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2.
Radiologia (Engl Ed) ; 66(3): 236-247, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38908885

RESUMO

Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.


Assuntos
Neoplasias das Paratireoides , Humanos , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico por Imagem/métodos , Hiperparatireoidismo Primário/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças das Paratireoides/diagnóstico por imagem
3.
Ann Acad Med Singap ; 53(4): 253-263, 2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38920182

RESUMO

Significant progress has been made in the understand-ing of many human diseases, especially cancers, which has contributed to improved and increased survival. The Human Genome Project and The Cancer Genome Atlas project brought about a new era, with an understanding of inherited diseases at a molecular level, which subsequently facilitated the option of precision medicine. Precision medicine has helped tailor treatment decisions at an individual level, for instance in terms of surgical treatments or targeted therapies in advanced diseases. Despite the increasing advances in genetic-lead precision medicine, this has not translated into increasing uptake among patients. Reasons for this may be potential knowledge gaps among clinicians; on reasons for poor uptake of genetic testing such as for cultural, religious or personal beliefs; and on financial implications such as lack of support from insurance companies. In this review, we look at the current scenario of genetic screening for common inherited endocrine conditions affecting the thyroid, parathyroid and adrenal glands in Singapore, and the implications associated with it.


Assuntos
Testes Genéticos , Humanos , Singapura , Testes Genéticos/métodos , Doenças da Glândula Tireoide/genética , Doenças da Glândula Tireoide/diagnóstico , Doenças do Sistema Endócrino/genética , Doenças do Sistema Endócrino/diagnóstico , Doenças das Paratireoides/genética , Doenças das Paratireoides/diagnóstico , Doenças das Glândulas Suprarrenais/genética , Doenças das Glândulas Suprarrenais/diagnóstico , Medicina de Precisão/métodos
4.
Expert Rev Endocrinol Metab ; 19(4): 317-333, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38899737

RESUMO

INTRODUCTION: Molecular imaging of thyroid and parathyroid diseases has changed in recent years due to the introduction of new radiopharmaceuticals and new imaging techniques. Accordingly, we provided an clinicians-oriented overview of such techniques and their indications. AREAS COVERED: A review of the literature was performed in the PubMed, Web of Science, and Scopus without time or language restrictions through the use of one or more fitting search criteria and terms as well as through screening of references in relevant selected papers. Literature up to and including December 2023 was included. Screening of titles/abstracts and removal of duplicates was performed and the full texts of the remaining potentially relevant articles were retrieved and reviewed. EXPERT OPINION: Thyroid and parathyroid scintigraphy remains integral in patients with thyrotoxicosis, thyroid nodules, differentiated thyroid cancer and, respectively, hyperparathyroidism. In the last years positron-emission tomography with different tracers emerged as a more accurate alternative in evaluating indeterminate thyroid nodules [18F-fluorodeoxyglucose (FDG)], differentiated thyroid cancer [124I-iodide, 18F-tetrafluoroborate, 18F-FDG] and hyperparathyroidism [18F-fluorocholine]. Other PET tracers are useful in evaluating relapsing/advanced forms of medullary thyroid cancer (18F-FDOPA) and selecting patients with advanced follicular and medullary thyroid cancers for theranostic treatments (68Ga/177Ga-somatostatin analogues).


Assuntos
Imagem Molecular , Doenças das Paratireoides , Compostos Radiofarmacêuticos , Doenças da Glândula Tireoide , Humanos , Imagem Molecular/métodos , Doenças das Paratireoides/diagnóstico por imagem , Doenças da Glândula Tireoide/diagnóstico por imagem , Tomografia por Emissão de Pósitrons
9.
Khirurgiia (Mosk) ; (2): 68-74, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38344962

RESUMO

OBJECTIVE: To study the features of clinical course, diagnosis and treatment of true non-functioning parathyroid cysts. MATERIAL AND METHODS: We retrospectively analyzed 18 patients with non-functioning true parathyroid cysts. Inclusion criteria: US-confirmed anechoic lesion of the neck without tissue component, cytological data on cystic lesion, high cystic parathyroid hormone and no laboratory signs of hyperparathyroidism. RESULTS: Non-functioning parathyroid cysts were asymptomatic and diagnosed accidentally after ultrasound of the neck. All patients were women aged 35-77 years. Four patients had cysts near the upper parathyroid glands, 14 patients - near the lower parathyroid glands. Of these, 2 ones had cysts below the level of the clavicle. Cyst volume was 4.3-110.3 cm3 (24.1±26.2 cm3). High cystic parathyroid hormone (2012.5±946.7 pg/ml) was observed in all patients. Simple aspiration was performed in 5 patients, aspiration with sclerotherapy - in 10 patients, cystectomy - in 3 patients. Recurrence was diagnosed in 1 patient after aspiration and 2 patients after sclerotherapy. CONCLUSION: No pathognomonic clinical and ultrasonic symptoms, as well as specific cytological data lead to misdiagnosis. Analysis of PTH in non-functioning parathyroid cysts is essential for diagnosis. Minimally invasive treatment is preferable for true parathyroid cysts. However, these approaches are not radical.


Assuntos
Cistos , Hiperparatireoidismo , Doenças das Paratireoides , Humanos , Feminino , Masculino , Estudos Retrospectivos , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/cirurgia , Hormônio Paratireóideo , Cistos/diagnóstico , Cistos/cirurgia
10.
Bipolar Disord ; 26(1): 71-83, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37300391

RESUMO

OBJECTIVES: Although potential adverse effects of lithium treatment on renal and endocrine systems have been extensively investigated, most prior studies are limited by selected populations and short follow-up. METHODS: Within the Psychiatric Services of the Central Denmark Region, we identified all patients with bipolar disorder and ≥1 serum-lithium (se-Li) measurements between January 1, 2013, and July 20, 2022, and reference patients with bipolar disorder matched on age, sex, and baseline creatinine. Outcomes were diagnoses of renal, thyroid and parathyroid disease, and blood tests measuring creatinine, estimated glomerular filtration rate (eGFR), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium. Analyses included unadjusted multilevel regression to describe changes in biochemical markers, and adjusted Cox regression to compare rates of disease/biochemical outcomes between lithium users and reference patients. RESULTS: Among 1646 lithium users (median age 36 years, 63% women) and 5013 reference patients, lithium users had decreasing TSH and eGFR, stable PTH, and increasing calcium levels over time. Lithium use was associated with increased rates of renal, thyroid and parathyroid disease, and levels of biochemical markers outside normal ranges (hazard rate ratios: 1.07-11.22), but the absolute number of severe outcomes was low (e.g., chronic kidney disease: N = 10, 0.6%). Notably, the rate of blood testing was substantially higher among lithium users than among reference patients (e.g., mean number of creatinine tests during the second year of follow-up: lithium users = 2.5, reference patients = 1.4). CONCLUSIONS: Severely adverse renal and endocrine outcomes are rare during lithium treatment. Observational studies of long-term lithium treatment are prone to detection bias.


Assuntos
Transtorno Bipolar , Doenças das Paratireoides , Humanos , Feminino , Adulto , Masculino , Lítio/efeitos adversos , Glândula Tireoide , Estudos de Coortes , Cálcio , Compostos de Lítio/efeitos adversos , Creatinina , Doenças das Paratireoides/induzido quimicamente , Tireotropina , Biomarcadores
11.
Otolaryngol Clin North Am ; 57(1): 11-24, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37634985

RESUMO

Thyroid and parathyroid disorders are quite common in the population and range from benign to malignant conditions that may be hormonally active or inactive. Select disorders of the thyroid and parathyroid can be managed medically, although there are a variety of circumstances that may require definitive management with surgery. Surgical intervention may be required for hormonal control, compressive symptoms, or for the removal and/or control of malignancy. The endocrinologist's perspective of the preoperative and postoperative management regarding thyroid and parathyroid surgeries will be discussed.


Assuntos
Doenças das Paratireoides , Glândula Tireoide , Humanos , Glândula Tireoide/cirurgia , Paratireoidectomia , Tireoidectomia , Estudos Retrospectivos , Doenças das Paratireoides/cirurgia
12.
Otolaryngol Clin North Am ; 57(1): 1-9, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37648633

RESUMO

The management of thyroid and parathyroid pathology varies widely, with unifying goals of symptomatic control and mitigating patient morbidity. In general, surgery is indicated when addressing malignancy or when medical management is insufficient. Over the last few decades, treatment paradigms for patients with head and neck endocrine disease have shifted significantly as our understanding of disease processes has expanded and with the advent of numerous relevant technologies. Here we provide a general overview of thyroid and parathyroid disease that may be managed by the otolaryngologist, with attention to emerging strategies in diagnosis and treatment.


Assuntos
Otolaringologia , Doenças das Paratireoides , Nódulo da Glândula Tireoide , Humanos , Glândula Tireoide/cirurgia , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/cirurgia , Resultado do Tratamento
14.
Langenbecks Arch Surg ; 408(1): 389, 2023 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-37806985

RESUMO

BACKGROUND: Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. METHODS: We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. CONCLUSION: Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.


Assuntos
Hiperparatireoidismo Primário , Doenças das Paratireoides , Neoplasias das Paratireoides , Humanos , Hormônio Paratireóideo , Paratireoidectomia/métodos , Doenças das Paratireoides/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Estudos Retrospectivos
15.
Probl Endokrinol (Mosk) ; 69(3): 24-34, 2023 Jun 30.
Artigo em Russo | MEDLINE | ID: mdl-37448244

RESUMO

BACKGROUND: Sporadic multiple parathyroid gland disease is » cases of primary hyperparathyroidism (PHPT). However, a single tactic for diagnosing and operating volume in patients with this variant of PHPT has not yet been developed. One of the possible directions in the search for pathogenetically substantiated methods of diagnosis and treatment is the study of the molecular genetic features of the disease and associated clinical and laboratory factors. AIM: To study the features of the expression of calcium sensitive (CaSR) and vitamin D (VDR) receptors on the surface of parathyroid cells in primary hyperparathyroidism with solitary and multiple lesions of the parathyroid glands, as well as its changes under the influence of a decrease in the filtration function of the kidneys. MATERIALS AND METHODS: In a single center observational prospective study with retrospective data collection, there were patients who during 2019-2021. operated on for PHPT, secondary hyperparathyroidism (SHPT) and all cases of tertiary hyperparathyroidism (THPT) operated during 2014-2021. The expression of CaSR, VDR and its relationship with the main laboratory parameters, the clinical variant of hyperparathyroidism, and the morphological substrate were studied. RESULTS: The study included 69 patients: 19 with multiple and 25 with solitary PTG near PHPT, 15 with SHPT, 10 with THPT. A statistically significant decrease in the frequency of detection of normal expression of CaSR and VDR receptors occurs in any morphological variant of hyperparathyroidism and is observed in 93-60% of drugs. A decrease in the normal expression of CaSR in hyperplasia is detected statistically significantly less frequently than in adenoma (p≤0.01). The median expression intensity in adenoma was 2.5 (2:3), in hyperplasia 3.5 (3-4) (p≤0.01). The difference in the molecular mechanisms of the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma (PHPT with solitary adenoma) or hyperplasia (SHPT and PHPT with multiple PTG lesions) is realized in the frequency of maintaining normal CaSR expression in the PTG tissue. These mechanisms are implemented at the local level, their variability does not change under the influence of RRT. A common molecular genetic mechanism for the development of hyperparathyroidism with a predominance of a morphological substrate in the form of adenoma or hyperplasia has been found to reduce the frequency of maintaining normal VDR expression in PTG (up to 7-13%), p<0.01. This mechanism is implemented at the local level, its variability changes under the influence of RRT, reaching statistically significant differences in patients with THPT. CONCLUSION: The study demonstrates the features of changes in the expression of CaSR and VDR in PHPT with multiple lesions of the parathyroid glands. The relationship between the expression of these receptors and the clinical variant of hyperparathyroidism, the morphological substrate, the main laboratory parameters, and renal function was shown.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Hiperparatireoidismo Secundário , Doenças das Paratireoides , Neoplasias das Paratireoides , Humanos , Adenoma/complicações , Cálcio da Dieta/análise , Cálcio da Dieta/metabolismo , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/genética , Hiperparatireoidismo Secundário/genética , Hiperparatireoidismo Secundário/complicações , Hiperplasia/genética , Doenças das Paratireoides/complicações , Doenças das Paratireoides/metabolismo , Doenças das Paratireoides/patologia , Glândulas Paratireoides , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/genética , Estudos Prospectivos , Receptores de Calcitriol/genética , Receptores de Calcitriol/análise , Receptores de Calcitriol/metabolismo , Estudos Retrospectivos
16.
Nan Fang Yi Ke Da Xue Xue Bao ; 43(5): 868-872, 2023 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-37313830

RESUMO

We report a case of functional parathyroid cyst treated by ultrasound-guided anhydrous ethanol sclerotherapy and microwave ablation. The 63-year-old female patient was diagnosed to have functional parathyroid cyst with hypercalcemia, high PTH and cystic space-occupying lesions in the neck by ultrasound, radionuclide scanning and PTH measurement of the cystic fluid. The patient refused to receive cyst resection, and anhydrous ethanol sclerotherapy with microwave ablation was performed under ultrasound guidance. The procedure was completed smoothly without any complications either during or after the operation. Follow-up examination of the patient at 18 months after the operation showed a significant reduction of the mass and normal blood calcium and iPTH levels, demonstrating a clinical cure of the patient. Ablative treatment of functional parathyroid cyst has not been documented so far. This approach provides a minimally invasive treatment modality for such cases where surgical resection is not an option, but its efficacy and safety need to be evaluated in more cases with longer follow-up time.


Assuntos
Técnicas de Ablação , Cistos , Doenças das Paratireoides , Feminino , Humanos , Pessoa de Meia-Idade , Cistos/cirurgia , Etanol/administração & dosagem , Micro-Ondas/uso terapêutico , Ultrassonografia de Intervenção , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Doenças das Paratireoides/cirurgia , Técnicas de Ablação/métodos
17.
Radiographics ; 43(6): e220111, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37141139

RESUMO

Ectopic tissue is an anatomic abnormality in which tissue develops in an area outside its normal location. It is primarily caused by abnormalities during the process of embryologic development. Although the majority of individuals with ectopic tissues remain asymptomatic, various symptoms and associated complications can occur. Failure in normal embryologic development leads to loss of normal physiologic function or may result in harmful functions such as ectopic hormonal secretion in the ectopic pituitary adenoma. Ectopic tissues may also frequently mimic tumors. For example, developmental abnormalities in the pharyngeal pouches may result in an ectopic parathyroid gland and ectopic thymus, both of which are frequently misdiagnosed as tumors. Adequate knowledge of embryology is essential for understanding the differential diagnoses of ectopic tissues and facilitating appropriate management. The authors summarize the embryologic development and pathogenesis of ectopic tissues by using illustrations to facilitate a deeper understanding of embryologic development and anatomy. Characteristic imaging findings (US, CT, MRI, and scintigraphy) are described for ectopic tissues of the brain, head, neck, thorax, abdomen, and pelvis by focusing on common conditions that radiologists may encounter in daily practice and their differential diagnoses. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.


Assuntos
Coristoma , Doenças das Paratireoides , Humanos , Coristoma/diagnóstico por imagem , Pescoço , Cabeça , Imageamento por Ressonância Magnética
18.
J Endocrinol Invest ; 46(6): 1065-1077, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36773188

RESUMO

PURPOSE: Parathyroid diseases are related to parathyroid hormone (PTH) dysregulation by parathyroid cells or alteration of PTH function. They include hyperparathyroidism (PTH excess), hypoparathyroidism (PTH deficiency) and pseudohypoparathyroidism (PTH resistance). Little is known about correlation between parathyroid diseases and metabolic syndrome (MetS). METHODS: An electronic-based search using PubMed was performed until October 2022 and articles were selected based on relevance of title, abstract, English language and publication in peer-reviewed journals. RESULTS: Possible association between PTH alterations and the diverse manifestation of MetS have been proposed and it could be supposed that MetS may negatively influence parathyroid diseases. Available data show significant association for hyperparathyroidism and pseudohypoparathyroidism. CONCLUSIONS: This review highlights the possible implications between MetS and parathyroid diseases. Given the increasing MetS global prevalence and the higher parathyroid diseases awareness and diagnosis, it may be interesting to further explore the possible role of alterations in parathyroid homeostasis in the development of MetS components with dedicated prospective studies.


Assuntos
Hiperparatireoidismo , Hipoparatireoidismo , Síndrome Metabólica , Doenças das Paratireoides , Pseudo-Hipoparatireoidismo , Humanos , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Estudos Prospectivos , Hormônio Paratireóideo , Hiperparatireoidismo/complicações
19.
J Clin Endocrinol Metab ; 108(6): 1505-1513, 2023 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-36546344

RESUMO

Taking care of patients with parathyroid disorders during pregnancy requires consideration of the physiological fundamental changes in bone and mineral metabolism occurring in these women. Diagnostic and therapeutic procedures regarding primary hyperparathyroidism (PHPT) and hypoparathyroidism significantly differ from the nonpregnant population. PHPT should preferably be cured by parathyroidectomy before pregnancy since in women with hypercalcemic PHPT, maternal and fetal pregnancy complications seem to increase according to the degree of hypercalcemia. Parathyroidectomy, if needed during pregnancy, is preferentially performed in the second trimester. Conservative treatment is recommended for milder cases and is mainly restricted to hydration, with only limited evidence regarding drug treatment. Women with hypoparathyroidism can be informed that there are no major concerns regarding disease-associated infertility and that the risk of pregnancy complications is low if the disease is properly managed. Regular active surveillance is recommended, as requirements for calcium and active vitamin D may change during the course of pregnancy in either direction, with an overall trend for rather reduced doses. Any woman suffering from parathyroid disorders during pregnancy requires further surveillance in the postpartum period and during lactation, as there is an increased risk of hypercalcemia after delivery. Newborns of mothers with parathyroid diseases should, depending on disease severity, be carefully monitored for calcium levels in the first days (to weeks) after delivery since intrauterine exposure to hyper- or hypocalcemia may impact their postnatal regulation of calcium metabolism.


Assuntos
Hipercalcemia , Hiperparatireoidismo Primário , Hipoparatireoidismo , Doenças das Paratireoides , Complicações na Gravidez , Gravidez , Humanos , Feminino , Recém-Nascido , Cálcio/metabolismo , Hipercalcemia/etiologia , Doenças das Paratireoides/complicações , Complicações na Gravidez/diagnóstico , Hipoparatireoidismo/complicações , Paratireoidectomia/efeitos adversos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia
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