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Salmon MK, Fritz CG, Barrette LX, Romeo D, Suresh NV, Ng JJ, Balar E, Prasad A, Moreira A, Rajasekaran K. Quality appraisal of clinical practice guidelines for the evaluation and management of primary hyperparathyroidism. Endocrine 2024; 85:864-872. [PMID: 38551756 PMCID: PMC11291579 DOI: 10.1007/s12020-024-03790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/17/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Multiple groups have created clinical practice guidelines (CPGs) for the management of primary hyperparathyroidism (PHPT). This report provides a rigorous quality assessment using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) to identify high-performing guidelines and areas for improvement. METHODS A systematic review was conducted to isolate CPGs addressing the management of PHPT. Guideline data was extracted and quality ratings were assigned by four independent reviewers. Intraclass correlation coefficients (ICC) were calculated to ensure interrater reliability. RESULTS Twelve guidelines were assessed. The American Association of Endocrine Surgeons (AAES) guideline had the highest mean scaled score across all domains (73.6 ± 31.4%). No other published guideline achieved a "high" quality designation. The highest scoring domain was "clarity of presentation" (mean 60.5 ± 26.5%). The lowest scoring domain was "applicability" (mean 19.8 ± 18.2%). Scoring reliability was excellent, with ICC ≥ 0.89 for all AGREE II 6 domains. CONCLUSION Although several working groups have developed guidelines to address PHPT management, only those published by the AAES meet all methodologic quality criteria necessary to ensure incorporation of recommendations into clinical practice. Future guidelines would benefit from the development of tools, resources, monitoring criteria that enhance applicability.
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Affiliation(s)
- Mandy K Salmon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Christian G Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Louis-Xavier Barrette
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Dominic Romeo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Neeraj V Suresh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jinggang J Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Eesha Balar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Aman Prasad
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Alalawi YF, Alrashidi TN, Alshahrani EH. Pancreatitis with Intraabdominal Venous Thrombosis as an Initial Presentation of Parathyroid Adenoma: A Rare Clinical Presentation. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943838. [PMID: 39049471 PMCID: PMC11299882 DOI: 10.12659/ajcr.943838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/23/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Benign parathyroid adenoma is a cause of hypercalcemia, which can lead to acute pancreatitis. Patients with acute pancreatitis are at risk for venous thrombosis. This report describes a 34-year-old woman with hypercalcemia due to parathyroid adenoma and acute pancreatitis associated with splenic vein and superior mesenteric vein thrombosis. CASE REPORT A previously healthy 34-year-old woman presented with severe epigastric pain that radiated to the back, associated with vomiting. Her abdominal examination was soft and lax, with epigastric and left upper quadrant tenderness. Pancreatitis with splenic and superior mesenteric veins thrombosis was diagnosed. The diagnosis was confirmed by an elevated serum lipase level and contrast-enhanced computed tomography (CT) of abdomen. Her serum calcium level was elevated. However, further workup revealed elevated parathyroid hormone (PTH) levels and radiological imaging showed parathyroid adenoma. She was diagnosed with hypercalcemia-induced pancreatitis secondary to hyperparathyroidism with intraabdominal venous thrombosis. The patient was initially treated conservatively, and later underwent parathyroidectomy after her condition was stabilized. The patient is currently in good condition, after a 2-year follow-up period. CONCLUSIONS Acute pancreatitis and thrombosis secondary to primary hyperparathyroidism (PHPT) are rare, but can lead to potentially fatal complications, especially in patients without symptoms of PHPT. This report highlights the importance of recognizing that hypercalcemia associated with parathyroid adenoma can result in acute pancreatitis, leading to hypercoagulable states and inflammation of adjacent vessels, including the splenic and mesenteric veins. To the best of our knowledge, this is second case report of acute pancreatitis with intraabdominal venous thrombosis secondary to PHPT.
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Affiliation(s)
- Yousef F. Alalawi
- Department of Breast and Endocrine Surgery, King Salman Armed Forces Hospital in North-Western Region, Tabuk, Saudi Arabia
| | - Tahani N. Alrashidi
- Department of General Surgery, King Salman Armed Forces Hospital in North-Western Region, Tabuk, Saudi Arabia
| | - Eid H. Alshahrani
- Department of Otorhinolaryngology, Head and Neck Surgery (ORL-HNS), King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia
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Gheorghe AM, Ciobica ML, Nistor C, Gurzun MM, Sandulescu BA, Stanciu M, Popa FL, Carsote M. Inquiry of the Metabolic Traits in Relationship with Daily Magnesium Intake: Focus on Type 2 Diabetic Population. Clin Pract 2024; 14:1319-1347. [PMID: 39051301 PMCID: PMC11270223 DOI: 10.3390/clinpract14040107] [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: 06/01/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
Magnesium (Mg), an essential nutrient with a wide area of physiological roles, stands as a cofactor in over 600 enzymatic reactions involved in the synthesis of proteins and nucleic acids, DNA repair, neuromuscular functions, neuronal transmission, cardiac rhythm regulation, and the modulation of metabolic pathways, as well as acting as a natural blocker for the calcium channels. Our objective was to highlight the most recent clinical data with respect to daily Mg intake (DMI) and metabolic traits, particularly type 2 diabetes mellitus (DM). This was a PubMed-based review of the English-language medical papers across different key terms of search; the time frame was from January 2019 until April 2024. We included (clinically relevant) original studies and excluded cases reports, series, reviews, editorials, opinion, experimental studies, and non-human data as well as studies that did not specifically assessed DMI and only provided assays of serum Mg, studies on patients diagnosed with type 1 or secondary DM. A total of 30 studies were included and we organized the key findings into several sections as follows. Studies investigating DMI in relationship with the adherence to local recommendations in diabetic subjects (n = 2, one transversal and another retrospective cohort; N = 2823) found that most of them had lower DMI. Deficient DMI was correlated with the risk of developing/having DM across five studies (n = 5, one prospective and four of cross-sectional design; N = 47,166). An inverse correlation between DMI and DM prevalence was identified, but these data are presented amid a rather heterogeneous spectrum. Four novel studies (N = 7279) analysed the relationship between DMI and DM control according to various methods (HbA1c, fasting and postprandial glycaemia, and insulin); the association may be linear in diabetic subjects only at certain levels of DMI; additionally, the multifactorial influence on HBA1c should take into consideration this dietary determinant, as well, but there are no homogenous results. Three studies concerning DMI and diabetic complications (one cross-sectional, one prospective, and another case-control study) in terms of retinopathy (n = 1, N = 3794) and nephropathy (n = 2, N = 4805) suggested a lower DMI was associated with a higher risk of such complications. Additionally, two other studies (one prospective and one retrospective cohort) focused on mortality (N = 6744), which, taking only certain mortality indicators into consideration, might be decreased in the subgroups with a higher DMI. Seven studies (N = 30,610) analysed the perspective of DMI in the general population with the endpoint of different features amid glucose profile, particularly, insulin resistance. Concerning HOMA-IR, there were three confirmatory studies and one non-confirmatory, while fasting plasma glucose was highlighted as inversely correlated with a DMI (n = 1). The highest level of evidence regarding Mg supplementation effects on glucose metabolism stands on seven randomised controlled trials (N = 350). However, the sample size was reduced (from 14 to 86 individuals per study, either diabetic or pre-diabetic) and outcomes were rather discordant. These clinical aspects are essential from a multidisciplinary perspective and further trials are mandatory to address the current areas of discordant results.
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Affiliation(s)
- Ana-Maria Gheorghe
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (B.-A.S.)
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania;
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Maria-Magdalena Gurzun
- Cardiology Discipline, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Laboratory of Non-Invasive Cardiovascular Exploration, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Bianca-Andreea Sandulescu
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (B.-A.S.)
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Mara Carsote
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania;
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Xu Q, La T, Ye K, Wang L, Wang S, Hu Y, Teng L, Yan L, Li J, Zhang Z, Shao Z, Zhang YY, Zhao XH, Feng YC, Jin L, Baker M, Thorne RF, Zhang XD, Shao F, Cao H. KMT2A and chronic inflammation as potential drivers of sporadic parathyroid adenoma. Clin Transl Med 2024; 14:e1734. [PMID: 38888967 PMCID: PMC11185127 DOI: 10.1002/ctm2.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Sporadic parathyroid adenoma (PA) is the most common cause of hyperparathyroidism, yet the mechanisms involved in its pathogenesis remain incompletely understood. METHODS Surgically removed PA samples, along with normal parathyroid gland (PG) tissues that were incidentally dissected during total thyroidectomy, were analysed using single-cell RNA-sequencing with the 10× Genomics Chromium Droplet platform and Cell Ranger software. Gene set variation analysis was conducted to characterise hallmark pathway gene signatures, and single-cell regulatory network inference and clustering were utilised to analyse transcription factor regulons. Immunohistochemistry and immunofluorescence were performed to validate cellular components of PA tissues. siRNA knockdown and gene overexpression, alongside quantitative polymerase chain reaction, Western blotting and cell proliferation assays, were conducted for functional investigations. RESULTS There was a pervasive increase in gene transcription in PA cells (PACs) compared with PG cells. This is associated with high expression of histone-lysine N-methyltransferase 2A (KMT2A). High KMT2A levels potentially contribute to promoting PAC proliferation through upregulation of the proto-oncogene CCND2, which is mediated by the transcription factors signal transducer and activator of transcription 3 (STAT3) and GATA binding protein 3 (GATA3). PA tissues are heavily infiltrated with myeloid cells, while fibroblasts, endothelial cells and macrophages in PA tissues are commonly enriched with proinflammatory gene signatures relative to their counterparts in PG tissues. CONCLUSIONS We revealed the previously underappreciated involvement of the KMT2A‒STAT3/GATA3‒CCND2 axis and chronic inflammation in the pathogenesis of PA. These findings underscore the therapeutic promise of KMT2A inhibition and anti-inflammatory strategies, highlighting the need for future investigations to translate these molecular insights into practical applications. HIGHLIGHTS Single-cell RNA-sequencing reveals a transcriptome catalogue comparing sporadic parathyroid adenomas (PAs) with normal parathyroid glands. PA cells show a pervasive increase in gene expression linked to KMT2A upregulation. KMT2A-mediated STAT3 and GATA3 upregulation is key to promoting PA cell proliferation via cyclin D2. PAs exhibit a proinflammatory microenvironment, suggesting a potential role of chronic inflammation in PA pathogenesis.
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Affiliation(s)
- Qin Xu
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
| | - Ting La
- National‐Local Joint Engineering Research Center of Biodiagnosis & BiotherapyThe Second Affiliated HospitalXi'an Jiaotong UniversityXi'anChina
| | - Kaihong Ye
- Translational Research InstituteHenan Provincial and Zhengzhou City Key Laboratory of Non‐Coding RNA and Cancer MetabolismHenan International Join Laboratory of Non‐Coding RNA and Metabolism in CancerZhengzhou University People's Hospital and Henan Provincial People's HospitalAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina
| | - Li Wang
- School of Basic Medical SciencesZhengzhou UniversityZhengzhouChina
| | - Shasha Wang
- Department of NephrologyXinxiang Medical UniversityXinxiangChina
| | - Yifeng Hu
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
| | - Liu Teng
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
| | - Lei Yan
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
| | - Jinming Li
- Translational Research InstituteHenan Provincial and Zhengzhou City Key Laboratory of Non‐Coding RNA and Cancer MetabolismHenan International Join Laboratory of Non‐Coding RNA and Metabolism in CancerZhengzhou University People's Hospital and Henan Provincial People's HospitalAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina
| | - Zhenhua Zhang
- Department of Thyroid SurgeryHenan Provincial People's HospitalZhengzhou University People's HospitalZhengzhouChina
| | - Zehua Shao
- Children's Heart CenterHenan Provincial People's HospitalZhengzhou University People's HospitalZhengzhouChina
| | - Yuan Yuan Zhang
- School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanNew South WalesAustralia
| | - Xiao Hong Zhao
- School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanNew South WalesAustralia
| | - Yu Chen Feng
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Lei Jin
- Translational Research InstituteHenan Provincial and Zhengzhou City Key Laboratory of Non‐Coding RNA and Cancer MetabolismHenan International Join Laboratory of Non‐Coding RNA and Metabolism in CancerZhengzhou University People's Hospital and Henan Provincial People's HospitalAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Mark Baker
- School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanNew South WalesAustralia
| | - Rick F. Thorne
- Translational Research InstituteHenan Provincial and Zhengzhou City Key Laboratory of Non‐Coding RNA and Cancer MetabolismHenan International Join Laboratory of Non‐Coding RNA and Metabolism in CancerZhengzhou University People's Hospital and Henan Provincial People's HospitalAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina
- School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanNew South WalesAustralia
| | - Xu Dong Zhang
- Translational Research InstituteHenan Provincial and Zhengzhou City Key Laboratory of Non‐Coding RNA and Cancer MetabolismHenan International Join Laboratory of Non‐Coding RNA and Metabolism in CancerZhengzhou University People's Hospital and Henan Provincial People's HospitalAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina
- School of Biomedical Sciences and PharmacyThe University of NewcastleCallaghanNew South WalesAustralia
| | - Feng‐Min Shao
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
| | - Huixia Cao
- Department of Nephrology, Henan Key Laboratory of Kidney Disease and Immunology of Zhengzhou University People's HospitalZhengzhou University People's Hospital ,Henan Provincial People's HospitalZhengzhouChina
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Bhadada SK, Ghosh J, Pal R, Mukherjee S. Phosphate: An underrated component of primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2024; 38:101837. [PMID: 37926613 DOI: 10.1016/j.beem.2023.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Primary hyperparathyroidism (PHPT) is a systemic disease that affects all the systems of the body, specifically the bones and the kidneys. Its main action is on calcium homeostasis. It tries to preserve the body's calcium level at the cost of phosphate. The criteria for surgery in asymptomatic PHPT patients revolve around raised serum calcium levels, renal dysfunction or nephrolithiasis, and bone health. It does not take into account the serum phosphate levels. Depending on the serum level, Hypophosphatemia is divided into mild, moderate, and severe categories. In PHPT, several studies have suggested that asymptomatic PHPT patients with moderate hypophosphatemia may warrant surgical intervention. Treatment of hypophosphatemia in PHPT is based upon the degree of hypophosphatemia, and treatment is given according to that oral or intravenous route; after surgical and medical treatment of PHPT, phosphate levels gradually normalized. But even after these considerations, phosphate levels in PHPT are not given much importance.
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Affiliation(s)
| | | | - Rimesh Pal
- Department of Endocrinology, PGIMER, Chandigarh, India.
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Antignani PL, Jezovnik MK, Blinc A, Mikhailidis DP, Anagnostis P, Schernthaner GH, Jensterle M, Studen KB, Sabovic M, Poredos P. Hyperparathyroidism and Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:88-94. [PMID: 38284694 DOI: 10.2174/0115701611280905231227045826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
Primary hyperparathyroidism (PHPT) is presented in various forms, including classic PHPT, characterised by increased parathyroid hormone (PTH) secretion, normohormonal PHPT, and normocalcaemic PHPT. Secondary hyperparathyroidism is characterised by increased PTH secretion triggered by factors such as vitamin D deficiency and kidney failure. This review aims to discuss the involvement of hyperparathyroidism (HPT) in atherosclerosis, including peripheral arterial disease (PAD). The increased level of PTH is involved in developing subclinical and overt vascular diseases, encompassing endothelial dysfunction, vascular stiffness, hypertension, and coronary and peripheral arterial diseases. It has been consistently associated with an augmented risk of cardiovascular morbidity and mortality, independent of classical risk factors for atherosclerosis. Chronic hypercalcemia associated with increased levels of PTH contributes to the development of calcification of vessel walls and atherosclerotic plaques. Vascular calcification can occur in the intima or media of the arterial wall and is associated with stiffness of peripheral arteries, which the formation of atherosclerotic plaques and narrowing of the vessel lumen can follow. For treating hyperparathyroidism, particularly SHPT, calcimimetics, novel phosphorus binders and novel vitamin D receptor activators are used. However, they are ineffective in severe PHPT. Therefore, parathyroidectomy remains the primary therapeutic option of PHPT.
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Affiliation(s)
| | - Mateja K Jezovnik
- Department of Advanced, Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ales Blinc
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Dimitri P Mikhailidis
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, UK
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical, School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mojca Jensterle
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Katica Bajuk Studen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Miso Sabovic
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
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7
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Dong Z, Li Y, Wang X, Tian H. A Case of TKA Failure in Patient with Primary Hyperparathyroidism. Orthop Surg 2023; 15:3006-3011. [PMID: 37749766 PMCID: PMC10622282 DOI: 10.1111/os.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is an endocrine disorder with high serum calcium and parathyroid hormone (PTH) levels. Excessive secretion of PTH can cause bone loss and may have potential damage to implant fixation after total knee arthroplasty (TKA). However, there is currently no research or literature reporting prosthesis loosening after TKA associated with PHPT. CASE PRESENTATION This case report describes a TKA failure of tibial prothesis loosening associated with PHPT. The patient faced aggravated pain and difficulty in walking 6 months after the primary TKA. Further examinations showed high serum calcium and PTH levels indicating the presence of PHPT. After the surgery of parathyroidectomy, the patient received revision TKA with 3D-printed metaphyseal cone. Knee symptoms and function were finally improved. CONCLUSION PHPT is a risk factor for prosthesis loosening after TKA. Preoperative screening test of serum calcium and PTH levels is important to diagnose PHPT. For patients with PHPT undergoing TKA, preoperative endocrinotherapy and parathyroidectomy are recommended to improve the survival of prosthesis.
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Affiliation(s)
- Ziyang Dong
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Yang Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Xinguang Wang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
| | - Hua Tian
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of EducationBeijingChina
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8
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Carsote M, Nistor C, Stanciu M, Popa FL, Cipaian RC, Popa-Velea O. Neuroendocrine Parathyroid Tumors: Quality of Life in Patients with Primary Hyperparathyroidism. Biomedicines 2023; 11:2059. [PMID: 37509698 PMCID: PMC10377520 DOI: 10.3390/biomedicines11072059] [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: 06/03/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Tumors of the parathyroid glands, when associated with PTH (parathyroid hormone) excess, display a large area of complications; in addition to the classical clinical picture of primary hyperparathyroidism (PHP), a complex panel of other symptoms/signs can be identified, including memory and cognitive impairment, chronic asthenia/fatigue, reduced muscle functionality, depressive mood, non-specific bone pain, and loss of sleep quality. The perception of quality of life (QoL) can be supplementarily enhanced by their progressive onset, which makes many patients not be fully aware of them. Their improvement was reported very early after parathyroidectomy (PTx), yet the level of statistical evidence does not qualify these non-classical elements as standalone indications for PTx. Our objective is introducing an up-to-date on QoL scores with regards to the patients diagnosed with PHP, particularly taking into consideration PHP management from baseline to post-operatory outcome, including in cases with multiple endocrine neoplasia. This is a narrative review of literature. We revised full-length papers published in English through PubMed research conducted between January 2018 and May 2023 by using the key words "quality of life" and "primary hyperparathyroidism". We particularly looked at data on self-reported QoL (through questionnaires). We excluded from the search the studies focused on non-PTH related hypercalcemia, secondary, and/or renal/tertiary hyperparathyroidism, and vitamin D supplementation. Overall, we identified 76 papers and selected for the final analysis 16 original studies on QoL and PHP (a total of 1327 subjects diagnosed with syndromic and non-syndromic PHP). The studies with the largest number of individuals were of 92, 104, 110, 134, 159, as well as 191. A few cohorts (n = 5) were of small size (between 20 and 40 patients in each of them). Concerning the study design, except for 2 papers, all the mentioned studies provided longitudinal information, particularly the timeframe from baseline (before PTx) and after surgery. The post-operatory follow-up was of 3-6 months, but mostly between 1 and 3 years (maximum a decade of surveillance). The age of the patients varies between medians of 56, 62, 64, and 68 years. Most frequent questionnaires were SF-36, PHPQoL, and PAS. Despite not being unanimously similar, an overall reduced score of QoL in patients with PHP versus controls was registered, as well as general improvement following PTx. Variations of QoL results might have a multifactorial background from different comorbidities, studied populations, technical aspects of collecting the data, etc. QoL scores in PHP represents a complex heterogeneous picture, from their correlation with clinical features and lab assays (e.g., the level of serum calcium), the associated comorbidities (such as multiple endocrine neoplasia syndromes), up to the assessment of the QoL improvement after parathyroidectomy (PTx). While current studies do not unanimously agree on each QoL domain, the assessment of QoL might represent a supplementary argument to consider when deciding for PTx, especially in asymptomatic cases and in patients who do not fit into well-known categories of surgery candidates, according to current guidelines, thus assessing QoL in PHP is part of a current research gap. QoL evaluation in PHP remains an open issue, towards which awareness should be cultivated by both endocrinologists and surgeons. The introduction of a routine evaluation of the QoL scores in patients, as well as the selection of the most appropriate questionnaire(s), represents an open chapter thus awareness in mandatory.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 050474 Bucharest, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy & Dr. Carol Davila Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Remus Calin Cipaian
- Department of Internal Medicine, Academic Emergency Hospital of Sibiu, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550245 Sibiu, Romania
| | - Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Kuo YS, Tsai YM. Exploring the Risk Factors and Possible Role of Calcium in Infective Endocarditis. Diagnostics (Basel) 2023; 13:2386. [PMID: 37510130 PMCID: PMC10378623 DOI: 10.3390/diagnostics13142386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/25/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Infective endocarditis (IE) is a severe and potentially life-threatening infection that affects the endocardium, the inner lining of the heart chambers and valves. Although rare, it is a potentially fatal condition, with an incidence of 3-10 cases per 100,000 people per year in developed countries and a mortality rate of up to 30% within 30 days. Early identification and diagnosis are critical for improving outcomes. The diagnosis of IE typically involves a combination of biomarkers, blood cultures, and echocardiography. However, currently, there are no specific biomarkers for the early detection of IE. Given the lack of specific biomarkers for IE, serum calcium levels have been suggested to play a unique role in IE. There have been few articles on the correlation between serum calcium and IE, suggesting that patients with endocarditis and lower levels of serum calcium may have a poorer prognosis. Therefore, in this article, we focus on biomarkers of endocarditis and discuss the evidence showing serum calcium as a potential indicator of IE.
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Affiliation(s)
- Yen-Shou Kuo
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Yuan-Ming Tsai
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
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10
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Li X, Lu Y, Zhang L, Song A, Zhang H, Pang B, Liu J, Sun X, Ji H, Huang L, Yang M. Primary and secondary hyperparathyroidism present different expressions of calcium-sensing receptor. BMC Surg 2023; 23:31. [PMID: 36755240 PMCID: PMC9906946 DOI: 10.1186/s12893-023-01928-5] [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: 02/08/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Decreased calcium-sensing receptor (CaSR) has been observed in hyperparathyroidism (HPT) without a known mechanism. The purpose of this study was to evaluate the expression of CaSR in primary (PHPT) and secondary (SHPT) subtypes. METHODS Immunohistochemical (IHC) staining and quantitative real-time PCR (qRT-PCR) assay were used to measure the differences in expression of CaSR protein and gene in PHPT and SHPT human samples, compared to matched controls. RESULTS CaSR protein was differentially downregulated in SHPT and PHPT compared to normal parathyroid tissues (2.42 ± 0.5 vs. 3.2 ± 0.62, P < 0.05; 1.8 ± 0.83 vs. 3.2 ± 0.62, P < 0.05, respectively). Furthermore, SHPT tissues exhibited significantly higher levels of CaSR mRNA (0.29 ± 0.23 vs. 0.01 ± 0.12, P < 0.05) and protein (2.42 ± 0.5 vs. 1.8 ± 0.83, P < 0.05) than those in PHPT tissue samples. CONCLUSION Depressed CaSR expression was a critical pathological hallmark of HPT. We found a differential decline of CaSR, in terms of both mRNA and protein levels, in PHPT and SHPT human samples. We think that CaSR dysregulation occurred at the very beginning of disease onset in PHPT, while a similar pathological scenario appeared at the later stage of SHPT. Future studies should be directed to dissect the mechanistic involvement of CaSR in PHPT and SHPT in order to bring treatment precisions in HPT management.
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Affiliation(s)
- Xin Li
- grid.415954.80000 0004 1771 3349Institute of Clinical Medicine Research, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Yao Lu
- grid.415954.80000 0004 1771 3349Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Ling Zhang
- grid.415954.80000 0004 1771 3349Center of Nephrology, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Aiping Song
- grid.415954.80000 0004 1771 3349Department of Pathology, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Honglei Zhang
- grid.415954.80000 0004 1771 3349Department of Pathology, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Bo Pang
- grid.508381.70000 0004 0647 272XState Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC 155, Changbai Road, Changping, Beijing, 102206 China
| | - Jun Liu
- grid.415954.80000 0004 1771 3349Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Xiaoliang Sun
- grid.415954.80000 0004 1771 3349Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Haoyang Ji
- grid.415954.80000 0004 1771 3349Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Linping Huang
- grid.415954.80000 0004 1771 3349Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Meng Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.
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Seyedinia SS, Mirshahvalad SA, Schweighofer-Zwink G, Hehenwarter L, Rendl G, Pirich C, Beheshti M. Evolving Role of [ 18F]Flurocholine PET/CT in Assessing Primary Hyperparathyroidism: Can It Be Considered the First-Line Functional Imaging Approach? J Clin Med 2023; 12:jcm12030812. [PMID: 36769460 PMCID: PMC9917644 DOI: 10.3390/jcm12030812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The accurate detection of hyperfunctioning parathyroid tissue (HFPT) is pivotal in the preoperative assessment of primary hyperparathyroidism (PHPT). PET/CT using [18F]fluorocholine ([18F]FCH) showed superior diagnostic performance compared to conventional functional imaging modalities. We aimed to evaluate the diagnostic performance of [18F]FCH PET/CT as a first-line functional imaging approach in patients with clinically diagnosed PHPT. The imaging and clinical data of 321 PHPT patients, including 271 overt PHPT and 50 mild PHPT, who underwent [18F]FCH PET/CT as first-line imaging were analysed in this retrospective study. Histopathology was the reference standard. In case of no available histopathology evaluation (conservative management), imaging and clinical follow-ups were considered reference standards. In the overt group (n = 271), [18F]FCH PET/CT showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 0.99, 0.91, 1.00, 0.80, and 0.99, respectively. Regarding the correlation of the index lesions and initial laboratory data, all [18F]FCH PET/CT parameters (SUVs, SULs, and mSAD) were significantly correlated with the serum iPTH level. Additionally, SUVmax, SULpeak, and mSAD were significantly associated with the serum calcium level. In the mild group (n = 50), [18F]FCH PET/CT showed a sensitivity, specificity, PPV, NPV, and accuracy of 0.93, 0.75, 0.95, 0.67, and 0.90. In conclusion, [18F]FCH PET/CT revealed high diagnostic performance in the detection of HFPTs and the potential to be considered as a first-line imaging modality in the assessment of PHPT, including both overt and mild types. However, its cost-benefit concerning the clinical impact of early PHPT detection should be investigated in future studies.
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Affiliation(s)
- Seyedeh Sara Seyedinia
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON M5G 2M2, Canada
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-(0)5-7255-26602
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12
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Johnson PJ, Townsend KS. Primary hyperparathyroidism in horses: What can we learn from human medicine? EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Philip J. Johnson
- Veterinary Health Center University of Missouri Columbia Missouri USA
| | - Kile S. Townsend
- Veterinary Health Center University of Missouri Columbia Missouri USA
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13
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Rajput S, Dutta A, Rajender S, Mithal A, Chattopadhyay N. Efficacy of antiresorptive agents bisphosphonates and denosumab in mitigating hypercalcemia and bone loss in primary hyperparathyroidism: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1098841. [PMID: 36817591 PMCID: PMC9931892 DOI: 10.3389/fendo.2023.1098841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) is characterized by increased bone remodeling and hypercalcemia. Parathyroidectomy (PTX), the current standard of care, is recommended in all symptomatic and some groups of asymptomatic patients. Anti-resorptive therapies (bisphosphonates and denosumab) have been used in patients where PTX is refused or contraindicated. In this meta-analysis, we investigated the effectiveness of anti-resorptives in preventing/treating PHPT-induced bone loss and mitigating hypercalcemia. METHOD PubMed, Scopus, and Cochrane Library databases were searched for articles with keywords containing PHPT, bisphosphonates, and denosumab in various combinations. We extracted and tabulated areal BMD (aBMD), serum mineral, and bone turnover parameters from the qualified studies and used comprehensive meta-analysis software for analysis. RESULTS Of the 1,914 articles screened, 13 were eligible for meta-analysis. In the pooled analysis, 12 months of anti-resoptives (bisphosphonates and denosumab) therapy significantly increased aBMD at the lumbar spine (Standard difference in means (SDM)=0.447, 95% CI=0.230 to 0.664, p=0.0001), femoral neck (SDM=0.270, 95% CI=0.049 to 0.491, p=0.017) and increased serum PTH (SDM=0.489, 95% CI=0.139 to 0.839, p=0.006), and decreased serum calcium (SDM=-0.545, 95% CI=-0.937 to -0.154, p=0.006) compared with baseline. 12 months of bisphosphonate use significantly increased aBMD only at the lumbar spine (SDM=0.330, 95% CI=0.088 to 0.571, p=0.007) with a significant increased in serum PTH levels (SDM=0.546, 95% CI= 0.162 to 0.930, p=0.005), and a decreased in serum calcium (SDM=-0.608, 95% CI=-1.048 to -0.169, p=0.007) and bone-turnover markers (BTMs) compared with baseline. Denosumab use for 12 months significantly increased aBMD at both the lumbar spine (SDM=0.828, 95% CI=0.378 to 1.278, p=0.0001) and femur neck (SDM=0.575, 95% CI=0.135 to 1.015, p=0.010) compared with baseline. Mean lumbar spine aBMD (SDM=0.350, 95% CI=0.041 to 0.659, p=0.027) and serum PTH (SDM=0.602, 95% CI= 0.145 to 1.059, p=0.010) were significantly increased after 12 months of alendronate use compared with placebo. When compared with baseline, alendronate significantly decreased BTMs after 12 months and increased aBMD without altering the PTH and calcium levels after 24 months. CONCLUSION Anti-resorptives are effective in mitigating bone loss and hypercalcemia in PHPT while maintaining or increasing aBMD. PTX reversed all changes in PHPT and normalized PTH levels.
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Affiliation(s)
- Swati Rajput
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), CSIR-Central Drug Research Institute, Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Aditya Dutta
- Institute of Endocrinology and Diabetes, Max Healthcare, Institutional Area, Press Enclave Road, Saket, New Delhi, India
| | - Singh Rajender
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), CSIR-Central Drug Research Institute, Lucknow, India
| | - Ambrish Mithal
- Institute of Endocrinology and Diabetes, Max Healthcare, Institutional Area, Press Enclave Road, Saket, New Delhi, India
- *Correspondence: Ambrish Mithal, ; Naibedya Chattopadhyay,
| | - Naibedya Chattopadhyay
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), CSIR-Central Drug Research Institute, Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- *Correspondence: Ambrish Mithal, ; Naibedya Chattopadhyay,
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Ramalingam AK, Nellaiappar P, Hussain Z, Parvathy NA, Venkatesh NS. Sciatica masquerading parathyroid carcinoma. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2023. [DOI: 10.4103/ijam.ijam_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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15
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Oueslati I, Kardi A, Yazidi M, Abidi S, Chaker F, Mellassi S, Chihaoui M. Management of severe hypercalcaemia secondary to primary hyperparathyroidism: The efficacy of saline hydration, furosemide, and zoledronic acid. Endocrinol Diabetes Metab 2022; 5:e380. [PMID: 36195995 PMCID: PMC9659652 DOI: 10.1002/edm2.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/13/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Severe hypercalcaemia is a life-threatening condition that should be managed urgently. The aim of this study was to assess the efficacy of saline hydration, furosemide, and zoledronic acid in the management of severe hypercalcaemia secondary to primary hyperparathyroidism (PHPT). METHODS We conducted a retrospective analysis of the management of 65 patients with severe hypercalcaemia (≥3 mmol/L) secondary to PHPT. The efficacy of each therapeutic agent was evaluated according to the variation in serum calcium level calculated as Δ calcium = initial calcium level - minimal calcium level reached after the administration of each agent. RESULTS The mean age of patients was 56.4 ± 13.8 years. At baseline, the mean total serum calcium level was 3.42 ± 0.40 mmol/L. After normal saline hydration, calcium level decreased from 3.25 ± 0.21 to 2.98 ± 0.2 mmol/L (p < 10-3 ) in 3.1 ± 1.7 days. Normalization of calcium level did not occur in any patient. Furosemide was prescribed in 35 patients. It resulted in a serum calcium increase of 0.09 ± 0.21 mmol/L. Calcium levels did not reach the normal range in any patient. Forty-five patients received intravenous zoledronic acid. The mean maximal reduction in serum calcium level was 0.57 ± 0.27 mmol/L (from 3.25 ± 0.26 mmol/L to 2.68 ± 0.22 mmol/L, p-value <10-3 ). Normalization of calcium levels occurred in 27 patients (60%). CONCLUSIONS Our results show the absence of a significant additional effect of furosemide on calcium levels in patients with severe hypercalcaemia secondary to PHPT when compared with the effect of saline hydration alone. However, zoledronic acid was more potent. Thus, appropriate normal saline hydration with immediate intravenous bisphosphonates infusion should be considered in the management of severe hypercalcaemia in patients with PHPT.
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Affiliation(s)
- Ibtissem Oueslati
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Asma Kardi
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Meriem Yazidi
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Sahar Abidi
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Fatma Chaker
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Seifeddine Mellassi
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
| | - Melika Chihaoui
- Department of endocrinology, Faculty of Medicine, La Rabta University HospitalUniversity of Tunis‐El ManarTunisTunisia
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16
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Матюшкина АС, Горбачева АМ, Ткачук АВ, Еремкина АК, Мокрышева НГ. [Case of clinically "aggressive" course of primary hyperparathyroidism, algorithm of differential diagnosis]. PROBLEMY ENDOKRINOLOGII 2022; 68:59-66. [PMID: 36689712 PMCID: PMC9939965 DOI: 10.14341/probl13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
Primary hyperparathyroidism (PHPT) is a significant endocrine disease caused by increased production of parathyroid hormone (PTH) by altered parathyroid glands and violation of the mechanisms of regulation of serum calcium concentrations. These changes can lead to nephrolithiasis, osteoporosis, erosive and ulcerative lesions of the gastrointestinal tract, a number of less specific symptoms (nausea, vomiting, weakness, fatigue, etc.). Etiologically, in more than 85% of cases, PHPT is a consequence of sporadic solitary adenoma or hyperplasia parathyroid glands, however, in 1-3% of cases, the cause is carcinoma of parathyroid glands , including as part of various genetic syndromes. The importance of timely examination for PHPT of patients with characteristic clinical manifestations of this disease and - with an aggressive course - alertness towards carcinomas of parathyroid glands was noted. At the same time, the severity of the clinical picture and even the presence of suspicious signs characteristic of hereditary forms of carcinomas of parathyroid glands are not always a consequence of the malignant process. We present a description of a young patient with a severe course of PHPT, multiple fractures and a voluminous tumor of the upper jaw, developed as a result of a typical adenoma of parathyroid glands. Additionally, the algorithm of pre- and postoperative differential diagnosis for such patients is highlighted.
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Affiliation(s)
- А. С. Матюшкина
- Национальный медицинский исследовательский центр эндокринологии
| | - А. М. Горбачева
- Национальный медицинский исследовательский центр эндокринологии
| | - А. В. Ткачук
- Национальный медицинский исследовательский центр эндокринологии
| | - А. К. Еремкина
- Национальный медицинский исследовательский центр эндокринологии
| | - Н. Г. Мокрышева
- Национальный медицинский исследовательский центр эндокринологии
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Radulova-Mauersberger O, Keßler J, Keßler U, Stange K, Korn S, Weitz J, Bork U. The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone. J Clin Med 2022; 11:jcm11072015. [PMID: 35407623 PMCID: PMC9000147 DOI: 10.3390/jcm11072015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cinacalcet is a calcimimetic drug that has increasingly been used as a bridging therapy for primary hyperparathyroidism (pHPT), especially during the COVID-19 pandemic. The aim of our study was to investigate if preoperative cinacalcet therapy affects intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy, which is an important indicator for the success of surgery. Methods: In this single-center retrospective analysis, we studied the outcomes of 72 patients who underwent surgery for pHPT. We evaluated two groups: those with cinacalcet therapy before operation—the cinacalcet group (CG)—and those without medical therapy preoperatively (non-CG). In order to perform a between-group comparison of time trends, we fit a linear mixed-effects model with PTH as the response variable and predictors PTH levels preoperatively, group (cinacalcet yes/no), time, the group-by-time interaction, and a random intercept (per subject). Results: Our cohort included 51 (71%) women and 21 (29%) men, who were operated upon for pHPT in the period from January 2018 until August 2021. All patients were diagnosed with pHPT and 54% of the cohort were symptomatic for hypercalcemia. Moreover, 30% of the patients were treated with cinacalcet as a bridging therapy preoperatively, and this increased during the COVID-19 pandemic, as 64% of this group were treated in the last two years. Calcium values were significantly different before (p < 0.001) and after (p = 0.0089) surgery, but calcium level change did not differ significantly between the CG and non-CG. Parathyroid hormone (PTH) levels dropped significantly in both groups during 10 min IOPTH monitoring (p < 0.001), but there was no significant difference between the two groups (p = 0.212). Conclusions: In the examined patient cohort, the use of cinacalcet did not affect the value of IOPTH monitoring during surgery for pHPT.
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Affiliation(s)
- Olga Radulova-Mauersberger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (O.R.-M.); (J.K.); (S.K.); (J.W.)
| | - Julia Keßler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (O.R.-M.); (J.K.); (S.K.); (J.W.)
| | - Ulrich Keßler
- Departments of Surgery and Endocrinology, Oberlausitz-Kliniken gGmbH and MVZ, 02625 Bautzen, Germany; (U.K.); (K.S.)
| | - Katrin Stange
- Departments of Surgery and Endocrinology, Oberlausitz-Kliniken gGmbH and MVZ, 02625 Bautzen, Germany; (U.K.); (K.S.)
| | - Sandra Korn
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (O.R.-M.); (J.K.); (S.K.); (J.W.)
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (O.R.-M.); (J.K.); (S.K.); (J.W.)
- National Center for Tumor Diseases (NCT/UCC), German Cancer Research Center (DKFZ), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf (HZDR), 01307 Dresden, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (O.R.-M.); (J.K.); (S.K.); (J.W.)
- Correspondence: ; Tel.: +49-351-458-4098
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Bernardor J, Flammier S, Salles JP, Amouroux C, Castanet M, Lienhardt A, Martinerie L, Damgov I, Linglart A, Bacchetta J. Off-label use of cinacalcet in pediatric primary hyperparathyroidism: A French multicenter experience. Front Pediatr 2022; 10:926986. [PMID: 36090548 PMCID: PMC9449487 DOI: 10.3389/fped.2022.926986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cinacalcet is a calcimimetic approved in adults with primary hyperparathyroidism (PHPT). Few cases reports described its use in pediatric HPT, with challenges related to the risk of hypocalcemia, increased QT interval and drug interactions. In this study, we report the French experience in this setting. METHODS We retrospectively analyzed data from 18 pediatric patients from 7 tertiary centers who received cinacalcet for PHPT. The results are presented as median (interquartile range). RESULTS At a median age of 10.8 (2.0-14.4) years, 18 patients received cinacalcet for primary HPT (N = 13 inactive CASR mutation, N = 1 CDC73 mutation, N = 1 multiple endocrine neoplasia type 1, N=3 unknown etiology). Cinacalcet was introduced at an estimated glomerular filtration rate (eGFR) of 120 (111-130) mL/min/1.73 m2, plasma calcium of 3.04 (2.96-3.14) mmol/L, plasma phosphate of 1.1 (1.0-1.3) mmol/L, age-standardized (z score) phosphate of -3.0 (-3.5;-1.9), total ALP of 212 (164-245) UI/L, 25-OHD of 37 (20-46) ng/L, age-standardized (z score) ALP of -2.4 (-3.7;-1.4), PTH of 75 (59-123) ng/L corresponding to 1.2 (1.0-2.3)-time the upper limit for normal (ULN). The starting daily dose of cinacalcet was 0.7 (0.6-1.0) mg/kg, with a maximum dose of 1.0 (0.9-1.4) mg/kg per day. With a follow-up of 2.2 (1.3-4.3) years on cinacalcet therapy, PTH and calcium significantly decreased to 37 (34-54) ng/L, corresponding to 0.8 (0.5-0.8) ULN (p = 0.01), and 2.66 (2.55-2.90) mmol/L (p = 0.002), respectively. In contrast, eGFR, 25-OHD, ALP and phosphate and urinary calcium levels remained stable. Nephrocalcinosis was not reported but one patient displayed nephrolithiasis. Cinacalcet was progressively withdrawn in three patients; no side effects were reported. CONCLUSIONS Cinacalcet in pediatric HPT can control hypercalcemia and PTH without significant side effects.
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Affiliation(s)
- Julie Bernardor
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron, France.,INSERM UMR S1033 Research Unit, Lyon, France.,Service de Néphrologie Pédiatrique, CHU de Nice, Hôpital Archet, Nice, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Sacha Flammier
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron, France
| | - Jean-Pierre Salles
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Unité d'Endocrinologie, Génétique et Pathologies Osseuses, Filières Santé Maladies Rares OSCAR et BOND, Hôpital des Enfants, Toulouse, France
| | - Cyril Amouroux
- Service d'Endrocrinologie et Néphrologie Pédiatrique, Filière de Santé Maladies Rares OSCAR, Hôpital Arnaud de Villeneuve - CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Mireille Castanet
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Département de Pédiatrie, Filière Santé Maladies Rares OSCAR, CHU Rouen, Rouen, France
| | | | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Ivan Damgov
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.,Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Agnès Linglart
- AP-HP, Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre Paris Saclay, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, AP-HP, Service d'endocrinologie et diabète de l'enfant, Service de médecine des adolescents, Hôpital de Bicêtre Paris Saclay, INSERM U1185, Le Kremlin-Bicêtre, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron, France.,INSERM UMR S1033 Research Unit, Lyon, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
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Zhou Y, Chu X, Jiang D, Wu X, Xu J, Qi H, Tang Y, Dai Y. Development and validation of a nomogram for risk prediction of nephrolithiasis recurrence in patients with primary hyperparathyroidism. Front Endocrinol (Lausanne) 2022; 13:947497. [PMID: 36120445 PMCID: PMC9470877 DOI: 10.3389/fendo.2022.947497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis is a common complication of primary hyperparathyroidism (PHPT), and the recurrence of nephrolithiasis in patients with PHPT is also an urgent concern. What is worse, there is a scarcity of recommended evaluation to predict the risk of nephrolithiasis recurrence in patients with PHPT. This study was aimed to develop and validate a nomogram to facilitate risk assessment in patients with PHPT. METHODS A total of 197 patients with PHPT were retrospectively included in this study from September 2016 to August 2021. Patients' demographic data, blood test parameters, urinalysis, stone parameters, and surgical intervention were collected. Extracted variables were submitted to a least absolute shrinkage and selection operator (LASSO) regression model. A nomogram was built and validated according to the area under the curve (AUC) value, calibration curve, and decision curve analysis. RESULTS According to the LASSO regression and logistic regression analyses, five predictors were derived from 22 variables: creatinine, uric acid, bilateral stone, multiplicity, and surgery. The AUC and concordance index of the training cohort and validation cohort were 0.829 and 0.856, and 0.827 and 0.877, respectively. The calibration curve analysis and the decision curve analysis showed that the nomogram had an adequate prediction accuracy. CONCLUSION We built a useful nomogram model to predict the risk of nephrolithiasis recurrence in patients with PHPT. This would assist clinicians to provide appropriate advices and managements for these patients.
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Affiliation(s)
- Yihong Zhou
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xi Chu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Dong Jiang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang Wu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jiarong Xu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hao Qi
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuxin Tang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
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Aurilia C, Donati S, Palmini G, Miglietta F, Falsetti I, Iantomasi T, Brandi ML. Are Non-Coding RNAs Useful Biomarkers in Parathyroid Tumorigenesis? Int J Mol Sci 2021; 22:ijms221910465. [PMID: 34638805 PMCID: PMC8508841 DOI: 10.3390/ijms221910465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
Tumors of the parathyroid glands are common endocrine diseases almost always characterized by parathyroid hormone hypersecretion that determines the clinical manifestations of primary hyperparathyroidism, such as fatigue, kidney problems, weakness, brittle bones, and other symptoms. Most parathyroid neoplasia are benign adenomas, although rare malignant forms have been described. They are heterogeneous in terms of clinical presentation and the associated signs and symptoms overlap with those of disease and aging. Furthermore, most patients with hypercalcemia are discovered during routine blood tests for other reasons. Surgical removal is considered the main therapeutic option to cure these endocrine tumors and, therefore, innovative therapeutic approaches are actively required. Recently, a growing number of studies have suggested that alterations to the epigenetic mechanisms could play a pivotal role in parathyroid tumorigenesis. Most of the attention has been focused on non-coding RNAs (ncRNAs) (i.e., miRNAs, lncRNAs, and circRNAs) whose expression profile has been found to be deregulated in parathyroid tumors. The aim of the present paper is to give an insight into the ncRNAs involved in parathyroid tumorigenesis, which could be used in the future either as innovative diagnostic biomarkers or as therapeutic targets for the treatment of this endocrine neoplasia.
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Affiliation(s)
- Cinzia Aurilia
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Simone Donati
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Gaia Palmini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Francesca Miglietta
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Irene Falsetti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Teresa Iantomasi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (C.A.); (S.D.); (G.P.); (F.M.); (I.F.); (T.I.)
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO Onlus), 50141 Florence, Italy
- Correspondence:
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21
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Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management. J Clin Med 2021; 10:jcm10132956. [PMID: 34209340 PMCID: PMC8268799 DOI: 10.3390/jcm10132956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications.
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