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Kulkarni P, Tucker J, King T, Goldenberg D. Symptomatic versus asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis. J Clin Transl Endocrinol 2023; 32:100317. [PMID: 37089759 PMCID: PMC10114222 DOI: 10.1016/j.jcte.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose Primary hyperparathyroidism (PHPT) is the underlying etiology for 90% of patients with hypercalcemia. PHPT patients have traditionally been characterized as being symptomatic or asymptomatic. However, we submit that even "asymptomatic" patients may still have clinical features, posing the idea of coining asymptomatic disease as a misnomer. This paper presents a systematic review and meta-analysis elucidating the differences between asymptomatic and symptomatic PHPT in the literature. Methods A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2012 to 2022. Inclusion criteria consisted of all studies comparing symptomatic and asymptomatic PHPT patients. Two reviewers independently evaluated the literature using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The level of evidence was determined using the Oxford Center for Level of Evidence-Based Medicine. Data were extracted, and a meta-analysis was performed. I2 index was employed for heterogeneity. Results There were 18 studies included, with a total of 4238 patients. The average age of patients included was 56.37, with 25.7% of the cohort being male. Several studies reported clinical features even for the "asymptomatic" group. Patients in the symptomatic group tended to have higher levels of PTH and calcium. The asymptomatic group had greater levels of vitamin D. There was observed heterogeneity between the studies. Conclusions More extreme PTH, calcium values, and low vitamin D levels were seen in patients with symptomatic disease. However, asymptomatic patients occasionally exhibited clinical features. Therefore, the terminology of "asymptomatic" disease is likely inappropriate for these patients.
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Collins RA, DiGennaro C, Beninato T, Gartland RM, Chaves N, Broekhuis JM, Reddy L, Lee J, Deimiller A, Alterio MM, Campbell MJ, Lee YJ, Khilnani TK, Stewart LA, O’Brien MA, Alvarado MVY, Zheng F, McAneny D, Liou R, McManus C, Dream SY, Wang TS, Yen TW, Alhefdhi A, Finnerty BM, Fahey TJ, Graves CE, Laird AM, Nehs MA, Drake FT, Lee JA, McHenry CR, James BC, Pasieka JL, Kuo JH, Lubitz CC. Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19. Surgery 2023; 173:93-100. [PMID: 36210185 PMCID: PMC9420726 DOI: 10.1016/j.surg.2022.06.043] [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: 02/28/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans. METHODS American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon. RESULTS Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ2 = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66). CONCLUSION Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
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Affiliation(s)
- Reagan A. Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Catherine DiGennaro
- Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jordan M. Broekhuis
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Lekha Reddy
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jenna Lee
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Maeve M. Alterio
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Latoya A. Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mollie A. O’Brien
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | | | - Feibi Zheng
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - David McAneny
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | - Rachel Liou
- Section of Endocrine Surgery, Columbia University, New York, NY
| | | | - Sophie Y. Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tracy S. Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Amal Alhefdhi
- Department of General Surgery, Breast and Endocrine Section, King Faisal Specialist Hospital and Research Centre, Al Mathar Ash Shamali, Riyadh, Saudi Arabia
| | - Brendan M. Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Thomas J. Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Amanda M. Laird
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Matthew A. Nehs
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - James A. Lee
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Christopher R. McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Benjamin C. James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Janice L. Pasieka
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer H. Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Carrie Cunningham Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA,Reprint requests: Carrie Cunningham Lubitz, MD, MPH, 55 Fruit Street, Boston, MA 02114
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Jaisinghani P, Sharma A, Wang X. Primary hyperparathyroidism in the geriatric population: A case report and mini literature review. Clin Case Rep 2022; 10:e6313. [PMID: 36408083 PMCID: PMC9669393 DOI: 10.1002/ccr3.6313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 93‐year‐old woman with PHPT secondary to a left inferior parathyroid adenoma. The patient met criteria to be a surgical candidate; however, literature about parathyroidectomy in the elderly was limited and controversial. The patient remained stable through medical management for the next 5 years. Diagnosis and management of PHPT in the geriatric population remains challenging. Although parathyroidectomy is the definitive treatment in the general population, medical management can be strongly considered in the geriatric population with PHPT.
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Affiliation(s)
- Priya Jaisinghani
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine New York University School of Medicine New Brunswick New Jersey USA
| | - Anupa Sharma
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine Rutgers University‐Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Xiangbang Wang
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine Rutgers University‐Robert Wood Johnson Medical School New Brunswick New Jersey USA
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Liu H, Luo K, Liao S, Tang H, Mo J, Xie T, Li C, Li B, Liu Y, Zhan X. Diagnosis and treatment of primary hyperparathyroidism with pathological fracture of the limbs: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29966. [PMID: 35984170 PMCID: PMC9388023 DOI: 10.1097/md.0000000000029966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) with pathological fracture is rare, and the early symptoms of PHPT lack specificity, leading to misdiagnosis. Therefore, this study aimed to summarize the clinical characteristics and treatment of PHPT patients with pathological fractures and to improve the attention of orthopedic clinicians to PHPT. It is a retrospective study, 2226 patients with hyperparathyroidism in our hospital from 2009 to 2019 were screened, excluding secondary hyperparathyroidism and patients without limb fracture, and the remaining 20 patients with PHPT accompanied by pathological fractures were finally analyzed. Parathyroid hormone (PTH) and calcium levels were compared on the first postoperative day, and the prognosis of the patients was assessed by bone mineral density and Visual Analogue Scale scores at 3 and 12 months postoperatively. The early symptoms of PHPT patients in this study included urinary calculi (80%), bone pain (30%), and digestive tract symptoms (25%). Fourteen (70%) cases were misdiagnosed at the initial diagnosis. After parathyroidectomy, the blood calcium and PTH levels decreased significantly in all patients (P < .05). For the treatment of fracture, 9 of the patients underwent surgical treatment of the fracture, while the remaining patients received splint external fixation. The follow-up time was 4.60 ± 0.62 years (1-10 years). All patients recovered well from the fracture, the symptoms of systemic bone pain were markedly improved, and bone mineral density was significantly improved after surgery. Orthopedic surgeons need to avoid misdiagnosis and pay attention to the early symptoms in PHPT patients with pathological fracture, and better therapeutic effects can be obtained by combining parathyroidectomy with fractures fixation.
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Affiliation(s)
- Huijiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Department of Orthopedics, The First People’s Hospital of Nanning, Nanning, China
| | - Kai Luo
- School of Basic Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Shijie Liao
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Haijun Tang
- Department of Orthopedics, The Minzu Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianming Mo
- Department of Orthopedics, The Minzu Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Tianyu Xie
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chong Li
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Boxiang Li
- Department of Orthopedics, The Minzu Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Liu
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * Correspondence: Xinli Zhan, PhD, Department of Orthopedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China (e-mail: ); Yun Liu, MD, Department of Orthopedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China (e-mail: )
| | - Xinli Zhan
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * Correspondence: Xinli Zhan, PhD, Department of Orthopedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China (e-mail: ); Yun Liu, MD, Department of Orthopedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China (e-mail: )
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Rojas AP, Fain K, Peiris AN. Resolution of hypercalcemia in primary hyperparathyroidism with vitamin D replacement. Proc (Bayl Univ Med Cent) 2020; 33:40-41. [PMID: 32063763 DOI: 10.1080/08998280.2019.1680060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022] Open
Abstract
Vitamin D deficiency is common in patients with primary hyperparathyroidism. We present a case of primary hyperparathyroidism with a positive parathyroid scan and history of nephrolithiasis. The patient had normal albumin and renal function but was vitamin D deficient. After treatment with vitamin D for 13 months, her parathyroid hormone values declined in parallel with the elevation in vitamin D. Although her total calcium normalized, her ionized calcium remained elevated throughout treatment. We believe vitamin D deficiency should be carefully monitored in primary hyperparathyroidism.
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Affiliation(s)
- Alexsandra P Rojas
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Kristen Fain
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Alan N Peiris
- Clinical Research Institute and Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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Horiuchi K, Yoshida Y, Okamoto T. Effects of surgery on the patient-reported outcomes of primary hyperparathyroidism patients with mild hypercalcemia without classic symptoms: a systematic review of the literature. Surg Today 2019; 50:650-656. [PMID: 31165923 DOI: 10.1007/s00595-019-01830-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To establish if parathyroidectomy is beneficial for patient-reported outcomes (PROs), including quality of life (QoL), of patients with mild hypercalcemia ( < 1.0 mg/dl above the upper limit of reference ranges) caused by primary hyperparathyroidism without classic symptoms (mild PHPT). METHODS We conducted a systematic review of the literature. Prospective studies were selected if PROs were measured before and after surgery and if the subpopulation of mild PHPT was clearly defined. Selected studies were appraised for their designs, PRO measures, and potential biases, as well as findings. Effect sizes were estimated to evaluate the extent of the benefits, if possible. RESULTS Four randomized controlled trials and six observational studies were included in this analysis. Seven studies used the SF-36 to measure QoL and the other three used different scales. Quantitative data on outcomes were provided in the four observational studies, but effect sizes could not be estimated. A placebo effect of surgery was discussed in five studies. Statistically significant improvements in PROs were observed in all studies, but the clinical importance of the changes was not discussed in detail. CONCLUSIONS The surgical treatment of mild PHPT may be associated with improved PROs, but the clinical significance of the changes is not yet confirmed.
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Affiliation(s)
- Kiyomi Horiuchi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Burneikis T, Colvin J, Jin J, Berber E, Krishnamurthy VD, Shin J, Siperstein A. Validation of a novel patient-reported outcome measure for parathyroid and thyroid disease (PROMPT). Surgery 2018; 165:232-239. [PMID: 30401480 DOI: 10.1016/j.surg.2018.04.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient-reported outcome measures are being used increasingly to assess disease severity and response to surgery. The purpose of this study was to create and validate a patient-reported outcome measure for symptoms of thyroid enlargement and hyperparathyroidism, 2 conditions where the presence of preoperative symptoms and response to surgery is often questioned. METHODS A questionnaire reviewing common symptoms was developed from a literature review and expert opinion. Internal validity, reliability, and initial responsiveness to surgery were evaluated. RESULTS Patient-Reported Outcome Measure for Parathyroid and Thyroid Disease (PROMPT) consists of 30 items: 10 compressive items and 20 hyperparathyroidism items; we evaluated 302 surveys collected over 10 months. PROMPT showed high internal consistency for compressive and hyperparathyroid constructs (Cronbach's α 0.84 and 0.95). Constructs were scored from 0-100, with greater scores corresponding to increased severity of symptoms. Preoperatively, patients with a goiter demonstrated greater compressive scores compared with other thyroid patients and hyperparathyroid patients (goiter, 47.5; nodule/other, 38.4; hyperparathyroid, 29.8; P < .0001). PROMPT demonstrated high test-retest reliability with acceptable intraclass correlation coefficients for both compressive score and hyperparathyroid score (0.840 and 0.646). Hyperparathyroid scores improved 2 weeks after (48.6 postop, 44.0 preop, P = .0470). CONCLUSION We validated a novel measure for symptoms of hyperparathyroidism and goiter. PROMPT demonstrates high internal consistency, test-retest reliability, and preliminary analysis, which suggests that it is sensitive to change after surgery.
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8
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Pappachan JM, Elnaggar MN, Sodi R, Jbeili K, Smith PR, Lahart IM. Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre. Endocrine 2018; 62:174-181. [PMID: 30019307 DOI: 10.1007/s12020-018-1676-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom. METHODS Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT. RESULTS The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5). CONCLUSIONS PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK.
| | - Mohamed Nabil Elnaggar
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
- Internal Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Ravinder Sodi
- Department of Biochemistry and Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Kahtan Jbeili
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Paul R Smith
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
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McDow AD, Sippel RS. Should Symptoms Be Considered an Indication for Parathyroidectomy in Primary Hyperparathyroidism? CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2018; 11:1179551418785135. [PMID: 30013413 PMCID: PMC6043916 DOI: 10.1177/1179551418785135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
Asymptomatic primary hyperparathyroidism is a very common endocrine condition, yet management of this disease process remains controversial. Primary hyperparathyroidism can lead to a myriad of symptoms which not only decreases the quality of life of patients but also increases the risk of cardiovascular disease, osteoporosis, and kidney stones. Parathyroidectomy is the only known cure for the disease. This review explores the definition of asymptomatic primary hyperparathyroidism, the burden of disease, and the overwhelming benefits of parathyroidectomy.
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Affiliation(s)
- Alexandria D McDow
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca S Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
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Huang DKR, Chou FF, Chi SY, Chan YC, Huang SC. Surgical management of primary hyperparathyroidism: A single-center experience. Asian J Surg 2017; 41:377-383. [PMID: 28689731 DOI: 10.1016/j.asjsur.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/25/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) can occur at any age. This study aimed to compare the necessity, feasibility, safety, and outcomes of parathyroidectomy in the management of minor-symptomatic or asymptomatic PHPT patients according to age (young vs. old). METHODS We retrospectively reviewed the medical records of 146 consecutive patients who underwent surgery for PHPT from January 2005 to June 2016 in our institution. The patients ranged in age from 12 to 85 years. For the analysis, the included patients (n = 137) were separated into young (age <50 years; n = 31, 22.6%) and old (age ≥50 years; n = 106, 77.4%) patients. The biochemical characteristics (parathyroid hormone, calcium, and creatinine levels), T-score of bone densitometry, surgical reports, pathology reports, perioperative intensive care unit care, and 30-day mortality were reviewed. RESULTS The average medical treatment course after diagnosis tended to be longer in the old group (33.3 vs. 26.2 weeks, p = 0.62). During the medical treatment course, the old group had a higher risk of developing new symptoms or severe complications (5.6% vs. 3.2%, p = 0.05), and the older patients seemed to have a longer postoperative hospitalization (p = 0.17). However, there were no significant differences in the 30-day mortality, immediate complications, and follow-up duration. CONCLUSION In older patients, surgical treatment of PHPT is safe and feasible, with comparable outcomes to in younger patients, and helps prevent the development or progression of symptoms and complication. Hence, parathyroidectomy should be the recommended treatment and should be performed in PHPT patients as early as possible, regardless their age and initial symptoms.
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Affiliation(s)
- David Kwan-Ru Huang
- Division of Cardiothoracic and Vascular Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Fong-Fu Chou
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan.
| | - Shun-Yu Chi
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Yi-Chia Chan
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Shun-Chen Huang
- Department of Pathology, Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
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11
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Shah-Becker S, Derr J, Oberman BS, Baker A, Saunders B, Carr MM, Goldenberg D. Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism. Laryngoscope 2017; 128:775-780. [DOI: 10.1002/lary.26617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/17/2017] [Accepted: 03/15/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Shivani Shah-Becker
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - Jonathan Derr
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - Benjamin S. Oberman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - Aaron Baker
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - Brian Saunders
- Division of General Surgery Specialties and Surgical Oncology, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - Michele M. Carr
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
| | - David Goldenberg
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania U.S.A
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"Silent" kidney stones in "asymptomatic" primary hyperparathyroidism-a comparison of multidetector computed tomography and ultrasound. Langenbecks Arch Surg 2016; 402:289-293. [PMID: 27734157 PMCID: PMC5346427 DOI: 10.1007/s00423-016-1520-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/02/2016] [Indexed: 12/02/2022]
Abstract
Purpose The purpose of this study was to demonstrate the high number of kidney stones in primary hyperparathyroidism (PHPT) and the low number of in fact “asymptomatic” patients. Methods Forty patients with PHPT (28 female, 12 male; median age 58 (range 33–80) years; interquartile range 17 years [51–68]) without known symptoms of kidney stones prospectively underwent multidetector computed tomography (MDCT) and ultrasound (US) examinations of the urinary tract prior to parathyroid surgery. Images were evaluated for the presence and absence of stones, as well as for the number of stones and sizes in the long axis. The MDCT and US examinations were interpreted by two experienced radiologists who were blinded to all clinical and biochemical data. Statistical analysis was performed using the Wilcoxon signed-rank test. Results US revealed a total of 4 kidney stones in 4 (10 %) of 40 patients (median size 6.5 mm, interquartile range 11.5 mm). MDCT showed a total of 41 stones (median size was 3 mm, interquartile range 2.25 mm) in 15 (38 %) of 40 patients. The number of kidney stones detected with MDCT was significantly higher compared to US (p = 0.00124). Conclusions MDCT is a highly sensitive method for the detection of “silent” kidney stones in patients with PHPT. By widely applying this method, the number of asymptomatic courses of PHPT may be substantially reduced. MDCT should be used primarily to detect kidney stones in PHPT and to exclude asymptomatic PHPT.
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Kim SM, Shu AD, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Declining Rates of Inpatient Parathyroidectomy for Primary Hyperparathyroidism in the US. PLoS One 2016; 11:e0161192. [PMID: 27529699 PMCID: PMC4986953 DOI: 10.1371/journal.pone.0161192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Aimee D. Shu
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jin Long
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mary B. Leonard
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jeffrey A. Norton
- Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Xue S, Chen H, Lv C, Shen X, Ding J, Liu J, Chen X. Preoperative diagnosis and prognosis in 40 Parathyroid Carcinoma Patients. Clin Endocrinol (Oxf) 2016; 85:29-36. [PMID: 26939543 DOI: 10.1111/cen.13055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/16/2016] [Accepted: 03/02/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Parathyroid carcinoma (PC) is a rare disease which is difficult to diagnose preoperatively and predict prognosis. The goal of this study was to analyse the preoperative predictive factors and prognostic factors in PC patients and to evaluate the possibility of diagnosing PC preoperatively. DESIGN, SETTING AND PATIENTS This is a retrospective study from Jan 2000 to Aug 2015 conducted in Shanghai Ruijin Hospital. MEASUREMENTS Comparisons were made between 40 parathyroid carcinoma patients and 282 patients with benign parathyroid lesions during the same period. All patients underwent parathyroid surgery, and the results were certified by paraffin pathology. Prognostic factors were analysed in the 40 PC patients. RESULTS Patients with higher levels of intact parathyroid hormone (P < 0·001, OR = 1·001, CI: 1·000-1·002), calcium (P = 0·008, OR = 3·395, CI: 1·382-8·341) and a larger parathyroid volume (P = 0·001, OR = 2·023, CI: 1·333-3·071) were more likely to have PC. Local excision (P = 0·008, OR = 4·992, CI: 1·533-16·252), stage III in the Schulte staging system (P = 0·039, OR = 9·600, CI: 1·12-82·322), high risk in the Schulte Risk Classification (P = 0·012, OR = 5·466, CI: 1·448-20·628) and first surgery by other medical teams (P = 0·008, OR = 4·992, CI: 1·496-15·037) were associated with PC recurrence. Calcium (P = 0·01, OR = 7·270, CI: 1·611-32·812), intact parathyroid hormone (P = 0·037, OR = 1·001, CI: 1·000-1·001), local excision (P = 0·009, OR = 6·875, CI: 1·633-28·936) and recurrence (P = 0·014, OR = 7·762, CI: 1·504-40·055) were associated with death. CONCLUSIONS A preoperative diagnostic system may provide a new method to distinguish PC from benign parathyroid lesions before surgery. For PC patients who did not undergo en-bloc resection at first operation, timely further surgery may offer a second chance of cure. Early diagnosis and surgery are pivotal to reduce mortality in PC patients.
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Affiliation(s)
- Song Xue
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haizhen Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chunhui Lv
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohui Shen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiazeng Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianmin Liu
- Shanghai Institute of Endocrinology and Metabolism, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xi Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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