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Ebrahiminik H, Chegeni H, Mosadegh Khah A, Salouti R, Ghomashchi G, Deldar Pasikhani M, Heydari I, Shamsi K, Beiranvand B, Azimi Aval MR, Mohammadi A, Mirza-Aghazadeh-Attari M, Fadaee N. Radiofrequency ablation of parathyroid adenomas causing primary hyperparathyroidism: A report of 27 patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:540-546. [PMID: 35278235 DOI: 10.1002/jcu.23181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To study treatment outcome of parathyroid adenomas using ultrasound-guided radiofrequency ablation. METHODS Twenty-seven patients with a single adenoma of the parathyroid gland were included in the study. Using color Doppler ultrasonography, the lesion and its characteristics were determined, and dextrose was injected to dissect the gland from the surrounding structures. The ablation process was done with 6-12 watts of power. RESULTS No complications were seen in any of the subjects. A significant reduction was seen in serum parathyroid hormone (PTH) and calcium levels after treatment. PTH levels showed a median decrease of 13.8%, and a median decrease of 8.2% was seen in serum calcium levels (p < 0.001). Phosphorus levels did not change significantly after treatment. In 1-month follow-up of patients, the lesion size had decreased considerably. In long-term follow-up, 11 of 20 patients having subsequent imaging had indistinguishable lesions. CONCLUSION Our results showed that RFA of parathyroid adenomas caused a significant reduction in biomedical indicators of disease and resulted in a significant reduction or disappearance of the lesion in the majority of the patients while having no considerable complications.
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Affiliation(s)
- Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, Aja University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadegh Khah
- Department of Endocrinology, Aja University of Medical Sciences, Tehran, Iran
| | - Rambod Salouti
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Ghazal Ghomashchi
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Maryam Deldar Pasikhani
- Department of Obstetrics and Gynecology, School of Medicine, Vali Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- Endocrinology Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Khosro Shamsi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Afshin Mohammadi
- Department of Radiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Narges Fadaee
- Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Özkan MB, Turhan VB. Use of Parathyroid Function Index and Wisconsin Index to Differentiate Primary Hyperparathyroidism From Secondary Hyperparathyroidism: A Case-Control Study. Cureus 2022; 14:e23043. [PMID: 35419240 PMCID: PMC8994672 DOI: 10.7759/cureus.23043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Patients with primary hyperparathyroidism (PHPT) can be asymptomatic or have a normal calcium level (NHPT). Patients with 25(OH) vitamin D insufficiency, on the other hand, may present with a similar presentation. In regions where 25(OH) vitamin D deficiency is common, patients are usually diagnosed with secondary hyperparathyroidism (SHPT). Therefore, it is necessary to separate PHPT and NHPT from SHPT. Parathormone and calcium values are used for differentiation in the clinic. The predictive value of the newly developed parathyroid function test (PFindex), which previously had a high diagnostic value, was evaluated in this patient population in our investigation. Methods: The study comprised 163 PHPT and NHPT patients with pathological confirmation and 56 SHPT patients. The PHPT, NHPT, and SHPT properties were defined using PFindex. The diagnostic power of PFindex was investigated using a receiver operating characteristic (ROC) curve of the results assessed in three groups. Results: The PHPT group had the highest PFindex (1365.4±784.6) compared to the other two groups (NHPT: 723.5±509.4; SHPT:227.2±49.9, all p < 0.001). A PFindex threshold of 327.8 yielded 91.9% and 90.9% sensitivity and specificity rates for distinguishing PHPT and NHPT from SHPT, respectively. Conclusion: PFindex gave the outstanding diagnostic capacity to distinguish PHPT from SHPT due to our research. This straightforward tool can assist in making quick decisions about vitamin D therapy or surgery for PHPT.
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De Martinis M, Allegra A, Sirufo MM, Tonacci A, Pioggia G, Raggiunti M, Ginaldi L, Gangemi S. Vitamin D Deficiency, Osteoporosis and Effect on Autoimmune Diseases and Hematopoiesis: A Review. Int J Mol Sci 2021; 22:ijms22168855. [PMID: 34445560 PMCID: PMC8396272 DOI: 10.3390/ijms22168855] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
Vitamin D (VD) is essential for bone homeostasis, but it is also involved in pleiotropic effects on various organs and tissues. In adults, VD deficiency can cause or exacerbate osteoporosis and induce osteomalacia. However, every tissue and cell in the body has a VD receptor, including the brain, heart, stomach, pancreas, skin, gonads, and immune cells, and a deficiency may modify the function of these organs. Thus, the wide-ranging actions of VD help to explain why a reduction in VD amount has been correlated with numerous chronic diseases. In fact, VD deficiency increases the risk of osteoporosis and several other diseases and complications characterized by impaired bone metabolisms, such as autoimmune diseases, inflammatory bowel diseases, allergy, endocrinological diseases, hematological malignancies, and bone marrow transplantation. This review aims to investigate the link between VD deficiency, osteoporosis, and its concomitant diseases. Further epidemiological and mechanistic studies are necessary in order to ascertain the real role of hypovitaminosis in causing the reported diseases; however, adequate vitamin supplementation and restoration of metabolic normality could be useful for better management of these pathologies.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, Division of Haematology, University of Messina, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-0902-212-364
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Martina Raggiunti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy;
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Slouma M, Rahmouni S, Dhahri R, Abbes M, Gharsallah I, Metoui L, Louzir B. Hypercalcemia in a patient with a bowing femur. Clin Case Rep 2021; 9:516-521. [PMID: 33489206 PMCID: PMC7813087 DOI: 10.1002/ccr3.3569] [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: 06/17/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022] Open
Abstract
Hypercalcemia in PDB is rare; its occurrence requires thorough investigations as it may reveal several diseases, such as primary hyperparathyroidism, malignant transformation, metastases, or myeloma.
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Affiliation(s)
- Maroua Slouma
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Safa Rahmouni
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Rim Dhahri
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Maissa Abbes
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Imen Gharsallah
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Leila Metoui
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Bassem Louzir
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
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5
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Dementia Improvement after Primary Hyperparathyroidism Surgery. Case Rep Med 2020; 2020:1095414. [PMID: 32670375 PMCID: PMC7333033 DOI: 10.1155/2020/1095414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
This is the case of a 76-year-old man admitted to hospital in a delirium state, previously diagnosed with a major depressive disorder at an age of 50 years, treated for years for chronic tension headache. The computed tomography of the head resulted negative. Inpatient laboratory tests revealed a mild hypercalcemia. Due to the progression of the disease (delirium state, dementia, tension headache, and depression), he was again admitted to hospital. The patient showed dysarthria, postural tremors, mirror movements and palmar hyperhidrosis, mild ataxia when walking, and rigidity. Sleep disturbances were also observed. He underwent several clinical diagnostic tests, which resulted negative. After more than 2 years, the ultrasound of the neck identified enlarged parathyroid glands. The patient was surgically treated, and three parathyroid glands were removed. Parathyroidectomy and lithium treatment resulted in improvement of cognitive functions. In elderly patients, concomitant presence of cognitive dysfunction may mask the underlying primary hyperparathyroidism.
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6
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Skeletal effects of combined medical and surgical management of primary hyperparathyroidism. Surgery 2020; 167:144-148. [DOI: 10.1016/j.surg.2019.04.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022]
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Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism. Case Rep Endocrinol 2019; 2019:4807081. [PMID: 31885946 PMCID: PMC6925713 DOI: 10.1155/2019/4807081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/18/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.
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8
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Kwak EJ, Cha IH, Nam W, Yook JI, Park YB, Kim HJ. Effects of locally administered rhBMP-2 and bisphosphonate on bone regeneration in the rat fibula. Oral Dis 2018; 24:1042-1056. [DOI: 10.1111/odi.12864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/25/2022]
Affiliation(s)
- E-J Kwak
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - I-H Cha
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - W Nam
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - JI Yook
- Department of Oral Pathology; College of Dentistry; Yonsei University; Seoul Korea
| | - Y-B Park
- Department of Prosthodontics; College of Dentistry; Yonsei University; Seoul Korea
| | - HJ Kim
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
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Smith ME, Pfleiderer AG, Shamil E. Open minimally invasive versus video-assisted minimally invasive parathyroidectomy for primary hyperparathyroidism. Hippokratia 2017. [DOI: 10.1002/14651858.cd012512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew E Smith
- Cambridge University Hospitals NHS Foundation Trust; Department of ENT Surgery; Hills Road Cambridge Cambridgeshire UK CB2 0QQ
| | - Andrew G Pfleiderer
- Peterborough and Stamford Hospitals Trust; Department of ENT Surgery; Peterborough City Hospital, Bretton Gate Peterborough Cambridgeshire UK PE3 9GZ
| | - Eamon Shamil
- Peterborough and Stamford Hospitals Trust; Department of ENT Surgery; Peterborough City Hospital, Bretton Gate Peterborough Cambridgeshire UK PE3 9GZ
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10
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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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Mirza F, Canalis E. Management of endocrine disease: Secondary osteoporosis: pathophysiology and management. Eur J Endocrinol 2015; 173:R131-51. [PMID: 25971649 PMCID: PMC4534332 DOI: 10.1530/eje-15-0118] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022]
Abstract
Osteoporosis is a skeletal disorder characterized by decreased mass and compromised bone strength predisposing to an increased risk of fractures. Although idiopathic osteoporosis is the most common form of osteoporosis, secondary factors may contribute to the bone loss and increased fracture risk in patients presenting with fragility fractures or osteoporosis. Several medical conditions and medications significantly increase the risk for bone loss and skeletal fragility. This review focuses on some of the common causes of osteoporosis, addressing the underlying mechanisms, diagnostic approach and treatment of low bone mass in the presence of these conditions.
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Affiliation(s)
- Faryal Mirza
- Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA
| | - Ernesto Canalis
- Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA Division of Endocrinology and MetabolismDepartments of MedicineOrthopaedic SurgeryUConn Musculoskeletal Institute, UConn Health, 263 Farmington Avenue, Farmington, Connecticut 06030-5456, USA
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Chen G, Xue Y, Zhang Q, Xue T, Yao J, Huang H, Liang J, Li L, Lin W, Lin L, Shi L, Cai L, Wen J. Is Normocalcemic Primary Hyperparathyroidism Harmful or Harmless? J Clin Endocrinol Metab 2015; 100:2420-4. [PMID: 25668199 DOI: 10.1210/jc.2014-4432] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is reported to be associated with an increased frequency of hypertension, however, information in this regard is sparse in relation to normocalcemic primary hyperparathyroidism (NPHPT). OBJECTIVE The aim of this study was to determine the association between NPHPT and blood pressure. DESIGN, SETTING, AND PATIENTS We retrospectively enrolled 940 patients who visited the Fujian Provincial Hospital between September 2010 and December 2013 with a measured serum parathyroid hormone (PTH) and calcium level. Among them, 11 patients were diagnosed with NPHPT, while 296 cases with normal PTH and albumin-adjusted serum calcium. MAIN OUTCOMES MEASURES Systolic blood pressure (SBP), diastolic blood pressure (DBP), intact serum PTH, and serum calcium were recorded. RESULTS There were no significant differences between subjects identified with NPHPT and those with normal PTH in terms of age, sex, body mass index, serum calcium, 25-Hydroxyvitamin D, serum creatinine, fasting plasma glucose, triglycerides, total cholesterol, high density lipoprotein, and low density lipoprotein. The subjects with a diagnosis of NPHPT had higher levels of SBP (141.9 ± 20.2 vs 131.2 ± 16.5, P = .041) and DBP (85.2 ± 12.4 vs 76.8 ± 10.3, P = .026) than the subjects in the cohort with normal PTH. After adjustment for all potential confounders, risks (odds ratios and 95% confidence interval) of SBP and DBP in NPHPT patients were 1.035 (1.000, 1.071) and 1.063 (1.004, 1.125), respectively (P < .05). CONCLUSIONS The NPHPT had higher risk of high blood pressure than subjects with normal PTH. It is worth considering the necessity of more aggressive therapeutic intervention aimed to normalize PTH even if patients with NPHPT continue to be normocalcemic.
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Affiliation(s)
- Gang Chen
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Ying Xue
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Qiongyao Zhang
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Ting Xue
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Jin Yao
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Jixing Liang
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Liantao Li
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Lixiang Lin
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Lidan Shi
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Liangchun Cai
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology (G.C., Y.X., T.X., J.Y., H.H., J.L., L.Li., W.L., L.Lin., L.S., L.C., J.W.), Fujian Provincial Hospital Key Laboratory of Endocrinology, Fujian Medical University, Fuzhou,350001, China; and Department of Information (Q.Z.), Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
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Khan A, Bilezikian J, Bone H, Gurevich A, Lakatos P, Misiorowski W, Rozhinskaya L, Trotman ML, Tóth M. Cinacalcet normalizes serum calcium in a double-blind randomized, placebo-controlled study in patients with primary hyperparathyroidism with contraindications to surgery. Eur J Endocrinol 2015; 172:527-35. [PMID: 25637076 PMCID: PMC5729741 DOI: 10.1530/eje-14-0877] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is diagnosed by the presence of hypercalcemia and elevated or nonsuppressed parathyroid hormone (PTH) levels. Although surgery is usually curative, some individuals fail or are unable or unwilling to undergo parathyroidectomy. In such individuals, targeted medical therapy may be of value. Cinacalcet normalized calcium level and lowered PTH in patients with PHPT in several phase 2 and open-label studies. We compared cinacalcet and placebo in subjects with PHPT unable to undergo parathyroidectomy. DESIGN Phase 3, double-blind, multi centere, randomized, placebo-controlled study. METHODS Sixty-seven subjects (78% women) with moderate PHPT were randomized (1:1) to cinacalcet or placebo for ≤28 weeks. MAIN OUTCOME MEASURE Achievement of a normal mean corrected total serum calcium concentration of ≤10.3 mg/dl (2.575 mmol/l). RESULTS Baseline median (quartile 1 (Q1), Q3) serum PTH was 164.0 (131.0, 211.0) pg/ml and mean (s.d.) serum Ca was 11.77 (0.46) mg/dl. Serum Ca normalized (≤10.3 mg/dl) in 75.8% of cinacalcet- vs 0% of placebo-treated subjects (P<0.001). Corrected serum Ca decreased by ≥1.0 mg/dl from baseline in 84.8% of cinacalcet- vs 5.9% of placebo-treated subjects (P<0.001). Least squares mean (s.e.m.) plasma PTH change from baseline was -23.80% (4.18%) (cinacalcet) vs -1.01% (4.05%) (placebo) (P<0.001). Similar numbers of subjects in the cinacalcet and placebo groups reported adverse events (AEs) (27 vs 20) and serious AEs (three vs four). Most commonly reported AEs were nausea and muscle spasms. CONCLUSIONS These results demonstrate that cinacalcet normalizes serum calcium in this PHPT population and appears to be well tolerated.
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Affiliation(s)
- Aliya Khan
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - John Bilezikian
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Henry Bone
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Andrey Gurevich
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Peter Lakatos
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Waldemar Misiorowski
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Liudmila Rozhinskaya
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Marie-Louise Trotman
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
| | - Miklós Tóth
- Divisions of Endocrinology and GeriatricsMcMaster University, 331-209 Sheddon Avenue, Oakville, Ontario, Canada L6J 1X8College of Physicians and SurgeonsColumbia University, New York, New York, USAMichigan Bone and Mineral ClinicDetroit, Michigan, USAAmgen (Europe) GmbHZug, Switzerland1st Department of MedicineSemmelweis University Medical School, Budapest, HungaryDepartment of EndocrinologyMedical Centre of Postgraduate Education, Warsaw, PolandEndocrinology Research CentreMoscow, RussiaAmgenInc., Thousand Oaks, California, USA2nd Department of MedicineSemmelweis University, Budapest, Hungary
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Marotta V, Di Somma C, Rubino M, Sciammarella C, Del Prete M, Marciello F, Ramundo V, Circelli L, Buonomano P, Modica R, Vitale M, Colao A, Faggiano A. Potential role of cinacalcet hydrochloride in sporadic primary hyperparathyroidism without surgery indication. Endocrine 2015; 49:274-8. [PMID: 25123977 DOI: 10.1007/s12020-014-0381-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/01/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Vincenzo Marotta
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy,
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15
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Deroux A, Chidlovskii E, Qin W, Couturier P, Gavazzi G. Primary hyperparathyroidism and multiple myeloma complicated by Fanconi syndrome: A fortuitous association? Presse Med 2015; 44:360-2. [DOI: 10.1016/j.lpm.2014.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 07/21/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
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Affiliation(s)
- H J Wallace
- From the Department of Elderly Care Medicine, Craigavon Area Hospital, Portadown, BT63 5QQ and Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - I R Wallace
- From the Department of Elderly Care Medicine, Craigavon Area Hospital, Portadown, BT63 5QQ and Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - P McCaffrey
- From the Department of Elderly Care Medicine, Craigavon Area Hospital, Portadown, BT63 5QQ and Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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17
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Primary hyperparathyroidism. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Primary hyperparathyroidism during pregnancy. Arch Gynecol Obstet 2014; 291:259-63. [PMID: 25367603 DOI: 10.1007/s00404-014-3526-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/21/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Primary hyperparathyroidism (pHPT) during pregnancy is rare and associated with increased morbidity and mortality for both mother and fetus. This review aims to draw together recent thinking on pregnancy and pHPT. METHODS We have performed a Pubmed (Medline(®)) search with no time limit using "primary hyperparathyroidism", "pregnancy" or "management" as keywords. We reviewed 37 articles in English and French languages on pHPT characteristics, clinical presentations, pregnancy complications, birth outcomes and management of pHPT during pregnancy. RESULTS The diagnosis of pHPT is characterized by an elevated serum calcium level associated with an inappropriate increase in the parathyroid hormone level. The clinical manifestations are directly related to the calcium level. Usual techniques to detect parathyroid adenoma or hyperplasia, as computerized tomography and 99mTc-sestamibi scintigraphy, are not recommended in pregnancy. Thus, ultrasonography of the neck is the current first-line investigation during pregnancy for localization of parathyroid diseases. pHPT during pregnancy with mildly elevated calcium levels may be managed with medical treatment: intravenous or oral rehydratation, with or without forced diuresis. Few drugs are available for pHTP during pregnancy; calcitonin and cinacalcet require further study; bisphosphonate should be restricted to life-threatening hypercalcemia. Surgery is the only curative treatment and is recommended when calcium levels are above 2.75 mmol/L. It should be performed in the second trimester and considered in the third trimester if there is inadequate response to medical therapy. CONCLUSION Early diagnosis of pHPT in a pregnant woman, followed by appropriate management and treatment, has been shown to significantly reduce maternal and fetal complications.
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19
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Denizot A, Grino M, Oliver C. Surgical management of primary hyperparathyroidism in older adults. J Am Geriatr Soc 2014; 62:1759-63. [PMID: 25113865 DOI: 10.1111/jgs.12968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the feasibility, safety, and outcome of parathyroidectomy in the management of primary hyperparathyroidism (PHPT) in individuals aged 75 and older with that of those younger than 50. DESIGN Retrospective chart review. SETTING Department of Endocrine Surgery, Hospital Paul Desbief (Marseille, France). PARTICIPANTS Individuals who underwent surgery from June 2005 to February 2013 (N = 526) had a clinical examination and laboratory and imaging assessments to diagnose PHPT. MEASUREMENTS The clinical and biochemical characteristics and surgery outcomes of individuals younger than 50 (n = 80) were compared with the characteristics and outcomes of those aged 75 and older (n = 89). RESULTS Most of the participants did not have any specific signs of PHPT, and the diagnosis of PHPT was established in some participants during routine clinical and laboratory examination. Nephrolithiasis and osteitis fibrosa cystica were observed only in the younger group. Urinary calcium decreased with age. Nine participants aged 75 and older did not undergo surgery (four declined, five had medical contraindications). Conventional surgery through transverse cervicotomy was used in the majority of participants. Cure rate was excellent (158/160), with few and reversible minor complications. The coexistence of thyroid lesions was significantly higher in the older (47.5%) than in the younger group (32.3%). Nodules and multinodular goiters were removed in the majority of participants during the parathyroidectomy procedure. CONCLUSION With the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative and should be considered as first-line choice for older adult with PHPT.
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Affiliation(s)
- Anne Denizot
- Department of Endocrine Surgery, European Hospital, Marseille, France
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Kim YS, Kim J, Shin S. Thoracoscopic removal of ectopic mediastinal parathyroid adenoma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:317-9. [PMID: 25207237 PMCID: PMC4157490 DOI: 10.5090/kjtcs.2014.47.3.317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/17/2013] [Accepted: 10/25/2013] [Indexed: 11/22/2022]
Abstract
Ectopic mediastinal parathyroid adenomas or hyperplasias account for up to 25% of primary hyperparathyroidism cases. Most abnormal parathyroid glands are found in the superior mediastinum within the thymus and can be removed through a cervical incision; however, a few of these glands are not accessible using standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy. However, recent advancement in video-assisted thoracic surgery techniques has decreased the need for sternotomy or thoracotomy to remove these ectopic parathyroid glands. Here, we report a successful case of video-assisted thoracoscopic removal of a mediastinal parathyroid adenoma.
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Affiliation(s)
- Young Su Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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21
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Wang TS, Pasieka JL, Carty SE. Techniques of parathyroid exploration at North American endocrine surgery fellowship programs: what the next generation is being taught. Am J Surg 2014; 207:527-32. [DOI: 10.1016/j.amjsurg.2013.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 05/16/2013] [Indexed: 01/14/2023]
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22
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Parkhurst J, Erickson S, Sun W, Funk G, Anderson C, Buatti JM. Parathyroid adenoma: report of a patient successfully treated with stereotactic body radiation therapy. Pract Radiat Oncol 2014; 4:55-7. [PMID: 24621424 DOI: 10.1016/j.prro.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Jessica Parkhurst
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Steven Erickson
- Veteran's Administration Community Based Outpatient Clinic, Waterloo, Iowa
| | - Wenqing Sun
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gerry Funk
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Carryn Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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Rosato L, Raffaelli M, Bellantone R, Pontecorvi A, Avenia N, Boniardi M, Brandi ML, Cetani F, Chiofalo MG, Conzo G, De Palma M, Gasparri G, Giordano A, Innaro N, Leopaldi E, Mariani G, Marcocci C, Marini P, Miccoli P, Nasi P, Pacini F, Paragliola R, Pelizzo MR, Testini M, De Toma G. Diagnostic, therapeutic and healthcare management protocols in parathyroid surgery: II Consensus Conference of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2014; 37:149-65. [PMID: 24497214 DOI: 10.1007/s40618-013-0022-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/16/2013] [Indexed: 02/08/2023]
Abstract
AIM To update the Diagnostic-Therapeutic-Healthcare Protocol (Protocollo Diagnostico-Terapeutico-Assistenziale, PDTA) created by the U.E.C. CLUB (Association of the Italian Endocrine Surgery Units) during the I Consensus Conference in 2008. METHODS In the preliminary phase, the II Consensus involved a selected group of experts; the elaboration phase was conducted via e-mail among all members; the conclusion phase took place during the X National Congress of the U.E.C. CLUB. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. CONCLUSIONS The PDTA for parathyroid surgery approved by the II Consensus Conference (June 2013) is the official PDTA of the U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO/4 Ivrea Hospital (TO), Piazza della Credenza, 2, 10015, IVREA, TO, Italy,
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Abstract
This review discusses recent findings on the clinical presentation, evaluation, medical and surgical management of primary hyperparathyroidism. Medical management includes the use of cinacalcet and bisphosphonates for bone loss and correction of vitamin D deficiency. Surgical updates reviewed recent studies on the preoperative localization of the disease, specifically, sestamibi scans, 4DCT and MRI. Focused parathyroidectomy continues to be the preferred surgical approach for a select group of patients, guided by intraoperative use of PTH and new technology, such as endoscopic and robotic platforms; however, there appears to be no difference in long-term success compared to the traditional approach.
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Affiliation(s)
- Zeina Habib
- a Mercy Hospital and Medical Center - Internal Medicine, Section of Endocrinology and Metabolism, 2525 S Michigan Ave, Chicago, IL 60616, USA
| | - Adam Kabaker
- b Loyola University - Surgery, Section of Endocrine Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Pauline Camacho
- c Loyola University - Endocrinology and Metabolism, 2160 S. First Avenue, Maywood, IL 60153, USA
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Gannon AW, Monk HM, Levine MA. Cinacalcet monotherapy in neonatal severe hyperparathyroidism: a case study and review. J Clin Endocrinol Metab 2014; 99:7-11. [PMID: 24203066 PMCID: PMC3879678 DOI: 10.1210/jc.2013-2834] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Neonatal severe hyperparathyroidism (NSHPT) is a severe form of familial hypocalciuric hypercalcemia characterized by severe hypercalcemia and skeletal demineralization. In most cases, NSHPT is due to biallelic loss-of-function mutations in the CASR gene encoding the calcium-sensing receptor (CaSR), but some patients have heterozygous mutations. Conventional treatment consists of iv saline, bisphosphonates, and parathyroidectomy. OBJECTIVE The aim of this project was to characterize the molecular basis for NSHPT in an affected newborn and to describe the response to monotherapy with cinacalcet. METHODS Clinical and biochemical features were monitored as cinacalcet therapy was initiated and maintained. Genomic DNA was obtained from the proband and parents. The CASR gene was amplified by PCR and sequenced directly. RESULTS The patient was a full-term male who developed hypotonia and respiratory failure soon after birth. He was found to have multiple fractures and diffuse bone demineralization, with a marked elevation in serum ionized calcium (1.99 mmol/L) and elevated serum levels of intact PTH (1154 pg/mL); serum 25-hydroxyvitamin D was low, and fractional excretion of calcium was reduced. The serum calcium level was not reduced by iv saline infusion. Based on an extensive family history of autosomal dominant hypercalcemia, a diagnosis of NSHPT was made, and cinacalcet therapy was initiated with a robust and durable effect. Molecular studies revealed a heterozygous R185Q missense mutation in the CASR in the patient and his father, whereas normal sequences for the CASR gene were present in the patient's mother. CONCLUSIONS We describe the first use of cinacalcet as monotherapy for severe hypercalcemia in a newborn with NSHPT. The rapid and durable response to cinacalcet suggests that a trial of calcimimetic therapy should be considered early in the course of NSHPT.
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Affiliation(s)
- Anthony W Gannon
- Division of Endocrinology and Diabetes (A.W.G., M.A.L.), and Department of Pharmacy Services (H.M.M.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Department of Pediatrics (A.W.G., M.A.L.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104
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Agrawal L, Habib Z, Emanuele NV. Neurologic disorders of mineral metabolism and parathyroid disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 120:737-48. [PMID: 24365349 DOI: 10.1016/b978-0-7020-4087-0.00049-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Disorders of mineral metabolism may cause neurologic manifestations of the central and peripheral nervous systems. This is because plasma calcium stabilizes excitable membranes in the nerve and muscle tissue, magnesium is predominantly intracellular and is required for activation of many intracellular enzymes, and extracellular magnesium affects synaptic transmission. This chapter reviews abnormalities in electrolytes and minerals which can be associated with several neuromuscular symptoms including neuromuscular irritability, mental status changes, cardiac and smooth muscle changes, etc.
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Affiliation(s)
- Lily Agrawal
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA.
| | - Zeina Habib
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas V Emanuele
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA; Endocrinology Section, Edward Hines Jr. VA Hospital, Hines, IL, USA
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Zawawi F, Mlynarek AM, Cantor A, Varshney R, Black MJ, Hier MP, Rochon L, Payne RJ. Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it? J Otolaryngol Head Neck Surg 2013; 42:56. [PMID: 24350891 PMCID: PMC3878236 DOI: 10.1186/1916-0216-42-56] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/03/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Intraoperative parathyroid hormone level (IOPTH) is withdrawn during parathyroidectomy to confirm the success of the procedure. Recently, the importance of IOPTH has been put to question. The purpose of this study is to determine whether IOPTH is necessary for all patients undergoing parathyroidectomy in the presence of frozen section. MATERIALS AND METHODS A cohort study of parathyroidectomies was performed in three university affiliated hospitals during 2007-2012. The patients were divided into two groups. Group 1: Patients with two preoperative concordant imaging localizing a hyperactive gland. Group 2: Patients without two concordant imaging. A comparison of benefit of IOPTH was carried out. Frozen section results were also analyzed to determine sensitivity and predictability of a parathyroid adenoma. RESULTS The study considered 221 patients having parathyroidectomies for primary hyperparathyroidism (PHPT). Of them, 10 were excluded due to incomplete data. Among the remaining, 186 had 2 concordant imaging preoperatively localizing an adenoma. 93.5% of whom were found intraoperatively in that location. IOPTH was not found to be of importance in 98.92% of the preoperative localized adenomas in the presence of frozen section. IOPTH added an estimate of 30.9 minutes on average to the surgery time. CONCLUSION This study demonstrates that the added operating time associated with IOPTH may not be justified for patients undergoing parathyroidectomy who have 2 concordant imaging preoperatively in the presence of frozen section. This study suggests a simple algorithm, The McGill Parathyroid Protocol (MPP), to help in approaching PHPT patients undergoing parathyroidectomy.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Room E3-37, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada.
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29
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Akbaba G, Isik S, Ates Tutuncu Y, Ozuguz U, Berker D, Guler S. Comparison of alendronate and raloxifene for the management of primary hyperparathyroidism. J Endocrinol Invest 2013; 36:1076-82. [PMID: 24081023 DOI: 10.3275/9095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To evaluate and compare the efficacy of alendronate sodium (ALN) and raloxifene (RLX) for the management of primary hyperparathyroidism (PHPT) in postmenopausal female patients (pts) with osteoporosis. METHODS Twenty-four postmenopausal women with osteoporosis who were diagnosed with PHPT, but refused the option of surgery, were enrolled. Participants were sequentially randomized into two groups: an ALN-group of 12 pts (70 mg/week) and a RLX-group of 12 pts (60 mg/day). The control group consisted of 10 pts with PHPT who did not have any indications for surgery. RESULTS The decrease in ionized calcium levels was significantly more pronounced in the ALN group compared to the RLX and control groups (p<0.001). In terms of difference from baseline in bone mineral density (BMD) of the lumbar area in percentages over a period of 12 months, pts in the ALN and RLX groups both showed statistically significant improvements compared to pts in the control group (control vs ALN, p<0.001; control vs RLX, p<0.001). BMD measurements of the femoral and radial areas were comparable in all three groups. CONCLUSIONS ALN and RLX may improve bone density in the lumbar area of osteoporotic post-menopausal women with PHPT. The more significant decrease in serum calcium levels which was observed in the ALN group compared to both RLX and control groups, suggests that ALN could be used for the short-term control of calcium levels in patients awaiting surgery.
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Affiliation(s)
- G Akbaba
- Ministry of Health, Mugla Sıtkı Kocman University Research and Training Hospital, Endocrinology and Metabolism Diseases Clinic, Aydın Yolu Bulvarı, Menteşe Evleri, Nil Sitesi, F Blok No 6, Mugla, Turkey.
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Crowley RK, Gittoes NJ. When would I use medical therapies for the treatment of primary hyperparathyroidism? Clin Endocrinol (Oxf) 2013; 79:770-3. [PMID: 24111629 DOI: 10.1111/cen.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/16/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
Although there may be controversy surrounding the indications for parathyroidectomy in primary hyperparathyroidism, it remains the only accepted definitive therapy. However, even if parathyroidectomy is indicated, some patients refuse surgery, are medically unfit or have residual or recurrent disease inaccessible to further surgery. Some of these patients may be suitable for long-term observation but others require intervention for management of symptomatic or moderate to severe hypercalcaemia, loss of bone mineral density or renal calculi. The selection of a suitable therapy for each patient should be individualized.
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Affiliation(s)
- Rachel K Crowley
- Department of Endocrinology, University Hospital Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Bedeutung von Dysfunktionen der Nebenschilddrüse in der späteren Postmenopause. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-013-0566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Maier JD, Levine SN. Hypercalcemia in the Intensive Care Unit: A Review of Pathophysiology, Diagnosis, and Modern Therapy. J Intensive Care Med 2013; 30:235-52. [PMID: 24130250 DOI: 10.1177/0885066613507530] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/13/2013] [Indexed: 02/02/2023]
Abstract
Hypercalcemia may be seen in a variety of clinical settings and often requires intensive management when serum calcium levels are dramatically elevated. All of the many etiologies of mild hypercalcemia can lead to severe hypercalcemia. Knowledge of the physiologic mechanisms involved in maintaining normocalcemia and basic pathophysiology is essential for making a timely diagnosis and hence prompt institution of etiology-specific therapy. The development of new medications and critical reviews of traditional therapies have changed the treatment paradigm for severe hypercalcemia, calling for a more limited role for aggressive isotonic fluid administration and furosemide and an expanded role for calcitonin and the bisphosphonates. Experimental therapies such as denosumab show promise.
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Affiliation(s)
- Joshua D Maier
- Department of Medicine, Section of Endocrinology and Metabolism, Overton Brooks Veterans Administration Medical Center, Shreveport, LA, USA
| | - Steven N Levine
- Department of Medicine, Section of Endocrinology and Metabolism, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Muscle Function Is Impaired in Patients With “Asymptomatic” Primary Hyperparathyroidism. World J Surg 2013; 38:549-57. [DOI: 10.1007/s00268-013-2273-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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Costa-Guda J, Imanishi Y, Palanisamy N, Kawamata N, Phillip Koeffler H, Chaganti RSK, Arnold A. Allelic imbalance in sporadic parathyroid carcinoma and evidence for its de novo origins. Endocrine 2013; 44:489-95. [PMID: 23435613 PMCID: PMC3683451 DOI: 10.1007/s12020-013-9903-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/07/2013] [Indexed: 12/26/2022]
Abstract
Parathyroid cancer is a rare, clinically aggressive cause of primary hyperparathyroidism, and whether these malignancies generally evolve from pre-existing benign adenomas or arise de novo is unclear. Furthermore, while inactivation of the CDC73 (HRPT2) tumor suppressor gene, encoding parafibromin, is a major contributor, other genes essential to parathyroid carcinogenesis remain unknown. We sought to identify genomic regions potentially harboring such oncogenes or tumor suppressor genes, and to gain insight into the origins and molecular relationship of malignant versus benign parathyroid tumors. We performed genome-wide copy-number and loss of heterozygosity analysis using Affymetrix 50K SNP mapping arrays and/or comparative genomic hybridization on 16 primary parathyroid carcinomas, local recurrences or distant metastases, and matched normal controls, from 10 individuals. Recurrent regions of allelic loss were observed on chromosomes 1p, 3, and 13q suggesting that key parathyroid tumor suppressor genes are located in these chromosomal locations. Recurrent allelic gains were seen on chromosomes 1q and 16, suggesting the presence of parathyroid oncogenes on these chromosomes. Importantly, the most common alteration in benign parathyroid adenomas, loss of 11q, was not found as a recurrent change in the malignant parathyroid tissues. Molecular allelotyping using highly polymorphic microsatellite markers provided further confirmation that the prevalence of 11q loss is markedly and significantly lower in carcinomas as compared with adenomas. Our observations provide molecular support for the concept that sporadic parathyroid cancer usually arises de novo, rather than evolving from a pre-existing typical benign adenoma. Furthermore, these results help direct future investigation to ultimately determine which of the candidate genes in these chromosomal locations make significant contributions to the molecular pathogenesis of parathyroid cancer.
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Saponaro F, Faggiano A, Grimaldi F, Borretta G, Brandi ML, Minisola S, Frasoldati A, Papini E, Scillitani A, Banti C, Del Prete M, Vescini F, Gianotti L, Cavalli L, Romagnoli E, Colao A, Cetani F, Marcocci C. Cinacalcet in the management of primary hyperparathyroidism: post marketing experience of an Italian multicentre group. Clin Endocrinol (Oxf) 2013; 79:20-6. [PMID: 23228121 DOI: 10.1111/cen.12108] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/13/2012] [Accepted: 11/14/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the Italian experience on cinacalcet use following its approval by the European Medical Agency (EMA) to control hypercalcaemia in patients with primary hyperparathyroidism (PHPT). DESIGN Retrospective data collection from 100 patients with sporadic (sPHPT) and 35 with familial PHPT (fPHPT) followed in eight Italian centres between October 2008 and March 2011. MEASUREMENTS Albumin-adjusted serum calcium, PTH, 25OHD, daily cinacalcet dose and adverse events were recorded during the follow-up (1-46 months). RESULTS Baseline serum calcium was 2·90 ± 0·27 nmol/l in sPHPT and 2·75 ± 0·17 nmol/l in fPHPT patients (P = 0·007). The cinacalcet EMA labelling was met in 53% sPHPT and 26% fPHPT patients. High surgical risk (34%), negative preoperative imaging (19%), control of hypercalcaemia before parathyroidectomy (PTx) (24%), and refusal of PTx (19%) accounted for cinacalcet prescription in 96% of sPHPT patients. Conversely, initial treatment (34%), persistent/relapsing PHPT after surgery (31%), and refusal of PTx (14%) were the indications in 79% fPHPT patients. Cinacalcet was started at 30 mg/daily in 64% of sPHPT and 91% of fPHPT and increased until normocalcaemia was reached or side effects occurred. The final daily dose ranged between 15 and 120 mg. The majority of patients (65% of sPHPT and 80% of fPHPT) become normocalcaemic. Treatment was withdrawn in six patients because of side effects. CONCLUSIONS There is a wide heterogeneity in the prescription of cinacalcet in PHPT patients in Italy and the EMA labelling is not always followed, particularly in fPHPT patients. Cinacalcet effectively reduces serum calcium in patients with either sPHPT or fPHPT.
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Affiliation(s)
- Federica Saponaro
- Dipartimento di Endocrinologia e Metabolismo, Università di Pisa, Pisa, Italy
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Abstract
Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the outpatient population. It is diagnosed in most individuals in the Western world at an asymptomatic stage without signs or symptoms of parathyroid hormone (PTH) calcium excess. Nonspecific symptoms include weakness, malaise, fatigue, and possible mood disturbances, which may be present at the time of diagnosis. The diagnosis of PHPT is confirmed in the presence of hypercalcemia and a normal or elevated PTH level in the absence of conditions that mimic PHPT. Indications for surgery have recently been revised based on international consensus, and surgery is advised in the presence of significant hypercalcemia, impaired renal function, and osteoporosis and in individuals younger than 50yr. The classical complications of PHPT are skeletal fragility, nephrolithiasis, and nephrocalcinosis. Surgery is always appropriate in an individual with confirmed PHPT after excluding conditions that can mimic PHPT and in the absence of contraindications. Individuals with asymptomatic PHPT not meeting the guidelines for surgery or those with contraindications for surgery may be followed and considered for medical management. For those at an increased risk of fragility fracture, antiresorptive therapy may be considered with close monitoring of biochemical data and bone densitometry. Targeted therapy with a calcimimetic agent may be of value in lowering serum calcium and PTH. There are currently no fracture data for the medical options available, and prospective randomized controlled trials are required to confirm the effects of medical therapy on fracture risk reduction in those with asymptomatic PHPT.
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Silverberg SJ, Walker MD, Bilezikian JP. Asymptomatic primary hyperparathyroidism. J Clin Densitom 2013; 16:14-21. [PMID: 23374736 PMCID: PMC3987990 DOI: 10.1016/j.jocd.2012.11.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/18/2012] [Indexed: 02/07/2023]
Abstract
The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term "asymptomatic primary hyperparathyroidism" was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease.
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Affiliation(s)
- Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Muñoz Torres M, Jodar Gimeno E, Reyes Garcia R, Martínez Diaz Guerra G, Amado JA, Gaztambide S, Quesada Gómez JM. Results from a national survey on the management of primary hyperparathyroidism. J Endocrinol Invest 2012; 35:957-63. [PMID: 22183161 DOI: 10.3275/8184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management of primary hyperparathyroidism (PHPT) continues to be challenging. At the Third International Workshop on PHPT, recent data on this disease were reviewed and new clinical recommendations were developed. There are few data on the influence of new guidelines in clinical practice. AIM We designed an online survey that was sent to all Spanish hospital endocrinology services. METHODS The questionnaire included 28 questions about diagnosis and management of PHPT. Ninety-nine of 131 sites (76%), giving health coverage to 70% of Spanish population, completed the survey. RESULTS The reported incidence of PHPT was 9.95/100,000 person-years. Heighty percent of patients were asymptomatic. Each center performed a median (Q1, Q3) of 12 (6, 20) parathyroidectomies/year. The median (Q1, Q3) percentage of curative interventions (at first trial) was 90% (80, 95). The main reasons for not performing surgery were, by decreasing frequency: surgery contraindication, patient's refusal, loss of monitoring, limited surgery experience. Localization techniques were used in 83% of cases. The main criteria for parathyroidectomy in asymptomatic patients were Ca≥2.875 mmol/l (79%), Tscore ≤-2.5 SD at any site (91%), age <50 yr (80%) and glomerular filtration rate <60 ml/min/1.73 m 2 (82%). Minimally invasive surgery was performed in 42% of centers. Frequency of biochemistry and bone density determinations for non-surgically managed patients was in accordance with international guidelines. CONCLUSIONS The clinical practice of Spanish endocrinologists is consistent with the recommendations of the guidelines from the Third International Workshop for the management of PHPT.
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Invernizzi M, Carda S, Righini V, Baricich A, Cisari C, Bevilacqua M. Different PTH response to oral peptone load and oral calcium load in patients with normocalcemic primary hyperparathyroidism, primary hyperparathyroidism, and healthy subjects. Eur J Endocrinol 2012; 167:491-7. [PMID: 22872468 DOI: 10.1530/eje-12-0362] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Normocalcemic primary hyperparathyroidism (PHPT-N) is a condition that may have similar long-term implications to primary hyperparathyroidism (PHPT); however, differential diagnosis and treatment for parathyroid disorders are not clearly defined. We investigated the effect of an oral peptone and an oral calcium load on calcium-regulating hormones in PHPT-N compared with PHPT and healthy controls to provide a new potential diagnostic tool. DESIGN Case-control study. METHODS We evaluated serum gastrin, PTH, ionized calcium, and phosphate responses to oral calcium (1 g) and peptone (10 g) load in 22 PHPT and 20 PHPT-N patients matched for PTH serum values. Moreover, 30 healthy subjects were enrolled as controls. In 12 patients for each group, we also performed the oral peptone test adding aluminum hydroxide (AH) to suppress phosphate absorption. RESULTS In PHPT patients, PTH increased significantly 30 min after the oral peptone load, while no significant increase was found in PHPT-N and controls. After oral calcium load, PTH remained stable in PHPT while it decreased dramatically in PHPT-N patients, and ionized calcium increased significantly in each of the three groups. Peptones plus AH induced a blunted PTH increase in the three groups. CONCLUSIONS Considering the marked difference in PTH response elicited by peptones in PHPT compared with PHPT-N, we suggest that the oral peptone test could be added to the diagnostic evaluation of PHPT patients. In case of absent response to peptones, patients should have their serum calcium levels assessed twice a year in accordance with recent guidelines.
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Affiliation(s)
- Marco Invernizzi
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont A. Avogadro, AOU Maggiore della Carità, Viale Piazza D'armi 1, 28100 Novara, Italy.
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Cinacalcet effects on the perioperative course of patients with secondary hyperparathyroidism. Langenbecks Arch Surg 2012; 398:131-8. [PMID: 23007384 DOI: 10.1007/s00423-012-1005-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Since its registration in 2004, the calcimimetic agent cinacalcet has been established as an alternative treatment for secondary hyperparathyroidism (SHPT). Working by allosteric activation of the calcium-sensing receptor, cinacalcet can lower parathyroid hormone (PTH) and calcium (Ca) in patients with SHPT. The influence of calcimimetics on the perioperative course has been unclear so far. METHODS We retrospectively analyzed the data of patients with primary operation for SHPT between 2004 and 2011, comparing the perioperative course of patients with and without preoperative cinacalcet treatment. RESULTS Fifty-six patients had cinacalcet therapy, and 54 patients had no calcimimetic medication prior to surgery. Gender, age, hemodialysis, and medical treatment were similar in both groups. Also, PTH levels were similar preoperatively and postoperatively (preoperative, 1,249 ± 676 vs. 1,196 ± 601 pg/ml; postoperative, 86 ± 220 vs. 62 ± 91 pg/ml). Patients with cinacalcet preoperatively had significant lower Ca levels preoperatively (2.49 ± 0.25 vs. 2.61 ± 0.24 mmol/l) and postoperatively (1.75 ± 0.37 vs. 1.86 ± 0.35 mmol/l) and had a higher rate of oral Ca substitution postoperatively (93 vs. 74 %). The risk for postoperative persistent disease was slightly higher in these patients compared to those without preoperative cinacalcet therapy (5 vs. 0 %, not significant). CONCLUSIONS In our experience, cinacalcet did not alter the perioperative course in SHPT patients.
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Souberbielle JC, Bienaimé F, Cavalier E, Cormier C. Vitamin D and primary hyperparathyroidism (PHPT). ANNALES D'ENDOCRINOLOGIE 2012; 73:165-9. [DOI: 10.1016/j.ando.2012.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
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Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez JM, Luque Fernández I, Varsavsky M, Guadalix Iglesias S, Cano Rodriguez I, Ballesteros Pomar MD, Vidal Casariego A, Rozas Moreno P, Cortés Berdonces M, Fernández García D, Calleja Canelas A, Palma Moya M, Martínez Díaz-Guerra G, Jimenez Moleón JJ, Muñoz Torres M. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. ACTA ACUST UNITED AC 2012; 59:174-96. [PMID: 22321561 DOI: 10.1016/j.endonu.2012.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.
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Abstract
Parathyroidectomy is currently the only curative treatment for primary hyperparathyroidism (PHPT). There are few alternative treatment options in patients who are ineligible for, or unwilling to undergo, surgery and those in whom parathyroidectomy has failed. Current options include the recently approved drug cinacalcet. Cinacalcet is an allosteric modulator of the calcium-sensing receptor, acting to sensitize this receptor to extracellular calcium. Cinacalcet has been found to be effective in reducing or normalizing serum calcium levels in several groups of PHPT patients, including those with mild-to-moderate PHPT, intractable disease, parathyroid carcinoma and multiple endocrine neoplasia Type 1. Cinacalcet slightly reduces parathyroid hormone levels and has no effect on bone mineral density. Cinacalcet is well tolerated when used at low doses, but side effects are not uncommon when relatively high doses are needed to control hypercalcemia. The current evidence indicates that cinacalcet may be of benefit in a wide spectrum of PHPT severities, offering a novel therapeutic option for the control of hypercalcemia in PHPT patients who are not able to undergo parathyroidectomy. It is presently unknown how much of the biochemical benefit of cinacalcet treatment translates into a clinical benefit, particularly in patients with mild-to-moderate hypercalcemia. Moreover, there are no data as to whether long-term treatment with cinacalcet can prevent the complications of PHPT.
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Affiliation(s)
- Filomena Cetani
- a Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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45
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Marcocci C, Cetani F. Update on the use of cinacalcet in the management of primary hyperparathyroidism. J Endocrinol Invest 2012; 35:90-5. [PMID: 22104762 DOI: 10.3275/8112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cinacalcet is an allosteric modulator of the calcium sensing receptor acting to sensitize this receptor to the extracellular calcium. Cinacalcet has been shown to be effective in reducing or normalizing serum calcium levels in several groups of patients with primary hyperparathyroidism (PHPT), including patients with mild to moderate PHPT, intractable PHPT, and parathyroid carcinoma, and in PHPT as a part of multiple endocrine neoplasia type 1. Cinacalcet slightly reduces PTH levels and has no effects on bone mineral density. Cinacalcet at low doses is well tolerated, but side effects are more frequent and severe when relatively high doses are needed to control hypercalcemia. Cinacalcet may be of benefit in a wide spectrum of PHPT severity, offering a novel therapeutic option for the control of hypercalcemia in PHPT patients who are not able to undergo parathyroidectomy. To what extent the reduction of serum calcium particularly in patients with mild to moderate hypercalcemia, translates into a clinical benefit is currently unknown. Moreover, there are no data as to whether long-term treatment with cinacalcet can prevent the complications of PHPT. Finally, more data are needed on the long-term safety of cinacalcet, particularly at the renal level.
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Affiliation(s)
- C Marcocci
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
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46
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Macfarlane DP, Yu N, Donnan PT, Leese GP. Should 'mild primary hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider? Clin Endocrinol (Oxf) 2011; 75:730-7. [PMID: 21848908 DOI: 10.1111/j.1365-2265.2011.04201.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a common incidental finding on routine biochemical testing, affecting around 1% of the population. The majority of individuals will be asymptomatic at diagnosis, with no evidence of end organ damage, and unless individuals aged <50 years at diagnosis, they are often considered to have 'mild' PHPT, as they do not meet published criteria for parathyroidectomy (PTX). However, there is increasing evidence that 'mild' PHPT is associated with adverse health outcomes. Long-term observational studies describing the natural history of 'mild' PHPT suggest that even though biochemistry may be relatively stable in the majority, bone mineral density (BMD) does decline after approximately 10 years of observation, whereas significant improvements in BMD are seen following PTX. Recent large European record linkage studies of 'mild PHPT' demonstrate significantly increased all-cause and cardiovascular mortality, similar to rates published for patients with PHPT who meet the NIH surgical criteria. 'Mild' PHPT was also associated with increased admissions for nonfatal cardiovascular disease, renal failure, renal stones, fractures, hypertension, psychiatric disease, cancer and diabetes, suggesting that 'insidious' PHPT may be a more appropriate description, or at least that the term 'mild' should be abandoned. Randomized controlled trials (RCTs) have begun to explore the benefits of PTX in this condition, demonstrating improvements in BMD and some psychiatric outcomes at approximately 2 years of follow-up. However, larger, adequately powered, long-term, RCTs will be required to determine whether PTX improves potential long-term morbidity and mortality in patients with PHPT who do not meet standard surgical criteria.
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Abstract
Primary hyperparathyroidism (PHPT) is a common, often asymptomatic, endocrine disorder characterized by hypercalcaemia in the face of a nonsuppressed parathyroid hormone (PTH) level. For those with symptomatic disease or who meet surgical criteria, parathyroidectomy is the treatment of choice. However, those patients who do not meet surgical criteria or who cannot undergo or refuse surgery must be managed medically. Medical management of PHPT involves continual assessment to determine who will benefit from surgical intervention, replacement of vitamin D, treatment of parathyroid bone disease and management of hypercalcaemia and renal stone disease.
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Affiliation(s)
- Mara J Horwitz
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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48
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Frey DP. [Parathyroid dysfunction and rheumatic manifestations]. Z Rheumatol 2011; 70:740-4, 746. [PMID: 21989974 DOI: 10.1007/s00393-011-0796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Parathyroid dysfunction, leading to severe clinical symptoms and radiographic changes, has decreased over the last years due to routine laboratory checks including serum calcium levels. Thus, abnormal calcium levels are detected early in the course of the disease and the underlying cause treated accordingly. Hyperparathyroidism often leads to osteoporosis and low-trauma fractures. When evaluating secondary osteoporosis analysis of calcium, phosphate and intact parathyroid hormone levels are mandatory. Osteitis fibrosa cystica and brown tumors are less frequent findings of hyperparathyroidism. However, in patients with arthritis or bone symptoms, hyperparathyroidism has to be evaluated as a possible reason. Other manifestations of hyperparathyroidism include myopathy, tendon ruptures and unspecific symptoms of the muscles and skeleton. Gout as well as pseudogout may be associated with hyperparathyroidism. Hypoparathyroidism may cause musculoskeletal diseases mimicking ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Myopathies are sometimes induced by hypoparathyroidism. An association between systemic lupus erythematosus and hypoparathyroidism seems to exist.
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Affiliation(s)
- D P Frey
- Rheumaklinik und Institut für Physikalische Medizin, Universitätsspital Zürich, Gloriastr. 25, 8091, Zürich, Schweiz.
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Rossini M, Viapiana O, Kalpakcioglu B, Dhangana R, Gatti D, Braga V, Fracassi E, Adami S. Long-term effects of neridronate and its discontinuation in patients with primary hyperparathyroidism. Calcif Tissue Int 2011; 89:21-8. [PMID: 21567168 DOI: 10.1007/s00223-011-9489-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 03/16/2011] [Indexed: 11/28/2022]
Abstract
In patients with primary hyperparathyroidism (PHPT) not suitable for surgical correction, a skeletal protection with bisphosphonates is considered a reasonable option, but the long-term effects after treatment discontinuation are not well known. Sixty postmenopausal women with PHPT were given 400-600 IU vitamin D(3) daily and 100 mg neridronate IV every 2 months for 2 years with 2 additional years of follow-up without antiresorptive therapies. Bone mineral density (BMD) progressively rose by 6.7 ± 7.6% (SD) and by 2.9 ± 4.5% at the spine and femoral neck, respectively. During follow-up, mean BMD progressively fell, but after 2 years it was still 3.9 ± 5.5% higher than baseline values at the spine. Bone alkaline phosphatase and serum C-telopeptide of type I collagen decreased significantly within 6 months (28 and 49% versus baseline, respectively) and rose to baseline values within 6-12 months during follow-up. Serum PTH significantly rose from baseline during treatment, but it remained significantly higher than baseline during follow-up. The PTH changes were significantly correlated with serum 25-hydroxyvitamin D (25OHD) levels. In conclusion, in this study we observed that in patients with mild PHPT treatment with bisphosphonates is associated with the expected changes in bone-turnover markers and that the significant increases of both hip and spine BMD are partially maintained for at least 2 years after treatment discontinuation at the vertebral site. The marked increases in serum PTH levels, particularly in subjects with low 25OHD levels, persist after treatment discontinuation and this raises the suspicion that this might reflect a worsening of PHPT.
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Affiliation(s)
- Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, OCM Borgo Trento, P.le Stefani 1, 37126, Verona, Italy.
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Björkman M, Tilvis R, Sorva A. Treatment indications of mild primary hyperparathyroidism in old age; a challenge for research. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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