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1.
Eur J Endocrinol ; 184(1): K7-K10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112283

RESUMO

Introduction: The least significant change (LSC) is a term used in individuals in order to evaluate whether one measurement has changed significantly from the previous one. It is widely used when assessing bone mineral density (BMD) scans. To the best of our knowledge, there no such estimate available in the literature for patients with disorders of calcium metabolism. Our aim was to provide an estimate of the least significant change for albumin-adjusted calcium in patients with normocalcaemic hyperparathyroidism (NPHPT) and primary hyperparathyroidism (PHPT). Methods: We used the within-subject standard deviatio calculated in a population of NPHPT and PHPT patients and multiplied it by 2.77. Results: The LSC for NPHPT and PHPT were found to be 0.25 and 0.24 mmol/L, respectively (1.00 and 0.96 mg/dL). In clinical practice, the value of 0.25 mmol/L could be used. Discussion: The least significant change given, could be used in two ways in these patients. First, it gives a range to which values are expected. This can provide some reassurance for the patient and the physician in cases of intermittent hypercalcaemia. Moreover, it can be a marker of whether an individual has an actual significant change of his calcium after parathyroid surgery.


Assuntos
Cálcio/sangue , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo/sangue , Adulto , Idoso , Biomarcadores/sangue , Distúrbios do Metabolismo do Cálcio/sangue , Feminino , Humanos , Hipercalcemia/sangue , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Valores de Referência
2.
Cochrane Database Syst Rev ; 10: CD010787, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33085088

RESUMO

BACKGROUND: Bilateral neck exploration (BNE) is the traditional approach to sporadic primary hyperparathyroidism. With the availability of the preoperative imaging techniques and intraoperative parathyroid hormone assays, minimally invasive parathyroidectomy (MIP) is fast becoming the favoured surgical approach. OBJECTIVES: To assess the effects of minimally invasive parathyroidectomy (MIP) guided by preoperative imaging and intraoperative parathyroid hormone monitoring versus bilateral neck exploration (BNE) for the surgical management of primary hyperparathyroidism. SEARCH METHODS: We searched CENTRAL, MEDLINE, WHO ICTRP and ClinicalTrials.gov. The date of the last search of all databases was 21 October 2019. There were no language restrictions applied. SELECTION CRITERIA: We included randomised controlled trials comparing MIP to BNE for the treatment of sporadic primary hyperparathyroidism in persons undergoing surgery for the first time. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts for relevance. Two review authors independently screened for inclusion, extracted data and carried out risk of bias assessment. The content expert senior author resolved conflicts. We assessed studies for overall certainty of the evidence using the GRADE instrument. We conducted meta-analyses using a random-effects model and performed statistical analyses according to the guidelines in the latest version of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We identified five eligible studies, all conducted in European university hospitals. They included 266 adults, 136 participants were randomised to MIP and 130 participants to BNE. Data were available for all participants post-surgery up to one year, with the exception of missing data for two participants in the MIP group and for one participant in the BNE group at one year. Nine participants in the MIP group and 11 participants in the BNE group had missing data at five years. No study had a low risk of bias in all risk of bias domains. The risk ratio (RR) for success rate (eucalcaemia) at six months in the MIP group compared to the BNE group was 0.98 (95% confidence interval (CI) 0.94 to 1.03; P = 0.43; 5 studies, 266 participants; very low-certainty evidence). A total of 132/136 (97.1%) participants in the MIP group compared with 129/130 (99.2%) participants in the BNE group were judged as operative success. At five years, the RR was 0.94 (95% CI 0.83 to 1.08; P = 0.38; 1 study, 77 participants; very low-certainty evidence). A total of 34/38 (89.5%) participants in the MIP group compared with 37/39 (94.9%) participants in the BNE group were judged as operative success. The RR for the total incidence of perioperative adverse events was 0.50, in favour of MIP (95% CI 0.33 to 0.76; P = 0.001; 5 studies, 236 participants; low-certainty evidence). Perioperative adverse events occurred in 23/136 (16.9%) participants in the MIP group compared with 44/130 (33.9%) participants in the BNE group. The 95% prediction interval ranged between 0.25 and 0.99. These adverse events included symptomatic hypocalcaemia, vocal cord palsy, bleeding, fever and infection. Fifteen of 104 (14.4%) participants experienced symptomatic hypocalcaemia in the MIP group compared with 26/98 (26.5%) participants in the BNE group. The RR for this event comparing MIP with BNE at two days was 0.54 (95% CI 0.32 to 0.92; P = 0.02; 4 studies, 202 participants). Statistical significance was lost in sensitivity analyses, with a 95% prediction interval ranging between 0.17 and 1.74. Five out of 133 (3.8%) participants in the MIP group experienced vocal cord paralysis compared with 2/128 (1.6%) participants in the BNE group. The RR for this event was 1.87 (95% CI 0.47 to 7.51; P = 0.38; 5 studies, 261 participants). The 95% prediction interval ranged between 0.20 and 17.87. The effect on all-cause mortality was not explicitly reported and could not be adequately assessed (very low-certainty evidence). There was no clear difference for health-related quality of life between the treatment groups in two studies, but studies did not report numerical data (very low-certainty evidence). There was a possible treatment benefit for MIP compared to BNE in terms of cosmetic satisfaction (very low-certainty evidence). The mean difference (MD) for duration of surgery comparing BNE with MIP was in favour of the MIP group (-18 minutes, 95% CI -31 to -6; P = 0.004; 3 studies, 171 participants; very low-certainty evidence). The 95% prediction interval ranged between -162 minutes and 126 minutes. The studies did not report length of hospital stay. Four studies reported intraoperative conversion rate from MIP to open procedure information. Out of 115 included participants, there were 24 incidences of conversion, amounting to a conversion rate of 20.8%. AUTHORS' CONCLUSIONS: The success rates of MIP and BNE at six months were comparable. There were similar results at five years, but these were only based on one study. The incidence of perioperative symptomatic hypocalcaemia was lower in the MIP compared to the BNE group, whereas the incidence of vocal cord paralysis tended to be higher. Our systematic review did not provide clear evidence for the superiority of MIP over BNE. However, it was limited by low-certainty to very low-certainty evidence.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Monitorização Intraoperatória/métodos , Hormônio Paratireóideo/sangue , Paratireoidectomia/métodos , Adulto , Viés , Humanos , Hiperparatireoidismo Primário/sangue , Hipocalcemia/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pescoço/cirurgia , Esvaziamento Cervical/métodos , Duração da Cirurgia , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Paralisia das Pregas Vocais/epidemiologia
4.
Surgery ; 168(4): 594-600, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32811695

RESUMO

BACKGROUND: Hypercalciuria is an important manifestation of primary hyperparathyroidism and may contribute to the risk of nephrolithiasis. This study examined the impact of parathyroidectomy on 24-hour urinary calcium (24-hour UCa) levels and rates of resolution of hypercalciuria after surgery. METHODS: A retrospective cohort study was performed of patients who underwent curative parathyroidectomy for primary hyperparathyroidism from 2007 to 2017. Baseline and postoperative urine and serum biochemistry levels were analyzed. The relationship between preoperative 24-hour UCa levels and the absolute decrease in postoperative UCa excretion was assessed using Spearman's rank correlation coefficient. RESULTS: Of 110 patients, 84 (76.4%) experienced a ≥20% decrease in 24-hour UCa level postoperatively. These patients had a higher baseline median 24-hour UCa level (293.5 vs 220.5 mg/24-hour; P = .001), higher baseline mean serum parathyroid hormone (106.5 vs 83; P = .05) and were more likely to have single gland disease (85.7% vs 65.4%, P = .04) compared with patients in whom 24-hour UCa excretion did not improve. Of the 28 patients (25%) who were hypercalciuric (24-hour UCa >400 mg/day) at baseline, 22 (79%) became normocalciuric postoperatively. A linear correlation was observed between preoperative 24-hour UCa levels and the decline in 24-hour UCa excretion after surgery (R2 = 0.59, P < .0001) such that the degree of improvement could be predicted using the following equation: absolute decrease in postoperative 24-hour UCa = 0.68 × preoperative 24-hour UCa-68. CONCLUSION: Parathyroidectomy reduces 24-hour UCa excretion in the majority of patients with PHPT and restores normocalciuria in 79% of patients with hypercalciuria at baseline.


Assuntos
Hipercalciúria/terapia , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia , Adulto , Idoso , Área Sob a Curva , Cálcio/urina , Feminino , Humanos , Hipercalciúria/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/urina , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Estudos Retrospectivos
5.
Surgery ; 168(5): 838-844, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32665141

RESUMO

BACKGROUND: Primary hyperparathyroidism is underdiagnosed and undertreated nationally despite the benefits of parathyroidectomy. However, the degree of hospital-level variation in the management of primary hyperparathyroidism is unknown. METHODS: We performed a national, retrospective study of Veterans with primary hyperparathyroidism using the Veterans Affairs Corporate Data Warehouse from January 2000 to September 2015. The objective was to characterize the extent of hospital-level variation in the use of parathyroidectomy for the management of primary hyperparathyroidism within a national, integrated healthcare system. Rate of parathyroidectomy in patients with primary hyperparathyroidism was stratified by (1) geographic region, (2) facility complexity level, (3) volume of parathyroidectomies per facility, and (4) frequency of parathyroid hormone testing in hypercalcemic patients. RESULTS: Among 47,158 Veterans with primary hyperparathyroidism, 6,048 (12.8%) underwent parathyroidectomy. Rates of parathyroidectomy were significantly higher in the Continental (17.0%) and Pacific (16.0%) regions than in other areas (11.4%, P < .01). The highest complexity referral centers had the highest rate of parathyroidectomy (13.6%) compared with all other facilities (12.1%, P < .01). Centers that performed the highest volume of parathyroidectomies were more likely to offer surgery (13.3%) than low volume centers (8.9%, P < .01). Facilities with higher frequency of parathyroid hormone testing among hypercalcemic patients were more likely to offer parathyroidectomy (15.2%) than those with the lowest parathyroid hormone testing frequency (12.6%, P < .01). CONCLUSION: Although there is notable variation in parathyroidectomy use for definitive treatment of primary hyperparathyroidism between Veterans Affairs facilities, parathyroidectomy rates are low across the entire system. Further research is needed to understand additional local contextual and other patient and clinician-level factors for the undertreatment of primary hyperparathyroidism to subsequently guide corrective interventions.


Assuntos
Assistência à Saúde , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Estudos Retrospectivos , Estados Unidos , United States Department of Veterans Affairs
6.
J Surg Res ; 255: 130-134, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543378

RESUMO

BACKGROUND: Surgery is the definitive management of primary hyperparathyroidism and the only curative therapy. However, many surgeons are hesitant to operate on individuals with mild primary hyperparathyroidism, with an even greater reluctance to operate on those who underwent a previous parathyroidectomy. We hypothesize that patients with mild primary hyperparathyroidism who undergo a re-operation have equivalent outcomes compared with those who undergo a first-time (FT) operation. METHODS: We reviewed a prospective database of 459 patients with mild primary hyperparathyroidism who underwent surgery by one endocrine surgeon. Of these patients, 59 had a re-operative (RE-OP) parathyroid surgery. We compared these patients to those with mild primary hyperparathyroidism who had FT surgery (n = 400) using either the Pearson chi-square, Fisher's exact test, or Student's t-test where appropriate. RESULTS: The mean age of our cohort was 60 ± 14 y, with 86% females. Patients in the RE-OP group had similar preoperative calcium and parathyroid hormone levels compared with those in the FT group. Most patients who underwent a RE-OP surgery had four gland hyperplasia on pathology (49.2%). Patients in the RE-OP and FT groups both had high and similar cure rates (100% versus 99.8%, P = 0.70). RE-OP patients had a higher rate of recurrent hyperparathyroidism (10.3% versus 3.3%, P = 0.025). CONCLUSIONS: In patients with mild primary hyperparathyroidism, those who undergo RE-OP parathyroidectomy have a high cure rate that is similar to FT surgery. Therefore, we recommend that these patients with recurrence of mild hyperparathyroid disease be considered for parathyroidectomy.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Reoperação/efeitos adversos , Adulto , Idoso , Cálcio/sangue , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hiperplasia/diagnóstico , Hiperplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
7.
J Steroid Biochem Mol Biol ; 201: 105695, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32407867

RESUMO

In patients with primary hyperparathyroidism, the size of the adenoma is a major determinant of biochemical indices, disease severity, and manner of presentation. However, the large variation in adenoma weight, both within and between populations and a steady decline in parathyroid adenoma weights over time remain largely unexplained. Based on the results in a small number of patients almost two decades ago we proposed that vitamin D nutritional status of the patient explains both the disease manifestations and much of the variation in adenoma size. Accordingly, we examined the relationship between vitamin D nutrition, as assessed by serum levels of 25-hydroxyvitamin D, and parathyroid gland weight, the best available index of disease severity, in a large number of patients (n = 440) with primary hyperparathyroidism. A significant inverse relationship was found between serum 25-hydroxyvitamin D level and log adenoma weight (r = -0.361; p < 0.001). Also, the adenoma weight was significantly related directly to serum PTH, calcium, and alkaline phosphatase as dependent variables. In patients with vitamin D deficiency (defined as serum 25-hydroxyvitamin D levels 15 ng/mL or lower), gland weight, PTH, AP, and adjusted calcium were each significantly higher than in patients with 25-hydroxyvitamin D levels of 16 ng/mL or higher, but serum 1,25-dihydroxyvitamin D levels were similar in both groups. We interpret this to mean that suboptimal vitamin D nutrition stimulates parathyroid adenoma growth by a mechanism unrelated to 1,25-dihydroxyvitamin D deficiency. We conclude that variable vitamin D nutritional status in the population may partly explain the differences in disease presentation.


Assuntos
Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Deficiência de Vitamina D , Vitamina D/análogos & derivados , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/patologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Carga Tumoral , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/patologia , Deficiência de Vitamina D/cirurgia
8.
Arch Endocrinol Metab ; 64(2): 105-110, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32236309

RESUMO

While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.


Assuntos
Hiperparatireoidismo Primário , Países em Desenvolvimento , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/epidemiologia , Índice de Gravidade de Doença
9.
Ann R Coll Surg Engl ; 102(5): 363-368, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233846

RESUMO

INTRODUCTION: Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. METHODS: The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. RESULTS: Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40-71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14-22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4-38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1-5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. CONCLUSIONS: Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.


Assuntos
Adenoma/complicações , Carcinoma/complicações , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/etiologia , Neoplasias das Paratireoides/complicações , Adenoma/sangue , Adenoma/cirurgia , Adulto , Idoso , Cálcio/sangue , Carcinoma/sangue , Carcinoma/cirurgia , Difosfonatos/administração & dosagem , Feminino , Furosemida/administração & dosagem , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/sangue , Paratireoidectomia , Período Pós-Operatório , Diálise Renal , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Ann R Coll Surg Engl ; 102(6): e111-e114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233855

RESUMO

INTRODUCTION: Bilateral giant parathyroid adenoma in the absence of multiple endocrine neoplasia (MEN) type 1 is extremely rare and literature on this subject is limited. CASE HISTORY: A 79-year-old man presented with acute kidney injury secondary to hypercalcaemia. Blood test results indicated primary hyperparathyroidism. Ultrasonography revealed bilateral parathyroid adenomas measuring 19.4mm x 19.5mm x 18.8mm (left) and 15.2mm x 18.3mm x 19.6mm (left) whereas on computed tomography, the measurements were 31mm x 20mm (left) and 30mm x 14mm (right). Intraoperatively, giant adenomas measuring 50mm x 25mm x 12mm (left, weighing 8.101g) and 48mm x 22mm x 10mm (right, weighing 7.339g) were identified and excised. Parathyroid hormone level dropped from 44.6pmol/l preoperatively to 8.9pmol/l postoperatively (normal range 1.3-7.6pmol/l). The patient was discharged with no complications. CONCLUSIONS: We report a rare phenomenon where bilateral giant parathyroid adenoma occurred in the absence of MEN type 1. It highlights the importance of cross-sectional imaging in delineating the anatomy of adenomas as their size can be grossly underestimated by ultrasonography alone.


Assuntos
Adenoma/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/diagnóstico , Paratireoidectomia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Adenoma/complicações , Adenoma/patologia , Adenoma/cirurgia , Idoso , Cálcio/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Ultrassonografia
11.
Maturitas ; 135: 47-52, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32252964

RESUMO

OBJECTIVE: With the current aging of the world's population, primary hyperparathyroidism (PHPT) is increasingly detected in the elderly. Yet data on the presentation and outcome of PHPT in this group are scarce. The objective was to describe a cohort of patients aged 75 years or more with PHPT observed in our endocrine clinic. STUDY DESIGN: A retrospective analysis of medical records in an endocrine clinic at a tertiary hospital. We evaluated 182 patients with PHPT, aged 75 years or more at their last follow-up, all diagnosed at age 65 or more. Laboratory data were compared at diagnosis and last follow-up. RESULTS: Mean age at diagnosis was 73 ± 4 years, last follow-up was at 83 ± 4 years, and mean follow-up was 11.3 ± 5.5 years. Osteoporosis, fractures, and nephrolithiasis were diagnosed in 114(63 %), 84(46 %), and 43(24 %) patients, respectively. Overall, 150 patients had an indication for surgery; of them, the 29 who underwent parathyroidectomy were younger than the non-operated patients and had higher rates of hypercalciuria. During the follow-up of the 141 patients who did not undergo operation, serum and urinary calcium levels significantly had decreased, and vitamin D level had increased at last visit (10.4 ± 0.5 mg/dl, 161 ± 70 mg/24 h, 69 ± 17 nmol/l, p < 0.01 respectively) compared with levels at diagnosis (10.6 ± 0.2 mg/dl, 223 ± 95 mg/24 h, 53 ± 15 nmol/l, respectively, p = 0.001). Overall, 38 of the 182 patients (20 %) died during follow-up; these patients were significantly older at diagnosis (76 ± 5 vs. 72 ± 4 years) but there were no differences in laboratory variables. CONCLUSIONS: While most patients had a formal indication for surgery, few underwent parathyroidectomy. Serum and urinary calcium significantly decreased during follow-up in patients who did not undergo surgery. Our data are reassuring and support at least the consideration of conservative treatment for these patients.


Assuntos
Tratamento Conservador , Hiperparatireoidismo Primário/terapia , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Cálcio/urina , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/urina , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/urina , Masculino , Nefrolitíase/sangue , Nefrolitíase/terapia , Nefrolitíase/urina , Osteoporose/sangue , Osteoporose/terapia , Osteoporose/urina , Paratireoidectomia , Estudos Retrospectivos , Vitamina D/sangue
12.
J Bone Miner Metab ; 38(5): 687-694, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32274572

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) is caused by parathyroid adenoma, primary parathyroid hyperplasia, or parathyroid carcinoma. For some patients with PHPT controlling serum calcium levels is critical. MATERIALS AND METHODS: We conducted an open-label, single-arm, 52-week, phase III study in Japanese patients with hypercalcemia due to PHPT to demonstrate efficacy and safety of evocalcet, a new calcimimetic. Patients with intractable PHPT (n = 13), postsurgical recurrence (n = 2), and parathyroid carcinoma (n = 3) were enrolled. Evocalcet administration started at a dose of 2 mg once or twice daily and was titrated to achieve the target serum corrected calcium (cCa) concentration (≤ 10.3 mg/dL) for two consecutive weeks (maximal dose 24 mg/day). RESULTS: Fourteen patients achieved the target (77.8%; 95% confidence interval [CI] 52.4-93.6). The lower limit of 95% CI exceeded the predetermined reference limit (11%), and thus, efficacy was confirmed. Of 18 patients, 12 (66.7%; 95% CI 41.0-86.7) showed decreased serum cCa of ≥ 1.0 mg/dL from the baseline for two consecutive weeks during the titration phase. Sixteen patients entered the maintenance phase, and 15 patients completed the study. Treatment-emergent adverse events (TEAEs) were recorded in 18/18 patients (100%) and drug-related TEAEs in 8/18 (44.4%). The most commonly observed drug-related TEAE was nausea (2/18 patients). No unexpected drug-related TEAEs were observed. All drug-related TEAEs were mild in severity. No patient discontinued the study because of drug-related TEAEs. CONCLUSION: Evocalcet demonstrated long-term effectiveness in reducing serum cCa concentrations and safety without any unexpected drug-related TEAEs in PHPT patients.


Assuntos
Hiperparatireoidismo Primário/tratamento farmacológico , Naftalenos/uso terapêutico , Pirrolidinas/uso terapêutico , Cálcio/sangue , Creatinina/sangue , Relação Dose-Resposta a Droga , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Masculino , Pessoa de Meia-Idade , Naftalenos/administração & dosagem , Naftalenos/efeitos adversos , Naftalenos/farmacologia , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Pirrolidinas/administração & dosagem , Pirrolidinas/efeitos adversos , Pirrolidinas/farmacologia
13.
Croat Med J ; 61(1): 33-39, 2020 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-32118376

RESUMO

AIM: TTo assess the effects of preoperative calcium levels and parathyroidectomy on estimated glomerular filtration rate (eGFR) in patients of primary hyperparathyroidism (PHPT) with mild renal dysfunction or normal renal function. METHODS: This retrospective study enrolled 71 patients who underwent parathyroidectomy for PHPT in the General Surgery Department at Ondokuz Mayis University Hospital from 2010 to 2018. All patients were histopathologically diagnosed with parathyroid adenoma. Total serum calcium, serum creatinine, serum intact parathyroid hormone (PTH), and serum 25-hydroxyvitamin D3 (25(OH)D3) were measured before and 3-6 months after surgery. Patients were assigned to the low eGFR group (60-90 mL/min/1.73 m2) or normal eGFR group (≥90 mL/min/1.73 m2) and to the low calcium group (≤11.2 mg/dL) or high calcium group (>11.2 mg/dL). RESULTS: In the low eGFR and high calcium group, there were significantly more patients with hypertension and older age. In the normal eGFR and high calcium group, eGFR was significantly reduced after surgery. Independent predictors of eGFR change after surgery were age, pre- parathyroidectomy calcium, and pre-parathyroidectomy eGFR. CONCLUSIONS: After surgery, patients with low eGFR had preserved renal function, whereas those with normal eGFR had decreased renal function. Mild renal dysfunction in PHPT was associated with older age, hypertension, and high calcium levels.


Assuntos
Cálcio/sangue , Taxa de Filtração Glomerular/fisiologia , Hiperparatireoidismo Primário/sangue , Rim/fisiologia , Paratireoidectomia , Adenoma/patologia , Adulto , Idoso , Calcifediol/sangue , Creatinina/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/patologia , Período Pré-Operatório , Estudos Retrospectivos
14.
J Steroid Biochem Mol Biol ; 199: 105616, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32027935

RESUMO

To evaluate the measured free 25-hydroxyvitamin D [25(OH)D] levels in patients with hyperparathyroidism (PHPT) and healthy controls. Eighty patients with PHPT(n = 40) and age and BMI matched controls (n = 40) were examined. Serum levels of total or free 25(OH)D, vitamin D binding protein (DBP), intact parathyroid hormone (iPTH) and calcium were measured. There was no significant difference in age (61.2 ± 11.9 vs 60.2 ± 7.0 years) and BMI (30.0 ± 6.1 vs 30.0 ± 2.2 kg/m2) between PHPT patients and healthy subjects. Levels of total 25(OH)D were about 20 % lower in PHPT patients (26.4 ± 7.7 ng/mL) compared to controls (31.0 ± 7.8 ng/mL, P < 0.05). There were no significant differences in calculated or measured free 25(OH)D levels between PHPT patients (4.9 ± 1.8 or 4.9 ± 1.6 pg/mL, respectively) and control subjects (5.1 ± 1.2 or 5.3 ± 1.6 pg/mL, respectively). Levels of free 25(OH)D were positively associated with levels of total 25(OH)D (r = 0.28, P < 0.05) but negatively correlated with iPTH and calcium levels (r=-0.22 and -0.23 respectively, P < 0.05). Serum total 25(OH)D levels were lower but the calculated or measured free 25(OH)D levels in patients with PHPT did not differ from healthy subjects. We suggest that total 25(OH)D levels may not reflect true vitamin D nutritional status in patients with PHPT.


Assuntos
Calcifediol/administração & dosagem , Hiperparatireoidismo Primário/sangue , Vitamina D/análogos & derivados , Vitamina D/genética , Idoso , Índice de Massa Corporal , Cálcio/sangue , Cálcio na Dieta/administração & dosagem , Feminino , Humanos , Hiperparatireoidismo Primário/genética , Hiperparatireoidismo Primário/patologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Hormônio Paratireóideo/sangue , Vitamina D/sangue
16.
J Bone Miner Metab ; 38(4): 570-580, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32100109

RESUMO

INTRODUCTION: Parathyroid venous sampling (PVS) has been reported to be a useful adjunctive test in localizing lesions in elusive cases of primary hyperparathyroidism (PHPT). Conventional cutoff (twofold) is now widely being used, but optimal cutoff threshold for PVS gradient based on discriminatory performance remains unclear. MATERIALS AND METHODS: Among a total of 197 consecutive patients (mean age 58.2 years, female 74.6%) with PHPT who underwent parathyroidectomy at a tertiary center between 2012 and 2018, we retrospectively analyzed 59 subjects who underwent PVS for persistent or recurrent disease after previous parathyroidectomy, or for equivocal or negative results from conventional imaging modalities including ultrasonography (US) and Tc99m-Sestamibi SPECT-CT (MIBI). True parathyroid lesions were confirmed by combination of surgical, pathological findings, and intraoperative parathyroid hormone (PTH) changes. Optimal PVS cutoff were determined by receiver-operating characteristics (ROC) analysis with Youden and Liu method. RESULTS: Compared to subjects who did not require PVS, PVS group tends to have lower PTH (119.8 pg/mL vs 133.7 pg/mL, p = 0.075). A total of 79 culprit parathyroid lesions (left 40; right 39) from 59 patients (left 24; right 26; bilateral 9) were confirmed by surgery. The optimal cutoff for PVS gradient was estimated as 1.5-fold gradient (1.5 ×) with sensitivity of 61.8% and specificity of 84%. When 1.5 × cutoff was applied, PVS improved the discrimination for true parathyroid lesions substantially based on area under ROC (0.892 to 0.942, p < 0.001) when added to US and MIBI. CONCLUSION: Our findings suggest that PVS with cutoff threshold 1.5 × can provide useful complementary information for pre-operative localization in selected cases.


Assuntos
Hiperparatireoidismo Primário/sangue , Glândulas Paratireoides/cirurgia , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Curva ROC , Estudos Retrospectivos , Ultrassonografia
17.
Int J Pediatr Otorhinolaryngol ; 131: 109895, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982848

RESUMO

OBJECTIVES: Primary hyperparathyroidism in juveniles is extremely rare condition, but in the last few decades the incidence is increasing. The aim of this study was to compare biochemical and clinical characteristics of juvenile and adult primary hyperparathyroidism patients. METHODS: A retrospective case-control study was conducted from 2004 until 2017 in high volume endocrine surgery center. Juvenile group consisted of all primary hyperparathyroidism patients younger than 20 who have undergone parathyroidectomy, and two-fold more patients older than 20 were classified in control (adult) group. RESULTS: A total of 14 patients with the age ≤20 years were included in the juvenile group, while 28 patients older than 20 were selected for the control group. Female-to-male ratio in juveniles was 1:1, and in adults 8:1 (p = 0.005). The most common form of the disease in juveniles was bone disease (42.9%) and most of adults were asymptomatic (39.3%). Mean preoperative serum calcium level was significantly higher in juveniles than in adults, 3.47 ± 0.74 mmol/L vs. 2.96 ± 0.25 mmol/L, p = 0.025. Mean preoperative PTH level was higher in juveniles than in control group, 572.6 ± 533.3 ng/L vs. 331.8 ± 347.5 ng/L, p = 0.089. CONCLUSION: Clinical manifestations of primary hyperparathyroidism significantly differ in juvenile and adult patients. Juvenile primary hyperparathyroidism represents more severe form of the disease, often with end-organ damages, and it should be considered in patients with unspecific symptoms.


Assuntos
Hiperparatireoidismo Primário/epidemiologia , Adolescente , Adulto , Fatores Etários , Cálcio/sangue , Estudos de Casos e Controles , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/cirurgia , Incidência , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Paratireoidectomia , Adulto Jovem
18.
BMC Endocr Disord ; 20(1): 5, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914999

RESUMO

BACKGROUND: Patients with primary hyperparathyroidism (PHPT) may be asymptomatic, and some may present with normocalcemic PHPT (NPHPT). Patients with vitamin D deficiency may also be asymptomatic, with normal calcium and elevated PTH concentrations. These latter patients are usually diagnosed with vitamin D deficiency-induced secondary hyperparathyroidism (VD-SHPT). Therefore, it is very difficult to distinguish PHPT and NPHPT from VD-SHPT based on calcium or PTH concentrations in clinical settings. In this case-control study, we aimed to verify the diagnostic power of a new parathyroid function index (PFindex = Ca*PTH/P). METHODS: This study enrolled 128 patients with surgically and pathologically confirmed PHPT, including 36 with NPHPT, at a hospital in West China between January 2009 and September 2017. Thirty-seven patients with VD-SHPT and 45 healthy controls were selected from the population of a cross-sectional epidemiological study as the SHPT and healthy groups, respectively. We used the PFindex to describe the characteristics of PHPT, NPHPT, and VD-SHPT.. Differences between the four groups were compared, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of PFindex. RESULTS: The PHPT group had the highest PFindex (454 ± 430), compared to the other three groups (NPHPT: 101 ± 111; SHPT: 21.7 ± 6.38; healthy: 12.2 ± 2.98, all p < 0.001). A PFindex cut-off value of 34 yielded sensitivity and specificity rates of 96.9 and 97.6% and of 94.4 and 94.6% for the diagnoses of PHPT and NPHPT, respectively. The use of a PFindex > 34 to differentiate NPHPT from VD-SHPT yielded the highest positive likelihood ratio and lowest negative likelihood ratio. CONCLUSION: The PFindex provided excellent diagnostic power for the differentiation of NPHPT from VD-SHPT. This simple tool may be useful for guiding timely decision-making processes regarding the initiation of vitamin D treatment or surgery for PHPT.


Assuntos
Biomarcadores/sangue , Diferenciação Celular , Hiperparatireoidismo Primário/patologia , Hiperparatireoidismo Secundário/patologia , Glândulas Paratireoides/patologia , Cálcio/sangue , Estudos de Casos e Controles , China/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/metabolismo , Hormônio Paratireóideo/sangue , Prognóstico , Curva ROC , Estudos Retrospectivos , Vitamina D/sangue
19.
Exp Clin Endocrinol Diabetes ; 128(3): 152-157, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31117148

RESUMO

BACKGROUND: Adipokines derived from adipocytes are one of the important factors that act as circulating regulators of bone metabolism. Complement C1q/tumor necrosis factor-related protein-3 (CTRP3), a paralog of adiponectin, is are member of the CTRP superfamily. The aim of this study was to investigate the role of serum CTRP3 in the development of osteoporosis in patients with primary hyperparathyroidism. METHODS: This study included 53 patients with diagnosed primary hyperparathyroidism and 30 healthy controls. Laboratory tests for the diagnosis of primary hyperparathyroidism and serum levels of CTRP3 measured for all patients. Bone mineral density was obtained on lumbar spine 1 and 4 by dual energy X-ray absorptiometry. RESULTS: Serum CTRP3 levels were lower in patients with primary hyperparathyroidism than in the control group (p<0.001). In addition, primary hyperparathyroidism patients are were divided into two groups as, with and without osteoporosis; the levels of CTRP3 were lower in patients with osteoporosis than in patients without osteoporosis (p=0.004). In logistic regression analysis, only CTRP3 levels independently determined the patients to be osteoporosis (p<0.05). According to this analysis, decreased CTRP3 (per 1 ng/mL) levels were found to increase the risk of patients for osteoporosis by 6.9%. When the CTRP3 cut-off values were taken as 30 ng/mL, it determined osteoporosis with 76.4% sensitivity and 73.2% specificity. CTRP3 and urine calcium levels were independently associated with T score in dual energy X-ray absorptiometry. CONCLUSIONS: CTRP3 levels were significantly decreased in patients with primary hyperparathyroidism, and it is also related to osteoporosis.


Assuntos
Densidade Óssea , Hiperparatireoidismo Primário/sangue , Osteoporose/sangue , Fatores de Necrose Tumoral/administração & dosagem , Absorciometria de Fóton , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade
20.
J Surg Res ; 245: 22-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31400574

RESUMO

BACKGROUND: Although primary hyperparathyroidism has been associated with insulin resistance, potential optimal effects of parathyroidectomy (PTX) on glucose homeostasis remain controversial. Accordingly, the impact of PTX on glucose-stimulated incretin (glucagon-like peptide 1 [GLP-1] and gastric inhibitory peptide) secretion has not been evaluated. The aim of this pilot study was to compare glucose-stimulated incretin secretion (GSIS) in patients with asymptomatic primary hyperparathyroidism with normal glucose homeostasis, before and after PTX. METHODS: Fourteen patients were included in the study. Fasting calcium, parathyroid hormone, glucose, insulin, GLP-1, and gastric inhibitory peptide were measured pre- and post-operatively. Homeostasis Model Assessment 2, QUICKI, and Matsuda indexes were used as markers of insulin sensitivity and resistance before and after PTX. Preoperatively, a 75 g oral glucose tolerance test (OGTT) was performed to evaluate the response of glucose, insulin, and GSIS. OGTT measurements were repeated 6 ± 2 wk post-PTX. RESULTS: Patients had a mean age of 52.93 ± 9.96 y, and female-to-male ratio was 12:2. Pre- and post-operatively, a positive correlation between parathyroid hormone and Homeostasis Model Assessment 2 for ß-cell function was evident (r = 0.74, P = 0.002 and r = 0.55, P = 0.04, respectively). After PTX, a significant increase in GSIS for GLP-1 during OGTT was observed (in 60 min: 63.06 ± 44.78 versus 102.64 ± 40.19 pg/mL, P = 0.02; and in 120 min: 71.20 ± 35.90 versus 102.49 ± 40.02 pg/mL, P = 0.03). CONCLUSIONS: The increase of GLP-1 response following oral glucose load after PTX may reflect an initial recovery phase of glucose homeostasis. Long-term studies are required to elucidate the physiological interplay between the normalization of calciotropic axis and the rising GLP-1 concentrations post-PTX.


Assuntos
Glicemia/metabolismo , Peptídeo 1 Semelhante ao Glucagon/sangue , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/efeitos adversos , Adulto , Glicemia/análise , Jejum , Feminino , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Teste de Tolerância a Glucose , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/metabolismo , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Hormônio Paratireóideo/metabolismo , Projetos Piloto , Período Pós-Operatório
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