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Chan K, Tseng CC, Milarachi E, Goldrich DY, King TS, Fernandez-Mendoza J, Saadi RA, Saunders B, Boltz M, Goldenberg D. Actigraphy measures show sleep improvement after parathyroidectomy for primary hyperparathyroidism. Am J Otolaryngol 2024; 45:104297. [PMID: 38692072 DOI: 10.1016/j.amjoto.2024.104297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
IMPORTANCE The symptoms of primary hyperparathyroidism are often subtle, such as fatigue, mood changes, and sleep disturbances. After parathyroidectomy, patients often report improvement in sleep and mood; however, objective data supporting these improvements is lacking. OBJECTIVE This prospective study uses standard measures to objectively and subjectively assess sleep in patients with primary hyperparathyroidism before and after parathyroidectomy. DESIGN A longitudinal prospective study was conducted over three one-week-long periods: pre-parathyroidectomy, 1-week post-parathyroidectomy, and three months post-parathyroidectomy. During each time point, patients wore an actigraphy device, recorded a sleep diary, and completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scale (DASS). Statistical analysis was performed using repeated measures models to compare the average measures among the three time points and test for trends over time. SETTING Single institution, tertiary care center. PARTICIPANTS Patients with primary hyperparathyroidism from ages 18 to 89 years old. EXPOSURE Parathyroidectomy between September 2020 and January 2024. MAIN OUTCOMES AND MEASURES Actigraphy data, consensus sleep diary, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Depression Anxiety Stress Scales - 21 Items (DASS). RESULTS Thirty-six patients were enrolled, and 34 patients completed the study. Actigraphy data showed a significant negative trend in average sleep latency (p = 0.045) and average time in bed (p = 0.046). Sleep diary data showed additional differences in the number of awakenings (p = 0.002), wake after sleep onset (p < 0.001), sleep quality (p < 0.001), and sleep efficiency (p = 0.02) among the three time points and/or as a significant negative trend. PSQI and ISI scores were significantly different among the three time points (p = 0.002 and p < 0.001, respectively) and also declined significantly over time (p = 0.008 and p = 0.007, respectively). DASS depression, anxiety, and stress scores were significantly different among the three time points (p < 0.001, p = 0.01, and p < 0.001, respectively), and stress also declined significantly over time (p = 0.005). CONCLUSION AND RELEVANCE This study represents the most extensive prospective study demonstrating objective and subjective sleep and mood improvement in patients with primary hyperparathyroidism after parathyroidectomy.
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Affiliation(s)
- Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Emily Milarachi
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Y Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Tonya S King
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert A Saadi
- University of Arkansas for Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, Little Rock, AR, USA
| | - Brian Saunders
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Melissa Boltz
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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De Martino V, Pepe J, Biamonte F, Colangelo L, Di Giuseppe L, Nieddu L, Occhiuto M, Minisola S, Cipriani C. Impairment in muscle strength and its determinants in primary hyperparathyroidism: A study in postmenopausal women. Bone 2023; 166:116604. [PMID: 36347434 DOI: 10.1016/j.bone.2022.116604] [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: 09/03/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
Neuromuscular impairment is described among the non-classical complications of primary hyperparathyroidism (PHPT). However, the extent of this complications and related mechanisms have not been fully addressed. The study aimed at assessing muscle strength and its main determinants in postmenopausal women with PHPT. We studied 48 postmenopausal women with PHPT (mean age 60.8 ± 5.6 SD years; BMI 25.6 ± 5.5 kg/m2) and 38 healthy postmenopausal women (mean age 58.6 ± 5.9; BMI 25.2 ± 3.5). In all subjects, the maximum voluntary contraction (MVC, Newton, N) was measured by Hand held Dynamometer (Kayser Italia srl, Livorno, Italy) and the lumbar spine, total hip, femoral neck, and non dominant distal one-third radius areal BMD (aBMD) by dual X-ray absorptiometry (DXA) (Hologic, Waltham, MA). Serum ionized calcium (Ca++), parathyroid hormone (PTH), phosphorus (P), and 25-hydroxyvitaminD [25(OH)D] levels were measured in both groups. A subgroup of 30 PHPT women agreed to participate to the follow-up sub-study and were re-assessed 24 months after parathyroidectomy (n = 15) or after baseline evaluation (n = 15). Patients with PHPT had significant lower MVC values compared to healthy women (p < 0.001). As expected, serum Ca++ and PTH levels were higher and P lower in PHPT compared to controls. We observed a significant association between MVC and total hip and one-third radius aBMD (R = 0.320 and 0.370, p < 0.05) and negative association with Ca++ (R = -0.340, p < 0.05) in the PHPT group; MVC was positively associated with one-third radius aBMD (R = 0.360, p < 0.05) and negatively with age, BMI and myostatin (R = -0.390, -0.340 and -0.450, p < 0.05) in the group of healthy women. The linear model using BMI, Ca++, P, 25(OH)D, PTH, myostatin, and aBMD as covariates showed that one-third radius aBMD was positively associated with MVC in PHPT patients (p < 0.02) and in healthy subjects (p < 0.001). Additionally, serum PTH and myostatin were negatively associated with MVC in healthy subjects (p < 0.03 and p < 0.01). The linear model showed that surgery was associated with an increase in MVC (p < 0.05) in PHPT patients after 24 months, all other variables being equal and by controlling for baseline values of MVC. Handgrip strength is significantly impaired in postmenopausal women with PHPT. Some common mechanisms influencing muscle function exist in PHPT and in healthy subjects; they are associated with the reduced aBMD at cortical sites. Hypercalcemia seems to be one of the main determinants of impairment in muscle strength in PHPT, while no role is played by myostatin.
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Affiliation(s)
- Viviana De Martino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Federica Biamonte
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Laura Di Giuseppe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Luciano Nieddu
- Faculty of Economics, UNINT University, Via Cristoforo Colombo 200, 00147 Rome, Italy
| | - Marco Occhiuto
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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3
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Kang MS, Lee GH, Yang MJ, Sung MC, Han HY, Lee BS, Baek B, Kim DW, Park EJ. Comparison of toxicity and cellular responses following pulmonary exposure to different types of nanofibers. Nanotoxicology 2022; 16:935-954. [PMID: 36803397 DOI: 10.1080/17435390.2023.2177205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Pulmonary effects of inhaled microfibers are an emerging public health concern. In this study, we investigated toxicity following pulmonary exposure to synthetic polyethylene oxide fibroin (PEONF) and silk fibroin (SFNF) nanofibers and the cellular responses. When instilled intratracheally weekly for four weeks, body weight gain was significantly reduced in female mice exposed to the higher dose of SFNF when compared with the control group. The total number of cells in the lungs was more significant in all treated groups than in the control, whereas the relative portion of neutrophils and eosinophils increased significantly only in female mice exposed to SFNF. Both types of nanofibers induced notable pathological changes and increased pulmonary expression of MCP-1α, CXCL1, and TGF-β. More importantly, blood calcium, creatinine kinase, sodium, and chloride concentration were affected significantly, showing sex- and material-dependent differences. The relative portion of eosinophils increased only in SFNF-treated mice. In addition, both types of nanofibers induced necrotic and late apoptotic cell death in alveolar macrophages after 24 h of exposure, with accompanying oxidative stress, increased NO production, cell membrane rupture, intracellular organelle damage, and intracellular calcium accumulation. Additionally, multinucleated giant cells were formed in cells exposed to PEONF or SFNF. Taken together, the findings indicate that inhaled PEONF and SFNF may cause systemic adverse health effects with lung tissue damage, showing differences by sex- and material. Furthermore, PEONF- and SFNF-induced inflammatory response may be partly due to the low clearance of dead (or damaged) pulmonary cells and the excellent durability of PEONF and SFNF.
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Affiliation(s)
- Min-Sung Kang
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul, South Korea.,Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, South Korea
| | - Gwang-Hee Lee
- School of Civil, Environmental and Architectural Engineering, Korea University, Seoul, South Korea
| | - Mi-Jin Yang
- Jeonbuk Branch Institute, Korea Institute of Toxicology, Jeongeup, South Korea
| | - Myeong-Chang Sung
- School of Civil, Environmental and Architectural Engineering, Korea University, Seoul, South Korea
| | | | | | - Bosung Baek
- Graduate School of Medicine, Kyung Hee University, Seoul, South Korea.,Toxicity Evaluation Center, Keyprime Research Company, Cheongju, South Korea
| | - Dong-Wan Kim
- School of Civil, Environmental and Architectural Engineering, Korea University, Seoul, South Korea
| | - Eun-Jung Park
- Graduate School of Medicine, Kyung Hee University, Seoul, South Korea.,Human Health and Environmental Toxins Research Center, Kyung Hee University, Seoul, South Korea
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Viggiano D, Bruchfeld A, Carriazo S, de Donato A, Endlich N, Ferreira AC, Figurek A, Fouque D, Franssen CFM, Giannakou K, Goumenos D, Hoorn EJ, Nitsch D, Arduan AO, Pešić V, Rastenyté D, Soler MJ, Rroji M, Trepiccione F, Unwin RJ, Wagner CA, Wiecek A, Zacchia M, Zoccali C, Capasso G. Brain dysfunction in tubular and tubulointerstitial kidney diseases. Nephrol Dial Transplant 2021; 37:ii46-ii55. [PMID: 34792176 PMCID: PMC8713153 DOI: 10.1093/ndt/gfab276] [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] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
Kidney function has two important elements: glomerular filtration and tubular function (secretion and reabsorption). A persistent decrease in glomerular filtration rate (GFR), with or without proteinuria, is diagnostic of chronic kidney disease (CKD). While glomerular injury or disease is a major cause of CKD and usually associated with proteinuria, predominant tubular injury, with or without tubulointerstitial disease, is typically non-proteinuric. CKD has been linked with cognitive impairment, but it is unclear how much this depends on a reduced GFR, altered tubular function or the presence of proteinuria. Since CKD is often accompanied by tubular and interstitial dysfunction, we explore here for the first time the potential role of the tubular and tubulointerstitial compartments in cognitive dysfunction. To help address this issue, we have selected a group of primary tubular diseases with preserved GFR, in which to review the evidence for any association with brain dysfunction. Cognition, mood, neurosensory, and motor disturbances are not well characterized in tubular diseases, possibly because they are subclinical and less prominent than other clinical manifestations. The available literature suggests that brain dysfunction in tubular and tubulointerstitial diseases is usually mild and is more often seen in disorders of water handling. Brain dysfunction may occur when severe electrolyte and water disorders in young children persist over a long period of time before the diagnosis is made. We have chosen as examples to highlight this topic, Bartter and Gitelman syndromes and nephrogenic diabetes insipidus. We discuss current published findings, some unanswered questions, and propose topics for future research.
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Affiliation(s)
- Davide Viggiano
- Department of Translational Medical Sciences, Univ. Campania "L.Vanvitelli", Naples, Italy. BIOGEM, Institute of Molecular Biology and Genetics, Ariano Irpino. Italy
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Sol Carriazo
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Antonio de Donato
- Department of Translational Medical Sciences, Univ. Campania "L.Vanvitelli", Naples, Italy. BIOGEM, Institute of Molecular Biology and Genetics, Ariano Irpino. Italy
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Germany
| | - Ana Carina Ferreira
- Nephrology Department, Centro Hospitalar E Universitário de Lisboa Central, Lisbon, Portugal; Universidade Nova de Lisboa
- Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Denis Fouque
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France; University of Lyon, France
| | - Casper F M Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, Patras University Hospital, Patras, Greece
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alberto Ortiz Arduan
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Vesna Pešić
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Daiva Rastenyté
- Medical Academy, Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maria José Soler
- Nephrology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Merita Rroji
- Department of Nephrology, University Hospital Center "Mother Tereza", Tirana, Albania
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, Univ. Campania "L.Vanvitelli", Naples, Italy. BIOGEM, Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Robert J Unwin
- Department of Renal Medicine, Division of Medicine, University College London, UK
| | - Carsten A Wagner
- Institute of Physiology, University of Zürich, Zurich, Switzerland
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Miriam Zacchia
- Department of Translational Medical Sciences, Univ. Campania "L.Vanvitelli", Naples, Italy. BIOGEM, Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA and Associazione Ipertensione, Nefrologia, Trapianto Renale (IPNET), Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, Univ. Campania "L.Vanvitelli", Naples, Italy. BIOGEM, Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
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Shorafa Y, Halawa I, Hewitt M, Nitsche MA, Antal A, Paulus W. Isometric agonist and antagonist muscle activation interacts differently with 140-Hz transcranial alternating current stimulation aftereffects at different intensities. J Neurophysiol 2021; 126:340-348. [PMID: 34191638 DOI: 10.1152/jn.00065.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During transcranial electric stimulation, increasing intracellular Ca2+ levels beyond those needed for inducing long term potentiation (LTP) may collapse aftereffects. State-dependent plastic aftereffects are reduced when applied during muscle activation as compared with rest. Cortical surround inhibition by antagonistic muscle activation inhibits the center-innervated agonist. The objective of this study is to determine the interaction of state dependency of transcranial alternating current stimulation (tACS) aftereffects at rest and under activation of agonist and antagonist muscles during stimulation with different intensities. In 13 healthy participants, we measured motor-evoked potential (MEP) amplitudes before and after applying tACS at 140 Hz over the motor cortex in nine single-blinded sessions using sham, 1 mA, and 2 mA stimulation intensities during rest and activation of agonist and antagonist muscles. During rest, only 1 mA tACS produced a significant MEP increase, whereas the 2 mA stimulation produced no significant MEP size shift. During agonist activation 1 mA did not induce MEP changes; after 2 mA, first a decrease and later an increase of MEPs were observed. Antagonist activation under sham tACS led to an inhibition, which was restored to baseline by 1 and 2 mA tACS. Increasing stimulation intensity beyond 1 mA does not increase excitability, compatible with too strong intracellular Ca2+ increase. Antagonist innervation leads to MEP inhibition, supporting the concept of surround inhibition, which can be overcome by tACS at both intensities. During agonist innervation, a tACS dose-dependent relationship exists. Our results integrate concepts of "leaky membranes" under activation, surround inhibition, intracellular Ca2+ increase, and their role in the aftereffects of tACS.NEW & NOTEWORTHY Stimulation intensity and activation of center versus surround muscles affect cortical excitability alterations generated by 140-Hz tACS. At rest, excitatory aftereffects were induced by tACS with 1 mA, but not 2 mA stimulation intensity. With agonistic muscle activation, excitability first decreases, and then increases with 2 mA. For antagonist activation, the MEP amplitude reduction observed in the sham condition is counteracted upon by 1 and 2 mA tACS. This reflects the relation of LTP-like aftereffects to Ca2+ concentration alterations.
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Affiliation(s)
- Y Shorafa
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - I Halawa
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany.,Medical Research Division, National Research Center, Cairo, Egypt
| | - M Hewitt
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - A Antal
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Centre Göttingen, Göttingen, Germany
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6
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Systematic review of biological markers of therapeutic repetitive transcranial magnetic stimulation in neurological and psychiatric disorders. Clin Neurophysiol 2021; 132:429-448. [DOI: 10.1016/j.clinph.2020.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/16/2020] [Accepted: 11/08/2020] [Indexed: 01/05/2023]
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Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, Occhiuto M, Piazzolla V, De Martino V, Ferrone F, Minisola S, Cipriani C. Diagnosis and management of hypocalcemia. Endocrine 2020; 69:485-495. [PMID: 32367335 DOI: 10.1007/s12020-020-02324-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
The aim of this clinical narrative review is to summarize and critically appraise the literature on the differential diagnosis of hypocalcemia and to provide its correct management. Calcium is essential for muscle contraction and neurotransmitter release, but clinical manifestations of hypocalcaemia (serum calcium level <8 mg/dl; 2.12 mmol/L) may involve almost any organ and system and may range from asymptomatic to life-threating conditions. Disorders causing hypocalcemia can be divided into parathyroid hormone (PTH) and non-PTH mediated. The most frequent cause of hypocalcemia is postsurgical hypoparathyroidism, while a more comprehensive search for other causes is needed for appropriate treatment in the non PTH-mediated forms. Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia. Oral calcium and/or vitamin D supplementation is the most frequently used as treatment of chronic hypocalcemia. In hypoparathyroidism, providing the missing hormone with the use of the recombinant human (rh) PTH(1-84) has been recently approved both by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA). This new therapy has the advantage of being effective for correcting serum calcium levels and significantly reducing the daily requirements of calcium and active vitamin D supplements. However, due to the high cost, a strict selection of candidates to this therapy is necessary. More challenging is the long-term hypocalcemia treatment, due to its associated complications. The development of long-acting recombinant human PTH will probably modify the management of chronic hypoparathyroidism in the future.
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Affiliation(s)
- Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy.
| | - Federica Biamonte
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Chiara Sonato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Vittoria Carmela Danese
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Veronica Cecchetti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Marco Occhiuto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Valentina Piazzolla
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Viviana De Martino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Federica Ferrone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
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Caton NL, Choudhury N. Quality of life improvement following parathyroid surgery: A preliminary 3-year review of 56 patients from a single surgical centre. Clin Otolaryngol 2018; 44:396-401. [PMID: 30588752 DOI: 10.1111/coa.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
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9
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Şahin E, Kalyon DM. The rheological behavior of a fast-setting calcium phosphate bone cement and its dependence on deformation conditions. J Mech Behav Biomed Mater 2017; 72:252-260. [DOI: https:/doi.org/10.1016/j.jmbbm.2017.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
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10
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Şahin E, Kalyon DM. The rheological behavior of a fast-setting calcium phosphate bone cement and its dependence on deformation conditions. J Mech Behav Biomed Mater 2017; 72:252-260. [PMID: 28505594 DOI: 10.1016/j.jmbbm.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Park S, Hieber R. Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review. Ment Health Clin 2016; 6:304-307. [PMID: 29955486 PMCID: PMC6007533 DOI: 10.9740/mhc.2016.11.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Hyperparathyroidism begins as a benign disease that is often left undetected unless the patient presents with severe symptoms. Often, the first sign of hyperparathyroidism is elevation in serum calcium. Case Description: A 38-year-old man presented with new onset acute psychosis. Laboratory testing revealed co-occurring untreated hyperparathyroidism. Discussion: A literature search was performed using PubMed to identify articles published in English with the following key terms: “hyperparathyroidism,” “psychosis,” and “hypercalcemia.” A review of findings follows the case report. Despite a thorough literature review, any pathophysiological explanation for psychiatric manifestations of hyperparathyroidism remains hypothetical.
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Affiliation(s)
- Sinae Park
- PharmD Candidate, Rosalind Franklin University, North Chicago, Illinois
| | - Robin Hieber
- Clinical Pharmacy Specialist of Mental Health, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois,
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12
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Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P. No beneficial effects of vitamin D supplementation on muscle function or quality of life in primary hyperparathyroidism: results from a randomized controlled trial. Eur J Endocrinol 2015; 172:609-17. [PMID: 25646406 DOI: 10.1530/eje-14-0940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Impairments of muscle function and strength in patients with primary hyperparathyroidism (PHPT) are rarely addressed, although decreased muscle function may contribute to increased fracture risk. OBJECTIVE We aimed to assess the changes in muscle strength, muscle function, postural stability, quality of life (QoL), and well-being during treatment with vitamin D or placebo before and after parathyroidectomy (PTX) in PHPT patients. DESIGN A randomized placebo-controlled trial. PATIENTS We included 46 PHPT patients, mean age 58 (range 29-77) years and 35 (76%) were women. INTERVENTIONS Daily treatment with 70 μg (2800 IU) cholecalciferol or placebo for 52 weeks. Treatment was administered 26 weeks before PTX and continued for 26 weeks after PTX. MAIN OUTCOME MEASURES Changes in QoL and measures of muscle strength and function. RESULTS Preoperatively, 25-hydroxyvitamin D (25OHD) increased significantly (50-94 nmol/l) compared with placebo (57-52 nmol/l). We did not measure any beneficial effects of supplementation with vitamin D compared with placebo regarding well-being, QoL, postural stability, muscle strength, or function. In all patients, we measured marked improvements in QoL, well-being (P<0.01), muscle strength in the knee flexion and extension (P<0.001), and muscle function tests (P<0.01) after surgical cure. Postural stability improved during standing with eyes closed (P<0.05), but decreased with eyes open (P<0.05). CONCLUSIONS Patients with PHPT and 25OHD levels around 50 nmol/l did not benefit from vitamin D supplementation concerning muscle strength, muscle function, postural stability, well-being, or QoL. Independent of preoperative 25OHD levels, PTX improved these parameters.
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Affiliation(s)
- Lars Rolighed
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Lars Rejnmark
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Tanja Sikjaer
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Lene Heickendorff
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Leif Mosekilde
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
| | - Peer Christiansen
- Breast and Endocrine SectionDepartment of Surgery PDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, DenmarkDepartment of Clinical BiochemistryAarhus University Hospital, NBG, Aarhus, DenmarkDepartment of Endocrinology and Clinical InstituteAalborg University Hospital, Aalborg, Denmark
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Hermsen A, Eienbröker A, Haag A, Mylius V, Hamer HM, Menzler K, Karakas E, Rosenow F. Perioperative changes in cortical excitability, mood, and quality of life in patients with primary hyperparathyroidism: a pilot study using transcranial magnetic stimulation. Eur J Endocrinol 2014; 170:201-9. [PMID: 24174287 DOI: 10.1530/eje-13-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Serum calcium (Ca(2)(+)) and parathyroid hormone (PTH), amongst others, modify cortical excitability. Alterations in cortical excitability were shown in patients with epilepsy as well as hyper- or hypoparathyroidism. In patients with primary hyperparathyroidism (pHPT), preoperative elevated serum calcium and parathyroidectomy (PTx) may affect mood and quality of life. We hypothesized that perioperative changes in Ca(2)(+) and PTH in pHPT will affect cortical excitability and improve subjective health. DESIGN AND METHODS Transcranial magnetic stimulation (TMS) was performed before and after surgery in 15 pHPT patients. We measured resting motor threshold, cortical silent period (CSP), short intracortical inhibition, and intracortical facilitation. Health questionnaires were administered before, 1 day and 6 months after PTx, along with the disease-specific Pasieka's parathyroid assessment of symptoms (PAS), which was, to our knowledge, its first use in German. RESULTS SURGERY WAS SUCCESSFUL IN ALL PATIENTS. TMS-MEASUREMENTS REMAINED UNCHANGED WHEN ANALYZING ALL PATIENTS IN THIS PILOT STUDY. POSTOPERATIVELY, DEPRESSION DECLINED (P=0.05) AND QUALITY OF LIFE IMPROVED SIGNIFICANTLY (P=0.001) IN THE SF-36-SUBSCALES: vitality, social functioning, mental health and subjective health transition (post-hoc analysis). The PAS proved early relief of disease-specific symptoms (P<0.001). CONCLUSIONS We found unchanged cortical excitability comparing pre- and post-PTx in this pilot study. Mood and quality of life improved postoperatively. The German PAS is valuable in detecting disease-specific changes early after PTx.
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Affiliation(s)
- A Hermsen
- Department of Neurology, Epilepsy Centre Hessen, Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany
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14
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Cipriani C, Romagnoli E, Cilli M, Piemonte S, Pepe J, Minisola S. Quality of life in patients with primary hyperparathyroidism. Expert Rev Pharmacoecon Outcomes Res 2014; 14:113-21. [PMID: 24397607 DOI: 10.1586/14737167.2014.873702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The clinical picture of primary hyperparathyroidism (PHPT) has changed over the last three decades and many asymptomatic patients are now diagnosed through the unexpected finding of high serum calcium levels. However, though not yet considered as typical features of the disease and therefore not included in the guidelines for surgery, many data are available on neuropsycological manifestations and their impact on quality of life in asymptomatic patients. PHPT patients indeed show early experience nonspecific symptoms, such as weakness, depression, sleep disturbance, memory loss and anxiety. Although the underlining mechanisms have not been still identified, the prevalence of psychiatric and cognitive deficits has been investigated in many studies, as well as the possible association with quality of life and well-being improvement after surgery. This article aims to review the current knowledge on quality of life in PHPT patients before and after surgery and the possible clinical implications of these findings.
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Affiliation(s)
- Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Cosentino G, Fierro B, Paladino P, Talamanca S, Vigneri S, Palermo A, Giglia G, Brighina F. Transcranial direct current stimulation preconditioning modulates the effect of high-frequency repetitive transcranial magnetic stimulation in the human motor cortex. Eur J Neurosci 2012; 35:119-24. [DOI: 10.1111/j.1460-9568.2011.07939.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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