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Arshad MF, Arambewela MH, Bennet WM, Sterrenburg M, Balasubramanian SP. Primary hyperparathyroidism in pregnancy: experience of a tertiary centre. Surg Today 2022; 53:470-475. [PMID: 36107253 PMCID: PMC10042935 DOI: 10.1007/s00595-022-02583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/03/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Background and purpose
The management of primary hyperparathyroidism (PHPT) during pregnancy is challenging and there is no clear consensus on whether it increases the risk of complications in pregnancy. We conducted this study to review the maternal and fetal outcomes of pregnant women treated for PHPT in a single centre.
Methods
Data on relevant clinical parameters, demographics, management strategies, maternal and fetal outcomes were collected from the medical records of pregnant patients with PHPT diagnosed between 2012 and 2019.
Results
Of 15 pregnant women with PHPT, 6 were managed medically and 9 underwent surgery. The median age at their index pregnancy was 28 years [range 19–42]. The median highest adjusted calcium level in the medical group was 2.90 [range 2.61–3.25] mmol/L vs. 3.11 [2.78–4.95] mmol/L in the surgical group. There was one miscarriage and the stillbirth of twins in the medical group, but no such outcomes in the surgical group. The median gestational ages were 39 + 3 weeks [range 24 + 2–41 + 2 weeks] and 39 + 4 weeks [range 37 + 1–39 + 5 weeks] in the medical and surgical groups, respectively. No birth was complicated by neonatal tetany or convulsions.
Conclusion
More complications developed in the pregnant PHPT patients who were managed medically than in those who underwent surgery. Surgery performed during the second trimester resulted in good outcomes. Multi-centre prospective studies are required to ascertain the risk of various complications in women with PHPT during pregnancy.
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Affiliation(s)
- Muhammad Fahad Arshad
- Oncology and Metabolism, University of Sheffield Medical School, Sheffield, S10 2RX, UK.
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Maulee Hiromi Arambewela
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
- University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - William M Bennet
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Monique Sterrenburg
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Saba P Balasubramanian
- Oncology and Metabolism, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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Мокрышева НГ, Еремкина АК, Мирная СС, Крупинова ЮА, Воронкова ИА, Ким ИВ, Бельцевич ДГ, Кузнецов НС, Пигарова ЕА, Рожинская ЛЯ, Дегтярев МВ, Егшатян ЛВ, Румянцев ПО, Андреева ЕН, Анциферов МБ, Маркина НВ, Крюкова ИВ, Каронова ТЛ, Лукьянов СВ, Слепцов ИВ, Чагай НБ, Мельниченко ГА, Дедов ИИ. [The clinical practice guidelines for primary hyperparathyroidism, short version]. PROBLEMY ENDOKRINOLOGII 2021; 67:94-124. [PMID: 34533017 PMCID: PMC9753843 DOI: 10.14341/probl12801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Abstract
Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.
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Affiliation(s)
- Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
| | - А. К. Еремкина
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Ю. А. Крупинова
- Национальный медицинский исследовательский центр эндокринологии
| | - И. А. Воронкова
- Национальный медицинский исследовательский центр эндокринологии
| | - И. В. Ким
- Национальный медицинский исследовательский центр эндокринологии
| | - Д. Г. Бельцевич
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. С. Кузнецов
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. А. Пигарова
- Национальный медицинский исследовательский центр эндокринологии
| | - Л. Я. Рожинская
- Национальный медицинский исследовательский центр эндокринологии
| | - М. В. Дегтярев
- Национальный медицинский исследовательский центр эндокринологии
| | - Л. В. Егшатян
- Национальный медицинский исследовательский центр эндокринологии
| | | | - Е. Н. Андреева
- Национальный медицинский исследовательский центр эндокринологии
| | - М. Б. Анциферов
- Эндокринологический диспансер Департамента здравоохранения города Москвы
| | - Н. В. Маркина
- Эндокринологический диспансер Департамента здравоохранения города Москвы
| | - И. В. Крюкова
- Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского
| | - Т. Л. Каронова
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | | | | | - Н. Б. Чагай
- Ставропольский государственный медицинский университет
| | | | - И. И. Дедов
- Национальный медицинский исследовательский центр эндокринологии
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Castellano E, Pellegrino M, Tardivo V, Attanasio R, Boriano A, Borretta G. Aldosterone Secretion in Patients With Primary Hyperparathyroidism Without Arterial Hypertension. Endocr Pract 2021; 27:1072-1076. [PMID: 33965584 DOI: 10.1016/j.eprac.2021.04.886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a direct bidirectional link between parathyroid hormone (PTH) and the renin-angiotensin-aldosterone system (RAAS), but few studies evaluated the RAAS in patients with primary hyperparathyroidism (PHPT), mainly biased from concomitant antihypertensive treatment. METHODS We retrospectively evaluated a consecutive series of 130 normotensive patients with PHPT comparing aldosterone (ALD) levels and plasma renin activity (PRA) with the demographic, biochemical, or clinical features of PHPT. RESULTS No correlation was found between ALD and PRA, and the demographic, biochemical, and bone densitometry parameters in patients with PHPT without hypertension, with the exception of a negative correlation between age and serum PRA. Moreover, there was no significant correlation between PTH and ALD levels even in patients whose PTH level was >100 ng/L (P = .088). CONCLUSION In our normotensive patients with PHPT, the ALD, PRA, and aldosterone/renin ratio were not correlated to PTH and calcium levels. In addition, they were neither related to PHPT clinical presentation nor renal function, vitamin D status, bone mass loss, or the presence of comorbidities such as diabetes and obesity. Further studies are needed to clarify the complex interplay between PTH and the RAAS in the modern PHPT presentation.
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Affiliation(s)
- Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy.
| | - Micaela Pellegrino
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Valentina Tardivo
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Roberto Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy
| | - Alberto Boriano
- Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
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Parathyroid Disease in Pregnancy and Lactation: A Narrative Review of the Literature. Biomedicines 2021; 9:biomedicines9050475. [PMID: 33925967 PMCID: PMC8145477 DOI: 10.3390/biomedicines9050475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
Pregnancy and lactation are characterized by sophisticated adaptations of calcium homeostasis, aiming to meet fetal, neonatal, and maternal calcium requirements. Pregnancy is primarily characterized by an enhancement of intestinal calcium absorption, whereas during lactation additional calcium is obtained through resorption from the maternal skeleton, a process which leads to bone loss but is reversible following weaning. These maternal adaptations during pregnancy and lactation may influence or confound the presentation, diagnosis, and management of parathyroid disorders such as primary hyperparathyroidism or hypoparathyroidism. Parathyroid diseases are uncommon in these settings but can be severe when they occur and may affect both maternal and fetal health. This review aims to delineate the changes in calcium physiology that occur with pregnancy and lactation, describe the disorders of calcium and parathyroid physiology that can occur, and outline treatment strategies for these diseases in the above settings.
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Buyuksimsek M, Gulumsek E, Demirtas D, Icen YK, Sumbul HE, Ogul A, Ay N, Saler T, Koc M. Carotid-femoral pulse wave velocity is significantly increased in newly diagnosed hypertensive patients with primary hyperparathyroidism and significantly related with serum calcium level. J Ultrasound 2020; 24:439-446. [PMID: 32705503 DOI: 10.1007/s40477-020-00512-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHP) is a rare cause of secondary hypertension (HT), but in patients with PHP, HT is very common and 20-80% of patients have HT. The aim of this study was to evaluate the change in carotid-femoral pulse wave velocity (CF-PWV) in hypertensive patients with PHP, and was to determine the clinical, laboratory, and echocardiographic parameters associated with CF-PWV. METHODS The study included 83 newly diagnosed hypertensive patients with PHP and 83 patients with newly diagnosed essential HT without PHP. All patients underwent echocardiography and CF-PWV measurements. RESULTS In patients with PHP, blood urea nitrogen, hs-CRP, uric acid, serum and urine calcium, parathyroid hormone level, CF-PWV value, LV wall thickness, LVMI, aortic and left atrium (LA) diameter, and presence of LVH and CF-PWV > 10 m/s were higher, and serum phosphorus levels were lower. Serum calcium, LA diameter, and LVMI values were closely correlated with CF-PWV. In the ROC analysis, the AUROC was calculated as 0.825 for calcium level to determine the patients with increased CF-PWV. When the serum calcium value was taken as 10 mg/dL, it was determined with CF-PWV > 10 m/s were 79.5% sensitivity and 78.2% specificity. CONCLUSION CF-PWV significantly increases in newly diagnosed hypertensive patients with PHP and significantly related to serum calcium level. To protect against target organ damage, high serum calcium levels should be monitored as well as blood pressure in hypertensive patients with PHP.
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Affiliation(s)
- Mahmut Buyuksimsek
- Department of Medical Oncology, University of Health Sciences - Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, 01230, Adana, Turkey.
| | - Erdinc Gulumsek
- Department of Gastroenterology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Derya Demirtas
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Ali Ogul
- Department of Medical Oncology, University of Health Sciences - Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, 01230, Adana, Turkey
| | - Nurettin Ay
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Tayyibe Saler
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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6
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Iyer S, Simon M, Tan C, Gesner L, Viggiano J, Chhabra S. Retro-tracheal parathyroid adenoma: A rare location of a common pathology. Radiol Case Rep 2020; 15:672-674. [PMID: 32280399 PMCID: PMC7136598 DOI: 10.1016/j.radcr.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022] Open
Abstract
Ectopic parathyroid adenoma in the mediastinum has been reported in several publications; however, its location in the posterior mediastinum, especially a retro-tracheal location, has been rarely reported. We report a case of a 61-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retro-tracheal mediastinal parathyroid adenoma. The surgical excision normalized the phosphocalcic balance with improvement in the patient's clinical symptoms. An ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent significant clinical complications.
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Affiliation(s)
- Sekhar Iyer
- Resident, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
| | - Michael Simon
- Resident, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
| | - Christopher Tan
- Resident, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
| | - Lyle Gesner
- Program Director, Chief of Neuroradiology, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
| | - Joseph Viggiano
- Chief of Nuclear Medicine, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
| | - Shalini Chhabra
- Associate Attending, Department of Radiology, RWJBH - Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA
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Zheng MH, Li FXZ, Xu F, Lin X, Wang Y, Xu QS, Guo B, Yuan LQ. The Interplay Between the Renin-Angiotensin-Aldosterone System and Parathyroid Hormone. Front Endocrinol (Lausanne) 2020; 11:539. [PMID: 32973674 PMCID: PMC7468498 DOI: 10.3389/fendo.2020.00539] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) is the regulatory system by which renin induces aldosterone production. Angiotensin II (Ang II) is the main effector substance of the RAAS. The RAAS regulates blood pressure and electrolyte balance by controlling blood volume and peripheral resistance. Excessive activation of the RAAS is an important factor in the onset of cardiovascular disease and the deterioration of this disease. The most common RAAS abnormality is primary aldosteronism (PA). Parathyroid hormone (PTH) is a peptide secreted by the main cells of the parathyroid gland, which promotes elevated blood calcium (Ca2+) levels and decreased blood phosphorus (Pi) levels. Excessive secretion of PTH can cause primary hyperparathyroidism (PHPT). Parathyroidism is highly prevalent in postmenopausal women and is often associated with secondary osteoporosis. PA and PHPT are common endocrine system diseases. However, studies have shown a link between the RAAS and PTH, indicating a positive relationship between them. In this review, we explore the complex bidirectional relationship between the RAAS and PTH. We also point out possible future treatment options for related diseases based on this relationship.
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Affiliation(s)
- Ming-Hui Zheng
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fu-Xing-Zi Li
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Lin
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Wang
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiu-Shuang Xu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bei Guo
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Qing Yuan
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ling-Qing Yuan
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Pal R, Mukherjee S, Bhadada SK, Bhansali A, Puravoor J, Behera A. Persistence of "non-dipping" pattern in blood pressure after curative parathyroidectomy in apparently normotensive patients with symptomatic primary hyperparathyroidism. MINERVA ENDOCRINOL 2019; 45:181-188. [PMID: 31789012 DOI: 10.23736/s0391-1977.19.03104-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The prevalence of hypertension in primary hyperparathyroidism (PHPT) varies from 20-80% with data being based on office-based blood pressure measurements. Little is known about ambulatory monitoring of blood pressure (AMBP) in PHPT and changes in blood pressure (BP) variables post-curative parathyroidectomy. Hence, we conducted a prospective study wherein we performed AMBP in apparently normotensive patients with PHPT and reevaluated them 3 months post-curative parathyroidectomy. METHODS Consecutive patients with symptomatic PHPT aged 20 years and above underwent 24 hours AMBP at enrollment and at 3 months after successful parathyroidectomy. Pre- and postoperative BP variables were compared and correlated with serum calcium, creatinine and intact parathyroid hormone (iPTH) levels. RESULTS After exclusion, 17 symptomatic PHPT patients were enrolled in the study. AMBP detected hypertension in 4 (23.5%) patients. There was a significant reduction in the average nighttime systolic (P=0.007) and diastolic BP (P=0.034) after parathyroidectomy. However, the average 24 hours systolic/diastolic BP, daytime systolic/diastolic BP and average 24 hours mean arterial pressure did not differ before and after surgery. Non-dipping blood pressure pattern was seen in 53% of patients at presentation and persisted in 50% of cases after successful surgery. None of the biochemical parameters significantly correlated with any BP variable. CONCLUSIONS AMBP can help detect hypertension in patients with PHPT that remains unrecognized with routine office-based blood pressure measurement. In addition, AMBP detects loss of normal dipping pattern in BP that persists in almost half of the patients even after successful parathyroidectomy, perhaps because of permanent vascular damage induced by PHPT.
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Affiliation(s)
- Rimesh Pal
- Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Soham Mukherjee
- Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India -
| | - Anil Bhansali
- Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayaprakash Puravoor
- Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunanshu Behera
- Departments of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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The value of intraoperative parathyroid hormone assay in the surgery of mediastinal ectopic parathyroid adenoma (A case series). Ann Med Surg (Lond) 2019; 44:51-56. [PMID: 31312444 PMCID: PMC6610238 DOI: 10.1016/j.amsu.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background and aims Ectopic parathyroid adenoma is a rare entity. Its clinical management is challenging due to varying locations in the mediastinum. The aim of our study is to report our experience about the preoperative localization of the ectopic parathyroid adenoma and to emphasize the major role of the intraoperative parathyroid hormone assay in such circumstances. Methods It is a monocentric, retrospective study about patients diagnosed with EPA (ectopic parathyroid adenoma) from January 2015 to December 2016. Clinical aspects, preoperative management as well as the surgical procedures have been analyzed. Results There were 7 women, with an average age of 59.14 years. Six patients presented with biological disorders of the phosphocalcic metabolism such as spontaneous bone fracture and recurrent renal lithiasis. In one case, EPA was discovered in the setting of malignant hypercalcemia. The topographic preoperative assessment with a cervicothoracic CT (computed tomography) showed spontaneously hyperdense tissular masses of variable localizations in the mediastinum. A Tc-99 m (99mTc - MIBI) scintigraphy was performed in 5 patients and showed uptake in all cases. We performed cervicotomy in 1 case, manubriotomy in 2 patients, neck manubriotomy in 2 cases, total vertical sternotomy in 1 case, and posterolateral thoracotomy in 1 patient. The lesion was localized in the mediastinum in 1 patient in the perithymic fat in 1 case; EPA was laterotracheal in 1 case, retro tracheal in 1 case, intra-thymic in 2 cases, inter-jugulo-carotidian with contact with the left subclavial artery in 1 case, and anterior mediastinal in 1 patient. The 1-h after-parathormonemia following removal of the surgical specimens showed a decrease value of 45 and 80% of the baseline value. No surgical morbidity was noted after an average follow-up of 7.9 months (range of 5–18 months). Conclusion The preoperative topographic diagnosis of ectopic parathyroid adenoma is challenging for the surgeon despite progress in the morphological assessment. The intraoperative parathyroid hormone assay is a valuable tool for an appropriate surgical management. Thoracic surgeons faced difficulties in the management of ectopic parathyroid adenomas in the mediastinal location. The intraoperative assay of parathormonemia helps guide the surgeon in his strategy of complete excision of the ectopic parathyroid adenom Hypocalcemia is a constant postoperative complication and its absence may make questionnable the quality of the tumor resection.
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Rigg J, Gilbertson E, Barrett HL, Britten FL, Lust K. Primary Hyperparathyroidism in Pregnancy: Maternofetal Outcomes at a Quaternary Referral Obstetric Hospital, 2000 Through 2015. J Clin Endocrinol Metab 2019; 104:721-729. [PMID: 30247615 DOI: 10.1210/jc.2018-01104] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with substantial maternofetal morbidity and mortality rates. The optimal treatment and timing of surgical intervention in pregnancy remain contested. OBJECTIVE To compare maternofetal outcomes of medically and surgically treated patients with PHPT in pregnancy. DESIGN Retrospective chart review. SETTING Quaternary referral hospital. PATIENTS Women with PHPT in pregnancy treated between 1 January 2000 and 31 December 2015. INTERVENTIONS Medical therapy or parathyroid surgery. MAIN OUTCOMES MEASURED Timing of diagnosis; maternal corrected serum calcium concentrations; gestation, indication and mode of delivery; complications attributable to PHPT; birth weight; and admission to the neonatal intensive care unit (NICU). RESULTS Twenty-two pregnancies were managed medically, and six patients underwent parathyroidectomy in pregnancy (five in trimester 2, and one at 32 weeks gestation). Most patients treated medically either had a corrected serum calcium concentration <2.85 mmol/L in early pregnancy or had PHPT diagnosed in trimester 3. Of viable medically managed pregnancies, 30% were complicated by preeclampsia, and preterm delivery occurred in 66% of this group. All preterm neonates required admission to the NICU for complications related to prematurity. All surgically treated patients delivered their babies at term, and there were no complications of parathyroid surgery. CONCLUSION Maternofetal outcomes have improved relative to that reported in early medical literature in patients treated medically and surgically, but the rates of preeclampsia and preterm delivery were higher in medically treated patients. The study was limited by its retrospective design and small sample sizes.
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MESH Headings
- Adult
- Antihypertensive Agents/therapeutic use
- Calcium/blood
- Female
- Humans
- Hyperparathyroidism, Primary/blood
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/therapy
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infusions, Intravenous
- Intensive Care Units, Neonatal/statistics & numerical data
- Pamidronate/therapeutic use
- Parathyroidectomy/statistics & numerical data
- Pre-Eclampsia/epidemiology
- Pre-Eclampsia/etiology
- Pregnancy
- Premature Birth/epidemiology
- Premature Birth/etiology
- Referral and Consultation/statistics & numerical data
- Rehydration Solutions/administration & dosage
- Retrospective Studies
- Time Factors
- Young Adult
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Affiliation(s)
- Jane Rigg
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Elise Gilbertson
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- The University of Queensland, Sunshine Coast Clinical Unit, Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Helen L Barrett
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Fiona L Britten
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Karin Lust
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
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11
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Nilsson IL. Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 2019; 285:149-164. [PMID: 30289185 DOI: 10.1111/joim.12840] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately 'normal' levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3-5%, is observed amongst women, and the prevalence increases with age. The female-to-male ratio is 3-4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost-effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.
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Affiliation(s)
- I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department ofBreast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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12
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Rabiou S, Efared B, Aminou S, Harmouchi H, Sidibé K, Lakranbi M, Ouadnouni Y, Smahi M. An Unusual Mass of Posterior Mediastinum: A Case of Retrotracheal Parathyroid Adenoma Presenting With Primary Hyperparathyroidism. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2018; 12:1179548418811840. [PMID: 30479491 PMCID: PMC6243414 DOI: 10.1177/1179548418811840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Abstract
Although parathyroid ectopy in the mediastinum has been the subject of several publications, its location in the posterior mediastinum is very rarely reported. We report a case of a 69-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retrotracheal mediastinal parathyroid adenoma. The surgical excision leads to a quick normalisation of the phosphocalcic balance with improvement of the clinical symptoms. Ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent further clinical complications.
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Affiliation(s)
- Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fès, Morocco
| | | | - Sani Aminou
- Department of Endocrinology and Metabolic Diseases, HNN, Morocco
| | | | - Kassim Sidibé
- Department of Radiology, CHU Hassan II, Fès, Morocco
| | | | - Yassine Ouadnouni
- Department of Thoracic Surgery, CHU Hassan II, Fès, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fès, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fès, Morocco
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13
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DeCarlo KE, Agrawal N. Double hit! A unique case of resistant hypertension. BMJ Case Rep 2017; 2017:bcr-2017-221530. [PMID: 29275380 DOI: 10.1136/bcr-2017-221530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing. CT scan of the adrenals was non-localising. Adrenal venous sampling confirmed bilateral idiopathic adrenal hyperplasia. Concurrent primary hyperparathyroidism was demonstrated by elevated calcium and parathyroid hormone levels and localised by sestamibi scan. Idiopathic adrenal hyperplasia was treated medically with spironolactone. Her BP remained elevated until postparathyroidectomy. Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA making this bidirectional link unique. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.
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Affiliation(s)
- Kristen Elizabeth DeCarlo
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nidhi Agrawal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, NYU School of Medicine, New York City, New York, USA
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14
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Sabljak VD, Zivaljevic VR, Milicic BR, Paunovic IR, Toskovic AR, Stevanovic KS, Tausanovic KM, Markovic DZ, Stojanovic MM, Lakicevic MV, Jovanovic MD, Diklic AD, Kalezic NK. Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism. Med Princ Pract 2017; 26:381-386. [PMID: 28399538 PMCID: PMC5768112 DOI: 10.1159/000475597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/10/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). SUBJECTS AND METHODS The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure ≥20% compared to baseline values which lasted for 15 min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. RESULTS Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102-3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360-0.901, p = 0.016). CONCLUSION In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH.
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Affiliation(s)
- Vera D. Sabljak
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Serbia
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
| | - Vladan R. Zivaljevic
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Center of Serbia, Serbia
| | - Biljana R. Milicic
- Institute for Medical Informatics and Statistics, School of Dentistry, University of Belgrade, Serbia
| | - Ivan R. Paunovic
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Center of Serbia, Serbia
| | - Anka R. Toskovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Serbia
| | | | | | - Dejan Z. Markovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Serbia
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
| | - Marina M. Stojanovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Serbia
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
| | - Mirko V. Lakicevic
- Department for Anesthesia and Resuscitation, Clinical Hospital Center Zemun, Belgrade, Serbia
| | | | - Aleksandar D. Diklic
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Center of Serbia, Serbia
| | - Nevena K. Kalezic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Serbia
- Department for Surgery and Anesthesiology, School of Medicine, University of Belgrade, Serbia
- *Prof. Nevena K. Kalezic, MD, PhD, Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Pasterova 2 St., RS-11000 Belgrade (Serbia), E-Mail
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15
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Verdelli C, Corbetta S. MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects. Eur J Endocrinol 2017; 176:R39-R52. [PMID: 27601015 DOI: 10.1530/eje-16-0430] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 12/27/2022]
Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.
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Affiliation(s)
- C Verdelli
- Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Corbetta
- Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Endocrinology ServiceDepartment of Biomedical Sciences for Health, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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16
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Parra P, Costa R, de Asúa DR, Moldenhauer F, Suárez C. Atherosclerotic Surrogate Markers in Adults With Down Syndrome: A Case-Control Study. J Clin Hypertens (Greenwich) 2016; 19:205-211. [DOI: 10.1111/jch.12890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/28/2016] [Accepted: 07/03/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Pedro Parra
- Adult Down Syndrome Outpatient Unit; Department of Internal Medicine; Fundación de Investigación Biomédica; Hospital Universitario de La Princesa; Madrid Spain
| | - Ramón Costa
- Adult Down Syndrome Outpatient Unit; Department of Internal Medicine; Fundación de Investigación Biomédica; Hospital Universitario de La Princesa; Madrid Spain
| | - Diego Real de Asúa
- Adult Down Syndrome Outpatient Unit; Department of Internal Medicine; Fundación de Investigación Biomédica; Hospital Universitario de La Princesa; Madrid Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Unit; Department of Internal Medicine; Fundación de Investigación Biomédica; Hospital Universitario de La Princesa; Madrid Spain
| | - Carmen Suárez
- Adult Down Syndrome Outpatient Unit; Department of Internal Medicine; Fundación de Investigación Biomédica; Hospital Universitario de La Princesa; Madrid Spain
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17
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Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary arterial hypertension. Beyond its effects on intravascular volume and blood pressure, PA causes metabolic alterations and a higher cardiovascular morbidity, which is reduced by PA-directed therapy. Experimental studies demonstrated that mineralocorticoid excess may also influence mineral homeostasis. A role in cardiovascular disease has also been attributed to parathyroid hormone (PTH). Increasing evidence supports a bidirectional interaction between aldosterone and PTH.Primary hyperparathyroidism is associated with arterial hypertension and an increased cardiovascular morbidity and mortality, which might be associated to higher aldosterone values; parathyreoidectomy results in lowered aldosterone and blood pressure levels. PA leads to secondary hyperparathyroidism, which is reversible by PA-directed therapy. A lower bone mineral density and a higher fracture rate were also shown to be reversible by PA-directed therapy. There is a suspicion of a bidirectional interaction between aldosterone and PTH, which might lead to a higher cardiovascular risk. There are more and more reports about coincident PA and primary hyperparathyroidism. From a pathophysiologic point of view this constellation is best characterized as tertiary hyperparathyroidism. Future aspects should further clarify the extent of these endocrine interactions and analyze the influence of this interplay on cardiovascular morbidity and mortality and bone health.
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Affiliation(s)
- E Asbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Bekeran
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
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18
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Tuna MM, Doğan BA, Arduç A, Imga NN, Tütüncü Y, Berker D, Güler S. Impaired endothelial function in patients with mild primary hyperparathyroidism improves after parathyroidectomy. Clin Endocrinol (Oxf) 2015; 83:951-6. [PMID: 25393455 DOI: 10.1111/cen.12666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/03/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity; however, data on the reversibility of cardiovascular disease in mild primary hyperparathyroidism are conflicting. The aim of this study was to assess endothelial function in patients with mild PHPT before and after parathyroidectomy (Ptx). METHODS We prospectively evaluated 53 patients with mild PHPT (Group 1; 45 women, eight men; aged 52 ± 3·1 years) and 46 healthy control subjects (Group 2; 38 women, eight men; aged 46 ± 9·5 years). Endothelial function was measured as flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) using Doppler ultrasonography. Patients with diabetes mellitus, coronary heart disease, impaired renal function, hyperthyroidism, hypothyroidism and a history of smoking were excluded from the study. Patients were studied at baseline and 6-12 months after the first evaluation. RESULTS There were no differences with respect to age, gender and BMI between the two groups. Hypertension prevalence was three times higher in group 1 than in controls. % FMD was lower in group 1 than in group 2 (2·6 ± 1·2 vs 14·8 ± 9·6, P < 0·001). CIMT was higher in patients with PHPT than controls (0·69 ± 0·18 vs 0·61 ± 0·12, P = 0·045). This significance remained when hypertensive patients were excluded from the analysis. While FMD and CIMT improved significantly after Ptx, there were no differences in mild PHPT patients who followed without parathyroidectomy. CONCLUSION FMD and CIMT are impaired in patients with mild PHPT compared to controls and improved significantly after a successful Ptx. Ptx improves endothelial function in patients with mild PHPT that may lead to decreased cardiovascular morbidity and mortality.
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Affiliation(s)
- Mazhar M Tuna
- Department of Metabolism, Medical Faculty of Endocrinology, Dicle University, Diyarbakir, Turkey
| | - Berçem A Doğan
- Department of Endocrinology and Metabolism, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ayşe Arduç
- Diabetes, Endocrine and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Washington, DC, USA
| | - Narin Nasiroğlu Imga
- Department of Endocrinology and Metabolism, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yasemin Tütüncü
- Department of Endocrinology and Metabolism, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Serdar Güler
- Department of Metabolism, Medical Faculty of Endocrinology, Hitit University, Çorum, Turkey
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19
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A Rare Presentation of Primary Hyperparathyroidism with Concurrent Aldosterone-Producing Adrenal Carcinoma. Case Rep Endocrinol 2015; 2015:910984. [PMID: 26161274 PMCID: PMC4487930 DOI: 10.1155/2015/910984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022] Open
Abstract
Aldosterone-producing adrenocortical carcinomas are an extremely rare cause of hyperaldosteronism (<1%). Coexistence of different endocrine tumors warrants additional screening for multiple endocrine neoplasia syndromes, especially in young patients with large or malignant masses. We present the case of a 40-year-old man with a history of hypertension that presented with an incidental left adrenal tumor during an ultrasound performed for nephrolithiasis. Biochemical assessment showed a mildly elevated calcium (11.1 mg/dL), high parathyroid hormone, and a plasma aldosterone concentration/plasma renin activity ratio of 124.5 (normal < 30), compatible with primary hyperparathyroidism with a concomitant primary hyperaldosteronism. A Tc99m-MIBI scintigraphy showed an abnormally increased tracer uptake in the right superior parathyroid and abdominal computed tomography confirmed a left adrenal tumor of 20 cm. The patient underwent parathyroidectomy and adrenalectomy with final pathology reports of parathyroid hyperplasia and adrenal carcinoma with biochemical remission of both endocrinopathies. He was started on chemotherapy, but the patient developed a frontal cortex and an arm metastasis and finally died less than one year later.
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20
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Mendoza-Zubieta V, Gonzalez-Villaseñor GA, Vargas-Ortega G, Gonzalez B, Ramirez-Renteria C, Mercado M, Molina-Ayala MA, Ferreira-Hermosillo A. High prevalence of metabolic syndrome in a mestizo group of adult patients with primary hyperparathyroidism (PHPT). BMC Endocr Disord 2015; 15:16. [PMID: 25886602 PMCID: PMC4415358 DOI: 10.1186/s12902-015-0014-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/27/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) and metabolic syndrome (MS) have been independently related to cardiovascular morbidities, however this association is still controversial. Mexican population has a high prevalence of metabolic syndrome, however its frequency seems to be even higher than expected in patients with PHPT. METHODS We retrospectively reviewed the charts of patients that underwent parathyroidectomy for PHPT in a referral center and used the criteria from the National Cholesterol Educational Program (NCEP)/Adult Treatment Panel III (ATP III) to define MS before surgery. We compared the characteristics between the patients with and without MS. RESULTS 60 patients were analyzed, 77% were female and 72% had a single parathyroid adenoma. MS was present in 59% of the patients, this group was significantly older (57 vs. 48 years, p = 0.01) and they had lower iPTH (115 vs. 161 ng/ml, p = 0.017). Other parameters did not show differences. CONCLUSIONS MS is frequent in our population diagnosed with primary hyperparathyroidism, adverse cardiovascular parameters are common and significant differences in calcium metabolism compared to the non-MS group are present.
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Affiliation(s)
- Victoria Mendoza-Zubieta
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Gloria A Gonzalez-Villaseñor
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Guadalupe Vargas-Ortega
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Baldomero Gonzalez
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Claudia Ramirez-Renteria
- Endocrinology Experimental Investigation Unit Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Moises Mercado
- Endocrinology Experimental Investigation Unit Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Mario A Molina-Ayala
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Aldo Ferreira-Hermosillo
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
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21
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Haglund F, Rosin G, Nilsson IL, Juhlin CC, Pernow Y, Norenstedt S, Dinets A, Larsson C, Hartman J, Höög A. Tumour nuclear oestrogen receptor beta 1 correlates inversely with parathyroid tumour weight. Endocr Connect 2015; 4:76-85. [PMID: 25648860 PMCID: PMC4351559 DOI: 10.1530/ec-14-0109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a common endocrinopathy, frequently caused by a parathyroid adenoma, rarely by a parathyroid carcinoma that lacks effective oncological treatment. As the majority of cases are present in postmenopausal women, oestrogen signalling has been implicated in the tumourigenesis. Oestrogen receptor beta 1 (ERB1) and ERB2 have been recently identified in parathyroid adenomas, the former inducing genes coupled to tumour apoptosis. We applied immunohistochemistry and slide digitalisation to quantify nuclear ERB1 and ERB2 in 172 parathyroid adenomas, atypical adenomas and carcinomas, and ten normal parathyroid glands. All the normal parathyroid glands expressed ERB1 and ERB2. The majority of tumours expressed ERB1 (70.6%) at varying intensities, and ERB2 (96.5%) at strong intensities. Parathyroid carcinomas expressed ERB1 in three out of six cases and ERB2 in five out of six cases. The intensity of tumour nuclear ERB1 staining significantly correlated inversely with tumour weight (P=0.011), and patients whose tumours were classified as ERB1-negative had significantly greater tumour weight as well as higher serum calcium (P=0.002) and parathyroid hormone levels (P=0.003). Additionally, tumour nuclear ERB1 was not expressed differentially with respect to sex or age of the patient. Levels of tumour nuclear ERB2 did not correlate with clinical characteristics. In conclusion, decreased ERB1 immunoreactivity is associated with increased tumour weight in parathyroid adenomas. Given the previously reported correlation with tumour-suppressive signalling, selective oestrogen receptor modulation (SERMs) may play a role in the treatment of parathyroid carcinomas. Future studies of SERMs and oestrogen treatment in PHPT should consider tumour weight as a potential factor in pharmacological responsiveness.
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Affiliation(s)
- Felix Haglund
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Gustaf Rosin
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Inga-Lena Nilsson
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - C Christofer Juhlin
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Ylva Pernow
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Sophie Norenstedt
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Andrii Dinets
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Catharina Larsson
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Johan Hartman
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
| | - Anders Höög
- Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine Department of Oncology-PathologyKarolinska Institutet, Stockholm, SwedenCancer Centre KarolinskaR8:04, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, SwedenDepartment of Biosciences and NutritionKarolinska Institutet, Novum, Huddinge, Stockholm, SwedenDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, SwedenDepartment of Surgery #4Bogomolets National Medical University, Kiev, Ukraine
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Bandeira F, Griz L, Chaves N, Carvalho NC, Borges LM, Lazaretti-Castro M, Borba V, Castro LCD, Borges JL, Bilezikian J. Diagnosis and management of primary hyperparathyroidism--a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism. ACTA ACUST UNITED AC 2014; 57:406-24. [PMID: 24030180 DOI: 10.1590/s0004-27302013000600002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/03/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. MATERIALS AND METHODS This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D", are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.
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Liu Y, Li S, Zeng Z, Wang J, Xie L, Li T, He Y, Qin X, Zhao J. Kidney Stones and Cardiovascular Risk: A Meta-analysis of Cohort Studies. Am J Kidney Dis 2014; 64:402-10. [DOI: 10.1053/j.ajkd.2014.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/26/2014] [Indexed: 12/18/2022]
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Fischer E, Hannemann A, Rettig R, Lieb W, Nauck M, Pallauf A, Bidlingmaier M, Beuschlein F, Wallaschofski H, Reincke M. A high aldosterone to renin ratio is associated with high serum parathyroid hormone concentrations in the general population. J Clin Endocrinol Metab 2014; 99:965-71. [PMID: 24423297 DOI: 10.1210/jc.2013-3214] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Activation of the renin-angiotensin-aldosterone system (RAAS) is associated with high serum PTH concentrations and vice versa. OBJECTIVE The aim of this study was to analyze the associations of the plasma aldosterone concentration (PAC), the plasma renin concentration (PRC), or the aldosterone to renin ratio (ARR) with serum PTH concentrations in a sample from the general population of northeast Germany. DESIGN We selected 3105 subjects (25-88 y) from the first 5-year follow-up examination of the Study of Health in Pomerania. The associations of PAC, PRC, or ARR with serum PTH concentrations were examined with multivariable linear regression analyses. We further calculated adjusted mean serum PTH concentrations according to PAC, PRC, and ARR categories (≥90th and < 90th sex specific percentiles and sex specific quartiles). The models were adjusted for age, sex, estimated glomerular filtration rate, serum 25-hydroxy vitamin D concentration, waist circumference, body mass index, hypertension, diabetes mellitus, liver disease, and intake of drugs that affect the RAAS or bone metabolism. RESULTS We found no associations between PAC or PRC and serum PTH concentrations in fully adjusted linear regression models. However, fully adjusted linear regression and ANOVA models revealed higher serum PTH concentrations in subjects with an ARR 90th percentile or greater than in subjects with a lower ARR. CONCLUSIONS Our data show that a high ARR is associated with high serum PTH concentrations in the general population and thus add to the increasing evidence of a relation between the RAAS and PTH.
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Affiliation(s)
- Evelyn Fischer
- Medizinische Klinik und Poliklinik IV (E.F., A.P., M.B., F.B., M.R.), Klinikum der Ludwig-Maximilians-Universität München, D-80336 München, Deutschland; Institut für Klinische Chemie und Laboratoriumsmedizin (A.H., M.N., H.W.), Universitätsmedizin Greifswald, D-17475 Greifswald, Deutschland; Institut für Physiologie (R.R.) and Institut für Community Medicine (W.L.), Universitätsmedizin Greifswald, D-17475 Greifswald, Deutschland; and Institut für Epidemiologie (W.L.), Christian-Albrechts-Universität Kiel, D-24105 Kiel, Deutschland
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25
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Macfarlane DP, Yu N, Leese GP. Subclinical and asymptomatic parathyroid disease: implications of emerging data. Lancet Diabetes Endocrinol 2013; 1:329-40. [PMID: 24622418 DOI: 10.1016/s2213-8587(13)70083-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary hyperparathyroidism, a disorder in which there is a tendency for hypercalcaemia caused by autonomous overproduction of parathyroid hormone, is common, especially in postmenopausal women. Although parathyroidectomy is indicated for symptomatic patients, most individuals with the disorder are asymptomatic and without classic complications, such as renal stones and osteoporosis, at diagnosis. Consensus guidelines suggest which individuals might be suitable for medical follow-up rather than parathyroidectomy, but there are no long-term randomised controlled trials to support the safety of medical surveillance, and some patients progress with time. Data from observational studies suggest that cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism, and might be predicted by parathyroid hormone concentrations, even in individuals with asymptomatic primary hyperparathyroidism. Whether parathyroidectomy improves cardiovascular outcomes in patients with asymptomatic primary hyperparathyroidism is unproven, but data suggest that surgery decreases fracture risk and might improve neuropsychological symptoms. Studies also show that patients with normocalcaemic (subclinical) hyperparathyroidism and hypoparathyroidism have a low risk of progression to overt disease, but their long-term risks are not defined. In this Review, we explore the increasing range of asymptomatic parathyroid disorders, focusing on current evidence about their natural history and potential complications, with a particular emphasis on primary hyperparathyroidism.
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Affiliation(s)
- David P Macfarlane
- Medical Research Institute, Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Ning Yu
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Graham P Leese
- Medical Research Institute, Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, Dundee, UK.
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26
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Norenstedt S, Pernow Y, Brismar K, Sääf M, Ekip A, Granath F, Zedenius J, Nilsson IL. Primary hyperparathyroidism and metabolic risk factors, impact of parathyroidectomy and vitamin D supplementation, and results of a randomized double-blind study. Eur J Endocrinol 2013; 169:795-804. [PMID: 24026893 PMCID: PMC3805017 DOI: 10.1530/eje-13-0547] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D insufficiency may increase the risk for cardio metabolic disturbances in patients with primary hyperparathyroidism (PHPT). OBJECTIVE To analyze the vitamin D status and indices of the metabolic syndrome in PHPT patients and the effect of vitamin D supplementation after parathyroid adenomectomy (PTX). DESIGN AND METHODS Double-blinded, randomized clinical trial (ClinicalTrials.gov identifier: NCT00982722) performed at Karolinska University Hospital, Sweden, April 2008 to November 2011. One hundred and fifty consecutive patients with PHPT (119 women) were randomized after PTX, 75 to oral treatment with calcium carbonate 1000 mg daily and 75 to calcium carbonate 1000 mg and cholecalciferol 1600 IU daily over 12 months. Changes in metabolic profile and ambulatory blood pressure (BP) were analyzed. Main outcome measures were changes in metabolic factors, BP, and body composition. RESULTS The 25-hydroxyvitamin D (25-OH-D)-level was <50 nmol/l in 76% of the patients before PTX. After PTX, glucose, insulin, and IGF1 decreased, while the 25-OH-D and the IGF-binding protein 1 increased and remained unchanged at follow-up after study medication. One year of vitamin D supplementation resulted in lower parathyroid hormone (PTH) (40 (34-52) vs 49 (38-66) ng/l) and higher 25-OH-D (76 (65-93) vs 49 (40-62) nmol/l; P<0.05). Other laboratory parameters were stable compared with after PTX. Systolic BP decreased and total bone mineral content increased in both groups. CONCLUSION Except for the lowering of the PTH level, no additive effect of vitamin D supplementation was seen. However, PTX proved effective in reducing insulin resistance.
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Affiliation(s)
- Sophie Norenstedt
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
- (Correspondence should be addressed to S Norenstedt who is now at Department of Breast and Endocrine Surgery, Karolinska University Hospital, P9:03, SE-171 76 Stockholm, Sweden; )
| | - Ylva Pernow
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Kerstin Brismar
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Maria Sääf
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Ayla Ekip
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | | | - Jan Zedenius
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
| | - Inga-Lena Nilsson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
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Asik M, Sahin S, Temiz A, Ozkaya M, Ozkul F, Sen H, Binnetoglu E, Gunes F, Bozkurt N, Sahin M, Ukinc K. Evaluation of epicardial fat tissue thickness in patients with primary hyperparathyroidism. Endocr Pract 2013; 20:26-32. [PMID: 24013988 DOI: 10.4158/ep13140.or] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT. METHODS The study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables. RESULTS Both the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels. CONCLUSIONS The results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia.
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Affiliation(s)
- Mehmt Asik
- Department of Endocrinology and Metabolism, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Sinan Sahin
- Department of Cardiology, Bergama Government Hospital, Izmir, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mesut Ozkaya
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Faruk Ozkul
- Department of General Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hacer Sen
- Department of General Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Emine Binnetoglu
- Department of General Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Fahri Gunes
- Department of General Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Neslihan Bozkurt
- Department of General Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Kubilay Ukinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Friedlander AH, Aghazadehsanai N, Chang TI, Harada N, Garrett NR. Prevalence of calcified carotid artery atheromas on panoramic images of individuals with primary hyperparathyroidism. Dentomaxillofac Radiol 2013; 42:20130118. [PMID: 23775925 DOI: 10.1259/dmfr.20130118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Primary hyperparathyroidism (PHPT), affecting 1% of the population, is associated with increased cardiovascular morbidity and mortality. The presence of calcified carotid artery plaque (CCAP) on panoramic images is a validated risk indicator of future adverse cardiovascular events. We hypothesized that military veterans aged 50 years or older diagnosed with PHPT by increased parathyroid hormone and calcium levels would frequently have CCAP on their images. METHODS We determined the prevalence rates of CCAP on the images of patients diagnosed with PHPT and evaluated their atherogenic risk profiles, including hypertension, dyslipidaemia, diabetes and obesity. Comparisons of atherogenic risk factors were made between subjects with and without observed CCAP on their panoramic images. RESULTS Of the 60 patients (86.7% males and 13.3% females, mean age 73.2 ± 11.3 years) with PHPT, 40% had atheromas. There were no significant differences between CCAP+ and CCAP- groups in gender or race (p > 0.05). The atherogenic profile (age, body mass index, hypertension, diabetes, hyperlipidaemia) in the CCAP+ and CCAP- groups was not significantly different (p > 0.05). CONCLUSIONS Calcified carotid artery atheromas are often seen on the panoramic images of patients with PHPT. Thus, dentists must be uniquely vigilant for these lesions when evaluating these studies.
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Affiliation(s)
- A H Friedlander
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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29
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Abstract
Primary hyperparathyroidism is the third most common endocrine disorder. The epidemiology of this disorder is increasingly well understood, but significant limitations still exist in our understanding of the mortality, hospitalizations, incidence, prevalence, and costs associated with this condition. These limitations are due to the small number of population-based epidemiologic studies that have evaluated this condition. Further studies will be required to fully characterize the epidemiology of primary hyperparathyroidism.
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Affiliation(s)
- Bart L Clarke
- College of Medicine, Mayo Clinic, Rochester, MN, USA.
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30
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Chopra S, Cherian D, Jacob JJ. The thyroid hormone, parathyroid hormone and vitamin D associated hypertension. Indian J Endocrinol Metab 2011; 15 Suppl 4:S354-60. [PMID: 22145139 PMCID: PMC3230087 DOI: 10.4103/2230-8210.86979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Thyroid disorders and primary hyperparathyroidism have been known to be associated with increases in blood pressure. The hypertension related to hypothyroidism is a result of increased peripheral resistance, changes in renal hemodynamics, hormonal changes and obesity. Treatment of hypothyroidism with levo-thyroxine replacement causes a decrease in blood pressure and an overall decline in cardiovascular risk. High blood pressure has also been noted in patients with subclinical hypothyroidism. Hyperthyroidism, on the other hand, is associated with systolic hypertension resulting from an expansion of the circulating blood volume and increase in stroke volume. Increased serum calcium levels associated with a primary increase in parathyroid hormone levels have been also associated with high blood pressure recordings. The mechanism for this is not clear but the theories include an increase in the activity of the renin-angiotensin-aldosterone system and vasoconstriction. Treatment of primary hyperparathyroidism by surgery results in a decline in blood pressure and a decrease in the plasma renin activity. Finally, this review also looks at more recent evidence linking hypovitaminosis D with cardiovascular risk factors, particularly hypertension, and the postulated mechanisms linking the two.
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Affiliation(s)
- Sandeep Chopra
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | - Davis Cherian
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | - Jubbin J. Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
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31
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Maniero C, Fassina A, Guzzardo V, Lenzini L, Amadori G, Pelizzo MR, Gomez-Sanchez C, Rossi GP. Primary hyperparathyroidism with concurrent primary aldosteronism. Hypertension 2011; 58:341-6. [PMID: 21825220 DOI: 10.1161/hypertensionaha.111.173948] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carmela Maniero
- Internal Medicine 4, University Hospital, via Giustiniani 2, 35126 Padova, Italy
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32
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Yu N, Donnan PT, Leese GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf) 2011; 75:169-76. [PMID: 21158894 DOI: 10.1111/j.1365-2265.2010.03958.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is a common endocrine disorder, but the majority of cases are perceived to be mild and remain untreated. OBJECTIVE To determine the risk of mortality and morbidities in patients with mild PHPT. SETTING Tayside, Scotland, 1997-2006. DESIGN A historical, prospective, record-linkage, population-based, matched cohort study. PATIENTS All patients with diagnosed but untreated, mild PHPT. METHOD AND OUTCOME MEASURES: Each patient with PHPT was matched with five population-based comparators, by age, gender and calendar year of PHPT diagnosis, selected from the general population. Primary outcomes were all-cause mortality, fatal and nonfatal cardiovascular disease (CVD). Secondary outcomes were cancer-related deaths and other hospital admitted morbidities, including cerebrovascular disease, fractures, hypertension, psychiatric disease, renal complications, cancer and diabetes. The risk was assessed using the Cox proportional hazards model, adjusting for confounding factors of pre-existing co-morbidities, previous prescription of bisphosphonates, socio-economic deprivation score and the probability of having a calcium check. RESULTS Compared to the matched cohort, the risk of all cause mortality, fatal and nonfatal CVD was increased in patients with asymptomatic PHPT: adjusted hazard ratios (HR) 1·64 (95% CI: 1·43-1·87), 1·64 (95% CI: 1·32-2·04) and 2·48 (95% CI: 2·13-2·89), respectively. The risk was also increased in all secondary outcomes, with the risk of renal failure and renal stones being the highest, adjusted HRs being 13·83 (95% CI: 10·41-18·37) and 5·15 (95% CI: 2·69-9·83), respectively. CONCLUSIONS Patients with mild PHPT had an increased risk of mortality, fatal and nonfatal CVD, and the risk of developing other co-morbidities was also increased.
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Affiliation(s)
- Ning Yu
- Dundee Epidemiology and Biostatistics Unit, Division of Clinical and Population Sciences and Education, School of Medicine, University of Dundee, Dundee, UK.
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Madero M, Wassel CL, Peralta CA, Najjar SS, Sutton-Tyrrell K, Fried LF, Boer IHD, Shlipak MG, Newman AB, Hausman D, Sarnak MJ, Kritchevsky SB, Ix JH. Markers of mineral metabolism are not associated with aortic pulse wave velocity in community-living elderly persons: the Health Aging and Body Composition study. Am J Hypertens 2011; 24:755-61. [PMID: 21436791 DOI: 10.1038/ajh.2011.43] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Disorders in mineral metabolism are associated with risk for cardiovascular disease (CVD) events in patients with kidney disease as well as in the general population. This risk is thought to be mediated, in part, through the mechanism of stiffening of the arteries. METHODS The objective of this study was to evaluate the relationships between serum calcium, phosphorus, intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D levels and arterial pulse wave velocity (aPWV) among 2,229 community-dwelling elderly persons participating in the Health Aging and Body Composition (Health ABC) study. RESULTS The mean age of the participants was 72 years; 52% were woman, 39% were black, and 17% had chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)). In parallel unadjusted analyses, the following associations were observed: 2.86% greater aPWV per 12 ng/ml (s.d.) lower 25-hydroxyvitamin D (95% confidence interval -4.38%, -1.31%), 3.04% greater aPWV per 28 pg/ml (s.d.) higher iPTH (95% confidence interval 1.42-4.68%), and 2.37% lower aPWV per 0.5 mg/dl (s.d.) higher phosphorus (95% confidence interval -3.90% to - 0.81%). Except for phosphorus, these associations were attenuated and rendered no longer statistically significant after adjustment for demographic risk factors, clinical site, season, medications and other CVD risk factors. The results were similar in men and women and were not dependent on the presence of CKD. CONCLUSIONS Among well-functioning community-dwelling elderly persons, only serum phosphorus was associated with aPWV; and this association was in the opposite direction of the one hypothesized. Factors other than vascular stiffening may mediate the relationship between disordered mineral metabolism and CVD events in community-living elders.
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Siilin H, Lundgren E, Mallmin H, Mellström D, Ohlsson C, Karlsson M, Orwoll E, Ljunggren Ö. Prevalence of Primary Hyperparathyroidism and Impact on Bone Mineral Density in Elderly Men: MrOs Sweden. World J Surg 2011; 35:1266-72. [DOI: 10.1007/s00268-011-1062-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Broulik PD, Brouliková A, Adámek S, Libanský P, Tvrdoň J, Broulikova K, Kubinyi J. Improvement of hypertension after parathyroidectomy of patients suffering from primary hyperparathyroidism. Int J Endocrinol 2011; 2011:309068. [PMID: 21403888 PMCID: PMC3043284 DOI: 10.1155/2011/309068] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/19/2010] [Accepted: 01/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Primary hyperparathyroidism (PHPT) is one of the most common endocrine conditions and is accompanied by hypertension and increased cardiovascular mortality. The purpose of this study was to evaluate the effect of parathyroidectomy on systolic and diastolic blood pressure (BP) in hypertensive patients with PHPT and whether hypertension occurs more frequently in PHPT than in control group. Methods. A total of 1020 patients with proved PHPT who underwent surgery were compared with with 1020 age, sex, BMI, and smoking status matched controls. We evaluated changes in serum calcium, parathyroid hormone (PTH), uric acid, and BP before and 6 months after surgery. Results. Parathyroidectomy corrected PHPT and resulted in a substantial fall in both mean systolic (150 ± 3.8 to 138 ± 3.6 mmHg) and mean diastolic pressures (97 ± 3 to 88 ± 2.8 mmHg) of the hypertensive subjects; P < .01. In these patients, PTH, calcium, and uric acid normalized. 726 patients from 1020 with PHPT (69.8%) were found to be hypertensive whilst only 489 (47.8%) from 1020 of our control group. Conclusion. Parathyroidectomy in hypertensive patients reduces systolic and diastolic BP. PHPT is accompanied by a variety of metabolic complications, which are a risk factor for hypertension, and parathyroidectomy can improve these metabolic complications.
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Affiliation(s)
- P. D. Broulik
- Third Department of Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- *P. D. Broulik:
| | - A. Brouliková
- Third Department of Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - S. Adámek
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - P. Libanský
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - J. Tvrdoň
- Third Department of Surgery, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - K. Broulikova
- Third Department of Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - J. Kubinyi
- Department of Nuclear Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Hyperparathyroidism, arterial hypertension and aortic stiffness: a possible bidirectional link between the adrenal cortex and the parathyroid glands that causes vascular damage? Hypertens Res 2010; 34:286-8. [PMID: 21160479 DOI: 10.1038/hr.2010.251] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rosa J, Raska I, Wichterle D, Petrak O, Strauch B, Somloova Z, Zelinka T, Holaj R, Widimsky J. Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy. Hypertens Res 2010; 34:296-300. [PMID: 21107330 DOI: 10.1038/hr.2010.232] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The study was aimed at investigating the arterial stiffness assessed by aortic pulse wave velocity (PWV) in the presence of primary hyperparathyroidism (PH), with and without concomitant hypertension. Subsequently, we examined the effect of parathyroidectomy (PTX) on arterial stiffness. A total of 28 patients with PH and concomitant hypertension, and 16 with PH without hypertension were investigated in comparison with 28 essential hypertensive patients and 18 healthy controls, respectively. Patients were matched for age, blood pressure (BP), body mass index, lipid profile and fasting glucose. Six months after PTX, 15 patients were examined again (hypertensive as well as normotensive). PWV was obtained using the SphygmoCor applanation tonometer (AtCor Medical, West Ryde, Australia). PWV was significantly higher in patients with PH and hypertension when compared with patients with essential hypertension (10.1 vs. 8.5 ms(-1), P=0.013). PWV remained significant even after adjustment for age and BP (P=0.02). Similarly, PWV was significantly higher in PH patients without hypertension in comparison with healthy controls (7.6 vs. 5.8 ms(-1), P<0.001). Six months after surgery, in addition to a normalization of calcium metabolism, a significant decrease in systolic BP (131 vs. 123 mmHg, P=0.004) and PWV (9.1 vs. 8.5 ms(-1), P=0.024) was observed. After adjusting for BP reduction, the decrease in PWV appeared non-significant. Our data indicate that PH increases PWV as a marker of arterial stiffness, in both hypertensive and non-hypertensive patients. However, neither the calcium serum level nor the parathyroid hormone level has been associated with PWV. Specific treatment by PTX significantly decreases PWV, which may be determined primarily by improved BP control after surgery.
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Affiliation(s)
- Jan Rosa
- 3rd Department of Internal Medicine, General Faculty Hospital, First Medical Faculty, Charles University, Prague, Czech Republic.
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Wu B, Haigh PI, Hwang R, Ituarte PHG, Liu ILA, Hahn TJ, Yeh MW. Underutilization of parathyroidectomy in elderly patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2010; 95:4324-30. [PMID: 20610600 PMCID: PMC2936062 DOI: 10.1210/jc.2009-2819] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) disproportionately affects older patients, who may face higher thresholds for surgical intervention compared to young patients. OBJECTIVE The aim was to examine for differences in the utilization of parathyroidectomy attributable to age. DESIGN We conducted a retrospective cohort study. PARTICIPANTS Patients with biochemically diagnosed PHPT during the years 1995-2008 were identified within an integrated health care delivery system in Southern California encompassing approximately 3 million individuals. MAIN OUTCOME MEASURES The outcome measures were parathyroidectomy (PTx) and time interval to surgery. RESULTS We found 3388 patients with PHPT, 964 (28%) of whom underwent PTx. Patients aged 60+ yr comprised 60% of the study cohort. The likelihood of PTx decreased linearly among patients aged 60+ when compared to patients aged 50-59, an effect that persisted in multivariate analysis: odds ratio 0.68 for ages 60-69 (P < 0.05); 0.41 for ages 70-79 (P < 0.0001), and 0.11 for age 80+ (P < 0.0001). The PTx rate for patients aged 70+ was 14%. Among patients meeting 2002 consensus criteria for surgical treatment, 45% of those aged 60-69 and 24% of those aged 70+ underwent PTx. A Cox proportional hazards model showed that patients aged 60+ experienced significantly longer delays from diagnosis to surgery compared to young patients (P < 0.0001). CONCLUSIONS PHPT is undertreated in the elderly. We observed a progressive age-related decline in PTx rate that renders patients aged 70+ unlikely to have definitive treatment, irrespective of comorbidity and eligibility for surgery.
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Affiliation(s)
- Bian Wu
- Endocrine Surgical Unit, Department of Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095, USA
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Feldstein CA, Akopian M, Pietrobelli D, Olivieri A, Garrido D. Long-Term Effects of Parathyroidectomy on Hypertension Prevalence and Circadian Blood Pressure Profile in Primary Hyperparathyroidism. Clin Exp Hypertens 2010; 32:154-8. [DOI: 10.3109/10641960903254471] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Most patients with primary hyperparathyroidism (PHPT) are asymptomatic at presentation. This presents the dilemma whether to treat surgically or manage by conservative follow-up. This article covers the risks of managing mild PHPT conservatively. Some of these risks are well established, for example worsening of bone disease and increased risk of nephrolithiasis. Others, such as effects on cardiovascular function or the risk of malignancy are more controversial. These factors are critical to decisions relating to surgical or conservative management of mild PHPT.
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Affiliation(s)
- N J L Gittoes
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Edgbaston.
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Ahlström T, Hagström E, Larsson A, Rudberg C, Lind L, Hellman P. Correlation between plasma calcium, parathyroid hormone (PTH) and the metabolic syndrome (MetS) in a community-based cohort of men and women. Clin Endocrinol (Oxf) 2009; 71:673-8. [PMID: 19250270 DOI: 10.1111/j.1365-2265.2009.03558.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CONTEXT In recent years, an association has been noted between several abnormalities that characterize the metabolic syndrome (MetS) and primary hyperparathyroidism (pHPT). These abnormalities include dyslipidaemia, obesity, insulin resistance and hypertension. The correlations between plasma calcium, parathyroid hormone (PTH) and the variables in the MetS in a normal population are still unclear. OBJECTIVE To describe correlations between plasma calcium and PTH and the various abnormalities present in the MetS in a healthy population. DESIGN We studied 1016 healthy individuals from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) population of 70 years old, by means of plasma analyses of calcium, PTH, creatinine, lipids, insulin and glucose, as well as by standardized blood pressure measurements. Further, body mass index (BMI) and waist circumference were determined. RESULTS The more National Cholesterol Education Program (NCEP) criteria for the MetS that were met, the higher the s-PTH and albumin-corrected s-calcium. Further, positive correlations between plasma calcium and BMI (P = 0.0003), waist circumference (P = 0.0009) and insulin resistance (P = 0.079) were found. PTH and BMI (P < 0.0001), waist circumference (P < 0.0001), systolic blood pressure (P = 0.0034), diastolic blood pressure (P = 0.0008), serum triglycerides (P = 0.0003) and insulin resistance (P = 0.0003) were positively correlated, whereas serum high density lipoproteins (HDL) (P = 0.036) and PTH were negatively correlated. CONCLUSIONS We conclude that PTH correlates with several of the metabolic factors included in the MetS within a normocalcaemic population. In addition, individuals with mild pHPT present significantly more NCEP criteria for MetS. We postulate that increased levels of PTH in pHPT may be associated with the increased cardiovascular morbidity and mortality seen in pHPT.
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Affiliation(s)
- Tommy Ahlström
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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Hultin H, Hellman P, Lundgren E, Olovsson M, Ekbom A, Rastad J, Montgomery SM. Association of parathyroid adenoma and pregnancy with preeclampsia. J Clin Endocrinol Metab 2009; 94:3394-9. [PMID: 19531594 DOI: 10.1210/jc.2009-0012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Case reports have described associations between calcium metabolism disturbances and primary hyperparathyroidism with preeclampsia, suggesting parathyroid involvement in preeclampsia etiology. This study examines whether parathyroid adenoma, the main cause of hyperparathyroidism, diagnosed and treated before pregnancy is associated with preeclampsia. DESIGN We conducted a register-based study to assess the association between parathyroid adenoma and subsequent preeclampsia. SETTING Births among Sweden's general population were studied. POPULATION The study population included 52 women with a diagnosis of parathyroid adenoma and 519 without, all of whom had a subsequent singleton pregnancy between 1973 and 1997. METHODS We performed a conditional logistic regression investigating the association of parathyroid adenoma with subsequent preeclampsia in the first singleton pregnancy with adjustment for potential confounding factors. MAIN OUTCOME MEASURE The main outcome was a diagnosis of preeclampsia that does not include women with prior chronic hypertension. To ensure that treatment of parathyroid adenoma was completed before pregnancy, those with a diagnosis of parathyroid adenoma made less than 2 yr before delivery (and the matched comparison women) were excluded. RESULTS Statistically, parathyroid adenoma prior to delivery is significantly (P < 0.001) associated with preeclampsia, producing an adjusted odds ratio of 6.89 (95% confidence interval, 2.30, 20.58). CONCLUSION A history of parathyroid adenoma should be viewed as a risk for preeclampsia.
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Affiliation(s)
- Hella Hultin
- Department of Surgical Sciences, University Hospital, SE-751 85 Uppsala, Sweden
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Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94:351-65. [PMID: 19193910 PMCID: PMC5393372 DOI: 10.1210/jc.2008-1760] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (PHPT) in May 2008, recent data on the disease were reviewed. We present the results of a literature review on issues arising from the clinical presentation and natural history of PHPT. METHODS Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was reviewed, and the questions of the International Task Force were addressed by the Consensus Panel. CONCLUSIONS 1) Data on the extent and nature of cardiovascular involvement in those with mild disease are too limited to provide a complete picture. 2) Patients with mild PHPT have neuropsychological complaints. Although some symptoms may improve with surgery, available data remain inconsistent on their precise nature and reversibility. 3) Surgery leads to long-term gains in spine, hip, and radius bone mineral density (BMD). Because some patients have early disease progression and others lose BMD after 8-10 yr, regular monitoring (serum calcium and three-site BMD) is essential in those followed without surgery. Patients may present with normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism). Data on the incidence and natural history of this phenotype are limited. 4) In the absence of kidney stones, data do not support the use of marked hypercalciuria (>10 mmol/d or 400 mg/d) as an indication for surgery for patients. 5) Patients with bone density T-score -2.5 or less at the lumbar spine, hip, or distal one third radius should have surgery.
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Affiliation(s)
- Shonni J Silverberg
- Columbia University College of Physicians & Surgeons, 630 West 168th Street, PH 8W-864, New York, New York 10032, USA.
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Effect of successful parathyroidectomy on 24-hour ambulatory blood pressure in patients with primary hyperparathyroidism. Int J Cardiol 2008; 142:15-21. [PMID: 19117619 DOI: 10.1016/j.ijcard.2008.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 12/06/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The pathogenesis of hypertension in patients with primary hyperparathyroidism (PHPT) is unclear, and the prevailing opinion is that parathyroidectomy does not affect the blood pressure (BP). Most previous studies have been based on BP measurements at rest in a clinical setting. The aim of this study was to get additional information by 24-hour ambulatory measurements. DESIGN AND PATIENTS Forty-nine consecutive patients with PHPT (age 63+/-12 years, 44 women) were examined before and 6 months after curative parathyroid surgery. MEASUREMENTS Serum concentrations of calcium and PTH, and 24-hour ambulatory mean, minimum, and maximum systolic (S) and diastolic BP, and mean arterial BP. RESULTS On average, the patients showed no BP change after parathyroidectomy. However, those with a history of hypertension (n=20) showed generally increased BP values after parathyroidectomy, with significantly increased minimum and average SBP (P=0.02 and P=0.04, respectively), whereas patients without a history of hypertension (n=29) showed unchanged or slightly reduced BP values after parathyroidectomy, with significantly decreased maximum SBP (P=0.04). Serum concentrations of PTH and calcium were not significantly related to any of the BP variables measured. CONCLUSIONS The novel finding that patients with both PHPT and hypertension may show increased BP after parathyroidectomy warrants intensified BP control postoperatively in these patients, and motivates early treatment of PHPT in order to prevent the development of complicating hypertension.
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Andrade J, Er L, Ignaszewski A, Levin A. Exploration of association of 1,25-OH2D3 with augmentation index, a composite measure of arterial stiffness. Clin J Am Soc Nephrol 2008; 3:1800-6. [PMID: 18922995 DOI: 10.2215/cjn.00900208] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Abnormalities in mineral metabolism [calcium, phosphate, and immunoreactive parathyroid hormone (PTH)] and vitamin D have been linked to increases in central arterial stiffness. Central arterial stiffness can be measured using noninvasive technologies, including augmentation index (AIx), a composite measure of arterial stiffness. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS In 131 outpatients identified from individual cardiac or kidney disease clinics, we examined conventional demographic and laboratory risk factors, vitamin D levels (1,25-OH2D3 and 25-OHD3), and markers of inflammation or endothelial function [C-reactive peptide (hsCRP), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), and IL-6] in relationship to AIx. RESULTS The median eGFR was significantly different between clinics (range 25-81 ml/min). Subjects with higher phosphate or MMP-9 levels were found to have a higher AIx (P = 0.02 and 0.07, respectively). Lower 1,25-OH2D3 levels or reduced eGFR were associated with higher AIx (P = 0.002 and 0.005, respectively). The associations between 1,25-OH2D3 and phosphate levels and AIx were observed for values within the normal range. No association was noted for calcium, iPTH, 25-OHD3, or hsCRP and AIx. Adjusting for potential confounders [eGFR, calcium, phosphate, and (log) iPTH] the association of lower 1,25-OH2D3 with AIx remained statistically significant. CONCLUSION This exploratory study demonstrates a significant association between AIx and 1,25-OH2D3 in a diverse group with cardiac, kidney disease, or both. These increasing understanding of the role of vitamin D in vascular health lends a context to these findings and raises questions as to additional modifiable risk factors in complex patients. Further studies are required.
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Affiliation(s)
- Jason Andrade
- Department of Medicine, University of British Columbia, Saint Paul's Hospital, Vancouver, BC, Canada
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Siilin H, Rastad J, Ljunggren O, Lundgren E. Disturbances of calcium homeostasis consistent with mild primary hyperparathyroidism in premenopausal women and associated morbidity. J Clin Endocrinol Metab 2008; 93:47-53. [PMID: 18042652 DOI: 10.1210/jc.2007-0600] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) and associated morbidity are comprehensively assessed in elderly females; however, less is known of the disease in younger women. OBJECTIVES Our objectives were to estimate the prevalence of mild disturbances in calcium homeostasis, which could be analogous with early PHPT, in a premenopausal population, and determine the potential presence of associated morbidity. DESIGN Initial results from this longitudinal study are from 2002-2004. SETTING We conducted a population-based screening of serum (s)-calcium in conjunction with routine mammography. PARTICIPANTS Participants included premenopausal women, 40-50 yr of age (n = 1900). Cases fulfilling previously evaluated biochemical criteria for PHPT (n=214) were matched to controls (n = 214). MAIN OUTCOME MEASUREMENTS All participants underwent investigation, including screening of parameters of calcium homeostasis, dual x-ray absorptiometry, and body mass index assessment, and filled out extensive health and quality of life (SF-36) questionnaires. Participants were divided into four groups depending on the relation between s-calcium/intact PTH. Statistical comparisons between cases and controls as well as among the four groups were performed to evaluate morbidity. RESULTS The prevalence of assumed mild PHPT, i.e. inappropriate intact PTH value in relation to total s-calcium, was estimated to be 5.1% (n = 96). Women with mild disturbances in calcium homeostasis had statistically significant lower bone mineral density in the proximal femur and femoral neck, higher body mass index, and lower scores for vitality and general health in the analysis of SF-36. CONCLUSIONS Mild disturbances in calcium homeostasis in premenopausal women were more prevalent than previously thought and were associated with obesity, lower bone mineral density, and decreased quality of life.
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Affiliation(s)
- Helene Siilin
- Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden.
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Ybarra J, Doñate T, Jurado J, Pou JM. Primary hyperparathyroidism, insulin resistance, and cardiovascular disease: a review. Nurs Clin North Am 2007; 42:79-85, vii. [PMID: 17270592 DOI: 10.1016/j.cnur.2006.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The presentation of primary hyperthyroidism (PHPT) has changed substantially in the last decade. Before the introduction of routine calcium measurement in most automated biochemistry serum analyzers, it usually was diagnosed after renal and bony lesions already were present. Nowadays, its presentation is practically asymptomatic. Nevertheless, the cardiovascular morbidity and mortality of mild to moderate forms of PHPT reportedly are increasing. Individuals who have mild to moderate forms of PHPT have an increased risk for enduring cardiovascular disease, arterial hypertension, left ventricular hypertrophy, myocardial and valvular calcifications, altered vascular reactivity, and cardiac conduction. Finally, they also reveal alterations in carbohydrate metabolism, insulin resistance, dyslipidemia, and body composition.
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Affiliation(s)
- Juan Ybarra
- Servicio de Endocrinología y Nutrición, Hospital de Sant Pau, Mas Casanovas 90, Barcelona 08041, Spain.
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Bergenfelz A, Jansson S, Mårtensson H, Reihnér E, Wallin G, Kristoffersson A, Lausen I. Scandinavian Quality Register for Thyroid and Parathyroid Surgery: audit of surgery for primary hyperparathyroidism. Langenbecks Arch Surg 2006; 392:445-51. [PMID: 17103223 DOI: 10.1007/s00423-006-0097-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIM Scandinavian Quality Register for Thyroid and Parathyroid Surgery is an on-line web-based database with the aim to improve the quality of thyroid and parathyroid surgery. Preliminary data from surgery for primary hyperparathyroidism are reported here. MATERIALS AND METHODS Fifteen departments registered 806 operations, with 639 women (79.7%) and 167 men. The median age of the patients was 62 years. RESULTS Approximately 95.4% of the patients had sporadic disease and first time operation was performed in 93.8% of the patients. Localization examinations were performed in 524 patients (65%); sestamibi scintigraphy in 413 patients, with a true positive adenoma localization in 64.4% and ultrasound in 293 patients with adenoma localization in 61.1%. Bilateral neck exploration was performed in 66.8%, unilateral exploration in 16.1%, and focused minimal invasive surgery in 17.1%. In 301 patients planned for limited parathyroid exploration, conversion to bilateral neck surgery occurred in 11%. The cure rate, based on short follow-up, was 91.9%. Postoperative hypocalcemia occurred in 11.4% of the patients, and was associated with reoperation, concomitant thyroid operation, and the weight of excised parathyroid tissue. CONCLUSION Localization examinations are performed in 2/3 of the patients, but limited neck exploration was performed in only approximately 1/3 of the operations. The cure rate was lower and postoperative hypocalcemia was more frequent than expected.
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Affiliation(s)
- Anders Bergenfelz
- Department of Surgery, Lund University Hospital, 221 85 Lund, Sweden.
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Gianotti L, Tassone F, Cesario F, Pia A, Razzore P, Magro G, Piovesan A, Borretta G. A slight decrease in renal function further impairs bone mineral density in primary hyperparathyroidism. J Clin Endocrinol Metab 2006; 91:3011-6. [PMID: 16735490 DOI: 10.1210/jc.2006-0070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The impairment of renal function can affect the clinical presentation of primary hyperparathyroidism (PHPT), increasing cardiovascular morbidity, fracture rate, and the risk of mortality. AIM The aim of the study was to assess the differences in bone status in a series of consecutive patients affected by PHPT without overt renal failure at diagnosis grouped according to creatinine clearance (Ccr). METHODS A total of 161 consecutive patients with PHPT were studied. They were divided into two groups based on Ccr. Group A had Ccr 70 ml/min or less (n = 49), and group B had Ccr greater than 70 ml/min (n = 112). PTH, total and ionized serum calcium; urinary calcium and phosphate; serum 25-hydroxyvitamin D3; serum and urinary bone markers; lumbar, forearm, and femoral bone mineral density (BMD) were evaluated. RESULTS Patients in group A were older than those in group B (P < 0.0001). PTH levels did not differ in the two groups, whereas both urinary calcium and phosphorus were lower in group A than group B (P < 0.01). Lower BMD was evident in group A at lumbar spine (P < 0.002), forearm (P < 0.0001), and femur (P < 0.01). In asymptomatic PHPT, those with Ccr 70 ml/min or less had lower forearm BMD than patients with higher Ccr (P < 0.00001). When adjusting for age and body mass index in PHPT, BMD at each site persisted being lower (P < 0.05) in group A than group B. In all PHPT subjects, Ccr (beta = 0.29, P < 0.0005), age (beta = -0.27, P < 0.00001), and PTH levels (beta = -0.27, P < 0.0005) were all independently associated with forearm BMD. CONCLUSIONS In PHPT a slight decrease in renal function is associated with more severe BMD decrease, independent of age, body mass index, and PTH levels. This association is also present in asymptomatic PHPT and strengthens the National Institutes of Health recommendations for surgery in patients with mild PHPT.
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Affiliation(s)
- Laura Gianotti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, S. Croce and Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy
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