
| | - Bruno Lapauw
- Ghent University Hospital (Department of Endocrinology, Unit for Osteoporosis and Metabolic Bone Diseases), Ghent University (Department of Internal Medicine and Pediatrics)
| | - Charlotte Verroken
- Ghent University Hospital (Department of Endocrinology, Unit for Osteoporosis and Metabolic Bone Diseases)
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29
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Carvalho ARTB, Araújo PHD, Romani FADP, Barra BB. Atypical parathyroid adenoma with severe bone manifestations in early adolescence. BMJ Case Rep 2024; 17:e259760. [PMID: 38604742 PMCID: PMC11015270 DOI: 10.1136/bcr-2024-259760] [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] [Indexed: 04/13/2024] Open
Abstract
This is a case of primary hyperparathyroidism in a female teenager with multiple fractures and severe bone manifestations. The histopathology revealed atypical parathyroid adenoma, an exceedingly rare form of hyperparathyroidism; its main differential diagnosis is parathyroid carcinoma, as it shares both clinical and histological characteristics with it, in addition to its still uncertain malignant potential.
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Affiliation(s)
| | | | | | - Betânia Bisinoto Barra
- Pediatric Endocrinology, Hospital Regional de Taguatinga, Taguatinga, Distrito Federal, Brazil
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30
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Krumeich LN, Santos A, Fraker DL, Kelz RR, Wachtel H. Modern Trends for Primary Hyperparathyroidism: Intervening on Less Biochemically Severe Disease. J Surg Res 2024; 296:489-496. [PMID: 38325011 DOI: 10.1016/j.jss.2024.01.013] [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: 05/04/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is defined by autonomous parathyroid hormone secretion, which has broad physiologic effects. Parathyroidectomy is the only cure and is recommended for patients demonstrating symptomatic disease and/or end organ damage. However, there may be a benefit to intervening before the development of complications. We sought to characterize institutional trends in the biochemical and symptomatic presentation of PHPT and the associated cure and complication rates. METHODS We performed a retrospective cohort study of 1087 patients undergoing parathyroidectomy for PHPT, evaluating patients at 2-year intervals between 2002 and 2019. We identified signs and symptoms of PHPT based on the 2016 American Association of Endocrine Surgery Guidelines. Trends were evaluated with Kruskal Wallis, Chi-square tests, and Fisher's exact tests. RESULTS Patients with PHPT are presenting with lower parathyroid hormone (P = 0.0001) and calcium (P = 0.001) in the current era. Parathyroidectomy is more commonly performed for borderline guideline concordant patients with osteopenia (40.2%) and modest calciuria (median 246 mg/dL/24 h). 93.7% are cured, with no difference over time or between groups by guideline concordance. CONCLUSIONS Parathyroidectomy is increasingly performed for patients who demonstrate modest bone and renal dysfunction. Patients experience excellent cure rates and rarely experience postoperative hypocalcemia, suggesting a role for broader surgical indications.
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Affiliation(s)
- Lauren N Krumeich
- Department for Surgery, University of Michigan, Ann Arbor, Michigan; Department for Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Angelica Santos
- Department for Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Patel AM, Shaari AL, Aftab OM, Lemdani MS, Choudhry HS, Filimonov A. Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:1910-1920. [PMID: 38566654 PMCID: PMC10982178 DOI: 10.1007/s12070-023-04444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS ≥ 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization. Level of Evidence: IV. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04444-3.
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Affiliation(s)
- Aman M. Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Ariana L. Shaari
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Owais M. Aftab
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Mehdi S. Lemdani
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Hassaam S. Choudhry
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Andrey Filimonov
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
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Kaszczewska M, Chudziński W, Kaszczewska J, Popow M, Grzybowski J, Bogdańska M, Skowrońska-Szcześniak A, Kozubek H, Elwertowski M, Gąsiorowski O, Gałązka Z. Do large parathyroid adenomas increase the risk of severe hypercalcemia? POLISH JOURNAL OF SURGERY 2024; 96:40-50. [PMID: 38940244 DOI: 10.5604/01.3001.0054.4440] [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] [Indexed: 06/29/2024]
Abstract
<b><br>Introduction:</b> Primary hyperparathyroidism (PHPT) is mainly caused by parathyroid adenoma (PA). Rare variants of PA, weighing >2.0-3.5 g are called "large" or "giant" adenomas and account for about 1.5% of all PA.</br> <b><br>Aim:</b> The aim of this study was to compare normal-sized and large parathyroid lesions identifying risk factors for severe hypercalcemia.</br> <b><br>Materials and methods:</b> 27 patients with PHPT and parathyroid lesion ≥2.0 cm3 (study group) were compared with 73 patients with PHPT and lesion < 2.0 cm<sup>3</sup> (control group). In both groups, the majority were women (81.5% - study group, 90.5% - control group, gender ratios 4.4:9.1, respectively). The patients were examined preoperatively and postoperatively: PTH, creatine, calcium, and phosphate serum and urine concentrations, and calcidiol serum levels were assessed. Preoperative ultrasonography (US) was performed.</br> <b><br>Results:</b> Patients with larger parathyroid lesions had signifficantly higher PTH and calcium serum concentrations and lower serum phosphate and calcidiol concentrations. There were no statistically significant differences in the concentration of creatine in serum and urine, calciuria, or tubular reabsorption of phosphorus (TRP). US relatively underestimated the parathyroid volume by about 0.3-0.4 mL (10% in larger lesions and 43% in smaller ones).</br> <b><br>Conclusions:</b> Due to higher PTH and calcium levels, larger parathyroid adenomas may constitute a higher risk of severe hypercalcemia. In general, US underestimated the parathyroid volume.</br>.
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Affiliation(s)
- Monika Kaszczewska
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Poland
| | - Witold Chudziński
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Poland
| | - Joanna Kaszczewska
- Department of General, Vascular, Endocrine and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Michał Popow
- Department of Endocrinology and Internal Medicine, Medical University of Warsaw, Poland
| | | | | | | | - Herbert Kozubek
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Poland
| | - Michał Elwertowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Poland
| | - Oskar Gąsiorowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Poland
| | - Zbigniew Gałązka
- University Clinical Center of the Medical University of Warsaw, Warsaw, Poland. Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, Poland
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Tay YZ, Balasubbiah N, Awang RR, Retna Pandian BD, Sathiamurthy N. A Surgical Management of Mediastinal Parathyroid Adenoma: A Regional Experience in Malaysia. Cureus 2024; 16:e56792. [PMID: 38650780 PMCID: PMC11034996 DOI: 10.7759/cureus.56792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution's surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023. All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATS was performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.
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Affiliation(s)
- Yen Zhir Tay
- General Surgery, Thoracic Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
| | | | - Raflis Ruzairee Awang
- General Surgery, Breast and Endocrine Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS
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Kim S, Shin JH, Hahn SY, Kim H, Kim MK. The Parathyroid Gland: An Overall Review of the Hidden Organ for Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:327-344. [PMID: 38617871 PMCID: PMC11009140 DOI: 10.3348/jksr.2022.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 04/16/2024]
Abstract
Parathyroid glands are small endocrine glands that regulate calcium metabolism by producing parathyroid hormone (PTH). These are located at the back of the thyroid gland. Typically, four glands comprise the parathyroid glands, although their numbers may vary among individuals. Parathyroid diseases are related to parathyroid gland dysfunction and can be caused by problems with the parathyroid gland itself or abnormal serum calcium levels arising from renal disease. In recent years, as comprehensive health checkups have become more common, abnormal serum calcium levels are often found incidentally in blood tests, after which several additional tests, including a PTH test, ultrasonography (US), technetium-99m sestamibi parathyroid scan, single-photon-emission CT (SPECT)/CT, four-dimensional CT (4D-CT), and PET/CT, are performed for further evaluation. However, the parathyroid gland remains an organ less familiar to radiologists. Therefore, the normal anatomy, pathophysiology, imaging, and clinical findings of the parathyroid gland and its associated diseases are discussed here.
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English KA, Lines KE, Thakker RV. Genetics of hereditary forms of primary hyperparathyroidism. Hormones (Athens) 2024; 23:3-14. [PMID: 38038882 PMCID: PMC10847196 DOI: 10.1007/s42000-023-00508-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
Primary hyperparathyroidism (PHPT), a relatively common disorder characterized by hypercalcemia with raised or inappropriately normal serum parathyroid hormone (PTH) concentrations, may occur as part of a hereditary syndromic disorder or as a non-syndromic disease. The associated syndromic disorders include multiple endocrine neoplasia types 1-5 (MEN1-5) and hyperparathyroidism with jaw tumor (HPT-JT) syndromes, and the non-syndromic forms include familial hypocalciuric hypercalcemia types 1-3 (FHH1-3), familial isolated hyperparathyroidism (FIHP), and neonatal severe hyperparathyroidism (NS-HPT). Such hereditary forms may occur in > 10% of patients with PHPT, and their recognition is important for implementation of gene-specific screening protocols and investigations for other associated tumors. Syndromic PHPT tends to be multifocal and multiglandular with most patients requiring parathyroidectomy with the aim of limiting end-organ damage associated with hypercalcemia, particularly osteoporosis, nephrolithiasis, and renal failure. Some patients with non-syndromic PHPT may have mutations of the MEN1 gene or the calcium-sensing receptor (CASR), whose loss of function mutations usually cause FHH1, a disorder associated with mild hypercalcemia and may follow a benign clinical course. Measurement of the urinary calcium-to-creatinine ratio clearance (UCCR) may help to distinguish patients with FHH from those with PHPT, as the majority of FHH patients have low urinary calcium excretion (UCCR < 0.01). Once genetic testing confirms a hereditary cause of PHPT, further genetic testing can be offered to the patients' relatives and subsequent screening can be carried out in these affected family members, which prevents inappropriate testing in normal individuals.
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Affiliation(s)
- Katherine A English
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK
| | - Kate E Lines
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK
| | - Rajesh V Thakker
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK.
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK.
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Shibue K, Kubo N, Oda H, Tanabe E, Okada T, Huang CL, Higuchi T, Hamasaki A, Inagaki N. Gestational Ectopic Hyperparathyroidism: A Case Report of Perioperative and Perinatal Outcomes. Cureus 2024; 16:e56406. [PMID: 38638771 PMCID: PMC11023742 DOI: 10.7759/cureus.56406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
In the realm of obstetric care, discerning the subtle signs of primary hyperparathyroidism (PHPT) amidst common pregnancy symptoms remains a formidable challenge. Our exploration into a case of gestational hypercalcemia peels back the layers of this complexity, revealing the clinical conundrum posed by overlapping gastrointestinal manifestations. The journey from diagnosis through surgical intervention to the resolution of symptoms underscores the importance of vigilance for PHPT in pregnant patients. This case further prompts consideration of gamma-aminobutyric acid (GABA) as a potential piece in the puzzle of persistent symptoms post-calcium normalization, inviting a broader dialogue on the intricacies of parathyroid pathology in pregnancy.
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Affiliation(s)
- Kimitaka Shibue
- Department of Endocrinology and Diabetes, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Nozomi Kubo
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Hiromi Oda
- Department of Thoracic Surgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Etsuko Tanabe
- Department of Endocrinology and Diabetes, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Tsutomu Okada
- Department of Radiology, Kansai Electric Power Hospital, Osaka, JPN
| | - Cheng-Long Huang
- Department of Thoracic Surgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Akihiro Hamasaki
- Department of Endocrinology and Diabetes, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
| | - Nobuya Inagaki
- Department of Endocrinology and Diabetes, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, JPN
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Meriam H, Kaaroud H, Karray R, Ben Hamida F, Bouzid K, Abderrahim E. Recurrent Urolithiasis Revealing Primary Hyperparathyroidism in a Nephrology Department. Case Rep Nephrol 2024; 2024:1265364. [PMID: 38419822 PMCID: PMC10901575 DOI: 10.1155/2024/1265364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Urinary lithiasis constitutes a recurrent pathology affecting a relatively young population. The risk of progression to chronic renal failure and the cost of treatment are the most important issues. Primary hyperparathyroidism (PHPT) is responsible for urolithiasis and nephrocalcinosis in 7% of patients, and it represents the 7th cause of urolithiasis in Tunisia. Unfortunately, it remains an underdiagnosed pathology although it is curable. We aim to determine the clinical, biological, therapeutic, and evolutionary particularities of urinary lithiasis associated with PHPT in a nephrology setting. Methods This is a monocentric, retrospective, descriptive study which took place in our nephrology department during the period from January 2010 to January 2023. Ten patients were included. All of them underwent blood and urine tests and a morphoconstitutional study of the urinary stones if possible. Results The median age at diagnosis of PHPT was 42 years (34-54). The median time from the onset of kidney stones to the diagnosis of PHPT was 6.2 years (1-17). The male/female gender ratio was 0.66. Five patients had hypertension, two patients had obesity, one patient had diabetes, and three patients had urinary tract infections. Kidney stones were bilateral in eight cases and unilateral in two cases. Nine patients underwent urological intervention: surgery in 5 cases associated with nephrectomy in one case, extracorporeal lithotripsy in 4 cases, and percutaneous nephrolithotomy in two cases. The diagnosis of PHPT was retained with high or uncontrolled PTH associated with hypercalcemia in 8 cases and normocalcemic PHPT was found in 2 patients. Two patients had parathyroid adenoma and one patient had mediastinal adenoma. Radiology exploration was normal for the others patients. Surgery was performed in 7 patients and histology revealed an adenoma in 5 cases and hyperplasia in one case. The predominant urinary risk factors in our study were hypercalciuria in 6 cases and insufficient diuresis in 4 cases. Conclusion This study underlines the role of the nephrologist in the exploration of urinary lithiasis and the prevention of recurrences, especially as PHPT is a curable aetiology of urolithiasis and affects a relatively young population. The determination of the epidemiological profile of patients with stones associated with primary PHPT and lithogenic risk factors allows the primary and secondary prevention of stone formation.
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Affiliation(s)
- Hajji Meriam
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Rahma Karray
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Kahena Bouzid
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Köroğlu EY, Tam AA, Fakı S, Tural Balsak B, Edis Özdemir FA, Özdemir D, Topaloğlu O, Ersoy R, Çakır B. The clinical significance of calcium/magnesium ratio in primary hyperparathyroidism: unveiling a clinical association. Hormones (Athens) 2024:10.1007/s42000-024-00530-5. [PMID: 38332247 DOI: 10.1007/s42000-024-00530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE In previous studies, magnesium (Mg) was found to be lower in cases with more severe primary hyperparathyroidism (PHPT) and higher calcium (Ca) levels. This study evaluated the relationship between serum Mg and serum Ca and phosphorus (P) levels in PHPT and their utility in determining the presence of osteoporosis and nephrolithiasis. METHODS Patients who were followed up with PHPT between March 2019 and March 2023 were analyzed retrospectively. Biochemical data, renal ultrasonography results, dual-energy x-ray absorptiometry (DEXA) reports, and technetium 99 m sestamibi parathyroid scintigraphy reports were obtained. MgxP, Mg/P, Ca/P, and corrected Ca (cCa)/P values were calculated. The relationships between biochemical parameters and clinical outcomes were evaluated statistically. RESULTS A total of 543 patients were included in the study. Patients with nephrolithiasis had higher cCa/Mg or Ca/Mg than those without nephrolithiasis. Additionally, ROC analysis revealed that cCa/Mg greater than 5.24 could identify the presence of nephrolithiasis with a sensitivity of 73.3% and a specificity of 73%. No statistically significant correlation existed between the results of the Mg/P, MgxP, cCa/Mg, Ca/Mg values, and DEXA-bone mineral densitometry(BMD). CONCLUSION Ca/Mg and cCa/Mg ratios in particular seem more valuable in determining the presence of nephrolithiasis than the currently used 24-h urine Ca measurement. Compared to urinary Ca measurements, they are cheaper, more practical, and more accessible.
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Affiliation(s)
- Ekin Yiğit Köroğlu
- Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey.
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University Faculty of Medicine, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Sevgül Fakı
- Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Belma Tural Balsak
- Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Fatma Ayça Edis Özdemir
- Department of Radiology, Ankara Bilkent City Hospital, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Didem Özdemir
- Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University Faculty of Medicine, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Oya Topaloğlu
- Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University Faculty of Medicine, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University Faculty of Medicine, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology and Metabolism, Ankara Yıldırım Beyazıt University Faculty of Medicine, Üniversiteler Mahallesi 1604. Cadde No: 9 Çankaya, Ankara, Turkey
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Kulkarni P, Goldenberg D. Surgery for Normocalcemic Hyperparathyroidism. Otolaryngol Clin North Am 2024; 57:111-116. [PMID: 37634986 DOI: 10.1016/j.otc.2023.07.012] [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] [Indexed: 08/29/2023]
Abstract
Primary hyperparathyroidism is the most common cause of hypercalcemia, accounting for about 90% of all cases. This disorder is characterized by overactive parathyroid glands, leading to increased parathyroid hormone and excess serum calcium.
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Affiliation(s)
- Pallavi Kulkarni
- Penn State Health Department of Otolaryngology-Head and Neck Surgery; The Pennsylvania State College of Medicine, 500 University Drive, P.O. Box 850 H091 Hershey, PA 17033, USA
| | - David Goldenberg
- Penn State Health Department of Otolaryngology-Head and Neck Surgery; The Pennsylvania State College of Medicine, 500 University Drive, P.O. Box 850 H091 Hershey, PA 17033, USA.
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Khattar G, Siddiqui FS, Grovu R, Baker SA, Sanayeh EB, Wei C, El Gharib K, Sattar SBA, Elsayegh D, El-Hage H, Sayegh SE, Chalhoub M, Mustafa A. The calcium-clot connection: investigating the association between primary hyperparathyroidism and acute venous thromboembolism. J Thromb Thrombolysis 2024; 57:220-225. [PMID: 37848627 DOI: 10.1007/s11239-023-02906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
Primary hyperthyroidism (PHPT) is a relatively uncommon disease and leads to increased calcium levels. Ionized calcium, known as clotting Factor IV, may lead to overt coagulation cascade activation, increasing the risk of venous thromboembolism (VTE). National Inpatient Sample Database was used to sample individuals with primary hyperparathyroidism, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data and age less than 18 were excluded. Moreover, patients with other types of hyperparathyroidism and risk factors for VTE, such as malignancy, thrombophilia, chronic kidney and liver disease, fractures, trauma, oral contraceptive/steroid use, and organ transplant, were excluded. Greedy propensity matching using R was performed to match patients with and without primary hyperparathyroidism on age, race, gender, and 10 other comorbidities, including chronic deep venous thromboembolism. Univariate analysis pre- and post-match were performed. Binary logistic regression was performed after matching to assess whether primary hyperparathyroidism was an independent risk factor for acute VTE. A p-value of < 0.05 was considered statistically significant. Out of 460,529 patients included in the study, 1114 (6.5%) had PHPT. Baseline comorbidities were more common in the PHPT group. On univariate analysis, patients with PHPT were more likely to have acute VTE (2.5% vs. 1.4%; p < 0.001). After 1:1 matching, PHPT patients were twice as likely to have Acute VTE. (OR: 2.1 [1.08-4.1]; p < 0.025). These findings suggest an association between PHPT and VTE, which should be further investigated to prevent the increasing incidence of VTE and its recurrence.
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Affiliation(s)
- Georges Khattar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA.
| | - Fasih Sami Siddiqui
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Radu Grovu
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Saif Abu Baker
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Elie Bou Sanayeh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Chapman Wei
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Khalil El Gharib
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Saud Bin Abdul Sattar
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Dany Elsayegh
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Halim El-Hage
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Suzanne El Sayegh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
- Department of Nephrology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Michel Chalhoub
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Ahmad Mustafa
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
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Sapundzhieva T, Sapundzhiev L, Klinkanov K, Mitev M, Batalov A. Severe Acro-osteolysis Mimicking Arthritis Mutilans in a Patient with Primary Hyperparathyroidism: A Case Report. Curr Rheumatol Rev 2024; 20:574-585. [PMID: 38314597 DOI: 10.2174/0115733971273126231214063403] [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: 08/19/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) should be considered in the differential diagnosis of a patient with suspected secondary osteoporosis, and severe osteoporosis with multiple fractures is frequently the first clinical manifestation of the disease. CASE PRESENTATION Mutilating arthritis (arthritis mutilans) can be part of the clinical presentation of a number of rheumatic diseases, most commonly seen in psoriatic arthritis, rheumatoid arthritis, and juvenile idiopathic arthritis, but also in systemic lupus, systemic sclerosis, and multicentric reticulohistiocytosis. Evidence exists that subperiosteal and subchondral bone resorption, seen in PHPT, could induce the so-called 'osteogenic synovitis', which could eventually lead to the development of a secondary osteoarthritis with bone deformities. CONCLUSION Here, we present a case report of a patient initially diagnosed with PHPT who presented with mutilating arthritis of the finger joints and discuss whether the severe acro-osteolysis is a manifestation of the endocrinopathy or whether there is a co-existing undiagnosed inflammatory joint disease.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Lyubomir Sapundzhiev
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Kamen Klinkanov
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Martin Mitev
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital 'Kaspela', Plovdiv, Bulgaria
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Milat F, Ramchand SK, Herath M, Gundara J, Harper S, Farrell S, Girgis CM, Clifton-Bligh R, Schneider HG, De Sousa SMC, Gill AJ, Serpell J, Taubman K, Christie J, Carroll RW, Miller JA, Grossmann M. Primary hyperparathyroidism in adults-(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society. Clin Endocrinol (Oxf) 2024; 100:3-18. [PMID: 34931708 DOI: 10.1111/cen.14659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. METHODS Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. RESULTS PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. CONCLUSIONS These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community.
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Affiliation(s)
- Frances Milat
- Department of Endocrinology, Monash Health, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
- Department of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Sabashini K Ramchand
- Department of Endocrinology, Austin Health, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
| | - Madhuni Herath
- Department of Endocrinology, Monash Health, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
- Department of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Justin Gundara
- Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Australia
- Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Simon Harper
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
- Department of Surgery, University of Otago, Wellington, New Zealand
| | - Stephen Farrell
- Department of Surgery, St Vincent's Hospital, Victoria, Australia
- Department of Surgery, Austin Hospital, Victoria, Australia
- Department of Surgery, Royal Children's Hospital, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Christian M Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Kolling Institute, University of Sydney, New South Wales, Australia
| | - Hans G Schneider
- Clinical Biochemistry Unit, Alfred Pathology Service, Alfred Health, Victoria, Australia
- Department of Endocrinology, Alfred Hospital, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Victoria, Australia
| | - Sunita M C De Sousa
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Anthony J Gill
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jonathan Serpell
- Department of General Surgery, The Alfred Hospital, Victoria, Australia
- Monash University Department of Endocrine Surgery, Victoria, Australia
| | - Kim Taubman
- Department of Medical Imaging, St Vincent's Hospital, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | | | - Richard W Carroll
- Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, Wellington, New Zealand
| | - Julie A Miller
- Department of Surgery, University of Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, Victoria, Australia
- Epworth Hospital Network, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
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Sawalkar RG, Patil DS, Gandhi RS. A Physiotherapeutic Approach to a Rare Case of Windswept Deformity in a Male Adolescent. Cureus 2024; 16:e53350. [PMID: 38435936 PMCID: PMC10908423 DOI: 10.7759/cureus.53350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Primary hyperparathyroidism (PHPT) can lead to a rare condition in children and adolescents known as windswept deformity. This deformity involves one knee exhibiting an abnormal outward angulation (valgus deformity), while the other knee shows an abnormal inward angulation (varus deformity). This asymmetrical syndrome, resembling the effect of strong winds, gives the impression that the knees are being swept in opposite directions. Various factors, such as structural bone or joint defects, accidents, or underlying disorders, can contribute to the development of windswept deformity. PHPT, a common endocrine condition characterized by elevated levels of parathyroid hormone and blood calcium, is unusual in the pediatric and adolescent populations. It can result in complications like osteoporosis and bone abnormalities, with genu valgus (outward knee angulation) being an exceptionally rare symptom. This case discusses a 19-year-old male who underwent corrective surgery for genu valgus and presented with windswept deformity due to teenage hyperparathyroidism. The case study outlines the physiotherapeutic rehabilitation strategy, emphasizing treatments such as cryotherapy, patellar mobilization, and gait training. Tailored physical therapy rehabilitation plays a crucial role in the postoperative care of patients undergoing corrective osteotomies. The results indicated a significant improvement in muscle strength, an expansion of the range of motion (ROM), and a noticeable enhancement in the individual's functional autonomy following adherence to the postoperative physiotherapy (PT) plan.
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Affiliation(s)
- Rutuja G Sawalkar
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Richa S Gandhi
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Te Beek ET, van Duijnhoven CPW, Slart RHJA, van den Bergh JP, Ten Broek MRJ. Quantitative CT Evaluation of Bone Mineral Density in the Thoracic Spine on 18F-Fluorocholine PET/CT Imaging in Patients With Primary Hyperparathyroidism. J Clin Densitom 2024; 27:101464. [PMID: 38150889 DOI: 10.1016/j.jocd.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Measurement of bone mineral density (BMD) with quantitative CT (QCT) carries several advantages over other densitometric techniques, including superior assessment of the spine. As most QCT studies evaluated the lumbar spine, measurements of the thoracic spine are limited. We performed QCT analysis of the thoracic spine in a cohort of patients with primary hyperparathyroidism. MATERIALS AND METHODS This study was a retrospective QCT analysis of the thoracic spine on 18F-fluorocholine PET/CT scans in patients with primary hyperparathyroidism patients between March 2018 and December 2022. Correlations between QCT-derived BMD or Hounsfield units (HU) and demographic data, laboratory parameters, results from histopathological examination after parathyroidectomy and results of DXA imaging were analyzed, when available. RESULTS In 189 patients, mean QCT-derived BMD at the thoracic spine was 85.6 mg/cm3. Results from recent DXA were available in 122 patients. Mean thoracic QCT-derived BMD and HU were significantly correlated with DXA-derived BMD in lumbar spine, total hip and femoral neck and with the lowest T-score at DXA imaging. Only weak correlations were found with BMI or 18F-fluorocholine uptake, while no significant correlations were found with adenoma weight, PTH or calcium levels. CONCLUSION Our study confirms correlation between QCT-derived BMD in the thoracic spine with age and DXA-derived BMD measurements within a population of patients with primary hyperparathyroidism. Establishment of reference BMD values for individual thoracic vertebrae, may allow direct osteoporosis classification on thoracic CT imaging.
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Affiliation(s)
- Erik T Te Beek
- Department of Nuclear Medicine, Reinier de Graaf Hospital, Delft, the Netherlands..
| | | | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen (UMCG), Groningen, the Netherlands; University of Twente, Enschede, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Marc R J Ten Broek
- Department of Nuclear Medicine, Reinier de Graaf Hospital, Delft, the Netherlands
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Vescini F, Borretta G, Chiodini I, Boniardi M, Carotti M, Castellano E, Cipriani C, Eller-Vainicher C, Giannini S, Iacobone M, Salcuni AS, Saponaro F, Spiezia S, Versari A, Zavatta G, Mitrova Z, Saulle R, Vecchi S, Antonini D, Basile M, Giovanazzi A, Paoletta A, Papini E, Persichetti A, Samperi I, Scoppola A, Novizio R, Calò PG, Cetani F, Cianferotti L, Corbetta S, De Rimini ML, Falchetti A, Iannetti G, Laureti S, Lombardi CP, Madeo B, Marcocci C, Mazzaferro S, Miele V, Minisola S, Palermo A, Pepe J, Scillitani A, Tonzar L, Grimaldi F, Cozzi R, Attanasio R. Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism. Endocr Metab Immune Disord Drug Targets 2024; 24:991-1006. [PMID: 38644730 PMCID: PMC11165713 DOI: 10.2174/0118715303260423231122111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 04/23/2024]
Abstract
AIM This guideline (GL) is aimed at providing a clinical practice reference for the management of sporadic primary hyperparathyroidism (PHPT) in adults. PHPT management in pregnancy was not considered. METHODS This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) and Società Italiana dell'Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (SIOMMMS) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for the clinical practice recommendations. RESULTS The present GL provides recommendations about the roles of pharmacological and surgical treatment for the clinical management of sporadic PHPT. Parathyroidectomy is recommended in comparison to surveillance or pharmacologic treatment in any adult (outside of pregnancy) or elderly subject diagnosed with sporadic PHPT who is symptomatic or meets any of the following criteria: • Serum calcium levels >1 mg/dL above the upper limit of normal range. • Urinary calcium levels >4 mg/kg/day. • Osteoporosis disclosed by DXA examination and/or any fragility fracture. • Renal function impairment (eGFR <60 mL/min). • Clinic or silent nephrolithiasis. • Age ≤50 years. Monitoring and treatment of any comorbidity or complication of PHPT at bone, kidney, or cardiovascular level are suggested for patients who do not meet the criteria for surgery or are not operated on for any reason. Sixteen indications for good clinical practice are provided in addition to the recommendations. CONCLUSION The present GL is directed to endocrinologists and surgeons - working in hospitals, territorial services or private practice - and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.
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Affiliation(s)
- Fabio Vescini
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Ospedale Santa Croce and Carle Hospital, Cuneo, Italy
| | - Iacopo Chiodini
- Endocrinology Department, ASST Grande Ospedale Metropolitano di Niguarda, Milan, Italy, Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Marco Boniardi
- General Oncologic and Mini-invasive Surgery Department, ASST Grande Ospedale Metropolitano di Niguarda, Milan, Italy
| | - Marina Carotti
- Department of Radiology, AOU delle Marche, Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Ospedale Santa Croce and Carle Hospital, Cuneo, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Antonio Stefano Salcuni
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
| | - Federica Saponaro
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Italy
| | - Guido Zavatta
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS AOU di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Debora Antonini
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Alexia Giovanazzi
- Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Agnese Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
| | | | | | - Roberto Novizio
- Endocrinology and Metabolism, Agostino Gemelli University Polyclinic (IRCCS), Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Giorgio Calò
- SIUEC President, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Filomena Cetani
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, AOU Careggi, Florence, Italy
| | - Sabrina Corbetta
- Bone Metabolism and Diabetes, IRCCS Istituto Auxologico Italiano, Milan, Italy, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Alberto Falchetti
- Laboratory of Experimental Clinical Research on Bone Metabolism, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giovanni Iannetti
- SIUMB President, Ultrasound Unit, S. Spirito Hospital, Pescara, Italy
| | | | | | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Claudio Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sandro Mazzaferro
- Nephrology Unit at Policlinico Umberto I Hospital and Department of Translation and Precision Medicine, Sapienza University of Rome, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Baggiovara, Italy
| | - Salvatore Minisola
- UOC Medicina Interna A, Malattie Metaboliche dell'Osso, Ambulatorio Osteoporosi e Osteopatie Fragilizzanti, Sapienza University of Rome, Rome Italy
| | - Andrea Palermo
- Unit of Thyroid and Bone-Metabolic Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Laura Tonzar
- Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy
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Carletti A, Gavaia PJ, Cancela ML, Laizé V. Metabolic bone disorders and the promise of marine osteoactive compounds. Cell Mol Life Sci 2023; 81:11. [PMID: 38117357 PMCID: PMC10733242 DOI: 10.1007/s00018-023-05033-x] [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: 06/20/2023] [Revised: 10/12/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023]
Abstract
Metabolic bone disorders and associated fragility fractures are major causes of disability and mortality worldwide and place an important financial burden on the global health systems. These disorders result from an unbalance between bone anabolic and resorptive processes and are characterized by different pathophysiological mechanisms. Drugs are available to treat bone metabolic pathologies, but they are either poorly effective or associated with undesired side effects that limit their use. The molecular mechanism underlying the most common metabolic bone disorders, and the availability, efficacy, and limitations of therapeutic options currently available are discussed here. A source for the unmet need of novel drugs to treat metabolic bone disorders is marine organisms, which produce natural osteoactive compounds of high pharmaceutical potential. In this review, we have inventoried the marine osteoactive compounds (MOCs) currently identified and spotted the groups of marine organisms with potential for MOC production. Finally, we briefly examine the availability of in vivo screening and validation tools for the study of MOCs.
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Affiliation(s)
- Alessio Carletti
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Paulo Jorge Gavaia
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal
- Associação Oceano Verde (GreenCoLab), Faro, Portugal
| | - Maria Leonor Cancela
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve, Faro, Portugal
| | - Vincent Laizé
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal.
- Collaborative Laboratory for Sustainable and Smart Aquaculture (S2AQUAcoLAB), Olhão, Portugal.
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Jiang Y, Chen R, Xu S, Ding Y, Zhang M, Bao M, He B, Li S. Assessing causal associations of hyperparathyroidism with blood counts and biochemical indicators: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1295040. [PMID: 38152136 PMCID: PMC10752421 DOI: 10.3389/fendo.2023.1295040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
Background The existing literature on the relationship of hyperparathyroidism with both blood counts and biochemical indicators primarily comprises observational studies, which have produced inconsistent findings. This study aimed to evaluate the causal relationship between hyperparathyroidism and blood counts and biochemical indicators. Methods Mendelian randomization (MR) analyses were conducted to investigate the associations between hyperparathyroidism and the identified 55 blood counts and biochemical indicators. The genome-wide association study (GWAS) for hyperparathyroidism data was obtained from FinnGen, while the GWASs for the blood counts and biochemical indicators were sourced from the UK Biobank (UKBB). Results The MR analysis using the inverse-variance weighted (IVW) method revealed potential causality between genetically predicted hyperparathyroidism and seven out of 55 blood counts and biochemical indicators. These markers include "Platelet count" (Beta = -0.041; 95% CI: -0.066, -0.016; p = 0.001), "Platelet distribution width (PDW)" (Beta = 0.031; 95% CI: 0.006, 0.056; p = 0.016), "Mean platelet volume (MPV)" (Beta = 0.043; 95% CI: 0.010, 0.076; p = 0.011), "Vitamin D" (Beta = -0.038; 95% CI: -0.063, -0.013; p = 0.003), "Calcium (Ca2+)" (Beta = 0.266; 95% CI: 0.022, 0.509; p = 0.033), "Phosphate" (Beta = -0.114; 95% CI: -0.214, -0.014; p = 0.025), and "Alkaline phosphatase (ALP)" (Beta = 0.030; 95% CI: 0.010, 0.049; p = 0.003). Conclusion The findings of our study revealed a suggestive causal relationship between hyperparathyroidism and blood cell count as well as biochemical markers. This presents a novel perspective for further investigating the etiology and pathological mechanisms underlying hyperparathyroidism.
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Affiliation(s)
- Yan Jiang
- School of Basic Medicine, Changsha Medical University, Changsha, China
- The Hunan Provincial Key Laboratory of the TCM Agricultural Biogenomics, Changsha Medical University, Changsha, China
- Hunan Key Laboratory Of The Research And Development Of Novel Pharmaceutical Preparations, School of Pharmaceutical Science, Changsha Medical University, Changsha, China
| | - Rumeng Chen
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Shuling Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yining Ding
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Mengling Zhang
- School of Stomatology, Changsha Medical University, Changsha, China
| | - Meihua Bao
- The Hunan Provincial Key Laboratory of the TCM Agricultural Biogenomics, Changsha Medical University, Changsha, China
- Hunan Key Laboratory Of The Research And Development Of Novel Pharmaceutical Preparations, School of Pharmaceutical Science, Changsha Medical University, Changsha, China
| | - Binsheng He
- The Hunan Provincial Key Laboratory of the TCM Agricultural Biogenomics, Changsha Medical University, Changsha, China
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
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Mu Y, Zhao Y, Zhao J, Zhao Q, Zhang Y, Li Y, Kou J, Dionigi G, Bian X, Sun H. Factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients. Front Endocrinol (Lausanne) 2023; 14:1276992. [PMID: 38116316 PMCID: PMC10728860 DOI: 10.3389/fendo.2023.1276992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Background Parathyroidectomy (PTX) is an effective treatment for primary hyperparathyroidism (PHPT) patients. Postoperative hypocalcemia is a common complication after PTX. This study aimed to analyze the factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients. Methods The retrospective study included 270 PHPT patients treated with PTX and collected their demographic and clinical information and their laboratory indices. Factors influencing serum calcium levels and hypocalcemia after PTX in PHPT patients were analyzed using univariate and multifactorial analyses. Results First, in patients with normal preoperative serum calcium levels (2.20-2.74 mmol/L), the higher the preoperative alkaline phosphatase and serum phosphorus levels, the lower the postoperative serum calcium levels. Furthermore, the higher the preoperative serum calcium levels and the accompanying clinical symptoms, the higher the postoperative serum calcium levels. Low preoperative serum calcium levels were shown to be a risk factor for postoperative hypocalcemia (OR=0.022), and the optimal preoperative serum calcium threshold was 2.625 mmol/L (sensitivity and specificity were 0.587 and 0.712, respectively). Second, in the mild preoperative hypercalcemia group (2.75-3.00 mmol/L), the older the patient, the higher the preoperative and postoperative serum calcium levels, the higher the postoperative serum calcium; the lower the alkaline phosphatase and calcitonin levels, the higher the postoperative serum calcium levels. On the other hand, the younger the patient was, the more likely hypocalcemia blood was (OR=0.947), with an optimal age threshold of 47.5 years (sensitivity and specificity were 0.543 and 0.754, respectively). Third, in the preoperative moderate to severe hypercalcemia group (>3.0mmol/L), patients undergoing a combined contralateral thyroidectomy and a total thyroidectomy had low postoperative serum calcium levels. Conclusion Patients with different preoperative serum calcium levels had various factors influencing their postoperative serum calcium levels and postoperative hypocalcemia, which facilitated the assessment of their prognosis.
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Affiliation(s)
- Yongliang Mu
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Yishen Zhao
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Jiannan Zhao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi Zhao
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Yushuai Zhang
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Yang Li
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Jiedong Kou
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Gianlorenzo Dionigi
- Division of General Surgery, Endocrine Surgery Section, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Xuehai Bian
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
| | - Hui Sun
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, Changchun, China
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Merdad M, Mogharbel AM, AlQurashi Y, Nujoom M, Wazzan M, Abduljabbar A, Daghistani RK, Samargandy S, Alhozali A, Alshehri B, Batawil N, Marzouki HZ. Accuracy of Four-Dimensional Computed Tomography and Different Imaging Modalities in Primary Hyperparathyroidism. Cureus 2023; 15:e50423. [PMID: 38222216 PMCID: PMC10784756 DOI: 10.7759/cureus.50423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Background This study aimed to compare the accuracy of different imaging modalities in the preoperative localization of parathyroid pathology in primary hyperparathyroidism. Methodology This prospective study enrolled 70 patients who were biochemically diagnosed with primary hyperparathyroidism between 2021 and 2022 at our center. Patients underwent scanning using three imaging modalities, namely, Tc99m sestamibi scan (sestamibi), parathyroid ultrasonography, and four-dimensional computed tomography (4DCT). A descriptive analysis was performed to determine and compare the respective localizing sensitivities. Results The most common site of parathyroid adenoma (PA) was the left inferior parathyroid gland, seen in 28 (40%) patients. Three patients had false-positive imaging studies with no parathyroid pathology identified surgically or on histological examination. The median levels of parathyroid hormone decreased significantly (p < 0.001) after the surgery, with a median of 24.3 (1.90-121). Furthermore, 4DCT accomplished a sensitivity of 97.14% for diagnosing the side and 94.03% for overall localization of PA. This sensitivity was superior to the sensitivity of ultrasonography and sestamibi scan to detect the side and quadrant of the adenoma. 4DCT was significantly higher in sensitivity when compared to the combination of ultrasound and sestamibi (p < 0.001). Conclusions 4DCT yielded the highest sensitivity in localizing parathyroid pathology from the imaging modalities studied with the lowest false-negative rate. Using ultrasound with 4DCT could be the most cost-effective combination for detecting primary hyperparathyroidism.
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Affiliation(s)
- Mazin Merdad
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ahmed M Mogharbel
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Yousuf AlQurashi
- Otolaryngology Head and Neck Surgery, Taif University, Taif, SAU
| | - Mohammed Nujoom
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohammad Wazzan
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ahmed Abduljabbar
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Razan K Daghistani
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Shaza Samargandy
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Amani Alhozali
- Department of Internal Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Nadia Batawil
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Hani Z Marzouki
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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50
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Viviani A, Colangelo L, Ciminelli BM, Novelletto A, Sonato C, Occhiuto M, Cipriani C, Diacinti D, De Martino V, Gianni W, Pepe J, Minisola S, Malaspina P. Genetic aspects underlying the normocalcemic and hypercalcemic phenotypes of primary hyperparathyroidism. Endocrine 2023; 82:646-653. [PMID: 37651007 PMCID: PMC10618301 DOI: 10.1007/s12020-023-03476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Hypercalcemic primary hyperparathyroidism (PHPT) is a common endocrine disorder that has been very well characterized. In contrast, many aspects of normocalcemic primary hyperparathyroidism (NPHPT) such as natural history, organ damage, and management are still matter of debate. In addition, both the pathophysiology and molecular basis of NPHPT are unclear. We investigated whether PHPT and NPHPT patient cohorts share the same pattern of genetic variation in genes known to be involved in calcium and/or bone metabolism. RESEARCH DESIGN AND METHODS Genotyping for 9 single nucleotide polymorphisms (SNPs) was performed by Real-Time PCR (TaqMan assays) on 27 NPHPT and 31 PHPT patients evaluated in a tertiary referral Center. The data of both groups were compared with 54 in house-controls and 503 subjects from the 1000 Genomes Project. All groups were compared for allele/haplotype frequencies, on a single locus, two loci and multi-locus basis. RESULTS The NPHPT group differed significantly at SNPs in OPG and ESR1. Also, the NPHPT cohort was peculiar for pairwise associations of genotypes and for the overrepresentation of unusual multilocus genotypes. CONCLUSIONS Our NPHPT patient set harbored a definitely larger quota of genetic diversity than the other samples. Specific genotypes may help in defining subgroups of NPHPT patients which deserve ad hoc clinical and follow-up studies.
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Affiliation(s)
- Arianna Viviani
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy.
| | | | | | - Chiara Sonato
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Marco Occhiuto
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy
| | - Viviana De Martino
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Walter Gianni
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
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