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Kurtom S, Carty SE. Primary Hyperparathyroidism: Part One: Evaluation. Surg Clin North Am 2024; 104:791-798. [PMID: 38944499 DOI: 10.1016/j.suc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Primary hyperparathyroidism (PHPT) is a disorder characterized by the autonomous overproduction of parathyroid hormone (PTH) that leads to hypercalcemia, multiple clinical sequelae, and heterogenous presentation. Whether PHPT is caused by a single benign adenoma (85%), multiglandular disease (15%), or parathyroid carcinoma (1%), surgery is the definitive treatment.
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Affiliation(s)
- Saba Kurtom
- Department of Surgical Oncology, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Suite 101, Pittsburgh, PA 15213, USA
| | - Sally E Carty
- Department of Surgical Oncology, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Suite 101, Pittsburgh, PA 15213, USA.
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2
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Han YH, Jeong HJ, Lee SY, Lim ST. Incidentally detected follicular thyroid carcinoma mimicking parathyroid adenoma on Tc-99m MIBI scan: A case report. Medicine (Baltimore) 2024; 103:e38107. [PMID: 38701245 PMCID: PMC11062725 DOI: 10.1097/md.0000000000038107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE Primary hyperparathyroidism, though relatively prevalent among endocrine disorders, affecting 1% of the general population, often presents diagnostic challenges. Given its potential to precipitate severe complications including nephrolithiasis and fractures, timely diagnosis, and effective management are crucial. PATIENT CONCERNS A 38-year-old woman with hypercalcemia was referred to the Department of Nuclear Medicine for a Tc-99m MIBI scan. DIAGNOSES Tc-99m MIBI scan showed focal increased uptake in the left thyroid gland area, initially suggesting a parathyroid adenoma. Further examination using SPECT/CT revealed a nodular lesion within the left thyroid gland showing high Tc-99m MIBI uptake. INTERVENTIONS Left thyroid lumpectomy confirmed the lesion as follicular thyroid carcinoma. On the second Tc-99m MIBI scan conducted after total thyroidectomy, a parathyroid adenoma was eventually detected in the right lower area, enabling the subsequent appropriate treatment, a right lower parathyroidectomy. OUTCOMES Thirteen days after the parathyroidectomy, serum levels of total calcium and parathyroid hormone returned to normal. Furthermore, bone mineral density evaluated using DEXA remained within the expected range for her age even after 14 months. LESSONS When interpreting the Tc-99m MIBI scan, it is essential to keep in mind that various tumors rich in mitochondria, such as thyroid carcinoma, could show a high uptake of Tc-99m MIBI.
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Affiliation(s)
- Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
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3
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Kubat Öktem E, Yazar M, Aysan E, Karabıyık Acar Ö. Computational drug repurposing for primary hyperparathyroidism. Mol Cell Endocrinol 2024; 583:112159. [PMID: 38228226 DOI: 10.1016/j.mce.2024.112159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024]
Abstract
In hyperparathyroidism (hyperPTH), excessive amounts of PTH are secreted, interfering with calcium regulation in the body. Several drugs can control the disease's side effects, but none of them is an alternative treatment to surgery. Therefore, new drug candidates are necessary. In this study, three computationally repositioned drugs, DG 041, IMD 0354, and cucurbitacin I, are evaluated in an in vitro model of hyperPTH. First, we integrated publicly available transcriptomics datasets to propose drug candidates. Using 3D spheroids derived from a single primary hyperPTH patient, we assessed their in vitro efficacy. None of the proposed drugs affected the viability of healthy cell control (HEK293) or overactive parathyroid cells at the level of toxicity. This behavior was attributed to the non-cancerous nature of the parathyroid cells, establishing the hyperPTH disease model. Cucurbitacin I and IMD 0354 exhibited a slight inverse relationship between increased drug concentrations and cell viability, whereas DG 041 increased viability. Based on these results, further studies are needed on the mechanism of action of the repurposed drugs, including determining the effects of these drugs on cellular PTH synthesis and secretion and on the metabolic pathways that regulate PTH secretion.
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Affiliation(s)
- Elif Kubat Öktem
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Istanbul Medeniyet University, 34700, Istanbul, Turkey
| | - Metin Yazar
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, Istanbul Okan University, 34959, Istanbul, Turkey
| | - Erhan Aysan
- Department of General Surgery, Faculty of Medicine, Yeditepe University, 34718, Istanbul, Turkey
| | - Özge Karabıyık Acar
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, Istanbul Okan University, 34959, Istanbul, Turkey.
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Cosme I, Nobre E, Travessa A, Santos C, Rocha J, Presa D, Barbosa AP. Ectopic Intrathyroidal Parathyroid Adenoma Presenting With Osteoporotic Fractures in a Young Man: A Case Report. Cureus 2023; 15:e47461. [PMID: 38021888 PMCID: PMC10662119 DOI: 10.7759/cureus.47461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) can be associated with osteoporosis (OP) and fractures. We present a case of a 49-year-old male referred to our osteoporosis outpatient clinic due to a right femur osteoporotic fracture. At the age of 38, a right plantar nodular lesion was excised, and its histology was compatible with a deep dermis nodule formed by mononuclear and giant osteoclast-like cells. He has reported osteoporotic fractures since age 39 and renal colic episodes since age 45. His father had lipomas and renal colic episodes, and his paternal grandmother had lipomas. The laboratory evaluation was compatible with PHPT. A cervical ultrasound showed a 10mm single solid nodule in the left thyroid lobe, strongly hypoechogenic, with microcalcifications. Its cytology showed parathyroid tissue without atypia. Parathyroid scintigraphy had no uptake. A dual-energy X-ray absorptiometry scan showed a femoral neck Z-score of -4.3. He started alendronate/cholecalciferol (70mg/5600IU) weekly. He was submitted to a left hemithyroidectomy. Its histology showed an intrathyroidal parathyroid adenoma. Ectopic parathyroid adenomas are rare, of which 0.7%-6% are intrathyroidal. The excised foot lesion could be a brown tumour. Furthermore, calcium metabolism evaluation at that time might have allowed a PHPT diagnosis and its morbidity prevention. Osteoporotic fractures in young men must alert to secondary OP.
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Affiliation(s)
- Inês Cosme
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Ema Nobre
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - André Travessa
- Genetics, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Catarina Santos
- Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - José Rocha
- Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Dolores Presa
- Pathology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Ana P Barbosa
- Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
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D AD, Suran A, Maldar AN, Chauhan PH, Lala M, Shah NF, Kirtane MV, Chadha M. Differences in the Clinical Presentation and Biochemical Profile of the Patients with Primary Hyperparathyroidism with regard to their Serum Vitamin D Levels: a Single-center Experience. Indian J Surg Oncol 2023; 14:301-307. [PMID: 37324304 PMCID: PMC10267019 DOI: 10.1007/s13193-022-01676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
The association between vitamin D deficiency and primary hyperparathyroidism (PHPT) is common and has clear implications. Vitamin D deficiency is commonly seen in PHPT population and exacerbates its severity with skeletal and metabolic effects. Retrospective data collection and review were done in patients who underwent surgery for PHPT at a tertiary care hospital in India between January 2011 and December 2020. A total of 150 subjects were included in the study and were divided into group 1 (vitamin D < 20 ng/ml, deficient), group 2 (vitamin D 21-29 ng/ml, insufficient), and group 3 (vitamin D > 30 ng/ml, sufficient). There was no difference in the duration of symptoms or the symptomatology between the three groups. Mean pre-operative serum calcium and serum phosphorous levels were also comparable in all the three groups. Mean pre-operative parathyroid hormone (PTH) levels in the three groups were 703 ± 996 vs 343.6 ± 396 vs 343.6 ± 396 pg/ml, respectively (P = 0.009). There was a statistically significant difference in group 1 vs groups 2 and 3 in their mean weight of the parathyroid gland (P = 0.018) and high alkaline phosphatase (ALP) levels (P = 0.047). Post-operative symptomatic hypocalcemia was observed in 17.3% of patients. Post-operative hungry bone syndrome occurred in 4 patients, all in group 1. PHPT in patients with low serum vitamin D was associated with higher serum PTH levels, increased frequency of high serum ALP levels, and higher weight of the excised gland, with no difference in the serum calcium and phosphorous.
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Affiliation(s)
- Amal Dev D
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Apoorva Suran
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Aasim N. Maldar
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Phulrenu H. Chauhan
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Murad Lala
- Department of Onco-Surgery, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - N. F. Shah
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Milind V. Kirtane
- Department of ENT, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
| | - Manoj Chadha
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016 India
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6
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Kulkarni P, Tucker J, King T, Goldenberg D. Symptomatic versus asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis. J Clin Transl Endocrinol 2023; 32:100317. [PMID: 37089759 PMCID: PMC10114222 DOI: 10.1016/j.jcte.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose Primary hyperparathyroidism (PHPT) is the underlying etiology for 90% of patients with hypercalcemia. PHPT patients have traditionally been characterized as being symptomatic or asymptomatic. However, we submit that even "asymptomatic" patients may still have clinical features, posing the idea of coining asymptomatic disease as a misnomer. This paper presents a systematic review and meta-analysis elucidating the differences between asymptomatic and symptomatic PHPT in the literature. Methods A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2012 to 2022. Inclusion criteria consisted of all studies comparing symptomatic and asymptomatic PHPT patients. Two reviewers independently evaluated the literature using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The level of evidence was determined using the Oxford Center for Level of Evidence-Based Medicine. Data were extracted, and a meta-analysis was performed. I2 index was employed for heterogeneity. Results There were 18 studies included, with a total of 4238 patients. The average age of patients included was 56.37, with 25.7% of the cohort being male. Several studies reported clinical features even for the "asymptomatic" group. Patients in the symptomatic group tended to have higher levels of PTH and calcium. The asymptomatic group had greater levels of vitamin D. There was observed heterogeneity between the studies. Conclusions More extreme PTH, calcium values, and low vitamin D levels were seen in patients with symptomatic disease. However, asymptomatic patients occasionally exhibited clinical features. Therefore, the terminology of "asymptomatic" disease is likely inappropriate for these patients.
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7
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Zhou Y, Wang Q, Zou L, Wu X, Yang A. Parathyroid carcinoma-related severe acute pancreatitis during pregnancy: a case report and literature review. Gastroenterol Rep (Oxf) 2023; 11:goac087. [PMID: 36686572 PMCID: PMC9846419 DOI: 10.1093/gastro/goac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Yaxuan Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China
| | - Qiang Wang
- Corresponding author. Department of Gastroenterology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, P. R. China. Tel: +86-10-62230810;
| | - Long Zou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xi Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
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8
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竹内 靖. [Bone and mineral disorders in elderly patients]. Nihon Ronen Igakkai Zasshi 2022; 59:163-168. [PMID: 35650049 DOI: 10.3143/geriatrics.59.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Ajith A, Corbett M, Garry S, Young O. Case of coronary vasospasm caused by hypocalcaemia post parathyroidectomy mimicking ST-elevation myocardial infarction. BMJ Case Rep 2022; 15:e247919. [PMID: 35450875 PMCID: PMC9024207 DOI: 10.1136/bcr-2021-247919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his 30s with primary hyperparathyroidism underwent an elective four-gland parathyroid exploration with intraoperative parathyroid hormone monitoring. On the fourth postoperative day (POD), the patient presented to the emergency department with severe symptomatic hypocalcaemia. ECG findings were in keeping with inferior-posterior ST-elevation myocardial infarction (STEMI); however, he was asymptomatic with no chest pain. Biochemistry revealed elevated serial troponin levels. Coronary angiogram and transthoracic echocardiogram were normal, suggesting coronary vasospasm, mimicking STEMI on ECG because of severe hypocalcaemia post parathyroidectomy. This is an uncommon and unreported complication of parathyroid surgery. The patient was successfully managed with intravenous calcium and discharged on oral calcium replacement on the tenth POD.
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Affiliation(s)
- Aiswarya Ajith
- ENT department, Galway University Hospital, Galway, Ireland
| | - Mel Corbett
- ENT department, Galway University Hospital, Galway, Ireland
| | - Stephen Garry
- ENT department, Galway University Hospital, Galway, Ireland
| | - Orla Young
- ENT department, Galway University Hospital, Galway, Ireland
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10
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Sultana N, Rijal A, Banu H, Jahan S, Fariduddin M, Dey BP, Hasanat MA. Localization and management of mediastinal parathyroid adenoma – a case report. IMC JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.55010/imcjms.16.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Ectopic parathyroid adenoma sometimes poses diagnostic challenge and can be a cause of persistent and recurrent primary hyperparathyroidism. Anterior mediastinum is one of the locations for ectopic parathyroid adenoma. Surgical excision is the only cure and for successful surgery, pre-operative localization is crucial. Chance of failed surgery is being increased without prior localization of the ectopic gland. The combination of single photon emission computed tomography (SPECT) and computed tomography (CT) has got high sensitivity for accurate localization of ectopic parathyroid. On the other hand, with accurate localization surgical outcome is excellent. Here we report, successful localization and management of a case of primary hyperparathyroidism due to adenoma in anterior mediastinum in 47-year-old man.
IMC J Med Sci 2022; 16(2): 003. DOI: https://doi.org/10.55010/imcjms.16.013
*Correspondence: Dr. Nusrat Sultana, Room no-1620, Block-D, 15th floor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Email: nusrat_sultana@bsmmu.edu.bd
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Affiliation(s)
- Nusrat Sultana
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Amrit Rijal
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
| | - Hurjahan Banu
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
| | - Sharmin Jahan
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
| | - M Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
| | - Bishnu Pada Dey
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
| | - MA Hasanat
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University
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Management of Primary Hyperparathyroidism. Indian J Surg Oncol 2022; 13:143-151. [PMID: 35462664 PMCID: PMC8986895 DOI: 10.1007/s13193-021-01319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is the unregulated overproduction of parathyroid hormone (PTH) resulting in abnormal calcium homeostasis. The disease profile has evolved over the last century from symptomatic hyperparathyroidism to asymptomatic hyperparathyroidism. Primary hyperparathyroidism is a biochemical diagnosis. Parathyroidectomy is the only established cure for this disease. Every effort is made to localize the offending gland preoperaively with various imaging modalities. These localization studies along with intraoperative parathormone monitoring will direct the surgeon to either a focused parathyroidectomy or a four gland exploration. All symptomatic patients and asymptomatic patients who meet the criteria for surgery should undergo parathyroidectomy if no medical contraindications exist. Pharmacologic approaches are reserved for those patients unfit or unwilling to undergo surgery.
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12
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Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism in the Same Patient. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Majumdar S, Uppala D, Kotina S, Alekhya B. Brown tumor of hyperparathyroidism with multiple lesions. J Oral Maxillofac Pathol 2022; 26:S111-S115. [PMID: 35450253 PMCID: PMC9017852 DOI: 10.4103/jomfp.jomfp_409_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone (PTH) on bone tissue in some patients with hyperparathyroidism. Browns tumor is a syndrome associated with an increase in PTH levels by parathyroid glands resulting in hypercalcemia. In the present case report, a 44-year-old female patient presented with a rare case of brown tumor with multiple lesions in the head-and-neck region. The recent advance in various diagnostic and biochemical tests helps in early diagnosis of hyperparathyroidism cases. The dentist should be aware of oral manifestations associated with this type of systemic disease.
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Affiliation(s)
- Sumit Majumdar
- Department of Oral Pathology and Microbiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Divya Uppala
- Department of Oral Pathology and Microbiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sreekanth Kotina
- Department of Oral Pathology and Microbiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Bandi Alekhya
- Department of Oral Pathology and Microbiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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Liu Y, Guo S, Wu J, Wang R, Liu J, Liu Y, Lv B, Liu N, Jiang L, Zhang X. Changes in clinical patterns of Chinese patients with primary hyperparathyroidism in the past 12 years: a single-center experience. Endocr Connect 2021; 10:1428-1434. [PMID: 34647902 PMCID: PMC8630764 DOI: 10.1530/ec-21-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
The clinical presentation of primary hyperparathyroidism (PHPT) differs between patients from developed and developing countries. In China, the clinical pattern has changed over the past few decades. Our aim was to elucidate general changes in the clinical characteristics of PHPT from 2010 to 2021. We enrolled 343 patients with PHPT at the Qilu Hospital of Shandong University, Jinan, China, from January 2010 to May 2021, including both surgical and non-surgical patients. Patients were divided into two subgroups, 2010-2016 (group A, n = 152) and 2017-2021 (group B, n = 191), based on the time span. We compared clinical manifestations and laboratory result data between these two groups. The mean patient age was 52.59 ± 13.55 years, and the male-to-female ratio was 1:2.54. Of the 343 patients, 183 (53.35%) had symptomatic PHPT; bone pain, urolithiasis, and fatigue were the most common symptoms. Post-operative pathology showed that 96.20% of the patients had parathyroid adenoma, whereas 2.41% had parathyroid carcinoma. Great changes occurred between 2010 and 2021; the percentage of patients with asymptomatic PHPT (aPHPT) increased from 36.18% in group A to 54.97% in group B. Moreover, patients in group B showed significantly lower serum calcium, alkaline phosphatase, parathyroid hormone, and urinary phosphate levels but higher serum 25-hydroxyvitamin D levels than those in group A. Clinical presentations in group B were also milder. In conclusion, the clinical characteristics of Chinese PHPT patients changed dramatically from 2010 to 2021, with asymptomatic PHPT (aPHPT becoming the predominant type over the last 3 years.
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Affiliation(s)
- Yuan Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Siyi Guo
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Jinsong Wu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Rongai Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Health Management Center, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang, China
| | - Jinbo Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Yan Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Bin Lv
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Nan Liu
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ling Jiang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
| | - Xiaoli Zhang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, China
- Key Laboratory of Endocrine and Metabolic Diseases, Shandong Province Medicine & Health, Jinan, China
- Correspondence should be addressed to X Zhang:
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Özçınar B, Öner G, Makay Ö, Soyder A, Zafer Cantürk N, Ümit Uğurlu M, Atakan Sezer Y, Görgülü S, Girgin M, Özemir Aİ, Özbaş S, Ünal B, Pandev R, Erel S, Uğur Emre A, İlker Filiz A, Nuran Akçay M, Demircioğlu S, Güler SA, Öztürk E, Yıldız R, Çakmak GK, Kurt Y, Erbil Y, Güllüoğlu BM. Which biochemical and clinical parameters correlate with parathyroid adenoma weight? Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study. Asian J Surg 2021; 45:407-411. [PMID: 34353709 DOI: 10.1016/j.asjsur.2021.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey. METHOD In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions. RESULTS Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p < 0.001). There was a correlation between adenoma weight and serum PTH level (p = 0.05) and Ca level (p = 0.035). CONCLUSION This study has provided a deeper insight into the effect of the regional differences upon clinicopathological changing and biochemical values of pHTP patients with adenoma. Awareness of regional differences will assist in biochemical screening and treatment of this patient group.
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Affiliation(s)
- Beyza Özçınar
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.
| | - Gizem Öner
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium; Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Özer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Aykut Soyder
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - N Zafer Cantürk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - M Ümit Uğurlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Y Atakan Sezer
- Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - Semih Görgülü
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Girgin
- Department of General Surgery, Fırat University School of Medicine, Elazığ, Turkey
| | - A İbrahim Özemir
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Serdar Özbaş
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Bülent Ünal
- Department of General Surgery, Inönü University School of Medicine, Malatya, Turkey
| | - Rumen Pandev
- Department of General Surgery, Division of Endocrine Surgery, Tsaritsa Yoanna University School of Medicine, Sofia, Bulgaria
| | - Serap Erel
- Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - A Uğur Emre
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - A İlker Filiz
- Department of General Surgery, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - M Nuran Akçay
- Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Salih Demircioğlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - S Ata Güler
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Erkan Öztürk
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ramazan Yıldız
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Yavuz Kurt
- Department of General Surgery, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - Yeşim Erbil
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Bahadır M Güllüoğlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Agrawal K, Arya AK, Sood A, Kumari P, Singh P, Sapara M, Rastogi A, Behera A, Bhadada SK. A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy. Clin Endocrinol (Oxf) 2021; 94:371-376. [PMID: 32789888 DOI: 10.1111/cen.14311] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a systemic disorder characterized by hypercalcaemia and inappropriately elevated parathyroid hormone (PTH). Renal manifestations are one of the main presenting features both in symptomatic and asymptomatic PHPT patients. OBJECTIVES We aimed to compare demographic, clinical and biochemical parameters of PHPT patients with and without renal manifestations and also analysed the influence of curative parathyroidectomy on renal functions. METHODS We retrospectively analysed the data of PHPT patients from the last 25 years (1995- March 2019) and compared the demographic and clinical presentation and biochemical measurements between patients with and without renal manifestations and evaluated the changes in renal functions after 1 year of curative parathyroidectomy. RESULTS Of the total 544 PHPT patients, 299 (55%) including 91 out of 141 (65%) males had renal manifestations. Among renal manifestations, nephrolithiasis and nephrocalcinosis were found in 41.7% and 27.6% PHPT patients, respectively. PHPT patients with renal manifestations had significantly higher creatinine (109.7 vs 79.6 µmol/L; P < .0001) and lower eGFR level (78.8 vs 93.9 mL/min/1.73 m2 ; P < .0001) compared to patients without renal manifestations. Parathyroidectomy resolved the clinical symptoms with biochemical cure in the patients from both the groups. Patients with renal manifestations showed improvement in creatinine and eGFR levels after 1 year of curative parathyroidectomy; however, patients without renal manifestations showed no change in creatinine and eGFR levels. CONCLUSION Young age and male gender are predictors of renal manifestations in PHPT. Curative parathyroidectomy improves renal functions in PHPT patients with renal manifestations compared to PHPT patients without renal manifestation.
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Affiliation(s)
- Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashutosh Kumar Arya
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Poonam Kumari
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Priyanka Singh
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Mohin Sapara
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Kumar A, Balbach J. Inactivation of parathyroid hormone: perspectives of drug discovery to combating hyperparathyroidism. Curr Mol Pharmacol 2021; 15:292-305. [PMID: 33573587 DOI: 10.2174/1874467214666210126112839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
Hormonal coordination is tightly regulated within the human body and thus regulates human physiology. The parathyroid hormone (PTH), a member of the endocrine system, regulates the calcium and phosphate level within the human body. Under non-physiological conditions, PTH levels get upregulated (hyperparathyroidism) or downregulated (hypoparathyroidism) due to external or internal factors. In the case of hyperparathyroidism, elevated PTH stimulates cellular receptors present in the bones, kidneys, and intestines to increase the blood calcium level, leading to calcium deposition. This eventually causes various symptoms including kidney stones. Currently, there is no known medication that directly targets PTH in order to suppress its function. Therefore, it is of great interest to find novel small molecules or any other means that can modulate PTH function. The molecular signaling of PTH starts by binding of its N-terminus to the G-protein coupled PTH1/2 receptor. Therefore, any intervention that affects the N-terminus of PTH could be a lead candidate for treating hyperparathyroidism. As a proof-of-concept, there are various possibilities to inhibit molecular PTH function by (i) a small molecule, (ii) N-terminal PTH phosphorylation, (iii) fibril formation and (iv) residue-specific mutations. These modifications put PTH into an inactive state, which will be discussed in detail in this review article. We anticipate that exploring small molecules or other means that affect the N-terminus of PTH could be lead candidates in combating hyperparathyroidism.
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Affiliation(s)
- Amit Kumar
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College of Science, Technology and Medicine London, South Kensington, London SW7 2BU. United Kingdom
| | - Jochen Balbach
- Institute of Physics, Biophysics, Martin-Luther-University Halle- Wittenberg. Germany
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18
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Appelbaum L, Goldberg SN, Ierace T, Mauri G, Solbiati L. US-guided laser treatment of parathyroid adenomas. Int J Hyperthermia 2020; 37:366-372. [PMID: 32308070 DOI: 10.1080/02656736.2020.1750712] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To determine the clinical efficacy of laser ablation for the tredatment of primary hyperparathyroidism (pHPT).Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400-600 s/fiber/insertion to a total 3600-9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms.Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n = 5], repeated renal colic [n = 5], vomiting [n = 3]). Only one patient (8%) reported transient dysphonia as a minor complication.Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.
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Affiliation(s)
- Liat Appelbaum
- Departments of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Shraga Nahum Goldberg
- Departments of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | - Luigi Solbiati
- Humanitas Clinical and Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
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19
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Sun M, Wu X, Yu Y, Wang L, Xie D, Zhang Z, Chen L, Lu A, Zhang G, Li F. Disorders of Calcium and Phosphorus Metabolism and the Proteomics/Metabolomics-Based Research. Front Cell Dev Biol 2020; 8:576110. [PMID: 33015068 PMCID: PMC7511772 DOI: 10.3389/fcell.2020.576110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022] Open
Abstract
Since calcium and phosphorus play vital roles in a multitude of physiologic systems, disorders of calcium and phosphorus metabolism always lead to severe consequences such as skeletal-related and cardiovascular morbidity, or even life-threatening. Physiologically, the maintenance of calcium and phosphorus homeostasis is achieved via a variety of concerted actions of hormones such as parathyroid hormone (PTH), vitamin D, and fibroblast growth factor (FGF23), which could be regulated mainly at three organs, the intestine, kidney, and bone. Disruption of any organ or factor might lead to disorders of calcium and phosphorus metabolism. Currently, lacking of accurate diagnostic approaches and unknown molecular basis of pathophysiology will result in patients being unable to receive a precise diagnosis and personalized treatment timely. Therefore, it is urgent to identify early diagnostic biomarkers and develop therapeutic strategies. Fortunately, proteomics and metabolomics offer promising tools to discover novel indicators and further understanding of pathological mechanisms. Therefore, in this review, we will give a systematic introduction on PTH-1,25(OH)2D-FGF23 axis in the disorders of calcium and phosphorus metabolism, diagnostic biomarkers identified, and potential altered metabolic pathways involved.
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Affiliation(s)
- Meiheng Sun
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China.,Jiangsu Key Laboratory of Xenotransplantation, School of Basic Medical Science, Nanjing Medical University, Nanjing, China
| | - Xiaoqiu Wu
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China
| | - Yuanyuan Yu
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China
| | - Luyao Wang
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China
| | - Duoli Xie
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lin Chen
- Department of Wound Repair and Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Aiping Lu
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.,Institute of Arthritis Research, Shanghai Academy of Chinese Medical Sciences, Shanghai, China
| | - Ge Zhang
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China
| | - Fangfei Li
- Law Sau Fai Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Integrated Bioinfomedicine and Translational Science, School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tsai, Hong Kong.,Institute of Precision Medicine and Innovative Drug Discovery, HKBU Institute for Research and Continuing Education, Shenzhen, China
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20
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Demir B, Binnetoglu A, Sahin A, Yavuz DG. Single Center Experience in the Surgical Management of Primary Hyperparathyroidism. Clin Exp Otorhinolaryngol 2020; 13:285-290. [PMID: 32646207 PMCID: PMC7435428 DOI: 10.21053/ceo.2019.01361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/13/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years. Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease. Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma. Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Adem Binnetoglu
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Elizabeth's Medical Center, Brighton, MA, USA
| | - Akın Sahin
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Section of Endocrinology and Metabolism, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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21
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Hwang JH, Chung ML, Lim YJ. Incidence and risk factors of subclinical umbilical catheter-related thrombosis in neonates. Thromb Res 2020; 194:21-25. [PMID: 32563060 DOI: 10.1016/j.thromres.2020.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aimed to determine the risk factors for subclinical umbilical catheter-related thrombosis (UCRT) and its association with clinical morbidities. MATERIALS AND METHODS In infants without any symptoms associated with umbilical catheterization, the presence of thrombosis was monitored using abdominal ultrasonography within 1 week after umbilical catheter removal. The association between UCRT and the clinical variables was analyzed by comparing the groups with and without UCRT. RESULTS UCRT occurred in 26 (19.0%) of 137 infants. The relative incidence rate of thrombosis was 12.3% at the umbilical artery and 21.7% at the umbilical vein. However, the type of umbilical vessels with a catheter was not associated with thrombosis (P = 0.095). Subclinical UCRT was associated with high serum calcium concentration in the multivariate analysis (95% confidence interval, 1.26-15.32; P = 0.020). UCRT was resolved within 3 weeks in 13 infants (50.0%), although the thrombosis persisted for up to 2 months in 2 infants (7.7%). We found no significant association between the subclinical UCRT and the neonatal morbidities in preterm infants. CONCLUSIONS Though a rare cause of thrombosis, hypercalcemia should be considered in the assessment of infants with subclinical UCRT, and calcium levels should be routinely checked in infants with umbilical catheters.
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Affiliation(s)
- Ji Hye Hwang
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
| | - Mi Lim Chung
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea.
| | - Yun Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
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22
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Al-Yahri O, Abdelaal A, El Ansari W, Farghaly H, Murshed K, Zirie MA, Al Hassan MS. First ever case report of co-occurrence of hobnail variant of papillary thyroid carcinoma and intrathyroid parathyroid adenoma in the same thyroid lobe. Int J Surg Case Rep 2020; 70:40-52. [PMID: 32408235 PMCID: PMC7218145 DOI: 10.1016/j.ijscr.2020.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/24/2023] Open
Abstract
First reported case of hobnail variant of papillary thyroid cancer and Intrathyroid parathyroid adenoma occurring within same thyroid lobe. Next-generation sequencing of the mutation spectrum of hobnail variant of papillary thyroid cancer showed BRAFV600E mutation. Studies that define other molecular abnormalities may be useful as therapeutic targets.
Introduction The hobnail variant of papillary thyroid cancer (PTC) is rare. Intrathyroid parathyroid adenoma (ITPA) is also rare. Co-ocurrence of PTC and ITPA in the same thyroid lobe is extremely rare. Likewise, primary hyperparathyroidism with such non-medullary thyroid carcinoma is rare. The specific molecular profile of hobnail PTC (HPTC) is different from the classic, poorly differentiated and anaplastic variants and may contribute to its aggressive behavior. HPTC’s genetic profile remains unclear. Presentation of case A 61-year-old woman presented to our endocrine clinic with generalized aches, bone pain, polyuria, and right neck swelling of a few months’ duration. Laboratory findings revealed hypercalcemia and hyperparathyroidism. Ultrasound of the neck showed 4.6 cm complex nodule within the right thyroid lobe. Sestamibi scan suggested parathyroid adenoma in the right thyroid lobe. Fine-needle aspiration (FNA) revealed atypical follicular lesion of undetermined significance. She underwent right lobectomy, which normalized the intraoperative intact parathyroid hormone levels. Final pathology with immunohistochemical stains demonstrated HPTC and IPTA (2 cm each). Next-generation sequencing investigated the mutation spectrum of HPTC and detected BRAFV600E mutation. Conclusions A parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma. Thyroid evaluation is needed for patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers. Cytomorphologic features to distinguish thyroid from parathyroid cells on FNA cytology must be considered. Immunohistochemical stains are important. BRAFV600E is the most common mutation in HPTC. This is possibly the first reported case of HPTC and ITPA co-occurring within the same thyroid lobe. Studies that define other molecular abnormalities may be useful as therapeutic targets.
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Affiliation(s)
- Omer Al-Yahri
- Department of General Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Hanan Farghaly
- Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar
| | - Khaled Murshed
- Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar
| | - Mahmoud A Zirie
- Department of Endocrinology, Hamad General Hospital, Doha, Qatar
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Yadav SK, Johri G, Bichoo RA, Jha CK, Kintu-Luwaga R, Mishra SK. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:105-110. [PMID: 32236309 PMCID: PMC10118947 DOI: 10.20945/2359-3997000000211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/26/2019] [Indexed: 11/23/2022]
Abstract
While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.
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Affiliation(s)
- Sanjay Kumar Yadav
- Department of Breast and Endocrine Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Goonj Johri
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Raouef Ahmed Bichoo
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Saroj Kanta Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kumar Yadav A, Pawar E, Harsoor A, Kumar G S P, Rohra H. Primary hyperparathyroidism with extensive brown tumours and distal humerus fracture-A case report. Int J Surg Case Rep 2020; 66:421-424. [PMID: 31991305 PMCID: PMC6994264 DOI: 10.1016/j.ijscr.2019.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/24/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION A brown tumour is benign bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. In this report, we present a case of 25-year-old woman with multiple swelling and bone pain. Plain radiographs of the affected bones revealed multiple erosive bone tumours, which were diagnosed as brown tumours associated with primary hyperparathyroidism. CASE REPORT A 25 year old female presented with swelling in left elbow since 1 month along with multiple swelling in body. Patient had pain in left elbow after trivial fall. X-ray showed lytic lesion of left elbow with pathological fracture. Biopsy was suggestive of brown tumour of distal humerus. DISCUSSION We managed this case with reconstruction of defect with fibula grafting and plating. CONCLUSION Pathological fracture in young adult should always be properly investigated. A high index of suspicion is necessary to diagnose unusual presentation of Primary Hyperparathyroidism.
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Affiliation(s)
- Amit Kumar Yadav
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
| | - Eknath Pawar
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India
| | - Abhishek Harsoor
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
| | | | - Hitesh Rohra
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
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Demir AD. A review of parathyroid mass and patients with nonspecific complaints. J Int Med Res 2020; 48:300060519827169. [PMID: 30791798 PMCID: PMC7140219 DOI: 10.1177/0300060519827169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Abstract
In this review, parathyroid mass and its nonspecific symptoms are discussed. In daily clinical practice, patients present with varying symptoms, including depression, chest pain, pancreatitis, or nonspecific fatigue. If the patient is not tested for a parathyroid mass along with performing routine electrolyte tests, diagnosing such a patient with a parathyroid mass may take several years. This issue and situation are discussed in this review.
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Affiliation(s)
- Aslıhan Dilara Demir
- Department of Internal Medicine, Amasya University
Research and Education Hospital, Amasya, Turkey
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Added value of ultrasonography and Tc-99m MIBI SPECT/CT combined protocol in preoperative evaluation of parathyroid adenoma. Eur J Radiol Open 2019; 6:336-342. [PMID: 31886318 PMCID: PMC6921373 DOI: 10.1016/j.ejro.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/02/2019] [Accepted: 11/02/2019] [Indexed: 11/23/2022] Open
Abstract
Concomitant use of ultrasonography and MIBI-SPECT/CT is highly recommended for better depiction of parathyroid adenoma. It also helps in accurate localization of parathyroid adenoma especially those of ectopic location. It will provide better success for parathyroid exploration and minimally invasive surgery.
Purpose Evaluating the diagnostic performance of combined protocol of ultrasonography and Tc-99 m MIBI SPECT/CT in preoperative depiction and localization of parathyroid adenoma. Methods and materials 60 patients were enrolled in this retrospective study who had primary hyperparathyroidism and parathyroidectomy for parathyroid adenoma, all of them underwent ultrasonography examination of parathyroid gland and MIBI SPECT/CT for exact pre-operative localization of parathyroid adenoma, surgical and pathological results were used as standard reference then sensitivity, specificity and accuracy for each modalility and for combined protocol of both modalities was calculated. Results The sensitivity, specificity and accuracy were highest with combined protocol of ultrasonography and MIBI-SPECT/CT (87 %), (71 %) and (85 %) respectively and lowest sensitivity, specificity and accuracy with ultrasonography alone (76 %), (63 %) and (73 %) respectively while (83 %), (66 %) and (80 %) with MIBI-SPECT/CT alone. Conclusion Concomitant use of ultrasonography and MIBI SPECT/CT is highly recommended for better preoperative depiction and localization of parathyroid adenoma.
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Jamora RDG, Espiritu AI, Santiago JJ, Wohldorf JJ, Cuanang JR. Blepharospasm as the presenting feature of papillary thyroid cancer and parathyroid adenoma. J Clin Neurosci 2019; 72:460-463. [PMID: 31889644 DOI: 10.1016/j.jocn.2019.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Blepharospasm is a type of focal dystonia depicted by periodic and spontaneous closure of the orbicularis oculi and surrounding muscles. Typical secondary etiologies of blepharospasm may include ophthalmologic and structural brain lesions. In this article, we report a novel case of a patient with a biopsy-proven concurrent papillary carcinoma of the thyroid gland and adenoma of the parathyroid gland with blepharospasm as an exceptionally unique initial manifestation. This report showed that a diagnostic work-up for causes of blepharospasm may include a search for these neoplasm and surgical removal of these masses may offer significant symptomatic control of the focal dystonia.
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Affiliation(s)
- Roland Dominic G Jamora
- Movement Disorders Service and Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines; Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Adrian I Espiritu
- Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Philippines
| | - Janet J Santiago
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Jocelyn J Wohldorf
- Section of Endocrinology, Department of Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | - Joven R Cuanang
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
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Do Symptoms and Serum Calcium Levels Affect the Results of Surgical Treatment of Primary Hyperparathyroidism? BIOMED RESEARCH INTERNATIONAL 2019; 2019:2150159. [PMID: 31355250 PMCID: PMC6634056 DOI: 10.1155/2019/2150159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022]
Abstract
Introduction The purpose of this study was to investigate the difference in surgical outcomes between symptomatic and asymptomatic patients with primary hyperparathyroidism (PHPT) and between patients with high serum calcium and those with normal blood calcium, as well as to explore the epidemiological trend of PHPT in northern China. Methods Clinicopathologic data of 197 patients (50 men and 147 women) with PHPT who underwent surgery at the First Affiliated Hospital of Harbin Medical University from 2008 to 2017 were analyzed. Changes in clinicopathology were compared among different subgroups of patients. Patients were categorized into subgroups based on serum calcium levels, whether or not they presented with symptoms, and admission time. Results Of the total patients, 82.23% had hypercalcemic primary hyperparathyroidism (HCPHPT), 17.77% had normocalcemic primary hyperparathyroidism (NCPHPT), 45.18% had symptomatic primary hyperparathyroidism (SPHPT), and 54.82% had asymptomatic primary hyperparathyroidism (ASPHPT). Seventy-seven cases of PHPT involved thyroid nodules, with 22 confirmed as papillary thyroid carcinoma, and 29 confirmed as nodular goiter. There was no significant difference in the success rate of surgery, postoperative recurrence rate, and the symptoms of temporary hypocalcemia between the HCPHPT and NCPHPT groups, and between the SPHPT and ASPHPT groups. The incidence of PHPT has increased threefold since 2013. Conclusions Symptoms and serum calcium levels did not affect the results of surgical treatment for PHPT. The incidence of PHPT in northern China is increasing. Moreover, PHPT manifestation has shifted from the symptomatic to the asymptomatic form. Thyroid surgery should be performed in PHPT patients with thyroid nodules.
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Yadav SK, Mishra SK, Mishra A, Mayilvagnan S, Chand G, Agarwal G, Agarwal A, Verma AK. Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India. Indian J Endocrinol Metab 2019; 23:468-472. [PMID: 31741908 PMCID: PMC6844166 DOI: 10.4103/ijem.ijem_255_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients. MATERIAL AND METHODS This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively. RESULTS Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively (P = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH (n = 213) and FPTx without IOPTH (n = 28). The outcome did not differ between two groups statistically. CONCLUSION FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients.
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Affiliation(s)
- Sanjay K. Yadav
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Saroj K. Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Sabaretnam Mayilvagnan
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Gyan Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Amit Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Ashok K. Verma
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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Yao XA, Wei BJ, Jiang T, Chang H. The characteristics of clinical changes in primary hyperparathyroidism in Chinese patients. J Bone Miner Metab 2019; 37:336-341. [PMID: 29721808 DOI: 10.1007/s00774-018-0922-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
In Western countries, the presentation of primary hyperparathyroidism (PHPT) changed from a symptomatic to an asymptomatic disease after the 1970s, whereas in China, only one study has evaluated the changing clinical characteristics and biochemical profiles of PHPT patients. The aim of this study was to explore changes in the clinical characteristics of PHPT in Chinese patients. Overall, 140 consecutive patients with PHPT were studied between January 1, 2010 and June 30, 2016. The patients were divided into two groups: 32 consecutive patients from January 1, 2010 to March 31, 2013 were included in group 1, and 108 consecutive patients from April 1, 2013 to June 30, 2016 were included in group 2. The most frequent complaints were ostealgia (46.02%), urolithiasis (41.59%), constipation (25.66%), fatigue (18.58%), polydipsia and polyuria (15.93%) and fracture history (15.04%). The number of cases in group 2 was 3.38-fold greater than that of group 1. The parathyroid hormone (PTH) and fasting blood glucose (FPG) levels were higher in group 1 than those in group 2 (p = 0.039, p < 0.001). In 62.14% of patients with PHPT, the proportion of the first diagnosis due to hypercalcemia found using a multichannel autoanalyzer in group 1 was lower than that found in group 2 (p = 0.039), and the proportion of the first diagnosis due to parathyroid lesions captured using routine neck ultrasonography in group 1 was higher than in group 2 (p = 0.003). The proportion of parathyroid carcinoma cases was higher in group 1 than group 2 (p = 0.036). Cases of PHPT increased with time, but the proportion of parathyroid carcinoma cases was lower in group 1 than that in group 2. Over time, the first diagnosis switched from parathyroid lesions captured by routine neck ultrasound to hypercalcemia found by a multichannel autoanalyser. At our centre, PHPT in Chinese patients still demonstrates classic characteristics.
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Affiliation(s)
- Xiao-Ai Yao
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Bo-Jun Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Tao Jiang
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
| | - Hong Chang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
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Meeting report of the "Symposium on kidney stones and mineral metabolism: calcium kidney stones in 2017". J Nephrol 2019; 32:681-698. [PMID: 30680550 DOI: 10.1007/s40620-019-00587-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
A symposium on kidney stones and mineral metabolism held on December 2017 in Brussels, Belgium was the first international multidisciplinary conference of the International Collaborative Network on Kidney Stones and Mineral Metabolism. This meeting addressed epidemiology, underlying pathophysiological mechanisms, genetics, pathological, as well as clinical and research topics. The participants included clinicians and recognized experts in the field from Europe and the United States interacted closely during the symposium which promoted a chance to explore new frontiers in the field of kidney stone disease. This manuscript summarizes some of the major highlights of the meeting.
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Rizwan A, Jamal A, Uzzaman M, Fatima S. Case report: lady with bone pains for 5 years-parathyroid carcinoma. BMC Res Notes 2018; 11:617. [PMID: 30157930 PMCID: PMC6114890 DOI: 10.1186/s13104-018-3711-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Parathyroid cancer is a rare cause of primary hyperparathyroidism. It presents a diagnostic and therapeutic challenge that may not be recognized preoperatively, and is often not conclusively identified during the operation. We present the case of a lady with backache and hypercalcemia, but with inadequate work-up for her condition for several years. Case presentation A middle aged lady of Asian descent presented with backache. Initial work up revealed mild hypercalcemia, negative work up for multiple myeloma, negative sestamibi scan for parathyroid pathology. A phenomenally elevated parathormone (PTH) level—2105 pg/mL (16–87 pg/mL), and rising serum calcium, 15.1 mg/dL, (8.6–10.5 mg/dL), ordered years later prompted a repeat sestamibi scan and ultrasonography of neck. Based on these investigations, a diagnosis of primary hyperparathyroidism, with high suspicion of parathyroid cancer was made. The patient underwent surgical tumour resection, with subsequent histopathological confirmation of diagnosis. Conclusion In the setting of hypercalcemia, PTH level assessment is a must. This helps to differentiate between the parathyroid dependant and independent causes of high serum calcium, thereby encouraging a comprehensive pathway to the work up of the cause of hypercalcemia. The parathyroid cancer is a very rare cause of hypercalcemia, which needs to be considered in the differentials of primary hyperparathyroidism, particularly in the setting of high PTH levels. Electronic supplementary material The online version of this article (10.1186/s13104-018-3711-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Azra Rizwan
- Section of Endocrinology, Department of Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Abid Jamal
- Department of Surgery, Healthcare Hospital, Defense Housing Authority, Phase 1, Karachi, Pakistan
| | - Maseeh Uzzaman
- Section of Nuclear Medicine, Department of Radiology, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Saira Fatima
- Section of Histopathology, Department Pathology, Aga Khan University Hospital, Stadium Road, P.O Box 3500, Karachi, 74800, Pakistan
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Zou H, Song L, Jia M, Wang L, Sun Y. Brown tumor of multiple facial bones associated with primary hyperparathyroidism: A clinical case report. Medicine (Baltimore) 2018; 97:e11877. [PMID: 30113484 PMCID: PMC6112971 DOI: 10.1097/md.0000000000011877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Only 4.5% of brown tumors involve facial bones; of these, solitary bone involvement is usual. Brown tumors of multiple facial bones are extremely rare. Here, we report the case of a brown tumor of multiple facial bones initially misdiagnosed as an odontogenic cyst. PATIENT CONCERNS A pregnant 26-year-old woman was referred to our hospital with painful swelling of multiple facial bones, anemia, urinary calculi, marasmus, and a history of multiple bone fractures. Laboratory examination revealed an elevated serum calcium level of 3.09 mmol/L (normal range: 2.0-2.8 mmol/L) and a low phosphorus level of 0.62 mmol/L (normal range: 0.81-1.65 mmol/L). The serum alkaline phosphatase concentration was 397 IU/L (normal range: 24-82 IU/L) and parathyroid hormone level was 267 pg/mL (normal range: 14-72 pg/mL). Cone beam computed tomography revealed multiple ossifying fibromas of the maxilla and mandible. Incisional biopsy revealed abundant spindle cells with areas of hemorrhage and haphazardly arranged diffuse multinucleated giant cells. DIAGNOSES The patient was diagnosed with primary hyperparathyroidism (HPT). INTERVENTIONS She was treated by parathyroidectomy. OUTCOMES The multiple osteitis fibrosa cystica gradually resolved as bone re-mineralized. The patient has been followed up for 2 years without evidence of tumor recurrence. LESSONS As multiple osteolytic lesions of facial bones can be caused by primary HPT, serum calcium and parathyroid hormone assays should be performed routinely when investigating these lesions.
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Affiliation(s)
- Haixiao Zou
- Department of Stomatology, the Second Affiliated Hospital of Nanchang University, Nanchang
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education
| | - Li Song
- Department of Stomatology, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Mengqi Jia
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education
- Department of Oral and Maxillofacial Surgery
| | - Li Wang
- Department of Pathology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Yanfang Sun
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education
- Department of Oral and Maxillofacial Surgery
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Abstract
PURPOSE OF REVIEW In the United States, the number of parathyroidectomies among patients with chronic dialysis has remained stable in the last decade. A fall in serum calcium concentration is common postparathyroidectomy in patients with hyperparathyroidism, which usually resolves in 2-4 days. A severe drop in serum total calcium concentration less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy is called hungry bone syndrome (HBS). Concomitant hypophosphatemia, hypomagnesemia, and hyperkalemia can be seen. Hypocalcemia and hypophosphatemia can persist for months to years. In contemporary clinical practice, HBS may be more commonly seen in patients with secondary compared to primary hyperparathyroidism. Preoperative radiological changes in bone, elevated serum alkaline phosphatase and parathyroid hormone (PTH) levels, and high numbers of osteoclasts on bone biopsy may identify patients at risk. Treatment consists of high-dose oral calcium and calcitriol supplementation. A low-dose pamidronate infusion 1-2 days prior to surgery may prevent HBS. RECENT FINDINGS Recent in-vitro studies reported net calcium movement into bone because of a sudden fall in serum PTH level after a prolonged period of elevation. This supports a previous hypothesis that a sudden drop in serum PTH level after surgery results in the unopposed action of osteoblasts and influx of calcium into bone. SUMMARY Incidence of HBS and its association with morbidity and mortality remains unclear in contemporary clinical practice. It is more common to encounter HBS in chronic dialysis patients with secondary hyperparathyroidism than those with primary hyperparathyroidism that undergo parathyroidectomies. Use of bisphosphonates to prevent HBS should be explored in future studies.
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Koh J, Hogue JA, Roman SA, Scheri RP, Fradin H, Corcoran DL, Sosa JA. Transcriptional profiling reveals distinct classes of parathyroid tumors in PHPT. Endocr Relat Cancer 2018; 25:407-420. [PMID: 29475894 PMCID: PMC5826637 DOI: 10.1530/erc-17-0470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
Abstract
The clinical presentation of primary hyperparathyroidism (PHPT) varies widely, although the underlying mechanistic reasons for this disparity remain unknown. We recently reported that parathyroid tumors can be functionally segregated into two distinct groups on the basis of their relative responsiveness to ambient calcium, and that patients in these groups differ significantly in their likelihood of manifesting bone disability. To examine the molecular basis for this phenotypic variation in PHPT, we compared the global gene expression profiles of calcium-sensitive and calcium-resistant parathyroid tumors. RNAseq and proteomic analysis identified a candidate set of differentially expressed genes highly correlated with calcium-sensing capacity. Subsequent quantitative assessment of the expression levels of these genes in an independent cohort of parathyroid tumors confirmed that calcium-sensitive tumors cluster in a discrete transcriptional profile group. These data indicate that PHPT is not an etiologically monolithic disorder and suggest that divergent molecular mechanisms could drive the observed phenotypic differences in PHPT disease course, provenance, and outcome.
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Affiliation(s)
- James Koh
- Dept. of Surgery, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Duke University Medical Center
- To whom reprint requests should be addressed: James Koh, Ph.D., Department of Surgery, Duke University Medical Center, Durham, NC 27710, Phone: 919-684-0892, FAX: 919-681-6622,
| | - Joyce A. Hogue
- Dept. of Surgery, Duke University Medical Center, Durham, NC
| | | | | | | | | | - Julie A. Sosa
- Dept. of Surgery, Duke University Medical Center, Durham, NC
- Dept. of Medicine, Duke University
- Duke Cancer Institute, Duke University Medical Center
- Duke Clinical Research Institute, Duke University Medical Center
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Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India. World J Surg 2018; 42:2732-2737. [DOI: 10.1007/s00268-018-4575-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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37
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Hiperparatiroidismo primario. Med Clin (Barc) 2018; 150:226-232. [DOI: 10.1016/j.medcli.2017.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 11/21/2022]
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Sun B, Guo B, Wu B, Kang J, Deng X, Zhang Z, Fan Y. Characteristics, management, and outcome of primary hyperparathyroidism at a single clinical center from 2005 to 2016. Osteoporos Int 2018; 29:635-642. [PMID: 29198075 DOI: 10.1007/s00198-017-4322-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study presents the clinical and biochemical profiles of patients with PHPT between 2005 and 2016 at our center. Most PHPT patients in China show symptomatic features. The number of symptomatic and asymptomatic patients increased during that time, and the number of individuals with parathyroid carcinoma is now increasing. INTRODUCTION Over the last decade, the prevalence of primary hyperparathyroidism (PHPT) has increased sharply, and the number of individuals with parathyroid cancer is still trending upward. Little is known about the clinical outlook of the disease over the last decade in China. The aim of this study was to describe the clinical characteristics of PHPT patients at our center from January 2005 to December 2016. METHODS Two hundred sixty patients with PHPT visiting Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled retrospectively. The clinical manifestations and biochemical abnormalities of these patients were analyzed. RESULTS Among all patients, 73.1% had symptomatic PHPT, while the number of symptomatic and asymptomatic patients increased 1 to 2.5 times and 1.5 to 3 times, respectively, from 2005 to 2016. Bone pain and single adenoma were the most frequent signs and pathological results. The patients with parathyroid carcinoma over the last 5 years accounted for 90% (9/10) of all parathyroid carcinoma patients from 2005 to 2016, and parathyroid carcinoma patients had higher levels of serum calcium, parathyroid hormone (PTH), and serum creatinine (P < 0.05) than parathyroid hyperplasia and parathyroid adenoma patients. CONCLUSIONS Most patients with PHPT in China still exhibit classic clinical and biochemical features. Both symptomatic and asymptomatic patients have increased over the last 12 years. Although the proportion of parathyroid carcinoma was small, a noticeable upward tendency was observed at our center.
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Affiliation(s)
- B Sun
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - B Guo
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - B Wu
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - J Kang
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - X Deng
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Z Zhang
- Department of Osteoporosis and Bone Diseases and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Y Fan
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Bell CF, Warrick MM, Gallagher KC, Baregamian N. Neurocognitive performance profile postparathyroidectomy: a pilot study of computerized assessment. Surgery 2017; 163:457-462. [PMID: 29133114 DOI: 10.1016/j.surg.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/01/2017] [Accepted: 09/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive symptoms attributable to primary hyperparathyroidism are important diagnostic criteria, yet the basic characterization and assessment of neurocognitive deficits in primary hyperparathyroidism are not defined fully. METHODS In this prospective pilot study, patients with unequivocal biochemical diagnosis of primary hyperparathyroidism were evaluated for neurocognitive performance preoperatively and postparathyroidectomy (2 weeks, 6 months) using a battery of computerized modular tests designed by LUMOSITY. The individual test scores and aggregate scores representing a subject's total neurocognitive performance profile were calculated. Statistical comparisons between groups were performed using univariate analysis and repeated measures of analysis of variance. RESULTS In the study, 34 participants were assessed preoperatively; 18 completed all 3 assessments, 2 completed pretest and 6-month assessments, and 30 completed preoperative and 2-week postparathyroidectomy assessments. Primary hyperparathyroidism patients demonstrated significant deficits in memory, attention, mental flexibility, and speed of processing when compared with controls. Total neurocognitive performance profile score was significantly lower at the preoperative (P = .0001) and 2-week postparathyroidectomy (P = .0004) time points when compared with controls; this difference was bridged by 6 months postparathyroidectomy. CONCLUSION Computerized neurocognitive performance profile assessment validated the neurocognitive benefits of parathyroidectomy. Additional study is needed to determine if this novel method provides long-term, objective, quantifiable, and accessible neurocognitive performance profile assessment in primary hyperparathyroidism patients and can serve as a valuable diagnostic and prognostic tool.
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Affiliation(s)
- Caitlin F Bell
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mathew M Warrick
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kathleen C Gallagher
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naira Baregamian
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Toneto MG, Prill S, Debon LM, Furlan FZ, Steffen N. The history of the parathyroid surgery. Rev Col Bras Cir 2017; 43:214-22. [PMID: 27556546 DOI: 10.1590/0100-69912016003003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/03/2016] [Indexed: 11/22/2022] Open
Abstract
The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment. RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.
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Affiliation(s)
- Marcelo Garcia Toneto
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Shandi Prill
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Leticia Manoel Debon
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Fernando Zucuni Furlan
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
| | - Nedio Steffen
- - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
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Abstract
Multiple endocrine neoplasia type 1 syndrome (MEN1) is a rare autosomal dominant familial cancer syndrome affecting multiple endocrine glands. Published literature on MEN1 from Indian subcontinent is scarce. We report here a case series of MEN1 patients (n = 18) from 14 unrelated families. Retrospective study describing the clinical profile of MEN1 patients from endocrine unit of a tertiary care hospital from western India. Additionally clinical profile of primary hyperparathyroidism (PHPT) in MEN1 patients was compared with that of apparently sporadic PHPT cohort from our centre. Eighteen patients (10 males, 8 females) diagnosed as MEN1 were included. Mean age at diagnosis was 31.5 ± 10.6 years (range 17-54). Incidence of primary hyperparathyroidism (PHPT), pituitary adenoma (PA), and gastro-entero-pancreatic neuroendocrine tumor (GEP-NET) was 94.4, 72.2, and 72.2 %, respectively. GEP-NET was the commonest presenting lesion (33.3 %), followed by PA (27.7 %), PHPT (16.6 %), thymic carcinoid (5.5 %), while 16.6 % cases were identified on family screening. PHPT manifestations (clinical and biochemical) in MEN1 were less severe as compared to those of sporadic PHPT. Contrast enhanced computed tomography (CECT) and (68)Ga-DOTANOC PET/CT were equally sensitive (64.7 vs. 63.5 %) in identifying multiglandular parathyroid disease. Non functioning tumors (NFT) were the most common GEP-NET, followed by insulinoma (5/13, two were metastatic). (68)Ga-DOTANOC PET/CT had higher sensitivity in detecting GEP-NET lesions than CECT (100 vs. 62.5 %). The most common pituitary lesion was prolactinoma, and all were cabergoline responsive. Genetic analysis was available in 13 patients and 11 patients showed mutation in MEN1 gene. The clinical profile of MEN1 in Asian Indian patients is largely comparable to that reported in other cohorts. Peculiar findings of our cohort are predominance of GEP-NET as a presenting manifestation and relatively higher prevalence of insulinoma with higher occurrence of metastatic insulinoma. Clinical and biochemical profile of MEN1 associated PHPT is less severe than that of our sporadic PHPT.
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Weber TJ, Koh J, Thomas SM, Hogue JA, Scheri RP, Roman SA, Sosa JA. Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density. Metabolism 2017; 74:22-31. [PMID: 28764845 PMCID: PMC5561769 DOI: 10.1016/j.metabol.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT A subset of PHPT patients exhibit a more severe disease phenotype characterized by bone loss, fractures, recurrent nephrolithiasis, and other dysfunctions, but the underlying reasons for this disparity in clinical presentation remain unknown. OBJECTIVE We sought to identify new mechanistic indices that could inform more personalized management of PHPT. DESIGN Pre-, peri-, and postoperative data and demographic, clinical, and pathological information from patients undergoing parathyroidectomy for PHPT were collected. Univariate and partial Spearman correlation was used to estimate the association of parathyroid tumor calcium sensing capacity with select variables. PATIENTS OR OTHER PARTICIPANTS An unselected series of 237 patients aged >18years and undergoing parathyroidectomy for PHPT were enrolled. MAIN OUTCOME MEASURES Calcium sensing capacity, expressed as the concentration required for half-maximal biochemical response (EC50), was evaluated in parathyroid tumors from an unselected series of 74 patients and assessed for association with clinical parameters. The hypothesis was that greater disease severity would be associated with attenuated calcium sensitivity and biochemically autonomous parathyroid tumor behavior. RESULTS Parathyroid tumors segregated into two distinct groups of calcium responsiveness (EC50<3.0 and ≥3.0mM). The low EC50 group (n=27) demonstrated a mean calcium EC50 value of 2.49mM [95% confidence interval (CI): 2.43-2.54mM], consistent with reference normal activity. In contrast, the high EC50 group (n=47) displayed attenuated calcium sensitivity with a mean EC50 value of 3.48mM [95% CI: 3.41-3.55mM]. Retrospective analysis of the clinical registry data suggested that high calcium EC50 patients presented with a more significant preoperative bone mineral density (BMD) deficit with a t-score of -2.7, (95% CI: -3.4 to -1.9) versus 0.9, (95% CI: -2.1 to -0.4) in low EC50 patients (p<0.001). After adjusting for gender, age, BMI, 25 OH vitamin D level and preoperative iPTH, lowest t-score and calcium EC50 were inversely correlated, with a partial Spearman correlation coefficient of -0.35 (p=0.02). CONCLUSIONS Impaired calcium sensing in parathyroid tumors is selectively observed in a subset of patients with more severe bone mineral density deficit. Assessment of parathyroid tumor biochemical behavior may be a useful predictor of disease severity as measured by bone mineral density in patients with PHPT.
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Affiliation(s)
- Thomas J Weber
- Dept. of Medicine, Duke University Medical Center, Durham, NC, United States.
| | - James Koh
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute, Duke University Medical Center, United States
| | - Samantha M Thomas
- Dept. of Biostatistics and Bioinformatics, Duke University, United States; Duke Cancer Institute, Duke University Medical Center, United States
| | - Joyce A Hogue
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Randall P Scheri
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Sanziana A Roman
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Julie A Sosa
- Dept. of Medicine, Duke University Medical Center, Durham, NC, United States; Dept. of Surgery, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute, Duke University Medical Center, United States; Duke Clinical Research Institute, Duke University Medical Center, United States
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Vaidya A, Curhan GC, Paik JM, Wang M, Taylor EN. Body Size and the Risk of Primary Hyperparathyroidism in Women: A Cohort Study. J Bone Miner Res 2017; 32:1900-1906. [PMID: 28488734 PMCID: PMC5555811 DOI: 10.1002/jbmr.3168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
Greater body weight and fat mass have been associated with higher serum parathyroid hormone levels and a higher prevalence of primary hyperparathyroidism (P-HPTH) in women. However, prospective studies to evaluate whether greater body size associates with a higher incidence of developing P-HPTH have not been reported. We investigated whether greater body size was independently associated with a higher risk for developing P-HPTH in women. We conducted a prospective cohort study of 85,013 female participants in the Nurses' Health Study I followed for up to 26 years. Body size was measured via multiple metrics: weight, body mass index (BMI), and waist circumference (WC). Weight and BMI were assessed every 2 years from 1986 to 2012, and WC was assessed in 1986, 1996, and 2000. Detailed dietary and demographic exposures were quantified via validated biennial questionnaires. Incident cases of P-HPTH were confirmed by individual medical record review. Cox proportional hazards models were used to evaluate whether WC, weight, and BMI were independent risk factors for developing P-HPTH. Models were adjusted for demographic variables, comorbidities, medications, intakes of calcium and vitamin D, and exposure to ultraviolet light. We confirmed 491 incident cases of P-HPTH during 2,128,068 person-years of follow-up. The multivariable-adjusted relative risks for incident P-HPTH increased across quartiles of WC: Q1, ref; Q2, 1.34 (0.97, 1.86); Q3, 1.70 (1.24, 2.31); Q4, 2.27 (1.63, 3.18); p trend < 0.001. Similarly, the multivariable-adjusted risks for incident P-HPTH increased across quartiles of weight: Q1, ref; Q2, 1.23 (0.92, 1.65); Q3, 1.63 (1.24, 2.14); Q4, 1.65 (1.24, 2.19); p trend < 0.001. A similar but statistically non-significant trend was observed across quartiles of BMI (p trend = 0.07). In summary, body size may be an independent and modifiable risk factor for developing P-HPTH in women. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension
- Brigham and Women's Hospital
- Harvard Medical School
| | - Gary C. Curhan
- Division of Renal Medicine
- Channing Division of Network Medicine
- Brigham and Women's Hospital
- Harvard Medical School
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Julie M. Paik
- Division of Renal Medicine
- Channing Division of Network Medicine
- Brigham and Women's Hospital
- Harvard Medical School
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Eric N. Taylor
- Channing Division of Network Medicine
- Brigham and Women's Hospital
- Division of Nephrology and Transplantation, Maine Medical Center
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Abstract
OBJECTIVE The aim of this article is to compare clinical characteristics and lab values for metabolic syndrome between primary hyperparathyroidism (PHPT) patients with different levels of serum intact parathyroid hormone (iPTH) and to determine correlation between different clinical characteristics among PHPT patients Methods: We reviewed charts of 212 PHPT patients in this retrospective study. Patients were divided into two groups according to their initial serum iPTH levels. Student's t-tests were used to compare the two groups for differences in clinical characteristics and laboratory values. Pearson's correlation coefficients were used to assess associations. RESULTS Of the 212 PHPT patients, 100 were classified as m-iPTH group (serum iPTH < 140 pg/mL), whereas 112 patients were defined as h-iPTH group (serum iPTH ≥ 140 pg/mL). The h-iPTH patients were younger, had higher serum calcium and alkaline phosphatase levels, but exhibited lower 25(OH)-vitamin D and HDL levels, when compared with those of m-iPTH patients. Adenoma weights in the h-iPTH group tended to be higher than that in the m-iPTH group. Furthermore, association studies revealed that the iPTH level was positively correlated with adenoma weight and serum calcium and triglyceride (TG) levels but negatively correlated with HDL level. CONCLUSION Our study supports the hypothesis that iPTH level is associated with TG and HDL levels and should be a factor to consider in the management of PHPT patients.
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Affiliation(s)
- Haidar Al-Hraishawi
- a Division of Endocrinology, Metabolism & Nutrition , Department of Medicine, Rutgers University-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Peter J Dellatore
- a Division of Endocrinology, Metabolism & Nutrition , Department of Medicine, Rutgers University-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Xinjiang Cai
- a Division of Endocrinology, Metabolism & Nutrition , Department of Medicine, Rutgers University-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
- b Department of Medicine , Icahn School of Medicine at Mount Sinai (James J. Peters VA Bronx) , New York , NY , USA
| | - Xiangbing Wang
- a Division of Endocrinology, Metabolism & Nutrition , Department of Medicine, Rutgers University-Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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Krishnamurthy A, Majhi U, Rangarajan GK, Ramshankar V, Kumar RK. The diagnostic and therapeutic challenges in the management of a double giant parathyroid adenoma. Indian J Nucl Med 2016; 31:301-304. [PMID: 27833320 PMCID: PMC5041423 DOI: 10.4103/0972-3919.187450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary hyperparathyroidism is a common endocrine disorder of the parathyroid gland. It is mostly seen as a single gland adenoma in up to 85% of the cases with the excess production of parathyroid hormone. Double adenomas although reported are very rare and double giant parathyroid adenomas are even rarer. We possibly report the second case in the literature of primary hyperparathyroidism caused by double giant parathyroid adenomas, presenting with severe symptomatic hypercalcemia and review the diagnostic and therapeutic challenges in its management. The presentation with severe hypercalcemia and the presence of atypia in one of the adenomas added to its uniqueness. A combination of the neck ultrasound and a parathyroid scintigraphy should be used for preoperative localization and selection of the right surgical approach for patients undergoing parathyroidectomy. The parathyroid scintigraphic protocols keep getting refined; it is hence vitally important and practical to adapt the diagnostic algorithms in accordance with local availability and expertise.
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Affiliation(s)
| | - Urmila Majhi
- Department of Pathology, Cancer Institute, Chennai, Tamil Nadu, India
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Costa JMDFT, Ranzolin A, Neto CADC, Marques CDL, Duarte ALBP. Frequência elevada de hiperparatireoidismo assintomático em pacientes com fibromialgia: associação ao acaso ou erro diagnóstico? REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kim SM, Shu AD, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Declining Rates of Inpatient Parathyroidectomy for Primary Hyperparathyroidism in the US. PLoS One 2016; 11:e0161192. [PMID: 27529699 PMCID: PMC4986953 DOI: 10.1371/journal.pone.0161192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Aimee D. Shu
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jin Long
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mary B. Leonard
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jeffrey A. Norton
- Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Feng L, Zhang X, Liu ST. Surgical treatment of primary hyperparathyroidism due to parathyroid tumor: A 15-year experience. Oncol Lett 2016; 12:1989-1993. [PMID: 27602126 DOI: 10.3892/ol.2016.4905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/01/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to highlight our experience over a 15-year period in dealing with primary hyperparathyroidism (PHPT) due to a parathyroid tumor. Parathyroidectomy is the standard therapy for patients with PHPT. Our study included all patients with PHPT treated by parathyroidectomy at the Affiliated Cancer Hospital of Zhengzhou University, China. Between 1998 and 2013, a total of 107 patients were recruited. Their clinical data, presentation, laboratory examinations, imageological diagnoses and surgical approaches were analyzed retrospectively. Eighty-four cases (78.5%) were followed up. During a median follow-up period of 5.7 years, a total of 80 patients were without recurrence and metastasis. The main symptoms of PHPT patients were palpable neck mass, joint pains and pathological fracture. The high levels of preoperative parathyroid hormone (PTH) and serum calcium in PHPT patients decreased to below the normal upper limit within 3 days of surgery. The sensitivity of neck ultrasonography, sestamibi scanning, CT, MRI and the combination of three or four types of test were 86.0%, 90.4%, 80.8%, 79.6% and 96.1%, respectively. A 50% or greater drop in PTH levels within 20 min compared with the highest PTH levels before surgery occurred in 95/107 cases (88.8%). Transient hypocalcemia was the most common surgical complication. The ultrasonography and sestamibi scan is the most effective examination for parathyroid tumor. The 20 min PTH measurement appears to be extremely useful, and avoids unnecessary bilateral exploration.
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Affiliation(s)
- Lu Feng
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Xu Zhang
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Shan-Ting Liu
- Department of Head and Neck Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
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Abstract
Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes. Hypercalcaemia is the biochemical hallmark of PHPT. Usually, the concentration of PTH is frankly increased but can remain within the normal range, which is abnormal in the setting of hypercalcaemia. Normocalcaemic PHPT, a variant in which the serum calcium level is persistently normal but PTH levels are increased in the absence of an obvious inciting stimulus, is now recognized. The clinical presentation of PHPT varies from asymptomatic disease (seen in countries where biochemical screening is routine) to classic symptomatic disease in which renal and/or skeletal complications are observed. Management guidelines have recently been revised to help the clinician to decide on the merits of a parathyroidectomy or a non-surgical course. This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT.
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50
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Garrel R, Bartolomeo M, Makeieff M, Crampette L, Guerrier B, Cartier C. Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:247-51. [PMID: 27133292 DOI: 10.1016/j.anorl.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction. MATERIALS AND METHOD A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C. RESULTS Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique. CONCLUSION With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C.
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Affiliation(s)
- R Garrel
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
| | - M Bartolomeo
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - M Makeieff
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - L Crampette
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - B Guerrier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - C Cartier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
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