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1.
Khirurgiia (Mosk) ; (6): 26-34, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317938

RESUMO

AIM: To optimize diagnosis and surgical treatment of patients with primary hyperparathyroidism. MATERIAL AND METHODS: Retrospective comparative analysis of diagnosis and surgical treatment included 444 patients who were treated at the specialized department of endocrine surgery of Pirogov National Medical Surgical Center in 2012-2017. Archival materials and electronic databases of the clinic were applied. RESULTS: It was developed the algorithm which may be used in most patients for minimally invasive parathyroidectomy. Minimally invasive surgery reduces the risk of complications and is associated with reliable efficacy and good cosmetic effect.


Assuntos
Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Paratireoidectomia/métodos , Algoritmos , Humanos , Hiperparatireoidismo Primário/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos
2.
Manchester; The National Institute for Health and Care Excellence (NICE); May 2019. 32 p.
Monografia em Inglês | BIGG | ID: biblio-1014947

RESUMO

This guideline covers diagnosing, assessing and managing primary hyperparathyroidism. It aims to improve recognition and treatment of this condition, reducing long-term complications and improving quality of life.


Assuntos
Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Qualidade de Vida , Pessoal Técnico de Saúde
3.
Eur Radiol ; 29(10): 5607-5616, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30888479

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of microwave ablation (MWA) with the assistance of continuous cool saline injection (CCSI) in patients with primary hyperparathyroidism (PHPT). METHODS: Between November 1, 2014, and February 29, 2016, 22 patients with PHPT were enrolled and treated with ultrasound-guided MWA assisted by CCSI. The levels of parathyroid hormone (PTH) and serum calcium were recorded before and after the MWA. Patients were divided into two groups (normalized and unnormalized groups) according to treatment efficacy. Fisher's exact test and the Mann-Whitney test were used to compare data between the two groups. Timing differences in serum PTH and calcium levels were analyzed with repeated measures analysis of variance. RESULTS: Normalized outcomes for both PTH and calcium levels were achieved in 19 of 22 (86.36%) patients with PHPT. In the normalized group, PTH levels remained normal for 12 months after MWA. PTH levels in the unnormalized group were outside the reference range at six of seven follow-ups within 12 months following MWA. By contrast, serum calcium levels gradually decreased in all patients in both groups. The mean serum PTH and mean calcium levels at 6 months after therapy were significantly lower than those before MWA (both p < 0.05). A transient voice change developed in eight patients. One patient experienced hypocalcaemia, which was corrected by oral calcium supplementation within 2 months. CONCLUSIONS: US-guided MWA assisted by CCSI is safe and effective for destroying parathyroid gland tissue and may serve as a therapeutic alternative for patients with PHPT. KEY POINTS: • Microwave ablation is a new option for patients with hypercalcemic or normocalcemic primary hyperparathyroidism. • Microwave ablation can decrease PTH and calcium levels with sustained efficacy in most patients. • Treatment is safe and causes only transient side effects.


Assuntos
Diatermia/métodos , Hiperparatireoidismo Primário/terapia , Micro-Ondas/uso terapêutico , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Front Horm Res ; 51: 1-12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641515

RESUMO

The 4 parathyroid glands derive from the third and fourth pharyngeal pouches and descend caudally to the anterior neck. Through the secretion of parathyroid hormone (PTH), the parathyroid glands are primarily responsible for maintaining extracellular calcium and phosphorus concentrations. Hypercalcemia may be distinguished in parathyroid-hypercalcemia and nonparathyroid hypercalcemia. The most common disorders include primary hyperparathyroidism (PHPT), malignancy, granulomatous diseases, and medications. PHPT is a disease characterized by excessive secretion of PTH. PHPT is most commonly due to a single benign parathyroid adenoma (80%) and with multiglandular disease seen in approximately 15-20% of patients. PHPT is due to multiglandular involvement consisting of either multiple adenomas or hyperplasia of all 4 glands (5-10%), and very rarely parathyroid carcinoma (<1%). In most patients the disease is sporadic, without a personal or family history of PHPT. The genetic syndromes associated with PHPT include multiple endocrine neoplasia type 1 (MEN1), MEN2A, and MEN4, hyperparathyroidism-jaw tumor syndrome, familial isolated PHPT, familial hypocalciuric hypercalcemia, and neonatal severe hyperparathyroidism. The asymptomatic clinical presentation is most common in countries where biochemical screening is routine. Conversely, target organ involvement at presentation dominates the clinical landscape of PHPT in other countries, such as China and India, where biochemical screening is not routine practice.


Assuntos
Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/terapia
5.
Front Horm Res ; 51: 52-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641521

RESUMO

Familial hypocalciuric hypercalcemia (FHH) and neonatal severe hyperparathyroidism (NSHPT) are genetically determined variants of primary hyperparathyroidism. FHH usually has a benign course, and patients do not require treatment, whereas NSHPT is a severe disorder often requiring early parathyroidectomy for young patients to survive. Recent discoveries in the genetic basis and new findings in therapeutic approaches have led to a great interest in these rare diseases.


Assuntos
Hipercalcemia/congênito , Hiperparatireoidismo Primário , Doenças do Recém-Nascido , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/genética , Hipercalcemia/terapia , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/genética , Hiperparatireoidismo Primário/terapia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/genética , Doenças do Recém-Nascido/terapia
6.
Front Horm Res ; 51: 13-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641522

RESUMO

Asymptomatic primary hyperparathyroidism has become the most common presentation of primary hyperparathyroidism in Europe and North America, and an increasingly common presentation in other parts of the world. As many as 25% of asymptomatic patients may develop indications for parathyroidectomy when followed long-term for up to 15 years. Patients who remain asymptomatic should be monitored for the development of complications that justify surgery. Patients who become symptomatic should be referred for surgery. Surgery may improve quality of life even in patients who remain asymptomatic.


Assuntos
Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Humanos , Hiperparatireoidismo Primário/epidemiologia
7.
Front Horm Res ; 51: 23-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641527

RESUMO

Parathyroid hormone (PTH) disorders are characterized by a wide spectrum of clinical and biochemical presentations. The increasing use of serum PTH assay in the set of the diagnostic workout in patients with osteoporosis has identified patients with features of surgically confirmed primary hyperparathyroidism (PHPT) associated with persistent normal serum calcium levels, which has been recognized as a distinct entity from hypercalcemic PHPT (HPHPT) by the last international consensus. Normocalcemic PHPT (NPHPT) affects about 6-8% of PHPT patients. Although hypercalcemia is absent, patients with NPHPT experience kidney, bone, and cardiovascular impairments similar to those observed in HPHPT, suggesting that NPHPT may significantly affect the health of patients. Diagnosis of NPHPT requires an intensive diagnostic workup aimed to: (1) exclude all causes of secondary hyperparathyroidism, and (2) evaluate the occurrence of PTH-related diseases. The management of NPHPT is controversial in part due to lack of solid data about the natural history as well as the effects of surgical or medical treatments. Nonetheless, a clinical and biochemical follow-up is recommended in order to detect potential progression. When hypercalcemia and/or PTH-related disorders arise, parathyroidectomy can be considered. When surgery is not advisable, medical treatment aimed to increase bone mineral density may be a therapeutic option.


Assuntos
Cálcio/sangue , Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/fisiopatologia , Hiperparatireoidismo Primário/terapia
8.
Endocrinol Diabetes Nutr ; 66(1): 41-48, 2019 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30616776

RESUMO

INTRODUCTION: The need for parathyroidectomy to treat asymptomatic patients with primary hyperparathyroidism is controversial. The aim of this study was to assess the impact of parathyroidectomy vs. surveillance on skeletal outcomes such as bone mineral density (BMD) and incident fractures. METHODS: This was a retrospective cohort study including 170 patients (112 treated with surgery and 58 subject to active surveillance) between 1991 and 2014. Changes in BMD in lumbar spine, femoral neck, total hip, and radius, and incidence of fractures, were monitored for 2-6 years. RESULTS: Patients treated with surgery had BMD gains at 2years of 4.37%, as compared to 1.59% in non-operated patients (p<0.05) in the lumbar spine, 3.90% vs. 0.19% (p<0.05) in the femoral neck, and 2.70% vs. 0.14% (p<0.05) in total hip. Gain in BMD in the lumbar spine and femoral neck remained significant in operated patients at 4 and 6 years. No improvement was seen in the radius in operated patients. No significant difference was seen in fracture occurrence between operated and non-operated patients. CONCLUSION: Patients with primary hyperparathyroidism treated with surgery experience greater BMD gains than non-operated patients, especially in the lumbar spine and femoral neck. The risk of fracture does not decrease in the group of operated patients.


Assuntos
Densidade Óssea , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Hiperparatireoidismo Primário/terapia , Paratireoidectomia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Conduta Expectante , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/cirurgia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Skeletal Radiol ; 48(8): 1279-1287, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30353279

RESUMO

Cases of spontaneous tendon ruptures have been previously reported in the literature. Although both renal failure and hyperparathyroidism have been implicated as separate aetiologies, their frequent co-existence has confounded analysis. We report a case of a young man with primary hyperparathyroidism presenting with multiple acute spontaneous tendon ruptures. This case affords an opportunity to evaluate the imaging features of acute spontaneous tendon ruptures in the context of primary hyperparathyroidism, and in conjunction with a review of previous literature reports, an imaging-based hypothesis on the pathophysiology and aetiology of spontaneous tendon ruptures is proposed.


Assuntos
Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/etiologia , Adulto , Humanos , Hiperparatireoidismo Primário/terapia , Masculino , Ruptura Espontânea , Traumatismos dos Tendões/terapia
10.
J Clin Endocrinol Metab ; 104(3): 721-729, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247615

RESUMO

Context: Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with substantial maternofetal morbidity and mortality rates. The optimal treatment and timing of surgical intervention in pregnancy remain contested. Objective: To compare maternofetal outcomes of medically and surgically treated patients with PHPT in pregnancy. Design: Retrospective chart review. Setting: Quaternary referral hospital. Patients: Women with PHPT in pregnancy treated between 1 January 2000 and 31 December 2015. Interventions: Medical therapy or parathyroid surgery. Main Outcomes Measured: Timing of diagnosis; maternal corrected serum calcium concentrations; gestation, indication and mode of delivery; complications attributable to PHPT; birth weight; and admission to the neonatal intensive care unit (NICU). Results: Twenty-two pregnancies were managed medically, and six patients underwent parathyroidectomy in pregnancy (five in trimester 2, and one at 32 weeks gestation). Most patients treated medically either had a corrected serum calcium concentration <2.85 mmol/L in early pregnancy or had PHPT diagnosed in trimester 3. Of viable medically managed pregnancies, 30% were complicated by preeclampsia, and preterm delivery occurred in 66% of this group. All preterm neonates required admission to the NICU for complications related to prematurity. All surgically treated patients delivered their babies at term, and there were no complications of parathyroid surgery. Conclusion: Maternofetal outcomes have improved relative to that reported in early medical literature in patients treated medically and surgically, but the rates of preeclampsia and preterm delivery were higher in medically treated patients. The study was limited by its retrospective design and small sample sizes.


Assuntos
Hiperparatireoidismo Primário/terapia , Doenças do Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Recém-Nascido , Doenças do Prematuro/etiologia , Doenças do Prematuro/terapia , Infusões Intravenosas , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Pamidronato/uso terapêutico , Paratireoidectomia/estatística & dados numéricos , Pré-Eclâmpsia/etiologia , Gravidez , Nascimento Prematuro/etiologia , Encaminhamento e Consulta/estatística & dados numéricos , Soluções para Reidratação/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
12.
Br Med Bull ; 129(1): 53-67, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30576424

RESUMO

INTRODUCTION: The presentation of primary hyperparathyroidism (PHPT) has shifted from a disease characterized by renal and skeletal complications to a mild or asymptomatic condition. Modern imaging allows localization of a surgical target in the majority of cases. SOURCES OF DATA: Data were collected from literature searches of online databases including PUBMED, MEDLINE and Cochrane. A narrative review was performed. AREAS OF AGREEMENT: Parathyroidectomy is the only therapy with curative potential with good outcomes and low risk of complications in experienced hands. Current guidelines advocate that surgery is offered in all symptomatic cases and in those who meet criteria depending on age, serum calcium concentration, skeletal and renal parameters. A structured monitoring approach should be offered to those who do not undergo surgery. AREAS OF CONTROVERSY: Thresholds for intervention to improve skeletal and renal outcomes are debatable. In addition, controversy persists over the benefit of surgery for non-skeletal/renal outcomes. GROWING POINTS: The role of medical management of PHPT using agents such as bisphosphonates, denosumab and cinacalcet are discussed. AREAS TIMELY FOR DEVELOPING RESEARCH: In summary, further data on the natural history and effects of treatment of mild and asymptomatic PHPT are required to determine thresholds for surgery. In particular, further investigations of non-skeletal and non-renal parameters, such as neurocognitive quality of life and cardiovascular disease are required. Data on normocalcaemic PHPT are lacking. Large-scale randomized controlled trials would be welcome in these areas, however in view of the cost implications a more pragmatic approach may be to develop collaborative multi-centre registries.


Assuntos
Hiperparatireoidismo Primário/terapia , Densidade Óssea , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Doenças Cardiovasculares/etiologia , Cinacalcete/uso terapêutico , Tomada de Decisão Clínica/métodos , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/fisiopatologia , Neoplasias/etiologia , Nefrolitíase/etiologia , Paratireoidectomia , Qualidade de Vida
13.
BMC Pediatr ; 18(1): 340, 2018 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-30376845

RESUMO

BACKGROUND: Neonatal severe primary hyperparathyroidism (NSHPT) is a rare autosomal recessive disorder of calcium homeostasis, characterized by striking hyperparathyroidism, marked hypercalcemia and hyperparathyroid bone disease. We report the case of a newborn with a novel homozygous mutation of the CaSR, treated by successful subtotal parathyroidectomy, who had an acute presentation of the disease, i.e. out-of hospital cardiorespiratory arrest. . CASE PRESENTATION: A 8-day-old female newborn was admitted to the NICU of University of Bari "Aldo Moro" (Italy) after a cardiorespiratory arrest occurred at home. Severe hypercalcemia was found and different drug therapies were employed (Furosemide, Cinacalcet and bisphosphonate), as well as hyperhydration, until subtotal parathyroidectomy, was performed at day 32. Our patient's mutation was never described before so that a strict and individualized long-term follow-up was started. CONCLUSIONS: This case of NSHPT suggests that a near-miss event, labelled as a possible case of SIDS, could also be due to severe hypercalcemia and evidentiates the difficulties of the neonatal management of NSHPT. Furthermore, the identification of the specific CaSR mutation provides the substrate for prenatal diagnosis.


Assuntos
Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/genética , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/genética , Mutação , Receptores de Detecção de Cálcio/genética , Conservadores da Densidade Óssea/uso terapêutico , Calcimiméticos/uso terapêutico , Cinacalcete/uso terapêutico , Ácido Clodrônico/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Hidratação , Furosemida/uso terapêutico , Genes Recessivos , Homozigoto , Humanos , Hiperparatireoidismo Primário/terapia , Recém-Nascido , Doenças do Recém-Nascido/terapia , Paratireoidectomia
14.
Saudi J Kidney Dis Transpl ; 29(5): 1216-1219, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30381523

RESUMO

Primary hyperparathyroidism (PHPT) usually presents with hypercalcemia related symptoms and signs. Kidneys play an important role in calcium homeostasis. PHPT has been reported to be associated with hyperchloremia, defective urinary acidification, and renal tubular acidosis (RTA). The dysfunction of distal renal tubules is proposed to be secondary to calcium deposition in distal tubules. This case report highlights an initial presentation of parathyroid adenoma as hypokalemia due to distal RTA secondary to medullary nephrocalcinosis.


Assuntos
Acidose Tubular Renal/etiologia , Adenoma/complicações , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/etiologia , Hipopotassemia/etiologia , Nefrocalcinose/etiologia , Neoplasias das Paratireoides/complicações , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/terapia , Adenoma/diagnóstico , Adulto , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Hipopotassemia/diagnóstico , Hipopotassemia/terapia , Masculino , Nefrocalcinose/diagnóstico , Nefrocalcinose/terapia , Neoplasias das Paratireoides/diagnóstico , Tomografia Computadorizada de Emissão
15.
Best Pract Res Clin Endocrinol Metab ; 32(5): 593-607, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30449543

RESUMO

Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women with hypercalcemia and parathyroid hormone (PTH) levels that are either frankly elevated or inappropriately normal. The clinical presentation of PHPT includes three phenotypes: target organ involvement of the renal and skeletal systems; mild asymptomatic hypercalcemia; and more recently, high PTH levels in the context of persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these three clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is employed, the prevalence of vitamin D deficiency, and whether a medical center or practitioner tends to routinely measure PTH levels in the evaluation of low bone density or frank osteoporosis. When biochemical screening is common, asymptomatic primary hyperparathyroidism is the most likely form of the disease. In countries where vitamin D deficiency is prevalent and biochemical screening is not a feature of the health care system, symptomatic disease with skeletal abnormalities is likely to predominate. Finally, when PTH levels are part of the evaluation for low bone mass, the normocalcemic variant is seen. Guidelines for surgical removal of hyperfunctioning parathyroid tissue apply to all three clinical forms of the disease. If guidelines for surgery are not met, parathyroidectomy can also be an appropriate option if there are no medical contraindications to surgery. In settings where either the serum calcium or bone mineral density is of concern, and surgery is not an option, pharmacological approaches are available and effective. Referencing in this article the most current published articles, we review the different presentations of PHPT, with particular emphasis on recent advances in our understanding of target organ involvement and management.


Assuntos
Hiperparatireoidismo Primário , Densidade Óssea , Cálcio/sangue , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/epidemiologia , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Primário/terapia , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/terapia , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/terapia
16.
Best Pract Res Clin Endocrinol Metab ; 32(5): 609-619, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30449544

RESUMO

Familial hypocalciuric hypercalcemia (FHH) causes hypercalcemia by three genetic mechanisms: inactivating mutations in the calcium-sensing receptor, the G-protein subunit α11, or adaptor-related protein complex 2, sigma 1 subunit. While hypercalcemia in other conditions causes significant morbidity and mortality, FHH generally follows a benign course. Failure to diagnose FHH can result in unwarranted treatment or surgery for the mistaken diagnosis of primary hyperparathyroidism (PHPT), given the significant overlap of biochemical features. Determinations of urinary calcium excretion greatly aid in distinguishing PHPT from FHH, but overlap still exists in certain cases. It is important that 24-h urine calcium and creatinine be included in the initial workup of hypercalcemia. FHH should be considered if low or even low normal urinary calcium levels are found in what is typically an asymptomatic hypercalcemic patient. The calcimimetic cinacalcet has been used to treat hypercalcemia in certain symptomatic causes of FHH.


Assuntos
Hipercalcemia/congênito , Complexo 2 de Proteínas Adaptadoras/genética , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP/genética , Humanos , Hipercalcemia/complicações , Hipercalcemia/diagnóstico , Hipercalcemia/epidemiologia , Hipercalcemia/genética , Hipercalcemia/terapia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Primário/terapia , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/genética , Nefropatias/terapia , Mutação , Receptores de Detecção de Cálcio/genética
17.
J Clin Endocrinol Metab ; 103(11): 3993-4004, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30060226

RESUMO

Background: Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women. The clinical presentation of PHPT has evolved over the past 40 years to include three distinct clinical phenotypes, each of which has been studied in detail and has led to evolving concepts about target organ involvement, natural history, and management. Methods: In the present review, I provide an evidence-based summary of this disorder as it has been studied worldwide, citing key concepts and data that have helped to shape our concepts about this disease. Results: PHPT is now recognized to include three clinical phenotypes: overt target organ involvement, mild asymptomatic hypercalcemia, and high PTH levels with persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is used, vitamin D deficiency is present, and whether parathyroid hormone levels are routinely measured in the evaluation of low bone density or frank osteoporosis. Guidelines for parathyroidectomy apply to all three clinical forms of the disease. If surgical guidelines are not met, parathyroidectomy can also be an appropriate option if no medical contraindications are present. If either the serum calcium or bone mineral density is of concern and surgery is not an option, pharmacological approaches are available and effective. Conclusions: Advances in our knowledge of PHPT have guided new concepts in diagnosis and management.


Assuntos
Medicina Baseada em Evidências/métodos , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/terapia , Hormônio Paratireóideo/metabolismo , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Conservadores da Densidade Óssea/uso terapêutico , Calcimiméticos/uso terapêutico , Cálcio/sangue , Cálcio/metabolismo , Medicina Baseada em Evidências/normas , Comportamento Alimentar/fisiologia , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/fisiopatologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/fisiopatologia , Masculino , Osteoporose/sangue , Osteoporose/diagnóstico , Osteoporose/fisiopatologia , Glândulas Paratireoides/metabolismo , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Paratireoidectomia/normas , Pós-Menopausa/psicologia , Guias de Prática Clínica como Assunto , Fatores Sexuais , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/fisiopatologia
18.
Curr Opin Rheumatol ; 30(4): 427-439, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29664757

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to describe recent advances and changes in the evaluation and management of primary hyperparathyroidism (PHPT). RECENT FINDINGS: Although it has long been recognized that asymptomatic PHPT is associated with bone loss, particularly at cortical skeletal sites when evaluated with dual-energy X-ray absorptiometry, new imaging techniques suggest that trabecular skeletal deterioration as well as clinically silent vertebral fractures and nephrolithiasis are common. Nonclassical targets of asymptomatic PHPT as well as the effect of vitamin D deficiency and treatment upon PHPT presentation have been the subject of recent intense investigation. Randomized clinical trials are now available regarding the effect of parathyroidectomy (PTX) upon both classical and nonclassical target organs. They have confirmed results from observational studies with regard to the skeletal benefits of PTX but have not consistently shown improvements in nonclassical symptoms. SUMMARY: These findings have led to recommendations for more extensive renal and skeletal evaluation and broader criteria for PTX in PHPT. In addition to dual-energy X-ray absorptiometry, vertebral and renal imaging is recommended. When available, trabecular imaging techniques may be helpful. PTX criteria now include subclinical kidney stones, vertebral fractures and hypercalciuria, in addition to those based on age, serum calcium, bone densitometry and renal function.


Assuntos
Hiperparatireoidismo Primário , Absorciometria de Fóton , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/terapia , Paratireoidectomia , Qualidade de Vida , Fraturas da Coluna Vertebral/etiologia
19.
World J Surg ; 42(10): 3215-3222, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29696330

RESUMO

BACKGROUND: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that predominantly affects patients >60 and is increasing in prevalence. Identifying risk factors for poor outcomes after parathyroidectomy in older adults will help tailor operative decision making. The impact of frailty on surgical outcomes in parathyroidectomy has not been established. METHODS: We performed a retrospective review of patients ≥40 years who underwent parathyroidectomy in the 2005-2010 ACS NSQIP. Frailty was assessed using the modified frailty index (mFI). Multivariable regression was used to determine the association of frailty with 30-day complications, length of stay (LOS), and reoperation. RESULTS: We identified 13,123 patients ≥40 who underwent parathyroidectomy for PHPT. The majority of patients were not frail, with 80% with a low NSQIP mFI score (0-1 frailty traits), 19% with an intermediate mFI score (2-3), and 0.9% with a high mFI score (≥4). Overall 30-day complications were rare, occurring in 141 (1.1%) patients. Increasing frailty was associated with an increased risk of complications with adjusted odds ratios (ORs) of 1.76 (95% CI 1.20-2.59; p = 0.004) for intermediate and 8.43 (95% CI 4.33-16.41; p < 0.001) for high mFI score. Patient age was independently associated with an increased risk of complications only when ≥75, as was African-American race. Anesthesia with local, monitored anesthesia care, or regional block was the only factor associated with decreased odds of complications. A high NSQIP mFI was also associated with a significant 4.77-day adjusted increase in LOS (95% CI 4.28-5.25; p < 0.001) and increased odds of reoperation (OR 4.20, 95% CI 1.64-10.74; p = 0.003). CONCLUSION: Patient frailty is associated with increased complications, reoperation and prolonged LOS in patients undergoing parathyroidectomy for PHPT. The risks of surgical management should be weighed against potential benefits in frail patients with PHPT to individualize treatment decisions in this vulnerable population.


Assuntos
Fragilidade/terapia , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/efeitos adversos , Idoso , Feminino , Fragilidade/complicações , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco
20.
J Laryngol Otol ; 132(3): 252-256, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29512477

RESUMO

OBJECTIVE: A parathyroid multidisciplinary team meeting was set up at East Sussex Healthcare Trust, from November 2014 to November 2015, in order to improve and streamline services for patients with parathyroid pathology. METHODS: Data were collected on all new referrals for hyperparathyroidism, and on the outcomes for each patient discussed at the meeting, including the number of operations and management outcomes. A survey was sent out to the members of the multidisciplinary team meeting to determine their perception of its effectiveness. RESULTS: Seventy-nine new referrals were discussed throughout the year; 43 per cent were recommended for surgery, 41 per cent had a trial of conservative or medical management before re-discussion, and 16 per cent required further imaging. Ninety-two per cent of patients underwent an ultrasound, single-photon emission computed tomography/computed tomography or nuclear medicine (sestamibi) scan prior to the meeting. All ultrasound scans were performed by a consultant radiologist. CONCLUSION: The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.


Assuntos
Adenoma/terapia , Tratamento Conservador , Processos Grupais , Hiperparatireoidismo Primário/terapia , Neoplasias das Paratireoides/terapia , Paratireoidectomia , Equipe de Assistência ao Paciente/organização & administração , Adenoma/diagnóstico por imagem , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Imagem por Ressonância Magnética , Neoplasias das Paratireoides/diagnóstico por imagem , Cintilografia , Encaminhamento e Consulta , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Ultrassonografia , Reino Unido
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