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Goncu B. Identification of suitable reference genes for RT-qPCR studies in human parathyroid tissue glandular cells. Gene 2024; 912:148380. [PMID: 38490511 DOI: 10.1016/j.gene.2024.148380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024]
Abstract
Identifying a proper reference gene allows us to understand fundamental changes in many biological processes. Normalization during gene expression analyses is essential for every tissue/cell type, including parathyroid tissue glandular cells. Quantitative method of gene expression analyses via qRT-PCR method provides the accurate examination of every target gene. There are limited reports to present commonly used reference genes in human parathyroid tissues rather than for glandular cell types. This study aims to determine and compare the most stable to least stable genes for parathyroid tissue cells. 43 human parathyroid tissue obtained from primary and secondary hyperparathyroidism patients and glandular cells isolated enzymatically by the removal of extracellular matrix components. After extraction of the total RNA, cDNA synthesis was performed, then qRT-PCR evaluated 14 candidate reference genes. Stability was determined by RefFinder software (Delta ct, BestKeeper, Genorm, and NormFinder algorithms), and the outcome was evaluated for five groups. Even if assessed with different groups, the most stable genes were RPLP0 and GAPDH, while the CLTC and RNA 18S were the least stable. We have confirmed the comprehensive ranking of the most stable three genes alone with the NormFinder algorithm to understand intergroup variation and found out that RPLP0>GAPDH>PGK1. Lastly, comparisons of relative target gene (GCM2) expression revealed similar expression patterns for the most stable reference genes. The most stable reference gene is recommended for the stages where stability is evaluated using the results of four different approaches using RefFinder. We aspire for this study to assist future research to conduct thorough assessments of appropriate reference genes before engaging in gene expression analyses for parathyroid tissue.
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Affiliation(s)
- Beyza Goncu
- Bezmialem Vakif University, Vocational School of Health Services, Department of Medical Services and Techniques, Istanbul, Turkiye; Bezmialem Vakif University Hospital, Organ Transplantation Center, Parathyroid Transplantation Unit, Istanbul, Turkiye.
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2
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Chehrehgosha H, Chegini H, Heydari I, Ebrahiminik H, Salouti R, Golzarian J. Radiofrequency Ablation of Parathyroid Adenoma: Results of a Retrospective Analysis of 60 Patients. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03725-w. [PMID: 38641669 DOI: 10.1007/s00270-024-03725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To present the effectiveness and safety of radiofrequency ablation (RFA) in parathyroid adenoma (PTA). MATERIALS AND METHODS In this retrospective study, 60 patients with a single PTA were evaluated for changes in biochemical and ultrasonographic features up to 6 months after RFA of the lesion. Adenomas were ablated with an alternative technique so called "Nik jet dissection" which incorporates full hydrodissection and polar artery coagulation. Complications as well as the variations in biochemical data and nodule volumes were analyzed between baseline measurements and at each follow-up interval data (first day, 1, 3, and 6 months after ablation) were analyzed. RESULTS A significant reduction in serum intact parathyroid hormone and calcium levels was observed 6 months after ablation, with a mean difference of - 83.4 ± 104.1 pg/mL, p < 0.001, and - 0.29 ± 0.22 mmol/L, p < 0.001, respectively. Serum phosphorus levels increased significantly with a mean difference of 0.09 ± 0.19 mmol/L, p = 0.040 at the end of the follow up. We observed a significant volume reduction rate of parathyroid adenomas with 89 ± 20.8 percent, p < 0.001. Also, 51% of adenomas disappeared at the end of the follow up. In this study, two cases of hematoma and one case of transient hoarseness (grade 1 of the CIRSE classification) were encountered. CONCLUSION Our study showed that RFA with the alternative technique, called "Nik jet dissection" is a safe and effective modality in management of PTA. Therefore, we suggest expanding the indications for RFA in PTA management, especially when surgery is not feasible. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Haleh Chehrehgosha
- Hazrat Rasool Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | | | - Iraj Heydari
- Endocrinology Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation, Sciences Research Center, AJA University of Medical Sciences, Etemadzadeh St, West Fatemi St, Tehran, Tehran Province, 11366, Islamic Republic of Iran.
| | | | - Jafar Golzarian
- Radiology and Vascular Imaging, Amplatz Chair in Interventional Radiology, University of Minnesota, Minneapolis, USA
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Geng C, Liu J, Guo B, Liu K, Gong P, Wang B, Wan Q, Sun L, Zhao J, Song Y. High lymphocyte signature genes expression in parathyroid endocrine cells and its downregulation linked to tumorigenesis. EBioMedicine 2024; 102:105053. [PMID: 38471398 PMCID: PMC10945207 DOI: 10.1016/j.ebiom.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND To date, because of the difficulty in obtaining normal parathyroid gland samples in human or in animal models, our understanding of this last-discovered organ remains limited. METHODS In the present study, we performed a single-cell transcriptome analysis of six normal parathyroid and eight parathyroid adenoma samples using 10 × Genomics platform. FINDINGS We have provided a detailed expression atlas of parathyroid endocrine cells. Interestingly, we found an exceptional high expression levels of CD4 and CD226 in parathyroid endocrine cells, which were even higher than those in lymphocytes. This unusual expression of lymphocyte markers in parathyroid endocrine cells was associated with the depletion of CD4 T cells in normal parathyroid glands. Moreover, CD4 and CD226 expression in endocrine cells was significantly decreased in parathyroid adenomas, which was associated with a significant increase in Treg counts. Finally, along the developmental trajectory, we discovered the loss of POMC, ART5, and CES1 expression as the earliest signature of parathyroid hyperplasia. INTERPRETATION We propose that the loss of CD4 and CD226 expression in parathyroid endocrine cells, coupled with an elevated number of Treg cells, could be linked to the pathogenesis of parathyroid adenoma. Our data also offer valuable information for understanding the noncanonical function of CD4 molecule. FUNDING This work was supported by the National Key R&D Program of China (2022YFA0806100), National Natural Science Foundation of China (82130025, 82270922, 31970636, 32211530422), Shandong Provincial Natural Science Foundation of China (ZR2020ZD14), Innovation Team of Jinan (2021GXRC048) and the Outstanding University Driven by Talents Program and Academic Promotion Program of Shandong First Medical University (2019LJ007).
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Affiliation(s)
- Chong Geng
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China
| | - Junjun Liu
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong First Medical University, No.105 Jiefang Road, Jinan, Shandong 250013, China; Shandong Institute of Endocrine and Metabolic Diseases, Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China
| | - Bingzhou Guo
- College of Artificial Intelligence and Big Data for Medical Sciences, Shandong First Medical University, No.6699 Qingdao Road Jinan, Shandong 250021, China
| | - Kailin Liu
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China
| | - Pengfei Gong
- College of Artificial Intelligence and Big Data for Medical Sciences, Shandong First Medical University, No.6699 Qingdao Road Jinan, Shandong 250021, China
| | - Bao Wang
- Shandong Institute of Endocrine and Metabolic Diseases, Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China
| | - Qiang Wan
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong First Medical University, No.105 Jiefang Road, Jinan, Shandong 250013, China.
| | - Liang Sun
- College of Artificial Intelligence and Big Data for Medical Sciences, Shandong First Medical University, No.6699 Qingdao Road Jinan, Shandong 250021, China.
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, No.324 Jingwu Road, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, No.324 Jingwu Road, Jinan, Shandong 250021, China.
| | - Yongfeng Song
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong First Medical University, No.105 Jiefang Road, Jinan, Shandong 250013, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, No.324 Jingwu Road, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, No.324 Jingwu Road, Jinan, Shandong 250021, China.
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Wang R, McMullin JL, Allahwasaya A, Akhund R, Fazendin J, Lindeman B, Chen H, Gillis A. Feasibility of an Online Patient-Driven International Parathyroid Registry. J Surg Res 2024; 296:217-222. [PMID: 38286100 DOI: 10.1016/j.jss.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Traditional parathyroid registries are labor-intensive and do not always capture long-term follow-up data. This study aimed to develop a patient-driven international parathyroid registry and leverage community connections to improve patient-centered care for hyperparathyroidism. METHODS An anonymous voluntary online survey was developed using Qualtrics and posted in an international patient and advocate-run social media group affiliated with over 11,700 members. The survey was developed from a literature review, expert opinion, and discussion with the social media group managers. It consists of seven sections: patient demographics, past medical history, preoperative symptoms, laboratory evaluation, preoperative imaging studies, operative findings, and operative outcomes. RESULTS From July 30, 2022, to October 1, 2022, 89 complete responses were received. Participants were from 12 countries, mostly (82.0%) from the United States across 31 states. Most participants were female (91.4%), White (96.7%) with a mean (±standard deviation) age of 58 ± 12 y. The most common preoperative symptoms were bone or joint pain (84.3%) and neuropsychiatric symptoms: including fatigue (82.0%), brain fog (79.8%), memory loss (79.8%), and difficulty with concentration (75.3%). The median (interquartile range) length from symptom onset to diagnosis was 40.0 (6.8-100.5) mo. Seventy-one percent of participants had elevated preoperative serum calcium, and 73.2% had elevated preoperative parathyroid hormone. All participants obtained preoperative imaging studies (88.4% ultrasound, 86.0% sestabimi scan, and 45.3% computed tomography). Among them, 48.8% of participants received two, and 34.9% had three imaging studies. The median (interquartile range) time from diagnosis to surgical intervention was 3 (2-9) mo. Twenty-two percent of participants traveled to different cities for surgical intervention. Forty-seven percent of participants underwent outpatient parathyroidectomy. Eighty-four percent of participants reported improved symptoms after parathyroidectomy, 12.4% required oral calcium supplementation for more than 6 mo, 32.6% experienced transient hoarseness after parathyroidectomy, and 14.6% required reoperation after initial parathyroidectomy. CONCLUSIONS This international online parathyroid registry provides a valuable collection of patient-entered clinical outcomes. The high number of responses over 10 wk demonstrates that participants were willing to be involved in research on their disease. The creation of this registry allows global participation and is feasible for future studies in hyperparathyroidism.
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Affiliation(s)
- Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Jessica Liu McMullin
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Ashba Allahwasaya
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
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Kubat Öktem E, Yazar M, Aysan E, Karabıyık Acar Ö. Computational drug repurposing for primary hyper parathyroidism. Mol Cell Endocrinol 2024; 583:112159. [PMID: 38228226 DOI: 10.1016/j.mce.2024.112159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024]
Abstract
In hyperparathyroidism (hyperPTH), excessive amounts of PTH are secreted, interfering with calcium regulation in the body. Several drugs can control the disease's side effects, but none of them is an alternative treatment to surgery. Therefore, new drug candidates are necessary. In this study, three computationally repositioned drugs, DG 041, IMD 0354, and cucurbitacin I, are evaluated in an in vitro model of hyperPTH. First, we integrated publicly available transcriptomics datasets to propose drug candidates. Using 3D spheroids derived from a single primary hyperPTH patient, we assessed their in vitro efficacy. None of the proposed drugs affected the viability of healthy cell control (HEK293) or overactive parathyroid cells at the level of toxicity. This behavior was attributed to the non-cancerous nature of the parathyroid cells, establishing the hyperPTH disease model. Cucurbitacin I and IMD 0354 exhibited a slight inverse relationship between increased drug concentrations and cell viability, whereas DG 041 increased viability. Based on these results, further studies are needed on the mechanism of action of the repurposed drugs, including determining the effects of these drugs on cellular PTH synthesis and secretion and on the metabolic pathways that regulate PTH secretion.
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Affiliation(s)
- Elif Kubat Öktem
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Istanbul Medeniyet University, 34700, Istanbul, Turkey
| | - Metin Yazar
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, Istanbul Okan University, 34959, Istanbul, Turkey
| | - Erhan Aysan
- Department of General Surgery, Faculty of Medicine, Yeditepe University, 34718, Istanbul, Turkey
| | - Özge Karabıyık Acar
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, Istanbul Okan University, 34959, Istanbul, Turkey.
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Kong SH, Bae JM, Kim JH, Kim SW, Han D, Shin CS. Protein Signatures of Parathyroid Adenoma according to Tumor Volume and Functionality. Endocrinol Metab (Seoul) 2024:EnM.2023.1827. [PMID: 38509667 DOI: 10.3803/enm.2023.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/21/2023] [Indexed: 03/22/2024] Open
Abstract
Background Parathyroid adenoma (PA) is a common endocrine disease linked to multiple complications, but the pathophysiology of the disease remains incompletely understood. The study aimed to identify the key regulator proteins and pathways of PA according to functionality and volume through quantitative proteomic analyses. Methods We conducted a retrospective study of 15 formalin-fixed, paraffin-embedded PA samples from tertiary hospitals in South Korea. Proteins were extracted, digested, and the resulting peptides were analyzed using liquid chromatography-tandem mass spectrometry. Pearson correlation analysis was employed to identify proteins significantly correlated with clinical variables. Canonical pathways and transcription factors were analyzed using Ingenuity Pathway Analysis. Results The median age of the participants was 52 years, and 60.0% were female. Among the 8,153 protein groups analyzed, 496 showed significant positive correlations with adenoma volume, while 431 proteins were significantly correlated with parathyroid hormone (PTH) levels. The proteins SLC12A9, LGALS3, and CARM1 were positively correlated with adenoma volume, while HSP90AB2P, HLA-DRA, and SCD5 showed negative correlations. DCPS, IRF2BPL, and FAM98A were the main proteins that exhibited positive correlations with PTH levels, and SLITRK4, LAP3, and AP4E1 had negative correlations. Canonical pathway analysis demonstrated that the RAN and sirtuin signaling pathways were positively correlated with both PTH levels and adenoma volume, while epithelial adherence junction pathways had negative correlations. Conclusion Our study identified pivotal proteins and pathways associated with PA, offering potential therapeutic targets. These findings accentuate the importance of proteomics in understanding disease pathophysiology and the need for further research.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dohyun Han
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Abstract
Primary hyperparathyroidism (PHPT), a relatively common disorder characterized by hypercalcemia with raised or inappropriately normal serum parathyroid hormone (PTH) concentrations, may occur as part of a hereditary syndromic disorder or as a non-syndromic disease. The associated syndromic disorders include multiple endocrine neoplasia types 1-5 (MEN1-5) and hyperparathyroidism with jaw tumor (HPT-JT) syndromes, and the non-syndromic forms include familial hypocalciuric hypercalcemia types 1-3 (FHH1-3), familial isolated hyperparathyroidism (FIHP), and neonatal severe hyperparathyroidism (NS-HPT). Such hereditary forms may occur in > 10% of patients with PHPT, and their recognition is important for implementation of gene-specific screening protocols and investigations for other associated tumors. Syndromic PHPT tends to be multifocal and multiglandular with most patients requiring parathyroidectomy with the aim of limiting end-organ damage associated with hypercalcemia, particularly osteoporosis, nephrolithiasis, and renal failure. Some patients with non-syndromic PHPT may have mutations of the MEN1 gene or the calcium-sensing receptor (CASR), whose loss of function mutations usually cause FHH1, a disorder associated with mild hypercalcemia and may follow a benign clinical course. Measurement of the urinary calcium-to-creatinine ratio clearance (UCCR) may help to distinguish patients with FHH from those with PHPT, as the majority of FHH patients have low urinary calcium excretion (UCCR < 0.01). Once genetic testing confirms a hereditary cause of PHPT, further genetic testing can be offered to the patients' relatives and subsequent screening can be carried out in these affected family members, which prevents inappropriate testing in normal individuals.
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Affiliation(s)
- Katherine A English
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK
| | - Kate E Lines
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK
| | - Rajesh V Thakker
- OCDEM, Radcliffe Department of Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK.
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK.
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Noltes ME, Kruijff S, Appelman APA, Jansen L, Zandee WT, Links TP, van Hemel BM, Schouw HM, Dierckx RAJO, Francken AB, Kelder W, van der Hoorn A, Brouwers AH. Head-to-head comparison of [ 11C]methionine PET, [ 11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2024; 51:1050-1059. [PMID: 37975887 PMCID: PMC10881780 DOI: 10.1007/s00259-023-06488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [11C]methionine PET/CT, [11C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan. METHODS We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and 99mTc-sestamibi. All patients underwent [11C]methionine PET/CT, [11C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6 months after surgery were used as gold standard for curation of HPT. RESULTS A total of 32 patients were included in the study. With blinded evaluation, [11C]choline PET/CT was positive in 28 patients (88%), [11C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [11C]choline PET/CT, [11C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [11C]choline PET/CT differed significantly from that of [11C]methionine PET/CT and 4D-CT (p = 0.031 and p < 0.0005, respectively). CONCLUSION In the setting of pHPT with negative first-line imaging, [11C]choline PET/CT is superior to [11C]methionine PET/CT and 4D-CT in localizing parathyroid adenomas, allowing correct localization in 85% of adenomas. Further studies are needed to determine cost-benefit and efficacy of these scans, including the timing of these scans as first- or second-line imaging techniques.
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Affiliation(s)
- Milou E Noltes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Auke P A Appelman
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter T Zandee
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thera P Links
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hugo M Schouw
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | | | - Wendy Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Abstract
Secondary hyperparathyroidism (SHPT) does not initiate as a primary dysfunction of parathyroid glands resulting from an intrinsic defect or disease but is the physiologic response of parathyroids to metabolic changes elsewhere in the body occurring over time. SHPT is a manifestation of a chronic condition that classically occurs from chronic kidney disease. In fact, given the relatively recent transition of populations from outside (agrarian) to indoor (industrial, information technology, and so forth) employment and a consequent reduction in sun exposure, combined with diets of highly processed food, vitamin D and calcium deficiencies are now the leading causes of SHPT.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology-HNS Southern Illinois University/SIU Medicine, 720 North Bond Street, PO Box 19662, Springfield, IL 62794-9662, USA.
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10
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Kulkarni P, Goldenberg D. Surgery for Normocalcemic Hyper parathyroidism. Otolaryngol Clin North Am 2024; 57:111-116. [PMID: 37634986 DOI: 10.1016/j.otc.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Primary hyperparathyroidism is the most common cause of hypercalcemia, accounting for about 90% of all cases. This disorder is characterized by overactive parathyroid glands, leading to increased parathyroid hormone and excess serum calcium.
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Affiliation(s)
- Pallavi Kulkarni
- Penn State Health Department of Otolaryngology-Head and Neck Surgery; The Pennsylvania State College of Medicine, 500 University Drive, P.O. Box 850 H091 Hershey, PA 17033, USA
| | - David Goldenberg
- Penn State Health Department of Otolaryngology-Head and Neck Surgery; The Pennsylvania State College of Medicine, 500 University Drive, P.O. Box 850 H091 Hershey, PA 17033, USA.
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Scott B, Wong RJ. Step-by-Step Thyroidectomy-Incision, Nerve Identification, Parathyroid Preservation, and Gland Removal. Otolaryngol Clin North Am 2024; 57:25-37. [PMID: 37748983 DOI: 10.1016/j.otc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Thyroidectomy is a surgical procedure to remove part or all of the thyroid gland. Although the general tenets of surgery have remained the same, improvements in techniques, diagnostics, understanding of anatomy, and technology have allowed thyroid surgery to become a standard, effective, and safe surgery. For surgeons undertaking this procedure, it is imperative to have an in-depth knowledge of critical anatomy and a comprehensive understanding of surgical techniques to perform safe and effective surgery. This article aims to provide an overview of surgical techniques that may be applied in both benign and malignant disease settings.
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Affiliation(s)
- Britney Scott
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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Goudet P, Cadiot G, Barlier A, Baudin E, Borson-Chazot F, Brunaud L, Caiazzo R, Cardot-Bauters C, Castinetti F, Chanson P, Cuny T, Dansin E, Gaujoux S, Giraud S, Groussin L, Le Bras M, Lifante JC, Mathonnet M, de Mestier L, Mirallié E, Pattou F, Romanet P, Sebag F, Tresallet C, Vezzosi D, Walter T, Tabarin A. French guidelines from the GTE, AFCE and ENDOCAN-RENATEN (Groupe d'étude des Tumeurs Endocrines/Association Francophone de Chirurgie Endocrinienne/Reseau national de prise en charge des tumeurs endocrines) for the screening, diagnosis and management of Multiple Endocrine Neoplasia Type 1. Ann Endocrinol (Paris) 2024; 85:2-19. [PMID: 37739121 DOI: 10.1016/j.ando.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Pierre Goudet
- Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France; INSERM, U1231, EPICAD Team UMR "Lipids, Nutrition, Cancer", Dijon, France; INSERM, CIC1432, Clinical epidemiology Dijon, Dijon, France.
| | - Guillaume Cadiot
- Department of Hepato-Gastro-Enterology and Digestive Oncology, Robert Debré Hospital, Reims, France.
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France.
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Françoise Borson-Chazot
- Federation of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon1 University and INSERM U1290, Lyon, France.
| | - Laurent Brunaud
- Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC), University Hospital of Nancy (CHRU Nancy), University of Lorraine, 54511 Vandoeuvre-les-Nancy, France; INSERM U1256 NGERE, Lorraine University, 11, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
| | - Robert Caiazzo
- General and Endocrine Surgery Department, University Hospital Center of Lille, Lille, France.
| | | | - Frédéric Castinetti
- Aix Marseille University, Marseille Medical Genetics, INSERM U1251 and Assistance Publique Hopitaux de Marseille, La Conception Hospital, Department of Endocrinology, Marseille, France.
| | - Philippe Chanson
- University Paris-Saclay, INSERM, Endocrine Physiology and Pathophysiology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Service of Endocrinology and Reproductive Diseases, National Reference Center for Rare Pituitary Diseases, 94275 Le Kremlin-Bicêtre, France.
| | - Thomas Cuny
- APHM, Marseille Medical Genetics, INSERM U1251, Conception Hospital, Endocrinology Department, Aix Marseille University, Marseille, France.
| | - Eric Dansin
- Department of Medical Oncology, Oscar Lambret Center, 59000 Lille, France.
| | - Sébastien Gaujoux
- Department of Endocrine and Pancreatic Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
| | - Sophie Giraud
- Cancer Genetics Unit, Institut Bergonié, Bordeaux, France.
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France.
| | - Maëlle Le Bras
- Department of Endocrinology, Nantes University Hospital, Nantes, France.
| | - Jean-Christophe Lifante
- Department of Digestive and Endocrine Surgery, University Hospital of Lyon Sud, Lyon, France; EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
| | - Muriel Mathonnet
- Department of Surgery, Dupuytren University Hospital of Limoges, Limoges, France.
| | - Louis de Mestier
- Paris-Cité University, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (AP-HP-Nord), Clichy, France.
| | - Eric Mirallié
- Department of Oncological, Digestive and Endocrine Surgery (CCDE) Hôtel Dieu, CIC-IMAD, Nantes, France.
| | - François Pattou
- Department of General and Endocrine Surgery, University Hospital. Lille, INSERM U1190, Lille, France.
| | - Pauline Romanet
- Aix Marseille University, APHM, INSERM, MMG, Laboratory of Molecular Biology, La Conception Hospital, Marseille, France.
| | - Frédéric Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France.
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne University Hospital, Sorbonne Paris Nord Universty, Assistance Pubique des Hôpitaux de Paris (APHP), Paris, France.
| | - Delphine Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex, France.
| | - Thomas Walter
- Medical Oncology Department, Edouard-Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Antoine Tabarin
- Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
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Manzella A, Kravchenko T, Kheng M, Chao J, Laird AM, Pitt HA, Beninato T. Effects of the COVID-19 pandemic on endocrine operations in the United States. Am J Surg 2024; 228:22-29. [PMID: 37659868 DOI: 10.1016/j.amjsurg.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the United States (US) healthcare system. Endocrine operations are predominantly elective and were likely affected. Therefore, our aim was to determine the effect of the pandemic on endocrine operations. STUDY DESIGN The Vizient Clinical Data Base® was examined for cases from 1/2019-12/2022 using ICD10 and CPT codes for thyroid, parathyroid, and adrenal operations. Control chart analysis identified trends in operative volume. Negative binomial regression was utilized to analyze demographic trends. RESULTS Monthly volumes for all operations from 515 hospitals decreased at the beginning of 2020, except for operations for adrenal malignancy. Inpatient operations (Thyroid -17.1%, Parathyroid -20.9%, p < 0.001 for both) experienced more significant and longer lasting disruptions than outpatient operations (Thyroid -2.6%, p = 0.883, Parathyroid -9.1%, p = 0.098). CONCLUSIONS The COVID-19 pandemic disrupted endocrine operations across the US. While all adrenal operations and outpatient thyroid and parathyroid operations have returned to pre-pandemic levels, inpatient operations for thyroid and parathyroid remain decreased.
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Affiliation(s)
- Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Timothy Kravchenko
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joshua Chao
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Department of General Surgery, New Brunswick, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Bräutigam K, Nesti C, Riss P, Scheuba C, Niederle B, Grob T, Di Domenico A, Neuenschwander M, Mazal P, Köhn N, Trepp R, Perren A, Kaderli RM. Syndromic MEN1 parathyroid adenomas consist of both subclonal nodules and clonally independent tumors. Virchows Arch 2024:10.1007/s00428-023-03730-3. [PMID: 38244045 DOI: 10.1007/s00428-023-03730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024]
Abstract
Primary hyperparathyroidism with parathyroid tumors is a typical manifestation of Multiple Endocrine Neoplasia Type 1 (MEN1) and is historically termed "primary hyperplasia". Whether these tumors represent a multi-glandular clonal disease or hyperplasia has not been robustly proven so far. Loss of Menin protein expression is associated with inactivation of both alleles and a good surrogate for a MEN1 gene mutation. The cyclin-dependent kinase inhibitor 1B (CDKN1B) gene is mutated in MEN4 and encodes for protein p27 whose expression is poorly studied in the syndromic MEN1 setting.Here, we analyzed histomorphology and protein expression of Menin and p27 in parathyroid adenomas of 25 patients of two independent, well-characterized MEN1 cohorts. The pattern of loss of heterozygosity (LOH) was assessed by fluorescence in situ hybridization (FISH) in one MEN1-associated parathyroid adenoma. Further, next-generation sequencing (NGS) was performed on eleven nodules of four MEN1 patients.Morphologically, the majority of MEN1 adenomas consisted of multiple distinct nodules, in which Menin expression was mostly lost and p27 protein expression reduced. FISH analysis revealed that most nodules exhibited MEN1 loss, with or without the loss of centromere 11. NGS demonstrated both subclonal evolution and the existence of clonally unrelated tumors.Syndromic MEN1 parathyroid adenomas therefore consist of multiple clones with subclones, which supports the current concept of the novel WHO classification of parathyroid tumors (2022). p27 expression was lost in a large fraction of MEN1 parathyroids and must therefore be used with caution in suggesting MEN4.
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Affiliation(s)
- Konstantin Bräutigam
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland.
| | - Cédric Nesti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Scheuba
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno Niederle
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Tobias Grob
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Annunziata Di Domenico
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Maja Neuenschwander
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Peter Mazal
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Nastassja Köhn
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aurel Perren
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Reto M Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Worth AL, Ayrapetyan M, Maygarden SJ, Li Z, Wu Z, Agala CB, Kim LT. Expression of the Calcium-Sensing Receptor on Normal and Abnormal Parathyroid and Thyroid Tissue. J Surg Res 2024; 293:618-624. [PMID: 37837817 PMCID: PMC10841155 DOI: 10.1016/j.jss.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Current imaging techniques have several limitations in detecting parathyroid glands. We have investigated the calcium-sensing receptor (CaSR) as a potential target for specifically labeling parathyroid glands for radiologic detection. For accurate imaging it is vital that a large differential expression exists between the target tissue and adjacent structures. We sought to investigate the relative abundance of the CaSR in normal and abnormal parathyroid tissue, as well as normal and abnormal thyroid. METHODS Existing clinical specimens were selected that represented a wide variety of pathologically and clinically confirmed malignant and benign thyroid and parathyroid specimens. Sections were stained for the CaSR using immunohistochemistry and scored for intensity and abundance of expression. (H score = intensity scored from 0 to 3 multiplied by the % of cells at each intensity. Range 0-300). RESULTS All parathyroid specimens expressed the CaSR to a high degree. Normal parathyroid had the highest H score (271, s.d. 25.4). Abnormal parathyroid specimens were slightly lower but still much higher than normal thyroid (H score 38.3, s.d. 23.3). Medullary thyroid cancer also expressed the CaSR significantly higher than normal thyroid (H score 182, s.d. 69.1, P < 0.001) but below parathyroid levels. Hürthle cell carcinoma expressed the CaSR to a lesser degree but higher than normal thyroid (H score 101, s.d. 46.4, P = 0.0037). CONCLUSIONS The CaSR is differentially expressed on parathyroid tissue making it a feasible target for parathyroid imaging. False positives might be anticipated with medullary and Hürthle cell cancers.
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Affiliation(s)
- Anne L Worth
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Mesrop Ayrapetyan
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Susan J Maygarden
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Zibo Li
- Department of Radiology, Biomedical Research Imaging Center, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Zhanhong Wu
- Department of Radiology, Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina
| | - Chris B Agala
- Division of Epidemiology and Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Lawrence T Kim
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Bränström R, Vukojević V, Lu M, Shabo I, Mun HC, Conigrave AD, Farnebo LO, Larsson C. Ca 2+-activated K + channels modulate membrane potential in the human parathyroid cell: Possible role in exocytosis. Exp Cell Res 2023; 433:113858. [PMID: 37995920 DOI: 10.1016/j.yexcr.2023.113858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
The relationships between parathyroid hormone (PTH) secretion and parathyroid cell membrane potential, including the identities and roles of K+ channels that regulate and/or modulate membrane potential are not well defined. Here we have used Western blot/immunohistochemistry as well as patch-clamp and perifusion techniques to identify and localize specific K+ channels in parathyroid cells and to investigate their roles in the control of membrane potential and PTH secretion. We also re-investigated the relationship between membrane potential and exocytosis. We showed that in single human parathyroid cells K+ current is dependent on at least two types of Ca2+-activated K+ channels: a small-conductance Ca2+-activated K+ channel (KSK) and a large-conductance voltage and Ca2+-activated K+ channel (KBK). These channels were sensitive to specific peptide blocking toxins including apamin, charybdotoxin, and iberiotoxin. These channels confer sensitivity of the membrane potential in single cells to high extracellular K+, TEA, and peptide toxins. Blocking of KBK potently inhibited K+ channel current, and KBK was shown to be expressed in the plasma membrane of parathyroid cells. In addition, when using the capacitance technique as an indicator of exocytosis, clamping the parathyroid cell at -60 mV prevented exocytosis, whereas holding the membrane potential at 0 mV facilitated it. Taken together, the results show that human parathyroid cells have functional KBK and KSK channels but the data presented herein suggest that KBK/KSK channels likely contribute to the maintenance of the membrane potential, and that membrane potential, per se, modulates exocytosis independently of [Ca2+]i.
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Affiliation(s)
- Robert Bränström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Vladana Vukojević
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ming Lu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Shabo
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Hee-Chang Mun
- School of Molecular and Microbial Biosciences, University of Sydney, Sydney, NSW, Australia
| | - Arthur D Conigrave
- School of Molecular and Microbial Biosciences, University of Sydney, Sydney, NSW, Australia
| | - Lars-Ove Farnebo
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Roberts SL, El-Shikh M, Alam P, Borumandi F. Incidence of post-surgical hypo parathyroidism (POSH) after total thyroidectomy. Br J Oral Maxillofac Surg 2023; 61:679-685. [PMID: 38126158 DOI: 10.1016/j.bjoms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023]
Abstract
Post-surgical hypoparathyroidism (POSH) is a recognised complication of total thyroidectomy, leading to hypocalcaemia and its associated adverse effects. This retrospective study aimed to determine the incidence of POSH and identify perioperative predictors for its development. Data from patients who underwent total or completion thyroidectomy between January 2017 and July 2022 were retrospectively analysed. The incidence of POSH was assessed, and patients were categorised into transient or prolonged POSH at six months postoperatively. Potential predictors for POSH were investigated including gender, histological diagnosis, and preoperative thyroid function. A total of 133 adult patients were included in the study. The incidence of patients recovering from transient POSH within six months was 15%, and 5% had prolonged POSH beyond six months of surgery. Parathyroid hormone (PTH) levels normalised in 83% of prolonged POSH patients within 14-33 months, reducing the incidence of persistent POSH to 0.75%. Despite normal PTH levels, overall, 3% had persistent marginally low calcium levels (mean 2.11 mmol/L) in keeping with relative parathyroid insufficiency. Histological diagnosis of malignancy was the only significant risk factor for both transient and prolonged POSH (RR 2.95, CI 1.54 to 5.67, p = 0.001) in this cohort. Cautious capsular dissection during thyroidectomy and protection of the parathyroid glands and vascular supply produce a low incidence of POSH. Although the vast majority of patients with POSH recover after six months, hypocalcaemia may persist due to relative parathyroid insufficiency, requiring long-term calcium supplementation. Further research is needed to determine the best strategies for preventing and treating this condition.
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Affiliation(s)
- Simon L Roberts
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Mahmoud El-Shikh
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Peyman Alam
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK; Worthing Hospital, Lyndhurst Rd, Worthing BN11 2DH, UK.
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Ivaniš S, Jovanović M, Dunđerović D, Zorić G, Odalović B, Slijepčević N, Taušanović K, Rovčanin B, Buzejić M, Vučen D, Stepanović B, Ilić J, Parezanović M, Marinković M, Stojanović M, Tošković A, Mojsić I, Živaljević V. Case presentation of the smallest non-functional parathyroid carcinoma and review of the literature. Eur Arch Otorhinolaryngol 2023; 280:5637-5647. [PMID: 37493843 DOI: 10.1007/s00405-023-08137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. CASE PRESENTATION A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. CONCLUSION Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on.
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Affiliation(s)
- S Ivaniš
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia.
| | - M Jovanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Dunđerović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - G Zorić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Odalović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - N Slijepčević
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - K Taušanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Rovčanin
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Buzejić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Vučen
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Stepanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Ilić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Parezanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Marinković
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Stojanović
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - A Tošković
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - I Mojsić
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - V Živaljević
- Clinic for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia
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Bann S, Nguyen A, Gill S, Raudzus J, Holmes DT, Wiseman SM. Lithium related thyroid and parathyroid disease: Updated clinical practice guidelines are needed. J Affect Disord 2023; 339:471-477. [PMID: 37442446 DOI: 10.1016/j.jad.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE This study aims to estimate the prevalence of and determine physician approaches to the screening and management of lithium-associated thyroid and parathyroid disorders in British Columbia, Canada. METHODS Serum lithium and thyroid/parathyroid laboratory data were collected retrospectively for patients with lithium levels measured at seven BC hospitals between 2012 and 2021. A mail-out survey about screening and management of thyroid/parathyroid disorders in patients on lithium was sent to the ordering physicians of patients with abnormal results. Three months after, a follow-up questionnaire was sent to respondents, and the original survey was re-sent to non-responders. RESULTS Of 4917 patients, 1.9 % had PTH (mean 22.33 ± 23.00 pmol/L) and 77.1 % had TSH (mean 3.61 ± 6.69 pmol/L) measured. Of 222 hypercalcemic patients (defined as any serum calcium or ionized calcium above the laboratory reference), 17.6 % had a PTH level measured. From 294 surveys sent to 214 physicians, the overall response rate was 31.6 % (n = 93) with twelve fully completed surveys. All twelve respondents monitored TSH levels every 6-12 months, and eight physicians monitored PTH and/or calcium at variable intervals. Two physicians routinely ordered both thyroid and parathyroid screening laboratory tests. Of the 80 non-respondents, limited patient contact was the most common reason for opting out (n = 27). CONCLUSIONS Our results suggest biochemical screening for lithium-associated parathyroid disorders is less common than for thyroid disorders. There is insufficient data to determine the true prevalence of lithium-associated thyroid and parathyroid disorders. This highlights the need for updated clinical guidelines for management of lithium-associated thyroid and parathyroid disorders.
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Affiliation(s)
- Sewon Bann
- Department of Endocrinology & Metabolism, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Nguyen
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Department of Endocrinology & Metabolism, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Raudzus
- Department of Psychiatry, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel T Holmes
- Department of Pathology & Laboratory Medicine, St. Paul's Hospital & University of British Columbia, Vancouver, Britsh Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
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20
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Murugan AK, Alzahrani AS. Potential impacts of SARS-CoV-2 on parathyroid: current advances and trends. Endocrine 2023; 81:391-408. [PMID: 37328666 DOI: 10.1007/s12020-023-03415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection affects several important organs including endocrine glands. Experimental studies demonstrated that the virus exploits the ACE2, a transmembrane glycoprotein on the cell surface as a receptor for cellular entry. This entry process is exclusively facilitated by other intracellular protein molecules such as TMPRSS2, furin, NRP1, and NRP2. Recent findings documented the involvement of the SARS-CoV-2 in inducing various parathyroid disorders including hypoparathyroidism and hypocalcemia, which received significant attention. This review extensively describes rapidly evolving knowledge on the potential part of SARS-CoV-2 in emerging various parathyroid disorders due to SARS-CoV-2 infection particularly parathyroid malfunction in COVID-19 cases, and post-COVID-19 conditions. Further, it presents the expression level of various molecules such as ACE2, TMPRSS2, furin, NRP1, and NRP2 in the parathyroid cells that facilitate the SARS-CoV-2 entry into the cell, and discusses the possible mechanism of parathyroid gland infection. Besides, it explores parathyroid malfunction in COVID-19 vaccine-administered cases. It also explains the possible long-COVID-19 effect on parathyroid and post-COVID-19 management of parathyroid. A complete understanding of the mechanisms of SARS-CoV-2-triggered pathogenesis in parathyroid dysfunctions may curtail treatment options and aid in the management of SARS-CoV-2-infected cases.
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Affiliation(s)
- Avaniyapuram Kannan Murugan
- Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
| | - Ali S Alzahrani
- Division of Molecular Endocrinology, Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
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21
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Kiernan CM, Solόrzano CC. New Techniques for Intraoperative Parathyroid Localization. Adv Surg 2023; 57:209-223. [PMID: 37536854 DOI: 10.1016/j.yasu.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Accurate identification of abnormal parathyroid glands (PGs) during parathyroidectomy and thyroidectomy can be challenging even for experienced surgeons given PGs variable location, size, and similar appearance to surrounding tissue. Inadvertent removal or devascularization of healthy PGs can lead to transient or permanent hypoparathyroidism. Permanent hypoparathyroidism is associated with increased rates of renal insufficiency, seizures, skeletal abnormalities, increased costs, decreased quality of life, and increased mortality. Conversely, the inability to identify and remove hyperfunctioning PGs results in failed parathyroidectomy which can result in need for reoperations that are associated with increased technical difficulty, operative duration, rates of hypoparathyroidism and recurrent laryngeal nerve damage, and cost.
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Affiliation(s)
- Colleen M Kiernan
- Department of Surgery, Vanderbilt University Medical Center, 2220 Pierce Avenue, 597 Preston Research Building, Nashville, TN 37232, USA.
| | - Carmen C Solόrzano
- Department of Surgery, John L. Sawyers Chair in Surgical Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, D-4314 Medical Center North, Nashville, TN 37232, USA
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22
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Jeon S, Lee YS, Oh SR, Jeong J, Lee DH, So KH, Hwang NS. Recent advances in endocrine organoids for therapeutic application. Adv Drug Deliv Rev 2023; 199:114959. [PMID: 37301512 DOI: 10.1016/j.addr.2023.114959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
The endocrine system, consisting of the hypothalamus, pituitary, endocrine glands, and hormones, plays a critical role in hormone metabolic interactions. The complexity of the endocrine system is a significant obstacle to understanding and treating endocrine disorders. Notably, advances in endocrine organoid generation allow a deeper understanding of the endocrine system by providing better comprehension of molecular mechanisms of pathogenesis. Here, we highlight recent advances in endocrine organoids for a wide range of therapeutic applications, from cell transplantation therapy to drug toxicity screening, combined with development in stem cell differentiation and gene editing technologies. In particular, we provide insights into the transplantation of endocrine organoids to reverse endocrine dysfunctions and progress in developing strategies for better engraftments. We also discuss the gap between preclinical and clinical research. Finally, we provide future perspectives for research on endocrine organoids for the development of more effective treatments for endocrine disorders.
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Affiliation(s)
- Suwan Jeon
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Young-Sun Lee
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Seh Ri Oh
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Jinseong Jeong
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea
| | - Dong-Hyun Lee
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyoung-Ha So
- School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Nathaniel S Hwang
- Interdisciplinary Program for Biochemical Engineering and Biotechnology, Seoul National University, Seoul 08826, Republic of Korea; School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea; Bio-MAX/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul 08826, Republic of Korea; Institute of Engineering Research, Seoul National University, Seoul, 08826, Republic of Korea.
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23
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Niraula A, Baidya S, Sharma VK, Tuladhar ET, Dubey RK, Bhattarai A, Raut M, Parajuli N. Biochemical spectrum of parathyroid hormone disorders in patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal. SAGE Open Med 2023; 11:20503121231182204. [PMID: 37342614 PMCID: PMC10278423 DOI: 10.1177/20503121231182204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives This study intends to determine the association of parathormone with vitamin D and other biochemical parameters (calcium and phosphate) and evaluate the relationship between low vitamin D and parathormone levels. Methods A hospital-based cross-sectional study was conducted among 310 study participants over the period of 1 year. Patients who underwent laboratory investigations for vitamin D, parathormone, calcium, and phosphate in the Clinical Biochemistry Laboratory at the Institute of Medicine, Tribhuvan University Teaching Hospital were included. Serum intact parathyroid hormone, vitamin D, calcium, and phosphate were measured in Abbott Architect (ci4100) integrated system autoanalyzer. Results Among the 310 study participants, 177 (57%) were males and 43% were females. The mean age of the patient was 47.09 ± 19.01 years. High intact parathyroid hormone (>68 pg/ml) was observed in 73% of the patients. Low vitamin D (<20 ng/ml) was present in 30.2% of the patients. The findings from our study depict that there is a negative significant correlation between intact parathyroid hormone levels, vitamin D, and calcium levels and a positive correlation between intact parathyroid hormone and phosphate levels (p < 0.001). Conclusions The findings from our study illustrate that there is a swapping drift in the profile of hyperparathyroidism in the Nepalese population. We report the presence of hyperparathyroidism in the middle age group than in the older age group contradictory to that reported in the literature.
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Affiliation(s)
- Apeksha Niraula
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Sujata Baidya
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Vijay Kumar Sharma
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Eans Tara Tuladhar
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Raju Kumar Dubey
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Aseem Bhattarai
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Mithileshwer Raut
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
| | - Naresh Parajuli
- Department of Internal Medicine/Endocrinology, Maharajgunj Medical Campus, Institute of Medicine, TUTH, Kathmandu, Nepal
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24
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Noltes ME, Rotstein L, Eskander A, Kluijfhout WP, Bongers P, Brouwers AH, Kruijff S, Metser U, Pasternak JD, Veit-Haibach P. 18F-fluorocholine PET/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas. Langenbecks Arch Surg 2023; 408:155. [PMID: 37079138 DOI: 10.1007/s00423-023-02893-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and 99mTechnetium (99mTc) -sestamibi scintigraphy) to [F-18]-fluorocholine positron emission tomography/magnetic resonance imaging (FCH-PET/MRI) to determine the additional clinical usefulness of PET/MRI in a Canadian cohort. METHODS We conducted a prospective, appropriately powered, study to compare the diagnostic value of -FCH PET/MRI to that of the US and 99mTc-sestamibi scintigraphy for localization of parathyroid adenomas in a patient with pHPT. The primary outcome was the per-lesion sensitivity and positive predictive value (PPV) of FCH-PET/MRI, US, and 99mTc-sestamibi scintigraphy. Intraoperative surgeon localization, parathormone levels, and histopathological findings were used as reference standards. RESULTS Forty-one patients underwent FCH-PET/MRI of which 36 patients had parathyroidectomy. In these 36 patients, 41 parathyroid lesions were histologically confirmed as adenomas or hyperplastic glands. Per-lesion sensitivity of FCH-PET/MRI was 82.9% and of US and 99mTc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and 99mTc-sestamibi scintigraphy (p = 0.002). In the 19 patients in whom both US and 99mTc-sestamibi scintigraphy were negative, PET/MRI correctly identified the parathyroid adenoma in 13 patients (68%). CONCLUSIONS FCH-PET/MRI is a highly accurate imaging modality for localization of parathyroid adenomas in a tertiary center in North America. It is a superior functional imaging modality to 99mTc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and 99mTc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.
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Affiliation(s)
- M E Noltes
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - L Rotstein
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A Eskander
- Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
| | - W P Kluijfhout
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - P Bongers
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A H Brouwers
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands
| | - S Kruijff
- University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands
| | - U Metser
- Toronto Joint Department Medical Imaging, University Health Network, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J D Pasternak
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - P Veit-Haibach
- Toronto Joint Department Medical Imaging, University Health Network, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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25
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Mazarico-Altisent I, Capel I, Baena N, Bella-Cueto MR, Barcons S, Guirao X, Albert L, Cano A, Pareja R, Caixàs A, Rigla M. Novel germline variants of CDKN1B and CDKN2C identified during screening for familial primary hyper parathyroidism. J Endocrinol Invest 2023; 46:829-840. [PMID: 36334246 PMCID: PMC10023768 DOI: 10.1007/s40618-022-01948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE CDKN1B mutations were established as a cause of multiple endocrine neoplasia 4 (MEN4) syndrome in patients with MEN1 phenotype without a mutation in the MEN1 gene. In addition, variants in other cyclin-dependent kinase inhibitors (CDKIs) were found in some MEN1-like cases without the MEN1 mutation. We aimed to describe novel germline mutations of these genes in patients with primary hyperparathyroidism (PHPT). METHODS During genetic screening for familial hyperparathyroidism, three novel CDKIs germline mutations in three unrelated cases between January 2019 and November 2021 were identified. In this report, we describe clinical features, DNA sequence analysis, and familial segregation studies based on these patients and their relatives. Genome-wide DNA study of loss of heterozygosity (LOH), copy number variation (CNV), and p27/kip immunohistochemistry was performed on tumour samples. RESULTS DNA screening was performed for atypical parathyroid adenomas in cases 1 and 2 and for cystic parathyroid adenoma and young age at diagnosis of PHPT in case 3. Genetic analysis identified likely pathogenic variants of CDKN1B in cases 1 and 2 and a variant of the uncertain significance of CDKN2C, with uniparental disomy in the tumour sample, in case 3. Neoplasm screening of probands showed other non-endocrine tumours in case 1 (colon adenoma with dysplasia and atypical lipomas) and case 2 (aberrant T-cell population) and a non-functional pituitary adenoma in case 3. CONCLUSION Germline mutations in CDKIs should be included in gene panels for genetic testing of primary hyperparathyroidism. New germline variants here described can be added to the current knowledge.
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Affiliation(s)
- I Mazarico-Altisent
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
| | - I Capel
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - N Baena
- Genetic Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M R Bella-Cueto
- Pathology Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - S Barcons
- Surgery Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - X Guirao
- Surgery Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - L Albert
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - A Cano
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - R Pareja
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - A Caixàs
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Rigla
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació Parc Taulí (I3PT), Medicine Department, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
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Kong SH, Lee JH, Bae JM, Hong N, Kim H, Park SY, Choi YJ, Lee S, Rhee Y, Kim SW, Han D, Kim JH, Shin CS. In-depth Proteomic Signature of Parathyroid Carcinoma. Eur J Endocrinol 2023; 188:385-394. [PMID: 36995894 DOI: 10.1093/ejendo/lvad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/05/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Diagnosing parathyroid carcinoma (PC) is complicated and controversial that early diagnosis and intervention are often difficult. Therefore, we aimed to elucidate the protein signatures of PC through quantitative proteomic analyses to aid in the early and accurate diagnosis of PC. DESIGN Retrospective cohort study. METHODS We performed liquid chromatography with tandem mass spectrometry using formalin-fixed paraffin-embedded samples. For the analyses, 23 PC and 15 parathyroid adenoma (PA) tissues were collected from 6 tertiary hospitals in South Korea. RESULTS The mean age of the patients was 52 years, and 63% were women. Proteomic expression profiling revealed 304 differentially expressed proteins (DEPs) with a cutoff of p < 0.05, and fold change >1.5. Among DEPs, we identified a set of 5 proteins that can discriminate PC from PA: carbonic anhydrase 4 [CA4], alpha/beta hydrolase domain-containing protein 14B [ABHD14B], laminin subunit beta-2 [LAMB2], CD44 antigen [CD44], and alpha-1-acid glycoprotein 1 [ORM1], that exhibited the highest area under the curve of 0.991 in neural network model. The nuclear percentage of CA4 and LAMB2 in immunohistochemistry were significantly lower in PC tissue than in the PA (CA4: 2.77 ± 1.96%, 26.2 ± 3.45%, p < 0.001; LAMB2: 6.86 ± 3.46%, 38.54 ± 4.13%, p < 0.001). The most enriched canonical pathways in PC included glycoprotein-6 signaling and mammalian target of rapamycin (mTOR). CONCLUSION We identified key proteins differentially expressed between PC and PA using proteomic analyses of parathyroid neoplasms. These findings may help to diagnose PC accurately and elucidate potential therapeutic targets.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Joon-Hyop Lee
- Department of Surgery, Gachon University Gil Medical Center, Incheon
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Seoul
| | - Hyeyoon Kim
- Proteomics core facility, Biomedical Research Institute, Seoul National University Hospital, Seoul
| | - So Young Park
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon
| | - Sihoon Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Seoul
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Dohyun Han
- Proteomics core facility, Biomedical Research Institute, Seoul National University Hospital, Seoul
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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Tjahjono R, Phung D, Elliott MS, Riffat F, Palme CE. The Utility of Near-Infrared Autofluorescence for Parathyroid Gland Identification During Thyroid Surgery: A Single-Center Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:121-125. [PMID: 37007878 PMCID: PMC10050657 DOI: 10.1007/s12070-022-03309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
Parathyroid gland injury during thyroid surgery is common and can lead to postoperative hypocalcemia. This study aims to determine the utility of near-infrared autofluorescence (NIRAF) technology for parathyroid gland identification in thyroid surgery. A prospective case series of patients who underwent thyroid surgery between March and June 2021 were examined. Following intra-operative visualisation, parathyroid glands and surrounding tissues were exposed to near-infrared light with a wavelength of approximately 800 nm using the Storz® Near-Infrared Range/Indocyanine Green (NIR/ICG) endoscopic system. Parathyroid glands were expected to show autofluorescence following exposure. Twenty patients who underwent thyroid surgery were included. Eighteen patients (90%) were female, with a median age of 50.0 (IQR 41.0 - 62.5). Surgeries performed include hemithyroidectomy (9 patients; 45.0%), total thyroidectomy (8 patients; 40.0%), completion thyroidectomy (2 patients; 10.0%) and right inferior parathyroidectomy (1 patient; 5.0%). Attempts were made to identify 56 parathyroid glands in this case series. There were 46/56 (82.1%) surgeon-identified parathyroid glands through direct visualisation. Using NIRAF technology, 39/46 (84.8%) were identified as parathyroid glands. There was no inadvertent resection of parathyroid glands or post-operative hypocalcaemia. NIRAF technology has the potential to be a useful tool in confirming the presence of parathyroid glands following direct visualisation intra-operatively.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
| | - Michael S. Elliott
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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28
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Ababneh E, Nosé V. Para This, Fibromin That: The Role of CDC73 in Parathyroid Tumors and Familial Tumor Syndromes. Surg Pathol Clin 2023; 16:97-105. [PMID: 36739170 DOI: 10.1016/j.path.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CDC73 alterations are associated with three main parathyroid lesions according to the World Health Organization (WHO) classification of tumors of the endocrine system. These include hyperparathyroidism-jaw tumor (HPT-JT) syndrome-associated adenomas, atypical parathyroid tumors (APTs), and parathyroid carcinomas (PCs). The loss of nuclear parafibromin expression, which serves as a surrogate marker for the underlying CDC73 alteration, encompasses these tumors under the term parafibromin-deficient parathyroid tumors. They have distinct morphologic features of more abundant eosinophilic cytoplasm with perinuclear clearing surrounding a large nucleus as well as prominent dilated branching "hemangiopericytoma-like" vasculature and a thick capsule as well as variably sized cystic spaces. These tumors include cases that show unequivocal histologic features fulfilling the criteria for PCs with growing data indicating a higher rate of recurrence or metastasis compared with parafibromin intact PCs. More importantly, the loss of parafibromin expression can be used in clinical practice to recognize APTs that fall short of a conclusive diagnosis of PCs, but clinically behave akin to them. Moreover, recognizing these tumors can lead to an underlying germline mutation and a diagnosis of HPT-JT, which impacts long-term treatment and surveillance for patients and close family.
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Affiliation(s)
- Emad Ababneh
- Department of Pathology, Warren 214, Massachusetts General Hospital, 55 Fruit street, Boston, MA 02114, USA; Pathology and Laboratory medicine Institute, L25, Cleveland Clinic foundation, 9500 Euclid ave, Cleveland, OH 44118, USA
| | - Vania Nosé
- Department of Pathology, Warren 214, Massachusetts General Hospital, 55 Fruit street, Boston, MA 02114, USA.
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Brown DR, Burney CP, Nevil GK, Gray PJ, Eid MA, Sorensen MJ. Extreme Elevation of Baseline Intraoperative Parathyroid Hormone Measurements: Should Usual Protocols Apply? J Surg Res 2023; 283:1073-1077. [PMID: 36914998 DOI: 10.1016/j.jss.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Intraoperative parathyroid hormone (IOPTH) monitoring is routinely used to facilitate minimally invasive parathyroidectomy. Many IOPTH protocols exist for predicting biochemical cure. Some patients are found to have extremely high baseline IOPTH levels (defined in this study as >500 pg/mL), which may affect the likelihood of satisfying certain final IOPTH criteria. We aimed to discover whether clinically significant differences exist in patients with extremely high baseline IOPTH and which IOPTH protocols are most appropriately applied to these patients. MATERIALS AND METHODS This is a retrospective review of 237 patients who underwent parathyroidectomy with IOPTH monitoring for primary hyperparathyroidism (pHPT) from 2016 to 2020. Baseline IOPTH levels, drawn prior to manipulation of parathyroid glands, were grouped into categories labeled "elevated" (>65-500 pg/mL) and "extremely elevated" (>500 pg/mL). Final IOPTH levels were analyzed to determine whether there was a >50% decrease from baseline and whether a normal IOPTH value was achieved. 6-wk postoperative calcium levels were also examined. RESULTS Of the patients in this cohort, 76% were in the elevated group and 24% in the extremely elevated group. Male sex and higher preoperative PTH levels were correlated with higher baseline IOPTH levels. Patients with extremely elevated baseline IOPTH were less likely to have IOPTH fall into normal range at the conclusion of the case (P = 0.019), and final IOPTH levels were higher (P < 0.001), but the IOPTH was equally likely to decrease >50% from baseline. There was no difference in the mean postoperative calcium levels between the two groups at 6-wk or at longer term follow-up (mean 525 d). CONCLUSIONS Detection of baseline IOPTH levels >500 pg/mL during parathyroidectomy performed for pHPT is not uncommon. IOPTH in patients with extremely elevated baseline levels were less likely to fall into normal range, but follow-up calcium levels were equal, suggesting that applying more stringent IOPTH criteria for predicting biochemical cure may not be appropriate for this population.
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Affiliation(s)
- David R Brown
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | | | - Grace K Nevil
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Phillip J Gray
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mark A Eid
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Meredith J Sorensen
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Gosnell HL, Sadow PM. Preoperative, Intraoperative, and Postoperative Parathyroid Pathology: Clinical Pathologic Collaboration for Optimal Patient Management. Surg Pathol Clin 2023; 16:87-96. [PMID: 36739169 DOI: 10.1016/j.path.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parathyroid disease typically presents with parathyroid hyperfunction as result of neoplasia or a consequence of non-neoplastic systemic disease. Given the parathyroid gland is a hormonally active organ with broad physiologic implications and serologically accessible markers for monitoring, the diagnosis of parathyroid disease is predominantly a clinical pathologic correlation. We provide the current pathological correlates of parathyroid disease and discuss preoperative, intraoperative, and postoperative pathology consultative practice for optimal patient care.
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Affiliation(s)
- Hailey L Gosnell
- Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Mail Code L25, Cleveland, OH 44195, USA
| | - Peter M Sadow
- Department of Pathology, Pathology Service, Massachusetts General Hospital, Harvard Medical School, WRN219, 55 Fruit Street, Boston, MA 02114, USA.
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Broekhuis JM, Chaves N, Chen HW, Drake FT, James BC. Are patients with limited English proficiency less likely to undergo parathyroidectomy for primary hyperparathyoidism? Am J Surg 2023; 225:236-41. [PMID: 35717203 DOI: 10.1016/j.amjsurg.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite meeting operative indications for primary hyperparathyroidism (PHPT), many patients never undergo parathyroidectomy. We hypothesized that patients with limited English proficiency (LEP) would be less likely to undergo parathyroidectomy than English-proficient (EP) patients. STUDY DESIGN We retrospectively analyzed patients with PHPT from an institution-wide registry who met operative criteria between 2010 and 2018. The cohort was stratified by English proficiency. Univariate associations between sociodemographic and clinical factors with parathyroidectomy were assessed. A multivariable logistic regression model was created to assess independent predictors of parathyroidectomy. RESULTS Among a cohort of 1,104 patients, 262 (24%) underwent parathyroidectomy. LEP patients (n = 135, 12%) were significantly younger (mean age 62 vs. 69, p < 0.001), more likely non-white race and ethnicity (p < 0.001), and less likely to have private insurance (p < 0.001). After adjusting for covariates, non-English and non-Spanish preferred language was an independent negative predictor of undergoing parathyroidectomy (OR 0.46, 95% CI 0.21-0.95, p = 0.037). CONCLUSIONS Limited English proficiency may be an independent barrier to appropriate surgical management of PHPT. Systems-level and disease-specific interventions are needed to address this disparity faced by patients with LEP.
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Harper C, Bonner A, Alexander A, Cooper J, Fazendin J, Chen H, Lindeman B. Down the Rabbit Hole: Evaluation of Internet Information Quality in Parathyroid and Thyroid Surgery. J Surg Res 2023; 282:65-70. [PMID: 36257165 DOI: 10.1016/j.jss.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Patients often discuss information obtained from Internet sources during clinic visits, which can be of variable quality and depth. We sought to review and assess information on the Internet regarding common operations within endocrine surgery. METHODS Using Google's search engine, the top 100 websites from the search phrase "parathyroid surgery," and the top 100 websites from the phrase "thyroid surgery" were identified. Each website was evaluated for accessibility, accuracy, and completeness of information about gland hormone function, associated disease processes, and surgery itself. Results were stratified based on the website type, and bivariate analysis was performed to determine accuracy by category. Presence of author credentials, last webpage update, and presence of advertisements were also assessed. Inter-rater reliability was calculated for each variable. RESULTS For parathyroid surgery, at least two-thirds of all websites included information about surgery, hormone function, and disease processes. For thyroid surgery, 71% of websites included procedure information, but only 52% included information about hormone function and 56% about disease processes. Less than 30% of all websites included advertisements and less than 25% listed author credentials or provided references. Academic or research-affiliated sources were most likely to have zero inaccuracies, but 44% of all websites had at least one potential inaccuracy. Inter-rater reliability achieved at least moderate agreement (>0.41) for 56% of variables. CONCLUSIONS There is a wide array of information available to patients online, and accuracy varies based on multiple factors including the type of website. Endocrine surgeons and related practitioners must be cognizant of this fact when discussing treatment plans with patients.
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Creighton EW, Dayer L, King D, Vural E, Sunde J, Moreno MA, Stack BC. Remote smart pill cap monitoring of post-surgical pain management in thyroid and parathyroid surgery. Am J Surg 2022; 225:988-993. [PMID: 36639303 DOI: 10.1016/j.amjsurg.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/30/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND With recent efforts to decrease opioid use following surgery, this study aims to answer: what pain regimen do patients follow at home? Is it controlling pain? METHODS This is a prospective, pilot study of thyroid and parathyroid surgery patients. Patients were prescribed acetaminophen, ibuprofen, and tramadol dispensed in smart pill (Pillsy) bottles that record "events" corresponding to medication use. Patients received messages querying their current pain level. Patients were compared to historical controls. RESULTS 26 patients were in the Pillsy group and 30 in the control group. In the Pillsy group, pain scores averaged 3.67 out of 10 in the first 24 h after surgery and decreased each day. Patients took an average of 6.45 doses of acetaminophen, 6.64 doses of ibuprofen, and 1.82 doses of tramadol in the first week. CONCLUSIONS Pain scores are highest in the first 24 h after surgery and decrease thereafter. This acceptable level of pain can be achieved with non-opioid medications.
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Affiliation(s)
- Erin Weatherford Creighton
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 543, Little Rock, AR, 72205, USA
| | - Lindsey Dayer
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 522, Little Rock, AR, 72205, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 543, Little Rock, AR, 72205, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 543, Little Rock, AR, 72205, USA
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 543, Little Rock, AR, 72205, USA
| | - Mauricio A Moreno
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 543, Little Rock, AR, 72205, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, P.O. Box 19662, Springfield, IL, 62794, USA.
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Miller WL, Imel EA. Rickets, Vitamin D, and Ca/P Metabolism. Horm Res Paediatr 2022; 95:579-592. [PMID: 36446330 DOI: 10.1159/000527011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Rickets was a major public health problem dating from Roman times, and medical descriptions of rickets date from the 17th century. Sniadecki first advocated treatment by exposure to sunshine in 1822; contemporaneously, several British physicians advocated use of cod liver oil. Both approaches were successful. Work in 1924 showed that exposure to UV light endowed fats and other foods with antirachitic properties. Vitamins D2 and D3, the antirachitic agent in cod liver oil, were, respectively, produced by UV radiation of ergosterol and 7-dehydrocholesterol. Calcitriol (1,25[OH]2D3) was identified as the biologically active form of vitamin D in the early 1970s. The vitamin D 25-hydroxylase, 24-hydroxylase, and 1α-hydroxylase were cloned in the 1990s and their genetic defects were soon delineated. The vitamin D receptor was also cloned and its mutations identified in vitamin D-resistant rickets. Work with parathyroid hormone (PTH) began much later, as the parathyroids were not identified until the late 19th century. In 1925, James B. Collip (of insulin fame) identified PTH by its ability to correct tetany in parathyroidectomized dogs, but only in the 1970s was it clear that only a small fragment of PTH conveyed its activity. Congenital hypoparathyroidism with immune defects was described in 1968, eventually linked to microdeletions in chromosome 22q11.2. X-linked hypophosphatemic rickets was reported in 1957, and genetic linkage analysis identified the causative PHEX gene in 1997. Autosomal dominant hypophosphatemic rickets similarly led to the discovery of FGF23, a phosphate-wasting humoral factor made in bone, in 2000, revolutionizing our understanding of phosphorus metabolism.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences and Institute for Human Genetics, University of California, San Francisco, San Francisco, California, USA
| | - Erik A Imel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Asya O, Yumuşakhuylu AC, Gündoğdu Y, İncaz S, Oysu Ç. Thyroid Surgery and Inadvertent Removal of Parathyroids. Indian J Otolaryngol Head Neck Surg 2022; 74:6022-6026. [PMID: 36742704 PMCID: PMC9895612 DOI: 10.1007/s12070-021-02590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to determine the incidence of inadvertent parathyroid removal during thyroid surgery and define its associated risk factors. In this single-center record-based study, we retrospectively analyzed the clinical and pathological records of 462 patients undergoing thyroidectomy. Incidental parathyroidectomy was detected in 61 of 462 patients (13.2%). The incidence of inadvertent parathyroid removal was 17.6% (36 of 205 patients) in patients having malign thyroid diseases, compared with 9.7% (25 of 257 patients) in patients with benign thyroid diseases (p = 0.045). Incidentally removed parathyroid tissue was intrathyroidal in 8 of the 61 patients. Thus, the ratio of intrathyroidal parathyroid tissue among all patients was 1.7% (8 out of 462). Central neck dissection was carried out in 40 patients (8.7%). Fourteen of these 40 patients (35%) had an incidental parathyroid in their specimen compared with 47 of 422 patients (11.1%) who did not undergo central neck dissection (p<0.001). Incidental parathyroidectomy occurred in 13.2% of patients undergoing thyroidectomy in our study. The majority of patients had one parathyroid identified in their specimen. Central neck dissection was significantly predictive for incidental parathyroidectomy. Well-trained senior otolaryngology residents can safely perform thyroid surgery with similar rates of incidental parathyroidectomy as their masters. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02590-0.
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Affiliation(s)
- Orhan Asya
- Otolaryngology Unit, Malazgirt State Hospital, Hastane Street, 49400 Malazgirt, Muş Turkey
| | - Ali Cemal Yumuşakhuylu
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Gündoğdu
- Otolaryngology Unit, İzzet Baysal State Hospital, Bolu, Turkey
| | - Sefa İncaz
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Çağatay Oysu
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Bover J, Trinidad P, Jara A, Soler-Majoral J, Martín-Malo A, Torres A, Frazão J, Ureña P, Dusso A, Arana C, Graterol F, Romero-González G, Troya M, Samaniego D, D'Marco L, Valdivielso JM, Fernández E, Arenas MD, Torregrosa V, Navarro-González JF, Lloret MJ, Ballarín JA, Bosch RJ, Górriz JL, de Francisco A, Gutiérrez O, Ara J, Felsenfeld A, Canalejo A, Almadén Y. Silver jubilee: 25 years of the first demonstration of the direct effect of phosphate on the parathyroid cell. Nefrologia 2022; 42:645-655. [PMID: 36925324 DOI: 10.1016/j.nefroe.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 06/18/2023] Open
Abstract
Although phosphorus is an essential element for life, it is not found in nature in its native state but rather combined in the form of inorganic phosphates (PO43-), with tightly regulated plasma levels that are associated with deleterious effects and mortality when these are out of bounds. The growing interest in the accumulation of PO43- in human pathophysiology originated in its attributed role in the pathogenesis of secondary hyperparathyroidism (SHPT) in chronic kidney disease. In this article, we review the mechanisms by which this effect was justified and we commemorate the important contribution of a Spanish group led by Dr. M. Rodríguez, just 25 years ago, when they first demonstrated the direct effect of PO43- on the regulation of the synthesis and secretion of parathyroid hormone by maintaining the structural integrity of the parathyroid glands in their original experimental model. In addition to demonstrating the importance of arachidonic acid (AA) and the phospholipase A2-AA pathway as a mediator of parathyroid gland response, these findings were predecessors of the recent description of the important role of PO43- on the activity of the calcium sensor-receptor, and also fueled various lines of research on the importance of PO43- overload not only for the pathophysiology of SHPT but also in its systemic pathogenic role.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain.
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, México
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jordi Soler-Majoral
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Alejandro Martín-Malo
- Unidad de Gestión Clinica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, España. Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Spain
| | - Armando Torres
- Servicio de Nefrología, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Tenerife, Spain
| | - João Frazão
- Department of Nephrology, Centro Hospitalar Universitário São João, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | - Pablo Ureña
- AURA Nord Saint Ouen Dialysis Service. Saint Ouen, France and Service d'Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, Paris, France
| | - Adriana Dusso
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, MO, USA
| | - Carolt Arana
- Departamento de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Fredzzia Graterol
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Gregorio Romero-González
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Maribel Troya
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Diana Samaniego
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Luis D'Marco
- CEU Cardenal Herrera University, Valencia, Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, Biomedical Research Institute, IRBLLEIDA, Lleida, España. Red Nacional de Investigación en Nefrología (REDinREN, RETIC), Instituto de Salud Carlos III, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, Biomedical Research Institute, IRBLLEIDA, Lleida, España. Red Nacional de Investigación en Nefrología (REDinREN, RETIC), Instituto de Salud Carlos III, Spain; Grupo de Investigación Traslacional Vascular y Renal, Fundación Renal Jaume Arnó, Lleida, Spain
| | | | - Vicente Torregrosa
- Departamento de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de la Candelaria, Instituto Universitario de Tecnologías Biomédicas, Universidad de la Laguna, Santa Cruz de Tenerife, España. Red Nacional de Investigación en Nefrología (REDinREN, RICORS), Instituto de Salud Carlos III, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain
| | - J A Ballarín
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain
| | - Ricardo J Bosch
- Unidad de Fisiología, Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José L Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine, Universidad de Alabama en Birmingham, Birmingham USA
| | - Jordi Ara
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Spain
| | - Arnold Felsenfeld
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Antonio Canalejo
- Departamento de Ciencias Integradas/Centro de Investigación RENSMA, Facultad de Ciencias Experimentales, Universidad de Huelva. Huelva, Spain
| | - Yolanda Almadén
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Yang CA, Lin JL, Dai SH, Cheng SP. Double water-clear cell parathyroid adenoma: a case report and literature review. Endocr J 2022; 69:717-724. [PMID: 34987145 DOI: 10.1507/endocrj.ej21-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Water-clear cell parathyroid adenoma is an uncommon cause of primary hyperparathyroidism. Herein, we report an interesting case of a 56-year-old man who presented with weight loss, bone pain, fatigue, and a palpable right neck mass. Laboratory tests indicated hypercalcemia, elevated parathyroid hormone (PTH) levels, and normal thyroid function. Further examinations detected osteoporosis and kidney stones. The ultrasound of neck revealed bilateral extrathyroidal tumors, which were sestamibi-avid. The patient underwent resection of the large right inferior and left inferior parathyroid tumors. Histopathology revealed a double water-clear cell parathyroid adenoma. His serum calcium and PTH levels normalized after surgery. The literature review identified 37 cases of water-clear cell parathyroid adenoma between 1985 and 2021. The median age at diagnosis was 56 years. Classic complications were common, including nephrolithiasis in nine and skeletal presentations in 10 patients. Before surgery, the median calcium and PTH levels were 12.0 mg/dL and 290 pg/mL, respectively. Overall, 89% were localized on ultrasonography, and 60% were positive on scintigraphy. Four patients had double adenomas. The median maximum diameter was 3.8 cm, and the median weight of the resected adenoma was 5.27 g. In summary, water-clear cell parathyroid adenoma has certain unique features. These include larger tumor size, relatively indolent biochemical profile, high prevalence of complications and nonspecific symptoms, an isoechoic appearance on ultrasonography, and reduced scintigraphic sensitivity.
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Affiliation(s)
- Chia-An Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei 104215, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei 104215, Taiwan
| | - Shuen-Han Dai
- Department of Pathology, MacKay Memorial Hospital and Mackay Medical College, Taipei 104215, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei 104215, Taiwan
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Bardales RH. Practice models from my 16 years of performing ultrasound-guided fine-needle aspiration of superficial masses at an outpatient clinic. Part I. Semin Diagn Pathol 2022; 39:440-447. [PMID: 35753848 DOI: 10.1053/j.semdp.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ricardo H Bardales
- Director, Interventional Cytopathology, Precision Pathology - Sacramento, CA, 7750 College Town Drive, Suite 102, Sacramento, Ca, USA.
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Frey S, Goronflot T, Blanchard C, Kerleau C, Gourraud PA, Wargny M, Caillard C, Hourmant M, Figueres L, Mirallié É. Impact of parathyroidectomy on kidney graft function in post-transplant tertiary hyperparathyroidism: a comparative study. Langenbecks Arch Surg 2022; 407:2489-2498. [PMID: 35596781 DOI: 10.1007/s00423-022-02555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Parathyroidectomy to treat tertiary hyperparathyroidism (THPT) is now on a par with calcimimetic treatment. The effects of cinacalcet and parathyroidectomy on kidney transplant function remain controversial. The aim of this study was to evaluate kidney transplant function in THPT patients treated either by parathyroidectomy, cinacalcet, or not treated. METHODS Between 2009 and 2019, 231 patients with functional grafts presenting THPT, defined either by calcaemia superior to 2.5 mmol/L with elevated PTH level or hypercalcaemia with non-adapted PTH level 1 year after kidney transplantation, were included. Hyperparathyroid patients treated by cinacalcet and parathyroidectomy were matched for age, sex, graft rank, and baseline eGFR with cinacalcet-only and untreated patients. Conditional logistic regression models were used to compare eGFR variations 1 year after parathyroidectomy between operated patients and matched controls. Five-year survivals were compared with the Mantel-Cox test. RESULTS Eleven patients treated with parathyroidectomy and cinacalcet were matched with 16 patients treated by cinacalcet-only and 29 untreated patients. Demographic characteristics were comparable between groups. Estimated odds ratios for eGFR evolution in operated patients compared with cinacalcet-only and untreated patients were 0.92 [95%CI 0.83-1.02] and 0.99 [0.89-1.10] respectively, indicating no significant impairment of eGFR 1 year after surgery. Five-year allograft survival was not significantly impaired in operated patients. CONCLUSIONS Parathyroidectomy did not appear to substantially alter or improve graft function 1 year after surgery or 5-year allograft survival. It could be hypothesized that in addition to its known benefits, parathyroidectomy can be safely performed vis-à-vis graft function in tertiary hyperparathyroidism.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France.,Université de Nantes, quai de Tourville, 44000, Nantes, France.,L'institut du Thorax, Unité Inserm UMR 1087 / CNRS UMR 6291, IRS 8 Quai Moncousu, 44000, Nantes, France
| | - Thomas Goronflot
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France.,Université de Nantes, quai de Tourville, 44000, Nantes, France.,L'institut du Thorax, Unité Inserm UMR 1087 / CNRS UMR 6291, IRS 8 Quai Moncousu, 44000, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Pierre-Antoine Gourraud
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Cécile Caillard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France
| | - Maryvonne Hourmant
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France.,Service de Néphrologie-Immunologie Clinique, CHU de Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Lucile Figueres
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France.,Service de Néphrologie-Immunologie Clinique, CHU de Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Éric Mirallié
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France. .,Université de Nantes, quai de Tourville, 44000, Nantes, France.
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de Jong MC, Lorente-Poch L, Sancho-Insenser J, Rozalén García V, Brain C, Abdel-Aziz TE, Hewitt RJ, Butler CR, Sitges-Serra A, Kurzawinski TR. Late Recovery of Parathyroid Function after Total Thyroidectomy in Children and Adults: Is There a Difference? Horm Res Paediatr 2022; 93:539-547. [PMID: 33706312 DOI: 10.1159/000513768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parathyroid failure after total thyroidectomy is the commonest adverse event amongst both children and adults. The phenomenon of late recovery of parathyroid function, especially in young patients with persistent hypoparathyroidism, is not well understood. This study investigated differences in rates of parathyroid recovery in children and adults and factors influencing this. METHODS A joint dual-centre database of patients who underwent a total thyroidectomy between 1998 and 2018 was searched for patients with persistent hypoparathyroidism, defined as dependence on oral calcium and vitamin D supplementation at 6 months. Demographic, surgical, pathological, and biochemical data were collected and analysed. <F00_Regular>Parathyroid Glands Remaining</F00_Regular> in Situ (PGRIS) score was calculated. RESULTS Out of 960 patients who had total thyroidectomy, 94 (9.8%) had persistent hypoparathyroidism at 6 months, 23 (24.5%) children with a median [range] age 10 [0-17], and 71 (75.5%) adults aged 55 [25-82] years, respectively. Both groups were comparable regarding sex, indication, extent of surgery, and PGRIS score. After a median follow-up of 20 months, the parathyroid recovery rate was identical for children and adults (11 [47.8%] vs. 34 [47.9%]; p = 0.92). Sex, extent, and indication for surgery had no effect on recovery (all p > 0.05). PGRIS score = 4 (HR = 0.48) and serum calcium >2.25 mmol/L (HR = 0.24) at 1 month were associated with a decreased risk of persistent hypoparathyroidism on multivariate analysis (p < 0.05). CONCLUSION Almost half of patients recovered from persistent hypoparathyroidism after 6 months; therefore, the term persistent instead of permanent hypoparathyroidism should be used. Recovery rates of parathyroid function in children and adults were similar. Regardless of age, predictive factors for recovery were PGRIS score = 4 and a serum calcium >2.25 mmol/L at 1 month.
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Affiliation(s)
- Mechteld C de Jong
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom,
| | | | | | - Virginia Rozalén García
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom
| | - Caroline Brain
- Department of Paediatric Endocrinology, University College London, Hospitals and Great Ormond Street Hospital for Children NHS Foundation Trusts, London, United Kingdom
| | - Tarek E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom
| | - Richard J Hewitt
- Department of Paediatric Ear, Nose and Throat Surgery, Great Ormond Street Hospitals NHS Foundation Trust, London, United Kingdom
| | - Colin R Butler
- Department of Paediatric Ear, Nose and Throat Surgery, Great Ormond Street Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Tom R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital, London, United Kingdom
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Agarwal S, Kardam S, Chatterjee P, Kumar C, Boruah M, Sharma MC, Tabin M, Ramakrishnan L. CaSR expression in normal parathyroid and PHPT: new insights into pathogenesis from an autopsy-based study. J Endocrinol Invest 2022; 45:337-346. [PMID: 34302683 DOI: 10.1007/s40618-021-01646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Calcium sensing receptor (CaSR), on the surface of normal parathyroid cells, is essential for maintaining serum calcium levels. The normal pattern of CaSR immunostaining remains undefined and is presumptively circumferential. Given the physiological variation in serum calcium, we postulated that CaSR expression could not be uniformly circumferential. Also, cytoplasmic expression has not been evaluated either in normal or pathological tissues. We studied normal parathyroid tissues derived from forensic autopsies and those rimming parathyroid adenomas for membranous and cytoplasmic CaSR immunoexpression. Results were compared with primary hyperparathyroidism (PHPT) to look for any pathogenetic implications. MATERIALS AND METHODS We evaluated 34 normal parathyroid tissues from 11 autopsies, 30 normal rims, 45 parathyroid adenoma, 10 hyperplasia, and 7 carcinoma cases. Membranous expression was categorized complete/incomplete and weak/moderate/strong; scored using Her2/Neu and Histo-scores; predominant pattern noted. Cytoplasmic expression was categorized negative/weak/moderate/strong; predominant intensity noted. RESULTS Normal autopsy-derived parathyroid tissues were Her2/Neu 3 + , but incomplete membranous staining predominated in 85%. Their immune-scores were significantly more than the cases (p < < 0.05). The mean histo-score of normal rims was intermediate between the two (p < < 0.05). Cytoplasmic expression was strong in all autopsy-derived tissues, weak/negative in hyperplasia (100%), moderate in 16% adenomas, and 43% carcinomas. CONCLUSIONS Normal autopsy-derived parathyroid tissues showed strong but predominantly incomplete membranous expression. Surface CaSR expression decreased in PHPT and is probably an early event in parathyroid adenoma, seen even in normal rims. Whether there is a defect in CaSR trafficking from the cytoplasm to the cell surface in adenoma and carcinoma needs further evaluation.
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Affiliation(s)
- S Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S Kardam
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - P Chatterjee
- Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - C Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - M Boruah
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Tabin
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - L Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Shin M, Choi JY, Kim SW, Kim JH, Cho YS. Usefulness of 99mTc-SESTAMIBI Scintigraphy in Persistent Hyper parathyroidism after Kidney Transplant. Nucl Med Mol Imaging 2021; 55:285-292. [PMID: 34868377 DOI: 10.1007/s13139-021-00722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
Purpose 99mTc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of 99mTc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT). Methods Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D. Results Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm. Conclusions Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.
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Affiliation(s)
- Muheon Shin
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Wook Kim
- Department of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Han Kim
- Department of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Piccardo A, Bottoni G, Boccalatte LA, Camponovo C, Musumeci M, Bacigalupo L, Collaud C, Ugolini M, Fiz F, Trimboli P. Head-to-head comparison among 18F-choline PET/CT, 4D contrast-enhanced CT, and 18F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis. Endocrine 2021; 74:404-412. [PMID: 34173158 DOI: 10.1007/s12020-021-02798-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In primary hyperparathyroidism (PHPT), the localization of hyperfunctioning parathyroid gland (HPTG) allows tailored surgery. Although Four-Dimensional Contrast-enhanced Computed Tomography (4DCeCT) and 18F-choline Positron Emission Tomography/Computed Tomography (PET/CT) are reported to be promising second-line imaging procedures, no meta-analysis of their comparison exists. DESIGN we conducted a systematic review and meta-analysis to find original papers reporting the head-to-head comparison of 4DCeCT, 18F-choline PET/CT and integrated 18F-choline-PET/4DCeCT. METHODS this systematic review was conducted according to PRISMA. PubMed, CENTRAL, Scopus, and Web of Science were searched until January 2021. Studies comparing the ability of 4DCeCT, 18F-choline PET/CT and 18F-choline PET/4DCeCT to identify HPTG in patients with PHPT were selected. A per patient-based analysis of the three procedures was conducted in all patients (detection rate, DR) and in those with histologically confirmed HPTG (sensitivity). RESULTS Of the 78 records identified, five articles (153 PHPT patients) published between January the 1st, 2018 and January the 31st, 2021 were included. The pooled DR of 18F-choline PET/CT, 4DCeCT and 18F-choline PET/4DCeCT was 0.86, 0.69, and 0.86, respectively, while their pooled sensitivity was 0.89, 0.77 and 0.93, respectively. The analysis of pooled discrepancy showed that the sensitivity of 18F-choline PET/CT and 18F-choline PET/4DCeCT was higher than that of 4DCeCT by 0.11 and 0.13, respectively, the sensitivity of 18F-choline PET/4DCeCT being 0.06 higher than that of 18F-Choline PET/CT. CONCLUSIONS This meta-analysis suggests that the sensitivity of 18F-choline PET/CT and 18F-choline PET/4DCeCT is higher than that of 4DCeCT, while only a slight difference was observed between 18F-choline PET/CT and 18F-choline PET/4DCeCT.
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Affiliation(s)
- Arnoldo Piccardo
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
| | - Gianluca Bottoni
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
| | | | - Chiara Camponovo
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Martina Musumeci
- Department of Endocrinology, Metabolism and Nuclear Medicine/PET-CT, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lorenzo Bacigalupo
- Radiology Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
| | - Carlos Collaud
- Department of Endocrinology, Metabolism and Nuclear Medicine/PET-CT, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martina Ugolini
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine Department, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy.
| | - Pierpaolo Trimboli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Cohen O, Tufano RP, Anuwong A, Shaha AR, Olsen KD, Zafereo M, Rinaldo A, Mäkitie AA, Nixon IJ, Russell JO, Ferlito A, Khafif A. Transoral endoscopic vestibular approach for thyroidectomy and parathyroidectomy - From promise to practice. Am J Otolaryngol 2021; 42:103022. [PMID: 33838355 DOI: 10.1016/j.amjoto.2021.103022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe the evolution and recent series on transoral endoscopic vestibular approach thyroidectomy and parathyroidectomy (TOET/PVA). DATA SOURCES PubMed, Google Scholar. REVIEW METHODS Review of the available English literature. RESULTS TOET/PVA may offer several advantages over other remote access thyroidectomy approaches and has been adopted by many centers worldwide with excellent success rates. Indications include benign disease and early thyroid cancer patients. Complication rate is comparable to the trans-cervical approach. The suggested framework has been validated in recent studies and its feasibility confirmed. CONCLUSION TOET/PVA has now been used to treat thousands of patients worldwide due to low cost, short learning curve and excellent cosmetic outcomes. Further studies will be necessary to demonstrate oncologic non-inferiority and also the true value that is added by the approach.
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Serra C, Silveira L. Evaluation of structural and ultrastructural changes in thyroid and parathyroid glands after near infrared irradiation: study on an animal model. PeerJ 2021; 9:e11891. [PMID: 34430082 PMCID: PMC8349517 DOI: 10.7717/peerj.11891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
Intraoperative identification of parathyroid glands is a tough task for surgeons performing thyroid or parathyroid surgery, because the small size, color and shape of these glands hinder their discrimination from other cervical tissues. In 2011, Paras described the autofluorescence of parathyroid glands, a property that could facilitate their intraoperative identification. Parathyroid glands submitted to a 785 nm laser beam emit fluorescence in the near infrared range, with a peak at 822 nm. As the intrinsic properties of secretory tissues may be affected by the exposure to the near infrared light, a situation that could preclude their intraoperative utilization, the authors compared the structural and ultra-structural patterns of rat’s thyroid and parathyroid glands submitted to irradiation replicating the conditions that allow their intraoperative identification, with those of non irradiated animals. Twenty-four Wistar rats were divided into six groups: animals of Groups 1, 3 and 5 were submitted under general anesthesia to direct irradiation of the cervical area with a 780 nm LED light for 3 minutes through a cervical incision, and animals of Groups 2, 4 and 6 were submitted to cervical dissection without irradiation. Animals of were euthanized immediately (Groups 1 and 2), at Day 30 (Groups 3 and 4) at and at Day 60 (Groups 5 and 6) and thyroid and parathyroid glands were removed: one lobe was prepared for conventional pathological examination and the other lobe for electron microscopy observed by three experienced pathological experts. Twenty-four samples were prepared for conventional histology and there were no alterations reported in any group. Due to technical problems, only 21 samples were observed by electron microscopy and there were no differences in the ultrastructure of parathyroid and thyroid glands, namely the nuclear pattern, mitochondria, endoplasmic reticulum or secretory granules, in any of the groups. These results confirm the innocuity of near infrared irradiation’, allowing its intraoperative utilization.
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Affiliation(s)
- Carlos Serra
- Hospital do SAMS, Lisboa, Portugal.,Universidade da Beira Interior, Faculdade de Ciências da Saúde, Covilhã, Portugal
| | - Luis Silveira
- Universidade da Beira Interior, Faculdade de Ciências da Saúde, Covilhã, Portugal
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Riordan F, Murphy MS, Feeley L, Sheahan P. Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation. Langenbecks Arch Surg 2021. [PMID: 34406491 DOI: 10.1007/s00423-021-02287-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Purpose Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism. Methods Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients. Results Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3–4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2–4 parathyroids, and identification of 3–4 parathyroids, were significant. Conclusions Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02287-6.
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Iversen P, Arveschoug AK, Rejnmark L, Rolighed L. C-11 methionine positron emission tomography scans improve the preoperative localization of pathologic parathyroid glands in primary hyperparathyroidism. Scand J Surg 2021; 111:14574969211036837. [PMID: 34399632 DOI: 10.1177/14574969211036837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Preoperative localization of pathologic parathyroid glands is essential in the preparation of a parathyroidectomy. We evaluated the use of a C-11 methionine positron emission tomography/computed tomography scan in a 7-year period in selected patients with primary hyperparathyroidism. The indications to perform a C-11 methionine positron emission tomography/computed tomography were either persistent primary hyperparathyroidism after parathyroidectomy or inconclusive preoperative localization on ultrasound and sestaMIBI. MATERIALS AND METHODS A group of 36 patients was referred for a C-11 methionine positron emission tomography/computed tomography. Biochemical data, pathology, and results of sestaMIBI were collected retrospectively. The primary hyperparathyroidism patients were divided into two groups. In group 1 (N = 17), the C-11 methionine positron emission tomography/computed tomography was performed before parathyroidectomy. In group 2 (N = 19), the C-11 methionine positron emission tomography/computed tomography was performed after unsuccessful parathyroidectomy and before a reoperation. RESULTS Overall, in 30 of the 36 patients (83%), C-11 methionine positron emission tomography/computed tomography identified a true-positive pathologic parathyroid gland confirmed by an experienced pathologist, consistent with a positive predictive value of 91%. In group 1, 94% of the patients (N = 16) had pathologic parathyroid tissue identified by C-11 methionine positron emission tomography/computed tomography. This resulted in a clinical benefit in 13 patients (76%). In group 2, the benefit was slightly lower, as 74% of the patients (N = 14) had a true-positive C-11 methionine positron emission tomography/computed tomography scan resulting in a clinical benefit in nine patients (47%). CONCLUSION In two selected groups of patients planned for an initial operation or reoperation of primary hyperparathyroidism and inconclusive conventional imaging, we found C-11 methionine positron emission tomography/computed tomography to give parathyroid surgeons a clinical benefit in the majority of cases, electing the patients for unilateral surgery.
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Affiliation(s)
- Peter Iversen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Entrance J, Level 2, J220, DK-8200 Aarhus N, Denmark
| | - Anne K Arveschoug
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Aarhus university Hospital, Aarhus N, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
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48
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Kim E, Ramonell KM, Mayfield N, Lindeman B. Parathyroid allotransplantation for the treatment of permanent hypoparathyroidism: A systematic review. Am J Surg 2021; 223:652-661. [PMID: 34304848 DOI: 10.1016/j.amjsurg.2021.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hypoparathyroidism is the most common complication of bilateral operations in the central neck. No formal guidelines exist for the management of permanent hypoparathyroidism. Current treatment involving medical supplementation increases resource utilization and patient morbidity while decreasing quality of life. Parathyroid allotransplant (PA) offers a promising therapy; however, the optimal technique and role of immunosuppression (IS) in PA remain unclear. METHODS We performed a systematic search of the Embase, MEDLINE, and Cochrane Library databases to identify studies investigating PA for treatment of hypoparathyroidism. RESULTS A total of 24 studies including 186 individual allograft transplants in 146 patients were identified. Pooled graft survival for allotransplants in transplant-naïve vs prior transplant recipients was 29.9% and 80%, respectively. CONCLUSIONS PA using normocellular, fresh parathyroid donor tissue that is ABO-compatible, with induction and, at minimum, short-term maintenance IS presents a potentially safe and effective therapeutic option for permanent hypoparathyroidism in patients tolerating IS.
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Affiliation(s)
- Eric Kim
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Nicolas Mayfield
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
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Serra C, Serra J, Ferreira Machado IL, Vieira Ferreira LF. Spectroscopic Analysis of Parathyroid and Thyroid Tissues by Ground-State diffuse Reflectance and Laser Induced Luminescence: a Preliminary Report. J Fluoresc 2021; 31:1235-1239. [PMID: 34283330 DOI: 10.1007/s10895-021-02783-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Intraoperative discrimination of thyroid and parathyroid tissues is fundamental in thyroid surgery. Recent fluorescence studies have shown stronger NIR emission in parathyroid tissue than in thyroid tissue, presenting a potential avenue for the development of a tool for surgical assistance. However, the fluorophore responsible for this emission has not yet been identified. In this work, spectroscopic analysis was performed to ascertain the origin of the emission peaks in parathyroid tissue. Ground-state diffuse reflectance (GSDR) absorption spectroscopy and laser-induced luminescence (LIL) emission spectroscopy were performed in parathyroid, thyroid, and fatty tissue samples and the resulting spectra were compared with the peaks of known fluorophores to identify the origin of each peak. The spectra of the different tissue types were also compared in order to evaluate the wavelength which presents the highest parathyroid emission relative to the emission of the surrounding tissues, representing the ideal wavelength for parathyroid detection. An emission peak in these conditions was observed for both thyroid and parathyroid tissue at 711 nm, with a higher intensity in parathyroid sample, making it suitable for detection applications. These results show a potential avenue for the development of a system allowing parathyroid detection in a surgical setting.
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Affiliation(s)
- Carlos Serra
- Hospital Dos Sams, 1849-017, Lisboa, Portugal. .,Faculdade de Ciências da Saúde, Universidade da Beira Interior, 6200-506, Covilhã, Portugal.
| | - João Serra
- Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias (INESC MN) , Lisboa, Portugal.,Instituto Superior Técnico, Universidade de Lisboa, 1049-0011, Lisboa, Portugal
| | - Isabel L Ferreira Machado
- Polytechnic Institute of Portalegre, 7300-110, Portalegre, Portugal.,BSIRG, Biospectroscopy and InterfacesResearch Group From IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, 1049-001, Lisboa, Portugal
| | - Luís F Vieira Ferreira
- BSIRG, Biospectroscopy and InterfacesResearch Group From IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, 1049-001, Lisboa, Portugal
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50
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Lajmi Z, Bdioui A, Bchir A, Oussama Belkacem, Ben Ammou E, Missaoui N, Hmissa S. The input of GATA-3 in the identification of parathyroid carcinoma diagnosis: Case report with review of literature. Ann Med Surg (Lond) 2021; 68:102571. [PMID: 34345427 DOI: 10.1016/j.amsu.2021.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and Importance: Parathyroid carcinoma is an exceptional cancer, with significant morbidity and mortality, associated with parathyroid hormone (PTH) mediated hypercalcemia. Case presentation We report a case of parathyroid carcinoma with a difficult histological diagnosis. This case illustrates the usefulness of the immunohistochemical marker “GATA-3” in parathyroid differentiation especially in tumours. Clinical discussion The diagnosis of parathyroid carcinoma is challenging without the knowledge of the clinical information, laboratory finding, and radiographic imaging studies. The immunohistochemistry is useful tool in these cases to identify the parathyroid origin of neoplasia. GATA-3 is a transcription factor that is involved in the embryonic development of the parathyroid glands and in adult parathyroid cell proliferation. Conclusion It is concluded that GATA-3 is a very sensitive and relatively specific immunohistochemical marker for parathyroid differentiation that can assist in the differential diagnosis of parathyroid tumours. Input of GATA-3 in the identification of parathyroid carcinoma.
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