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Bilha SC, Matei A, Branisteanu DD, Teodoriu LC, Hristov I, Bilha S, Leustean L, Ungureanu MC, Apostol Ciobanu DG, Preda C, Velicescu C. Coincidence or Causality: Parathyroid Carcinoma in Chronic Kidney Disease-Case Report and Literature Review. Diagnostics (Basel) 2024; 14:1127. [PMID: 38893652 PMCID: PMC11172095 DOI: 10.3390/diagnostics14111127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/12/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Parathyroid carcinoma (PC) associated with primary hyperparathyroidism (PHPT) has been well investigated in recent years. Data regarding PC evolution in secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) are, however, scarce. Most features that raise the suspicion of PC in PHPT are part of the usual SHPT evolution in CKD, mirroring the natural changes undergone by the parathyroid glands. Therefore, pre-surgically establishing the malignant or benign character of the lesions is cumbersome. We present two cases of PC in end-stage renal disease, one of which was bilateral, diagnosed after total parathyroidectomy in a high-volume parathyroid surgery center. A literature review of the data was also performed. A systematic search of the PubMed/MEDLINE database until January 2024 identified 42 cases of PC associated with SHPT. Understanding the PC features in CKD might improve associated bone and mineral disease management, and reduce the risk of metastasis, parathyromatosis, or recurrence. Irradiation, prolonged immunosuppression, long dialysis vintage, and genotype may predispose to the malignant transformation of chronically stimulated parathyroids. Despite postsurgical diagnosis, favorable outcomes occurred when distant metastases were absent, even without "en bloc" resection. Further research is warranted to delineate specific diagnostic and therapeutic approaches tailored to this particular patient subpopulation.
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Affiliation(s)
- Stefana Catalina Bilha
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Matei
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dumitru D. Branisteanu
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Medicine, Charles E. Smith College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | | | - Ioana Hristov
- Endocrinology Department, Elytis Hospital Hope, 700010 Iasi, Romania
| | - Stefan Bilha
- Department of Nuclear Medicine, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Letitia Leustean
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria-Christina Ungureanu
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Delia Gabriela Apostol Ciobanu
- Department of Pathology, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania
| | - Cristina Preda
- Endocrinology Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristian Velicescu
- Surgery Department, “St. Spiridon” Emergency Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Gulcicek S, Seyahi N. Comparison of chronic kidney disease progression and associated complications between geriatric and non-geriatric groups. Medicine (Baltimore) 2024; 103:e37422. [PMID: 38428881 PMCID: PMC10906592 DOI: 10.1097/md.0000000000037422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
There is no consensus on the physiologic decline in estimated glomerular filtration rate (GFR) due to geriatric conditions related with the aging or chronic kidney disease (CKD) itself. In this study, we aimed to compare the CKD progression and associated complications in a large sample of geriatric and non-geriatric patients. The data of in 506 patients at age between 30 to 90 years and diagnosed with CKD at stage 2 and above (15 mL/min/1.73 m2 ≤ eGFR < 90 mL/min/1.73 m2) were collected retrospectively and compared among geriatric (>65 years old) and non-geriatric individuals. The rate of hypertension was higher in geriatrics compared to non-geriatrics (96.6% vs 91.9%, P = .04). Among laboratory findings, only PTH level was significantly lower and HCO3 concentration was higher in geriatrics compared to non-geriatrics (P = .02, P < .001, respectively). There was no significant difference in last measured eGFR (P = .99) while that measured 4 years ago was lower in geriatrics compared to that of non-geriatrics (P < .001). eGFR change was smaller in geriatrics compared to non-geriatrics (P < .001), and rate of progressive renal disease among non-geriatric group (39%) was found to be significantly higher than in the geriatrics (17.2%) (P < .001). The prevalence of hyperkalemia was lower in geriatrics at stage 3a (P = .02); prevalence of hyperparathyroidism was lower in those at stage 3b (P = .02) and lastly the acidosis was observed significantly lower in geriatric patients at stage 3a, 3b, and 4 compared to the non-geriatrics at corresponding stages (P < .001, P = .03, and P = .04, respectively). The eGFR change was significantly smaller in geriatrics at stage 3b and 4 (P < .001 and P = .04, respectively) while the rate of progressed renal disease was lower in geriatrics at stage 3a and 3b (21.1% vs 9.9%, P = .03 and 41.2% vs 11.1%, P < .001, respectively). eGFR change in 4-year period and the rates of progressive renal disease are higher in the non-geriatrics and also the prevalence of secondary complications of CKD, such as hyperparathyroidism, acidosis, and hyperkalemia, are higher in non-geriatrics. This may reflect that decline of GFR in geriatric individuals is at least partially related to physiological aging rather than kidney disease. Therefore, devising age related CKD definitions might be appropriate.
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Affiliation(s)
- Sibel Gulcicek
- Department of Nephrology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Santoso D, Thaha M, Empitu MA, Kadariswantiningsih IN, Suryantoro SD, Haryati MR, Hertanto DM, Pramudya D, Bintoro SUY, Nasronudin N, Alsagaff MY, Susilo H, Wungu CDK, Budhiparama NC, Hogendoorn PCW. Brown Tumour in Chronic Kidney Disease: Revisiting an Old Disease with a New Perspective. Cancers (Basel) 2023; 15:4107. [PMID: 37627135 PMCID: PMC10452999 DOI: 10.3390/cancers15164107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Osteitis fibrosa cystica (OFC) and Brown Tumours are two related but distinct types of bone lesions that result from the overactivity of osteoclasts and are most often associated with chronic kidney disease (CKD). Despite their potential consequences, these conditions are poorly understood because of their rare prevalence and variability in their clinical manifestation. Canonically, OFC and Brown Tumours are caused by secondary hyperparathyroidism in CKD. Recent literature showed that multiple factors, such as hyperactivation of the renin-angiotensin-aldosterone system and chronic inflammation, may also contribute to the occurrence of these diseases through osteoclast activation. Moreover, hotspot KRAS mutations were identified in these lesions, placing them in the spectrum of RAS-MAPK-driven neoplasms, which were until recently thought to be reactive lesions. Some risk factors contributed to the occurrence of OFC and Brown Tumours, such as age, gender, comorbidities, and certain medications. The diagnosis of OFC and Brown Tumours includes clinical symptoms involving chronic bone pain and laboratory findings of hyperparathyroidism. In radiological imaging, the X-ray and Computed tomography (CT) scan could show lytic or multi-lobular cystic alterations. Histologically, both lesions are characterized by clustered osteoclasts in a fibrotic hemorrhagic background. Based on the latest understanding of the mechanism of OFC, this review elaborates on the manifestation, diagnosis, and available therapies that can be leveraged to prevent the occurrence of OFC and Brown Tumours.
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Affiliation(s)
- Djoko Santoso
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mochammad Thaha
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Maulana A. Empitu
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | | | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mutiara Rizki Haryati
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Decsa Medika Hertanto
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
| | - Dana Pramudya
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
| | | | - Nasronudin Nasronudin
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (M.Y.A.); (H.S.)
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (M.Y.A.); (H.S.)
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Nicolaas C. Budhiparama
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Pancras C. W. Hogendoorn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Cheng M, Zhang Q, Wang M, Huang B, Tao Y, Fan C, Wang H, Zhang M. A New Calculation Model for Calcium Requirements After Parathyroidectomy in Patients With Secondary Hyperparathyroidism. Clin Exp Otorhinolaryngol 2023; 16:282-289. [PMID: 37475139 PMCID: PMC10471907 DOI: 10.21053/ceo.2023.00584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES We aimed to develop a new calculation model for calcium requirements in dialysis patients following parathyroidectomy. METHODS A total of 98 patients with secondary hyperparathyroidism receiving parathyroidectomy from January 2014 to January 2022 were enrolled in this study. Among these patients, 78 were randomly selected for construction of the calcium requirement calculation model, and the remaining 20 patients were selected for model validation. The calcium requirement model estimated the total calcium supplementation for 1 week after surgery using variables with significant relationships in the derivation group by stepwise multiple linear regression analysis. Bias, precision, and accuracy were measured in the validation group to determine the performance of the model. RESULTS The model was as follows: calcium requirement for 1 week after surgery=33.798-8.929×immediate postoperative calcium+0.190×C-reactive protein-0.125×age+0.002×preoperative intact parathyroid hormone+0.003×preoperative alkaline phosphatase (R2=0.8). The model was successfully validated. CONCLUSION We generated a novel model to guide calcium supplementation. This model can assist in stabilizing the serum calcium levels of patients during the early postoperative period. Furthermore, it contributes to the individualized and precise treatment of hypocalcemia in patients following parathyroidectomy.
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Affiliation(s)
- Ming Cheng
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengjing Wang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bihong Huang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Tao
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunyan Fan
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongying Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Minmin Zhang
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Disthabanchong S, Saeseow S, Khunapornphairote S, Suvikapakornkul R, Wasutit Y, Tungkeeratichai J. Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis. Front Med (Lausanne) 2023; 10:1132566. [PMID: 37484844 PMCID: PMC10359897 DOI: 10.3389/fmed.2023.1132566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/31/2023] [Indexed: 07/25/2023] Open
Abstract
Aims/Introduction Parathyroidectomy is associated with improved survival in patients with end-stage kidney disease. Protein-energy wasting (PEW) is common in patients with kidney failure and predicts poor outcomes. Recent clinical trials have linked hyperparathyroidism to PEW. The present retrospective cohort study examined whether parathyroidectomy was associated with improvement in nutritional status in maintenance hemodialysis patients. Materials and methods One hundred twenty-nine maintenance hemodialysis patients who had successful parathyroidectomy during 2012-2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1,000 pg./mL (non-PTX control group) and 187 patients with PTH levels >1,000 pg./mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional parameters associated with PEW were compared over the 12-month study period. Results In cohort 1, substantially lower serum albumin and serum creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low albumin) and serum Cr/BSA ≤380 μmol/L/m2 (low Cr/BSA) were observed in the PTX group. These parameters improved significantly after parathyroidectomy. Total lymphocyte count (TLC) was comparable at baseline but the percentage of patients with TLC <800 cells/mm3 (low TLC) decreased substantially after parathyroidectomy. At follow-up, serum albumin, serum Cr/BSA and proportions of patients with low albumin and Cr/BSA became comparable with the non-PTX control group. The percentage of patients with low TLC became lower in the PTX group. Mixed-models analysis confirmed significant differences in the changes in serum albumin, serum Cr/BSA, and proportions of patients with low albumin and TLC between the two groups. In cohort 2, nutritional parameters were comparable at baseline. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index ≤18.5 kg/m2, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. A substantial reduction in blood pressure was also observed in the PTX group. Conclusion Severe hyperparathyroidism was associated with nutritional impairment which improved considerably after parathyroidectomy.
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Affiliation(s)
- Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarunya Saeseow
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Khunapornphairote
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ronnarat Suvikapakornkul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Wasutit
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jumroon Tungkeeratichai
- Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Treatment for secondary hyperparathyroidism focusing on parathyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1169793. [PMID: 37152972 PMCID: PMC10159274 DOI: 10.3389/fendo.2023.1169793] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients' need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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Wang Y, Liu Y, Li N, Xu K, Zhang W. Quantitative application of dual-phase 99mTc-sestamibi SPECT/CT imaging of parathyroid lesions: identification of optimal timing in secondary hyperparathyroidism. EJNMMI Phys 2023; 10:29. [PMID: 37079194 PMCID: PMC10119365 DOI: 10.1186/s40658-023-00548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/07/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE In this retrospective study, we compared the maximum standardized uptake values (SUVmax) of parathyroid lesions and the target-to-background ratio (TBR) of parathyroid lesions to thyroid tissue in early-phase single-photon emission computed tomography/computed tomography (SPECT/CT) versus delayed-phase SPECT/CT in patients with secondary hyperparathyroidism (SHPT) in order to determine the optimal timing of 99mTc- methoxyisobutylisonitrile (99mTc-MIBI) SPECT/CT imaging. METHODS Seventeen patients with a history of chronic kidney failure stage 5 on hemodialysis, underwent pre-operative parathyroid scintigraphy for detection and localization of parathyroid lesions. Retrospective analysis was conducted for lesions with focal accumulation of 99mTc-MIBI. All patients underwent dual-phase 99mTc-MIBI parathyroid scintigraphy and dual-phase SPECT/CT. SUVmax of parathyroid lesions and thyroid tissues was measured. RESULTS Mean SUVmax of parathyroid lesions was 4.86 on early-phase and 2.58 on delayed-phase SPECT/CT, respectively. Mean TBR was 1.14 on early phase and 1.48 on delayed-phase SPECT/CT, respectively. Statistically significant differences in SUVmax and TBR between dual-phase SPECT/CT were observed (P < 0.001). CONCLUSIONS Delayed-phase SPECT/CT in SHPT is required because of the better image contrast.
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Affiliation(s)
- Yuhua Wang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ye Liu
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Na Li
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kang Xu
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wanchun Zhang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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He C, Zhang Y, Li L, Cheng G, Zhang W, Tang Y, Wang C. Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism. Int J Endocrinol 2023; 2023:1901697. [PMID: 36700169 PMCID: PMC9870689 DOI: 10.1155/2023/1901697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. METHODS A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. RESULTS The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816-0.916) and 0.867 (95% CI, 0.793-0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%-78.4%) and 75.0% (58.6%-88.5%), and negative predictive values of the nomogram were 90.0% (82.9%-93.6%) and 86.4% (73.5%-94.0%) for the training and validation cohorts, respectively. CONCLUSIONS We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.
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Affiliation(s)
- Chenchen He
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
- China Medical University, Shenyang, China
| | - Yibing Zhang
- Department of Medical Affairs, The General Hospital of Northern Theater Command, Shenyang, China
| | - Longfei Li
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Guangming Cheng
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Wei Zhang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yufu Tang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
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Udyavar NR, Ahn J, Crepeau P, Morris-Wiseman LF, Thompson V, Chen Y, Segev DL, McAdams-DeMarco M, Mathur A. Black patients are more likely to undergo parathyroidectomy for secondary hyperparathyroidism. Surgery 2023; 173:111-116. [PMID: 36195501 PMCID: PMC10443691 DOI: 10.1016/j.surg.2022.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prior studies have demonstrated racial disparities in the severity of secondary hyperparathyroidism among dialysis patients. Our primary objective was to study the racial and socioeconomic differences in the timing and likelihood of parathyroidectomy in patients with secondary hyperparathyroidism. METHODS We used the United States Renal Data System to identify 634,428 adult (age ≥18) patients who were on maintenance dialysis between 2006 and 2016 with Medicare as their primary payor. Adjusted multivariable Cox regression was performed to quantify the differences in parathyroidectomy by race. RESULTS Of this cohort, 27.3% (173,267) were of Black race. Compared to 15.4% of White patients, 23.1% of Black patients lived in a neighborhood that was below a predefined poverty level (P < .001). The cumulative incidence of parathyroidectomy at 10 years after dialysis initiation was 8.8% among Black patients compared to 4.3% among White patients (P < .001). On univariable analysis, Black patients were more likely to undergo parathyroidectomy (adjusted hazard ratio = 1.83; 95% confidence interval, 1.74-1.93). This association persisted after adjusting for age, sex, cause of end-stage renal disease, body mass index, comorbidities, dialysis modality, and poverty level (adjusted hazard ratio = 1.35; 95% confidence interval, 1.27-1.43). Therefore, patient characteristics and socioeconomic status explained 26% of the association between race and likelihood of parathyroidectomy. CONCLUSION Black patients with secondary hyperparathyroidism due to end-stage renal disease are more likely to undergo parathyroidectomy with shorter intervals between dialysis initiation and parathyroidectomy. This association is only partially explained by patient characteristics and socioeconomic factors.
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Affiliation(s)
- N Rhea Udyavar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - JiYoon Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Philip Crepeau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Valerie Thompson
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Yusi Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University, Grossman School of Medicine and Langone Health, New York, NY
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Pruritus in Chronic Kidney Disease: An Update. ALLERGIES 2022. [DOI: 10.3390/allergies2030009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into routine clinical practice. Further efforts are also needed in order to increase the awareness of clinicians and patients so that they can identify the CKDaP signs and symptoms in a timely manner. Currently established treatment options for CKDaP focus on the prevention of xerosis via topical emollients, the optimization of dialysis management, early referral to kidney transplantation if appropriate, oral antihistamine, and a variety of neuropathic agents. Other novel treatment options include the following: topical analgesics, topical tacrolimus, cannabinoid-containing compounds, antidepressants, oral leukotrienes, opioids, and non-pharmacological alternative therapies (i.e., phototherapy, dietary supplements, acupuncture/acupressure). We provide an updated review on the evidence relating to the epidemiology, the pathophysiology, the clinical assessment and diagnosis, and the management of CKDaP.
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11
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A predictive risk score to diagnose hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism: a 22-year retrospective cohort study. Sci Rep 2022; 12:9548. [PMID: 35681076 PMCID: PMC9184730 DOI: 10.1038/s41598-022-13880-0] [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] [Received: 01/20/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Hypocalcemia is a common complication found in patients with secondary hyperparathyroidism (SHPT) who undergo parathyroidectomy. This study aimed to construct a predictive risk score for the occurrence of hypocalcemia after parathyroidectomy in patients with SHPT who underwent chronic renal replacement therapy (RRT). This 22-year retrospective cohort study enrolled 179 patients with SHPT who had their first parathyroidectomy. Eighty-two percent of patients developed hypocalcemia within 16.9 (95% CI 14.5–19.5) h after parathyroidectomy. This study demonstrated four factors as independent risk factors for post-parathyroidectomy hypocalcemia, including duration of RRT, preoperative serum phosphate, preoperative serum alkaline phosphatase (ALP) and mean difference of serum intact parathyroid hormone (iPTH). By using logistic regression analysis, this study demonstrated cut-off points for these four risk factors for the diagnosis of hypocalcemia after parathyroidectomy: 5 years for the duration of RRT, 5 mg/dL for serum phosphate, 387 U/L for serum ALP, and 97% for the mean difference of serum iPTH. Finally, the predictive risk score was constructed by assigning a score of one to each factor. With a total score of at least 2, the proposed predictive risk score has an AuROC of 0.755 with a sensitivity of 78.2%, a specificity of 71.4%, and an accuracy of 76.9%.
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12
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Zhang DL, Chen S, Gao MZ, Lin YC, Hong FY, You ZH, Chen X, Wu SS. Ultrasound-Guided Radiofrequency Ablation: A New Attempt to the Treatment of Refractory Hyperparathyroidism Secondary to Chronic Kidney Disease. Kidney Int Rep 2022; 7:282-288. [PMID: 35155867 PMCID: PMC8820997 DOI: 10.1016/j.ekir.2021.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dan-Ling Zhang
- Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fuzhou No. 7 Hospital, Fuzhou, People’s Republic of China
| | - Sheng Chen
- Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Mei-Zhu Gao
- Department of Nephrology, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Yu-Cheng Lin
- Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Affiliated Fuzhou First Hospital of Fujian Medical, Fuzhou, People’s Republic of China
| | - Fu-Yuan Hong
- Department of Nephrology, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Zhen-Hui You
- Department of General Surgery, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Xing Chen
- Department of General Surgery, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
| | - Song-Song Wu
- Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
- Correspondence: Song-Song-Wu, Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, 134 East Street, Gu Lou District, Fuzhou City, Fujian Province, People’s Republic of China.
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13
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Büyük Nİ, Tüfekçi K, Cumbul A, Ayşan E, Torun Köse G. A novel method for providing scaffold: Decellularization of parathyroid capsule. J Biomater Appl 2021; 36:1201-1212. [PMID: 34918999 DOI: 10.1177/08853282211054321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aimed to generate a novel biomatrix from the decellularized human parathyroid capsule using different methods and to compare the efficiency of decellularization in the means of cell removal, structural integrity and extracellular matrix preservation. The parathyroid capsules, which were carefully dissected from the parathyroid tissue, were randomly divided into four groups and then decellularized using three different protocols: freeze-thaw only, sodium dodecyl sulphate and Triton X-100 treatments after freeze-thawing. Quantitative DNA analysis, agarose gel electrophoresis, sulphated glycosaminoglycan assay, histological analysis, immunohistochemistry and scanning electron microscopy were used to observe the efficiency of parathyroid capsule decellularization and preservation of extracellular matrix components. Considering all the results, it can be said that only freeze-thawing is not an effective method in parathyroid capsule decellularization. When the tissue was treated with a detergent agent in addition to freeze-thawing, the amount of DNA decreased by 90% while sulphated glycosaminoglycan amount maintained 50% compared to untreated tissue. Comparing the effects of the two detergents on the preservation of extracellular matrix such as collagen and sulphated glycosaminoglycan, it was seen that the integrity of tissues treated with Triton X-100 was preserved more than tissues treated with sodium dodecyl sulphate. It is concluded that Triton X-100 treatment with freeze-thawing is the most suitable and effective method for decellularizing the human parathyroid capsule. The biomatrix obtained with this method can be applied in the transplantation of parathyroid tissue and other endocrine tissue types in the body.
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Affiliation(s)
- Nisa İrem Büyük
- Genetics & Bioengineering, 52998Yeditepe University, Istanbul, Turkey
| | - Kardelen Tüfekçi
- Genetics & Bioengineering, 52998Yeditepe University, Istanbul, Turkey
| | - Alev Cumbul
- Histology and Embryology, 52998Yeditepe University, Istanbul, Turkey
| | - Erhan Ayşan
- General Surgery, 64173Yeditepe Üniversity Hospital, Istanbul, Turkey
| | - Gamze Torun Köse
- Genetics & Bioengineering, 52998Yeditepe University, Istanbul, Turkey
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14
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Saeseow S, Vantanasiri K, Suvikapakornkul R, Sukarayothin T, Apirakkittikul N, Disthabanchong S. Parathyroidectomy is associated with slow progression of vascular calcification in maintenance haemodialysis patients: A propensity score-matched case-control study. Nephrology (Carlton) 2021; 27:355-362. [PMID: 34651396 DOI: 10.1111/nep.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/18/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Parathyroidectomy has been the mainstay of treatment of severe hyperparathyroidism in patients with kidney failure until the introduction of calcimimetic. Several large observational studies demonstrated the improvement in patient outcomes after parathyroidectomy. The benefit of parathyroidectomy on vascular calcification remains largely unexplored. AIM To examine the association between parathyroidectomy and the progression of vascular calcification as well as overall survival in maintenance haemodialysis patients. METHOD This is a matched case-control study undertaken between 2012 and 2020. Patients who underwent parathyroidectomy were identified and matched 1:1 to non-parathyroidectomized (non-PTX) haemodialysis patients using propensity score matching method resulting in 120 patients in each arm. Aortic arch calcification (AoAC) score was determined annually in the posteroanterior chest x-ray. The average follow-up period was 38 months. RESULTS Baseline demographic, laboratory data and AoAC score were comparable among the two groups of patients. The prevalence of AoAC was 59% in the PTX group and 54% in the non-PTX group (p = .43). Progression of AoAC occurred in 33% in the PTX group and 47% in the non-PTX group (p = .04). Multivariate generalized linear model revealed parathyroidectomy as an independent protective factor [β (95% CI) -1.04 (-1.68, -0.41)] and increased serum calcium as a potentiating factor [β (95% CI) 0.62 (0.25, 0.1)] for progression of AoAC. Linear mixed models revealed an increase in AoAC score in both groups but between group comparisons indicated substantially slower progression in the PTX group. Rapid progression of AoAC was also observed more frequently among non-PTX patients. Death occurred in 7 and 16% in the PTX and non-PTX groups, respectively. Kaplan-Meier survival curve revealed better survival associated with parathyroidectomy (p = .01). More rapid progression of AoAC also correlated with worse survival. CONCLUSION Parathyroidectomy was associated with slow progression of vascular calcification in maintenance haemodialysis patients.
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Affiliation(s)
- Sarunya Saeseow
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Ronnarat Suvikapakornkul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thongchai Sukarayothin
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Navarat Apirakkittikul
- Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Zhang Z, Cai L, Wu H, Xu X, Fang W, He X, Wang X, Li X. Paricalcitol versus Calcitriol + Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease in China: A Cost-Effectiveness Analysis. Front Public Health 2021; 9:712027. [PMID: 34368073 PMCID: PMC8333861 DOI: 10.3389/fpubh.2021.712027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Chronic Kidney Disease (CKD) is a global chronic disease with increasing prevalence in recent years, particularly CKD accompanied by Secondary Hyperparathyroidism (SHPT) leads to reduced quality of life, increased mortality, a considerable economic burden for patients and society. The aim of this study was to investigate the cost-effectiveness analysis of paricalcitol vs. calcitriol + cinacalcet for CKD patients with SHPT in China in 2020. Methods: A Markov model was conducted employing data derived from published literature, clinical trials, official sources, and tertiary public hospital data in China, based on a 10-year horizon from the perspective of the healthcare system. Calcitriol + Cinacalcet was used as the reference group. CKD stage 5 (CKD-5) dialysis patients suffering from SHPT were included in the study. Effectiveness was measured in quality-adjusted life years (QALYs). The discount rate (5%) was applied to costs and effectiveness. Sensitivity analysis was performed to confirm the robustness of the findings. Results: The base case analysis demonstrated that Patients treated with paricalcitol could gain an increase in utility (0.183 QALYs) and require fewer expenditures (6925.612 yuan). One-way sensitivity analysis was performed to showed that impact factors were the price of cinacalcet, the hospitalization costs of patients with paricalcitol and calcitriol, the costs and utilities of hemodialysis and the costs of calcitriol, the costs of paricalcitol regardless of period. Probabilistic simulation analysis displayed when willingness-to-pay was ¥217113, the probability that Paricalcitol was dominant is 96.20%. Conclusion: The results showed that paricalcitol administrated to treat patients diagnosed with Secondary hyperparathyroidism in Chronic Kidney Disease, compared to calcitriol and cinacalcet, might be dominant in China.
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Affiliation(s)
- Zhuolin Zhang
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Lele Cai
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Hong Wu
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Pharmacy, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xinglu Xu
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Wenqing Fang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xuan He
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xiao Wang
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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16
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Diao Z, Qian L, Teng C, Zhang N, Liang J, Kong L, Li H, Tian C, Liu W. Microwave ablation versus parathyroidectomy for severe secondary hyperparathyroidism in patients on hemodialysis: a retrospective multicenter study. Int J Hyperthermia 2021; 38:213-219. [PMID: 33593216 DOI: 10.1080/02656736.2021.1885754] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Microwave ablation is effective for severe secondary hyperparathyroidism, but the difference in efficacy between microwave ablation and parathyroidectomy remains unclear. In this multicenter retrospective cohort study, we compared the long-term clinical efficacy of microwave ablation and parathyroidectomy for severe secondary hyperparathyroidism undergoing hemodialysis. MATERIALS AND METHODS The patients were divided into microwave ablation and parathyroidectomy groups. The primary endpoint was the proportion of patients with intact parathyroid hormone (iPTH) concentrations within the target range (100-600 pg/mL) during the efficacy assessment phase. The secondary endpoints were (i) differences in iPTH concentrations over time between the two groups, and (ii) decreases in iPTH concentrations over time in the two groups. RESULTS Microwave ablation was performed in 47/92 patients and parathyroidectomy in 45/92. Primary endpoint: iPTH concentrations within the target range were achieved during the efficacy assessment phase in 26/47 patients (55.3%) and in 14/45 (31.1%) patients in the microwave ablation and parathyroidectomy groups, respectively (p = .02). Secondary endpoints: (i) Mean iPTH concentrations during the efficacy assessment phase were significantly higher in the microwave ablation versus parathyroidectomy groups (649 ± 519 pg/mL versus 136 ± 228 pg/mL, respectively; p < .01). (ii) Mean decrease in iPTH concentration from baseline was 725 ± 605 pg/mL versus 1369 ± 478 pg/mL in the MWA versus parathyroidectomy groups, respectively (p < .01). CONCLUSIONS Ultrasound-guided percutaneous microwave ablation provides higher iPTH target-achieving rates than parathyroidectomy in patients with severe secondary hyperparathyroidism undergoing hemodialysis.
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Affiliation(s)
- Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Changsheng Teng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zhang
- Department of Nephrology, Beijing Moslem People Hospital, Beijing, China
| | - Jun Liang
- Department of Nephrology, Beijing East District First People's Hospital, Beijing, China
| | - Lingxin Kong
- Department of Nephrology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Hongbin Li
- Department of Nephrology, Beijing East District First People's Hospital, Beijing, China
| | - Chaoyang Tian
- Department of Nephrology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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17
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Pediatric hyperparathyroidism: review and imaging update. Pediatr Radiol 2021; 51:1106-1120. [PMID: 33904951 DOI: 10.1007/s00247-021-05050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Hyperparathyroidism, due to increased secretion of parathyroid hormones, may be primary, secondary or tertiary. Most pediatric patients with sporadic primary hyperparathyroidism will be symptomatic, presenting with either end-organ damage or nonspecific symptoms. In younger patients with primary hyperparathyroidism, there is a higher prevalence of familial hyperparathyroidism including germline inactivating mutations of the calcium-sensing receptor genes that result in either neonatal severe hyperparathyroidism or familial hypocalciuric hypercalcemia. Parathyroid scintigraphy and ultrasound are complementary, first-line imaging modalities for localizing hyperfunctioning parathyroid glands. Second-line imaging modalities are multiphase computed tomography (CT) and magnetic resonance imaging. In pediatrics, multiphase CT protocols should be adjusted to optimize radiation dose. Although, the role of these imaging modalities is better established in preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism, the same principles apply in secondary and tertiary hyperparathyroidism. In this manuscript, we will review the embryology, anatomy, pathophysiology and preoperative localization of parathyroid glands as well as several subtypes of primary familial hyperparathyroidism. While most of the recent imaging literature centers on adults, we will focus on the issues that are pertinent and applicable to pediatrics.
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18
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Fonseca-Correa JI, Nava-Santana C, Tamez-Pedroza L, Paz-Cortes A, Santillan-Ceron A, Rojas-Concha LJ, Pantoja-Millán JP, Sierra-Salazar M, Velazquez-Fernández D, Herrera MF, Correa-Rotter R, Ramirez-Sandoval JC. Clinical factors associated with early and persistent hypocalcaemia after parathyroidectomy in patients on dialysis with severe hyperparathyroidism. Nephrology (Carlton) 2021; 26:408-419. [PMID: 33502071 DOI: 10.1111/nep.13854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
AIM Severe hypocalcaemia following parathyroidectomy for secondary or tertiary hyperparathyroidism (SHPT/THPT) is scarcely studied. We aimed to describe and identify risk factors for early and persistent hypocalcaemia after parathyroidectomy. METHODS Retrospective pair-matched cohort study. We assessed 87 dialysis patients with SHPT (n = 73) or THPT (n = 14) paired with 146 subjects with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy and were followed for 12 months. Early severe hypocalcaemia was defined as a free Ca ≤0.8 mmol/L [3.2 mg/dl] or corrected Ca ≤1.87 mmol/L [7.5 mg/dl] within 48 h. After parathyroidectomy and persistent hypocalcaemia, as an elemental Ca intake >3.0 g/day to achieve corrected Ca >2 mmol/L [8.0 mg/dl]. RESULTS Early severe hypocalcaemia occurred in 77% (67/87) versus 6.8% (10/146) of subjects with SHPT/THPT and PHPT, respectively (p < .001). In SHPT/THPT cases, persistent hypocalcaemia occurred in 77% (49/64) and 64% (35/54) after 6 and 12 months of parathyroidectomy, respectively. In PHPT cases, persistent hypocalcaemia occurred in 6.8% (10/146) after 4-12 months of parathyroidectomy. Preoperative serum alkaline phosphatase (ALP) was the only risk factor associated to early severe hypocalcaemia (OR 7.3, 95% C.I. 1.7-10.9, p = .006) and persistent hypocalcaemia (OR 7.1, 95% C.I: 2.1-14.2, p = .011). Subjects with persistently low intact parathormone (iPTH) (<5.3 pmol/L [50 ng/ml]), suggestive of adynamic bone disease) showed higher Ca increases and less oral calcium requirements compared to those who progressively increased iPTH after parathyroidectomy. CONCLUSION Early and persistent hypocalcaemia after parathyroidectomy in severe HPT were a common event associated directly to preoperative ALP levels. Subjects with persistently low postoperative iPTH normalized serum Ca more frequently after 1 year of follow up.
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Affiliation(s)
- Jorge I Fonseca-Correa
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Nava-Santana
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis Tamez-Pedroza
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Paz-Cortes
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Airy Santillan-Ceron
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis J Rojas-Concha
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Pablo Pantoja-Millán
- Department of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra-Salazar
- Department of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Velazquez-Fernández
- Department of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel F Herrera
- Department of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan C Ramirez-Sandoval
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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19
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Wen P, Xu L, Zhao S, Gan W, Hou D, Zhang L, Cao J, Xiong M, Jiang L, Yang J. Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy. Int J Endocrinol 2021; 2021:6613659. [PMID: 33868402 PMCID: PMC8035008 DOI: 10.1155/2021/6613659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. OBJECTIVES This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. METHODS We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. RESULTS After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. CONCLUSIONS The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.
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Affiliation(s)
- Ping Wen
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingling Xu
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shasha Zhao
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gan
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dawei Hou
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Zhang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Cao
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingxia Xiong
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Jiang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junwei Yang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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20
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Greene B, Kim SJ, McCarthy EP, Pasternak JD. Effects of Social Disparities on Management and Surgical Outcomes for Patients with Secondary Hyperparathyroidism. World J Surg 2020; 44:537-543. [PMID: 31570954 DOI: 10.1007/s00268-019-05207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Nearly 80% of chronic renal failure patients have secondary hyperparathyroidism. Cinacalcet is used to lower parathyroid hormone; however, it is expensive and has side effects. When secondary hyperparathyroidism is resistant to medication or medications are inaccessible, parathyroidectomy is performed. Race and socioeconomic status influence access to care and surgical outcomes. We sought to evaluate the effect of race and socioeconomic status on parathyroidectomy rate as well as surgical outcomes of patients with secondary hyperparathyroidism. METHODS We undertook cross-sectional analysis of adults diagnosed with secondary hyperparathyroidism in the USA between 2012 and 2014, using the National Inpatient Sample. Univariate and multivariate analyses were used to determine associations between social disparities, likelihood to undergo parathyroidectomy, and surgical outcomes. RESULTS Between 2012 and 2014, a national estimate of 724,170 hospitalizations were identified where patients had a diagnosis of secondary hyperparathyroidism. Operative rate was 0.67%. By socioeconomic status, differences in rates of surgery in the poorest compared to the richest were not significant (0.74% vs. 0.55%, OR 1.08, p = 0.5). African-American patients had higher rates of parathyroidectomy compared to Caucasians (1 vs. 0.74%, OR 1.49, p < 0.001). African-American patients also had a trend toward more complications and greater length of stay. CONCLUSIONS According to a large administrative dataset, parathyroidectomy for secondary hyperparathyroidism is seldom used in the USA. African-American patients have higher rates of surgical management. Surgical outcomes may be affected by race. Clinicians treating secondary hyperparathyroidism should be aware of existing disparities within their health system.
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Affiliation(s)
- Brittany Greene
- Division of General Surgery, Department of Surgery, University Health Network, Toronto General Hospital, 10 En 214, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - S Joseph Kim
- Division of Nephrology, Department of Medicine, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, ON, M5G 2N2, Canada
| | - Ellen P McCarthy
- Department of Epidemiology, Harvard School of Public Health, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Jesse D Pasternak
- Division of General Surgery, Department of Surgery, University Health Network, Toronto General Hospital, 10 En 214, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
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Li X, Li J, Li Y, Wang H, Yang J, Mou S, Zhou M, Jiang C, Ning C. The role of preoperative ultrasound, contrast-enhanced ultrasound, and 99mTc-MIBI scanning with single-photon emission computed tomography/X-ray computed tomography localization in refractory secondary hyperparathyroidism. Clin Hemorheol Microcirc 2020; 75:35-46. [PMID: 31868660 DOI: 10.3233/ch-190723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the role of preoperative US, CEUS, and 99mTc-MIBI scanning with SPECT/CT in localizing diseased parathyroid glands in cases of refractory secondary hyperparathyroidism (SHPT). MATERIAL AND METHODS Using pathological results as the gold standard, we compared the operative findings with the preoperative localization of each modality in 73 nodules and evaluated the accuracy, and sensitivity of each modality and combinations of the four modalities. RESULTS The sensitivity of US, CEUS, 99mTc-MIBI and SPECT/CT was 98.59%, 94.37%, 50.70% and 78.87%, respectively. US had the highest sensitivity of the four imaging methods and the diagnostic sensitivity of US and CEUS was superior to that of 99mTc-MIBI (p < 0.001 and p < 0.001) and SPECT/CT (p = 0.001 and p = 0.012). In addition, we found that the sensitivity of the combination of US with CEUS, US with 99mTc-MIBI and/or SPECT/CT, CEUS with 99mTc-MIBI and/or SPECT/CT, US with CEUS and two other imaging modalities (99mTc-MIBI and/or SPECT/CT) was 98.59%, 100%, 95.77%, and 100%, respectively. CONCLUSIONS The combination of US with SPECT/CT is the best choice for the comprehensive preoperative localization of glands in refractory SHPT. CEUS can elevate the accuracy of US in differential diagnosis via the interpretation of dynamic microvascular features.
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Affiliation(s)
- XiuMei Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jun Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yong Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - HongQiao Wang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - JingRu Yang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - MaoPing Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - CaiYun Jiang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - ChunPing Ning
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Chou YC, Chan YC, Chi SY, Chou FF. Being elderly is not a contraindication of parathyroidectomy for renal hyperparathyroidism and chronic kidney disease-mineral and bone disorder. Asian J Surg 2020; 44:321-328. [PMID: 32891512 DOI: 10.1016/j.asjsur.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorder (CKD-MBD) has more influence in the elderly. Parathyroidectomy remains the golden standard for this situation but has tended to be excluded for older patients for many reasons. This study aimed to evaluate the efficacy and safety of the surgery in the elderly population. METHODS 156 patients were included and arranged into younger (≦65 years of age, n = 139) and elderly (>65 years of age, n = 17) groups. The change of bone mineral density (BMD) data, recovery potential {[(postoperative BMD) - (preoperative BMD)]/(preoperative BMD) ∗ 100%}, surgical successful rate and related complications were collected. RESULTS Both groups exhibited significant postoperative improvement on the BMD results. The recovery potential of the elderly was not lower than the younger group. High success rate and none of persistent vocal palsy, hypocalcemia or any sequela were also observed in the elderly. CONCLUSIONS Parathyroidectomy is an effective and safe intervention for the CKD-MBD in the elderly.
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Affiliation(s)
- Ya-Chen Chou
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Chia Chan
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Fong-Fu Chou
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Golingan H, Samuels SK, Camacho P, Dadhania DM, Pedraza-Taborda FE, Randolph G, Parangi S, Bimston DN, Harrell RM. MANAGEMENT OF HYPERPARATHYROIDISM IN KIDNEY TRANSPLANTATION CANDIDATES: A NEED FOR CONSENSUS. Endocr Pract 2019; 26:299-304. [PMID: 31682519 DOI: 10.4158/ep-2019-0392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the evolving standards of care for hyperparathyroidism in kidney transplant candidates. Methods: An 11-question, Institutional Review Board-approved survey was designed and reviewed by multiple institutions. The questionnaire was made available to the American Society of Transplantation's Kidney Pancreas Community of Practice membership via their online hub from April through July 2019. Results: Twenty percent (n = 41) of kidney transplant centers responded out of 202 programs in the United States. Forty-one percent (n = 17) of respondents believed medical literature supports the concept that a serum parathyroid hormone level greater than 800 pg/mL could endanger the survival of a transplanted kidney and therefore makes transplantation in an affected patient relatively or absolutely contraindicated. Sixty-six percent (n = 27) said they occasionally recommend parathyroidectomy for secondary hyperparathyroidism prior to transplantation, and 66% (n = 27) recommend parathyroidectomy after transplantation based on persistent, unsatisfactory posttransplantation parathyroid hormone levels. Forty-six percent (n = 19) prefer subtotal parathyroidectomy as their choice; 44% (n = 18) had no standard preference. Endocrine surgery and otolaryngology were the most common surgical specialties consulted to perform parathyroidectomy in kidney transplant candidates. The majority of respondents (71%, n = 29) do not involve endocrinologists in the management of kidney transplantation candidates. Conclusion: Our survey shows wide divergence of clinical practice in the area of surgical management of kidney transplantation candidates with hyperparathyroidism. We suggest that medical/surgical societies involved in the transplantation care spectrum convene a multidisciplinary group of experts to create a new section in the kidney transplantation guidelines addressing the collaborative management of parathyroid disease in transplantation candidates. Abbreviations: AACE = American Association of Clinical Endocrinologists; AAES = American Association of Endocrine Surgeons; AHNS = American Head and Neck Society; CKD = chronic kidney disease; CKD-MBD = chronic kidney disease-mineral and bone disorder; ESRD = end-stage renal disease; HPT = hyperparathyroidism; KDIGO = Kidney Disease Improving Global Outcomes; KT = kidney transplantation; KTC = kidney transplant candidate; PTH = parathyroid hormone; PTX = parathyroidectomy; US = ultrasonography.
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Assumpção LR, de Paula Ramos I, Nunes da Cunha G, de Mello Vianna CM, Araújo Maya MC, Araújo DV. Refractory secondary hyperparathyroidism in waiting list for parathyroidectomy: who we should operate first in a quaternary hospital in Brazil regarding survival. Ren Fail 2019; 41:183-189. [PMID: 30942649 PMCID: PMC6450528 DOI: 10.1080/0886022x.2019.1590210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Few centers in Brazil perform parathyroidectomy (PTX) for recalcitrant secondary hyperparathyroidism (SHPT) generating a long queue. There is little data regarding prioritize criteria besides chronological order and survival. OBJECTIVES To determine the difference of clinical and laboratory factors between PTX patients and those who remained in the line despite the need for surgery and their survival. METHODS A retrospective cohort study was conducted in a quaternary hospital in Brazil, where 43 patients with PTX indication due to severe SHPT were followed from 2009 to 2016. While 31 patients underwent PTX, 12 remained in the queue. Data on clinical and laboratory factors were collected for comparison and Kaplan-Meier and Cox regression survival analysis were used. RESULTS PTX group was younger (40.9 vs. 49.3 years, p = .03), had higher PTH levels (2578 vs. 1937 pg/ml, p = .01) and higher CaxP product (62 vs. 47.5, p = .02). There were no percentage differences between groups of fractures, calciphylaxis and other complications due to SHPT. Patients who were not operated had a worst overall survival (5 y 62.2% vs. 96.7%, p = .04) with a HR for death of 8.08 (p = .07, PTX as a TVC). Other variables associated with decreased survival included a history of previous myocardial infarction (HR: 10.4, p = .01) and age per additional year (HR: 1.09, p = .02). CONCLUSIONS Patients with severe SHPT are at increased risk of death while waiting for PTX. Clinical events like fracture were not used to prioritize patients beyond consecutive order. Therefore, optimizing priority criteria for PTX may result in improved survival in this population.
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Affiliation(s)
- Lia Roque Assumpção
- Department of Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Rio de Janeiro State University, Medical Sciences Post-Graduation Program, Rio de Janeiro, Brazil
| | | | - Gerson Nunes da Cunha
- Planning and Health Policy Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Denizar Vianna Araújo
- Rio de Janeiro State University, Medical Sciences Post-Graduation Program, Rio de Janeiro, Brazil
- Department of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Ko WC, Liu CL, Lee JJ, Liu TP, Wu CJ, Cheng SP. Osteocalcin is an Independent Predictor for Hungry Bone Syndrome After Parathyroidectomy. World J Surg 2019; 44:795-802. [DOI: 10.1007/s00268-019-05251-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Yuan Q, Liao Y, Zhou R, Liu J, Tang J, Wu G. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2019; 404:669-679. [PMID: 31377854 DOI: 10.1007/s00423-019-01809-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The optimal surgical approach of parathyroidectomy for patients with secondary hyperparathyroidism (SHPT) has been controversial. The updated meta-analysis aimed to compare the effectiveness of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation (TPTX + AT). METHODS A thorough systematic search was performed on the databases of PubMed, EMBASE, and Cochrane library to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the symptomatic improvement, radiological changes, hypocalcemia rate, the requirement for vitamin D analogues, time to recurrence, recurrence, persistence, and reoperation rates of SPTX versus TPTX + AT. RESULTS A total of 18 studies with 3656 patients (1864 patients in SPTX and 1792 patients in TPTX + AT group) were included, and 15 studies were included in quantitative synthesis. No significant difference was observed in symptomatic improvement (93.3%, 89.0%; P = 0.99), radiological changes (85.4%, 85.3%; P = 0.91), hypocalcemia rate (16.6%, 18.1%; P = 0.29), persistence rate (6.1%, 2.0%; P = 0.16), time to recurrence (mean difference 1.46; P = 0.87), recurrence rate (9.2%, 7.1%; P = 0.76), and reoperation rate (5.3%, 5.8%; P = 0.66) between SPTX and TPTX + AT groups. Longer operative time (150 vs. 120 min), prolonged in-hospital stay (5.0 vs. 4.1 days), lower 1-month serum calcium level, and higher requirement for vitamin D analogues at 12 months were significantly observed in patients who underwent TPTX + AT compared to SPTX. CONCLUSIONS The two surgical approaches were both effective at controlling SHPT in clinical and laboratory terms. However, most of the data shown were not statistically significant. It was acceptable that surgeons chose either SPTX or TPTX + AT for SHPT.
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jiuyang Liu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
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van der Plas WY, Noltes ME, van Ginhoven TM, Kruijff S. Secondary and Tertiary Hyperparathyroidism: A Narrative Review. Scand J Surg 2019; 109:271-278. [DOI: 10.1177/1457496919866015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
End-stage renal disease is often complicated by the occurrence of secondary and eventually tertiary hyperparathyroidism, characterized by increased parathormone, calcium, and phosphate concentrations. Related symptoms include pruritus and osteodynia, concentration difficulties, and feelings of depression may be present. In the long-term, end-stage renal disease patients with hyperparathyroidism have an increased risk of all-cause and cardiovascular mortality. Among treatment options are vitamin D supplements, phosphate binders, calcimimetics, and surgical parathyroidectomy. Determining the optimal treatment for the individual patient is challenging for nephrologists and endocrine surgeons. This review resumes the pathogenesis of hyperparathyroidism, clinical presentation, required diagnostic work-up, and discusses indications for the available treatment options for patients with secondary and tertiary hyperparathyroidism.
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Affiliation(s)
- W. Y. van der Plas
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. E. Noltes
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T. M. van Ginhoven
- Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - S. Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kakani E, Sloan D, Sawaya BP, El-Husseini A, Malluche HH, Rao M. Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient. Semin Dial 2019; 32:541-552. [PMID: 31313380 DOI: 10.1111/sdi.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Parathyroidectomy (PTX) remains an important intervention for dialysis patients with poorly controlled secondary hyperparathyroidism (SHPT), though there are only retrospective and observational data that show a mortality benefit to this procedure. Potential consequences that we seek to avoid after PTX include persistent or recurrent hyperparathyroidism, and parathyroid insufficiency. There is considerable subjectivity in defining and diagnosing these conditions, given that we poorly understand the optimal PTH targets (particularly post PTX) needed to maintain bone and vascular health. While lowering PTH after PTX decreases bone turnover, long-term changes in bone activity have been poorly explored. High turnover bone disease, usually present at the time a PTX is considered, often swings to a state of low turnover in the setting of sufficiently low PTH levels. It remains unclear if all low bone turnover equate with disease. However, such changes in bone turnover appear to predispose to vascular calcification, with positive calcium balance after PTX being a potential contributor. We know little of how the post-PTX state resets calcium balance, how calcium and VDRA requirements change or what kind of adjustments are needed to avoid calcium loading. The current consensus cautions against excessive reduction of PTH although there is insufficient evidence-based guidance regarding the management of chronic kidney disease - mineral bone disease (CKD-MBD) parameters in the post-PTX state. This article aims to compile existing research, provide an overview of current practice with regard to PTX and post-PTX chronic management. It highlights gaps and controversies and aims to re-orient the focus to clinically relevant contemporary priorities in CKD-MBD management after PTX.
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Affiliation(s)
- Elijah Kakani
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - David Sloan
- Division of Endocrine Surgery, University of Kentucky, Lexington, KY, USA
| | - B Peter Sawaya
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Hartmut H Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Madhumathi Rao
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
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Preda C, Branisteanu D, Armasu I, Danila R, Velicescu C, Ciobanu D, Covic A, Grigorovici A. Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics. BMC Surg 2019; 19:94. [PMID: 31311533 PMCID: PMC6636032 DOI: 10.1186/s12893-019-0556-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT). METHODS Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017. RESULTS Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients (p < 0.001) with respect to age (54.6 ± 13y versus 48.8 ± 12y), female-to-male ratio (8:1 versus ~ 1:1), surgical technique (single gland parathyroidectomy in 82.8% PHPT cases; versus subtotal parathyroidectomy in 85.7% SHPT cases) and presurgical PTH (357.51 ± 38.11 pg/ml versus 1020 ± 161.38 pg/ml). Morphopathological particularities, TNM classification and multifocality incidence of PTC were similar in the two groups. All PTC from patients with SHPT were thyroid microcarcinomas (TMC, i.e. tumors with a diameter smaller than 1 cm), whereas seven out of the 19 cases with PTC and PHPT were larger than 1 cm. CONCLUSIONS PTC was frequently and similarly associated with both PHPT and SHPT irrespective of presurgical PTH levels. Thyroid tumors above 1 cm were found only in patients with PHPT. Investigators should focus also on associated thyroid nodular pathology in patients with PHPT.
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Affiliation(s)
- Cristina Preda
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Dumitru Branisteanu
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.
| | - Ioana Armasu
- Department of Morphofunctional Sciences, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Radu Danila
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Cristian Velicescu
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Delia Ciobanu
- Faculty of Medicine, Department of Morphopathology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, Department of Nephrology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.,Academy of Romanian Scientists, Bucuresti, Romania
| | - Alexandru Grigorovici
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
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Management of Secondary Hyperparathyroidism in Chronic Kidney Disease: A Focus on the Elderly. Drugs Aging 2019; 36:885-895. [DOI: 10.1007/s40266-019-00696-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Susantitaphong P, Vadcharavivad S, Susomboon T, Singhan W, Dumrongpisutikul N, Jakchairoongruang K, Eiam-Ong S, Praditpornsilpa K. The effectiveness of cinacalcet: a randomized, open label study in chronic hemodialysis patients with severe secondary hyperparathyroidism. Ren Fail 2019; 41:326-333. [PMID: 31014177 PMCID: PMC6493313 DOI: 10.1080/0886022x.2018.1562356] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Secondary hyperparathyroidism (SHPT) is associated with high incidences of cardiovascular disease, bone fracture, and mortality. This study was conducted to demonstrate the effectiveness of cinacalcet treatment on chronic kidney disease-mineral bone disorder (CKD-MBD) markers in chronic hemodialysis patients with severe SHPT. Methods: In phase 1, 30 adult HD patients were randomized to cinacalcet or control groups for 12 weeks to explore the achievement of >30% reduction of iPTH. In phase 2, 45 patients were participated to further explore the effect of cinacalcet on CKD-MBD parameters for 24-week follow up and 12 additional weeks after cinacalcet discontinuation. Results: In phase 1, the baseline serum iPTH levels were not different [1374 (955, 1639) pg/mL in the control group vs. 1191 (1005, 1884) pg/mL in the cinacalcet group], the percentage of patients achieving iPTH target were significantly higher in the treatment group [80% vs. 13%, p = .001]. In phase 2, the significant reductions of iPTH, FGF-23, tartrate-resistant acid phosphatase 5b, and slightly decreased size of parathyroid gland and stabilized vascular calcification were observed at 24-week follow up and markedly rebounded after discontinuation of cinacalcet. Conclusions: The effectiveness of cinacalcet were still obviously demonstrated even in chronic HD patients with severe SHPT. In addition, the improvements of bone markers and FGF-23, and stabilization of vascular calcification were observed. Therefore, cinacalcet can provide salutary effects on CKD-MBD in severe SHPT and might be an initially effective PTH-lowering therapy prior to surgical parathyroidectomy as well as an alternative treatment in the patients unsuitable for surgery. Clinical trial registration: ClinicalTrials.gov: NCT02056730. Date of registration: February 4, 2014.
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Affiliation(s)
- Paweena Susantitaphong
- a Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok , Thailand
| | | | - Teerada Susomboon
- b Department of Pharmacy Practice , Chulalongkorn University , Bangkok , Thailand
| | - Wanchana Singhan
- b Department of Pharmacy Practice , Chulalongkorn University , Bangkok , Thailand
| | | | | | - Somchai Eiam-Ong
- a Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok , Thailand
| | - Kearkiat Praditpornsilpa
- a Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok , Thailand
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Taterra D, Wong LM, Vikse J, Sanna B, Pękala P, Walocha J, Cirocchi R, Tomaszewski K, Henry BM. The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery. Langenbecks Arch Surg 2019; 404:63-70. [PMID: 30762091 PMCID: PMC6394670 DOI: 10.1007/s00423-019-01751-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
Purpose The anatomy of parathyroid glands (PTG) is highly variable in the population. The aim of this study was to conduct a systematic analysis on the prevalence and location of PTG in healthy and hyperparathyroidism (HPT) patients. Methods An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the number of PTG per patient and location of PTG. The data was extracted from the eligible studies and pooled into a meta-analysis. Results The overall analysis of 26 studies (n = 7005 patients; n = 23,519 PTG) on the number of PTG showed that 81.4% (95% CI 65.4–85.8) of patients have four PTG. A total of 15.9% of PTG are present in ectopic locations, with 11.6% (95% CI 5.1–19.1) in the neck and 4.3% (95% CI 0.7–9.9) in mediastinum. The subgroup analysis of ectopic PTG showed that 51.7% of ectopic PTG in the neck are localized in retroesophageal/paraesophageal space or in the thyroid gland. No significant differences were observed between the healthy and HPT patients and cadaveric and intraoperative studies. Conclusions Knowledge regarding the prevalence, location, and anatomy of PTG is essential for surgeons planning for and carrying out parathyroidectomies, as any unidentified PTG, either supernumerary or in ectopic location, can result in unsuccessful treatment and need for reoperation. Electronic supplementary material The online version of this article (10.1007/s00423-019-01751-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Linda M Wong
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Beatrice Sanna
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Przemysław Pękala
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy
| | - Krzysztof Tomaszewski
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, 12 Kopernika St., 31-034, Kraków, Poland.
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Edmonston D, Morris JD, Middleton JP. Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4. Adv Chronic Kidney Dis 2018; 25:454-467. [PMID: 30309463 DOI: 10.1053/j.ackd.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 12/17/2022]
Abstract
Chronic diseases of the heart and of the kidneys commonly coexist in individuals. Certainly combined and persistent heart and kidney failure can arise from a common pathologic insult, for example, as a consequence of poorly controlled hypertension or of severe diffuse arterial disease. However, strong evidence is emerging to suggest that cross talk exists between the heart and the kidney. Independent processes are set in motion when kidney function is chronically diminished, and these processes can have distinct adverse effects on the heart. The complex chronic heart condition that results from chronic kidney disease (CKD) has been termed cardiorenal syndrome type 4. This review will include an updated description of the cardiac morphology in patients who have CKD, an overview of the most likely CKD-sourced culprits for these cardiac changes, and the potential therapeutic strategies to limit cardiac complications in patients who have CKD.
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Vangala C, Pan J, Cotton RT, Ramanathan V. Mineral and Bone Disorders After Kidney Transplantation. Front Med (Lausanne) 2018; 5:211. [PMID: 30109232 PMCID: PMC6079303 DOI: 10.3389/fmed.2018.00211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022] Open
Abstract
The risk of mineral and bone disorders among patients with chronic kidney disease is substantially elevated, owing largely to alterations in calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23. The interwoven relationship among these minerals and hormones results in maladaptive responses that are differentially affected by the process of kidney transplantation. Interpretation of conventional labs, imaging, and other fracture risk assessment tools are not standardized in the post-transplant setting. Post-transplant bone disease is not uniformly improved and considerable variation exists in monitoring and treatment practices. A spectrum of abnormalities such as hypophosphatemia, hypercalcemia, hyperparathyroidism, osteomalacia, osteopenia, and osteoporosis are commonly encountered in the post-transplant period. Thus, reducing fracture risk and other bone-related complications requires recognition of these abnormalities along with the risk incurred by concomitant immunosuppression use. As kidney transplant recipients continue to age, the drivers of bone disease vary throughout the post-transplant period among persistent hyperparathyroidism, de novo hyperparathyroidism, and osteoporosis. The use of anti-resorptive therapies require understanding of different options and the clinical scenarios that warrant their use. With limited studies underscoring clinical events such as fractures, expert understanding of MBD physiology, and surrogate marker interpretation is needed to determine ideal and individualized therapy.
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Affiliation(s)
- Chandan Vangala
- Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Jenny Pan
- Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Ronald T Cotton
- Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Venkat Ramanathan
- Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Abstract
We herein report on a nationwide survey conducted in Italy to investigate the use of parathyroidectomy (PTX). In spite of the availability of newer and more effective drugs to control chronic kidney disease mineral bone disorder (CKD-MBD) biochemical abnormalities, PTX still remains a resource for nephrologists to use. However, observational analyses suggest that in recent years there has been a constant decline in the number of patients undergoing PTX. The reasons are not clear, though the increasing age and number of comorbidities of dialysis patients may partly explain this trend. Poor adherence to guidelines and/or geographical as well as logistic factors may also contribute to the lower use of PTX. The working group on CKD-MBD of the Italian Society of Nephrology launched a nationwide survey to investigate clinical practice patterns for PTX in Italy and identify modifiable factors that may limit accessibility to surgery.
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