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1.
Ther Umsch ; 77(9): 433-440, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146098

RESUMO

Primary hyperparathyroidism Abstract. Primary hyperparathyroidism is a common endocrine disease that comes along with a disruption of the calcium homeostasis and is accompanied by a variety of downstream disorders. These are often overlooked as patients present with a multitude of unspecific symptoms or may even be asymptomatic. The diagnosis of primary hyperparathyroidism can be made with the determination of calcium and parathyroid hormone levels, including the measurement of calcium in the 24-hours urine. The operation is the only therapy to cure primary hyperparathyroidism. To successfully conduct focused parathyroidectomy an accompanying visual imaging methodology is of great value and improves the operation success rate. Furthermore, an intraoperative parathyroid hormone monitoring is applied. A bilateral neck exploration technique is applicable in selected cases. The endocrine surgical expertise is pivotal in particular for re-operations, hereditary primary hyperparathyroidism and carcinomas. If surgery is not possible, a medication-based therapy is applied. This medical therapy requests a continuous therapy progress monitoring. In conclusion, to treat primary hyperparathyroidism an interdisciplinary team approach with endocrinologists and endocrine surgeons shows the best results.


Assuntos
Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/terapia , Monitorização Intraoperatória , Hormônio Paratireóideo , Paratireoidectomia , Reoperação
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
3.
Wei Sheng Yan Jiu ; 49(5): 699-704, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070813

RESUMO

OBJECTIVE: To study the relationship between 25-hydroxyvitamin D [25(OH)D] concentration and intact parathyroid hormone(iPTH) concentration in the Chinese non-clinical population aged 18-44 y, and to explore the threshold value of determining the appropriate nutritional status of vitamin D. METHODS: A total of 650 plasma samples of adults aged 18-44 years old were selected from the established biological samples' bank of Chinese Chronic Diseases and Nutrition Survey(CCDNS, 2015-2018). Basic information(including age, gender, region type, season, etc. ) was collected by questionnaires, and the waist circumference, height and weight of the subjects were determined unified. North and South area was divided by Qinling Mountains and Huaihe River. The serum 25(OH)D concentration was determined by high performance liquid chromatography tandem mass spectrometer, and the iPTH was determined by electronic chemiluminescence method. The relationship of 25(OH)D and iPTH were analyzed by partial correlation analysis, and the threshold of 25(OH)D was analyzed by locally weighted scatter plot smoothing method after adjusting the iPTH by age, season of blood draw, BMI, waist, sex and latitude. RESULTS: A total of 623 serum samples(293 male, 330 female) of 25(OH)D concentration and iPTH concentration were analyzed after excluding samples with poor blood sample quality. Significant higher 25(OH)D concentration was found in male than female(P<0. 0001). And the samples from the southern China had higher 25(OH)D concentration than those from the northern China(P<0. 0001). Samples from autumn had higher 25(OH)D concentration than those from spring and winter(P<0. 0001). The 25(OH)D concentration of samples from cities was lower than that of rural areas(P=0. 018). The inversely relationship between 25(OH)D concentration and iPTH concentration was observed when the 25(OH)D was below 17. 6 ng/mL for both sexes. The threshold of 25(OH)D for male was 16. 2 ng/mL and it was 25. 6 ng/mL for female. CONCLUSION: The threshold and the relationship between 25(OH)D and iPTH differs by sex among Chinese adults aged 18-44 y. Further study is needed to evaluate the sex-specific ranges of optimal vitamin D.


Assuntos
Deficiência de Vitamina D , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Calcifediol , China/epidemiologia , Feminino , Humanos , Masculino , Hormônio Paratireóideo , Deficiência de Vitamina D/epidemiologia , Adulto Jovem
4.
Eur J Endocrinol ; 183(6): K13-K21, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33112267

RESUMO

Introduction: Gain-of-function mutations in the CASR gene cause Autosomal Dominant Hypocalcemia Type 1 (ADH1), the most common genetic cause of isolated hypoparathyroidism. Subjects have increased calcium sensitivity in the renal tubule, leading to increased urinary calcium excretion, nephrocalcinosis and nephrolithiasis when compared with other causes of hypoparathyroidism. The traditional approach to treatment includes activated vitamin D but this further increases urinary calcium excretion. Methods: In this case series, we describe the use of recombinant human parathyroid hormone (rhPTH)1-84 to treat subjects with ADH1, with improved control of serum and urinary calcium levels. Results: We describe two children and one adult with ADH1 due to heterozygous CASR mutations who were treated with rhPTH(1-84). Case 1 was a 9.4-year-old female whose 24-h urinary calcium decreased from 7.5 to 3.9 mg/kg at 1 year. Calcitriol and calcium supplementation were discontinued after titration of rhPTH(1-84). Case 2 was a 9.5-year-old male whose 24-h urinary calcium decreased from 11.7 to 1.7 mg/kg at 1 year, and calcitriol was also discontinued. Case 3 was a 24-year-old female whose treatment was switched from multi-dose teriparatide to daily rhPTH(1-84). All three subjects achieved or maintained target serum levels of calcium and normal or improved urinary calcium levels with daily rhPTH(1-84) monotherapy. Conclusions: We have described three subjects with ADH1 who were treated effectively with rhPTH(1-84). In all cases, hypercalciuria improved by comparison to treatment with conventional therapy consisting of calcium supplementation and calcitriol.


Assuntos
Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/genética , Hormônio Paratireóideo/administração & dosagem , Receptores de Detecção de Cálcio/genética , Criança , Feminino , Humanos , Hipoparatireoidismo/diagnóstico , Masculino , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento , Adulto Jovem
5.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32913635

RESUMO

Secondary hyperparathyroidism is a complex pathology that develops as chronic kidney disease progresses. The retention of phosphorus and the reductions in calcium and vitamin D levels stimulate the synthesis and secretion of parathyroid hormone as well as the proliferation rate of parathyroid cells. Parathyroid growth is initially diffuse but it becomes nodular as the disease progresses, making the gland less susceptible to be inhibited. Although the mechanisms underlying the pathophysiology of secondary hyperparathyroidism are well known, new evidence has shed light on unknown aspects of the deregulation of parathyroid function. Secondary hyperparathyroidism is an important feature of chronic kidney disease-mineral and bone disorder and plays an important role in the development of bone disease and vascular calcification. Thus, part of the management of chronic kidney disease relies on maintaining acceptable levels of mineral metabolism parameters in an attempt to slow down or prevent the development of secondary hyperparathyroidism. Here, we will also review the latest evidence regarding several aspects of the clinical and surgical management of secondary hyperparathyroidism.


Assuntos
Hiperparatireoidismo Secundário , Insuficiência Renal Crônica , Cálcio/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/terapia , Hormônio Paratireóideo , Fósforo/sangue , Insuficiência Renal Crônica/complicações , Vitamina D/sangue
7.
Nutrients ; 12(9)2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32932831

RESUMO

The novel Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is a global health concern. Vitamin D (VITD) deficiency has been suggested to alter SARS-CoV-2 susceptibility and the course of disease. Thus, we aimed to investigate associations of VITD status to disease presentation within the CovILD registry. This prospective, multicenter, observational study on long-term sequelae includes patients with COVID-19 after hospitalization or outpatients with persistent symptoms. Eight weeks after PCR confirmed diagnosis, a detailed questionnaire, a clinical examination, and laboratory testing, including VITD status, were evaluated. Furthermore, available laboratory specimens close to hospital admission were used to retrospectively analyze 25-hydroxyvitamin D levels at disease onset. A total of 109 patients were included in the analysis (60% males, 40% females), aged 58 ± 14 years. Eight weeks after the onset of COVID-19, a high proportion of patients presented with impaired VITD metabolism and elevated parathyroid hormone (PTH) levels. PTH concentrations were increased in patients who needed intensive care unit (ICU) treatment, while VITD levels were not significantly different between disease severity groups. Low VITD levels at disease onset or at eight-week follow-up were not related to persistent symptom burden, lung function impairment, ongoing inflammation, or more severe CT abnormalities. VITD deficiency is frequent among COVID-19 patients but not associated with disease outcomes. However, individuals with severe disease display a disturbed parathyroid-vitamin-D axis within their recovery phase. The proposed significance of VITD supplementation in the clinical management of COVID-19 remains elusive.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Pneumonia Viral/sangue , Deficiência de Vitamina D/virologia , Vitamina D/análogos & derivados , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Pandemias , Hormônio Paratireóideo/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
8.
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
9.
Artigo em Chinês | MEDLINE | ID: mdl-32791613

RESUMO

Objective:To compare the different therapeutic effects of modified syringe forearm quantitative injection and forearm brachioradialis intramuscular transplantation after receiving total parathyroidectomy in patients with secondary hyperparathyroidism. Method:One hundred and fifty-two patients with secondary hyperparathyroidism who underwent total parathyroidectomy were divided into the forearm brachioradialis intramuscular transplantation group and the modified syringe forearm quantitative injection group according to the different forearm transplantation methods. The study counted and compared the duration of surgery, preoperative and postoperative parathyroid hormone levels, blood calcium and other indicators. Result:The results showed that there was no statistically significant difference in laboratory test data between the two groups, but the modified syringe forearm quantitative injection method was more convenient, and the recovery time of the parathyroid function was shortened from an average of 6 months to an average of 3 months(P=0.03). There was no statistical difference in the recurrence of the two groups of patients after transplantation. Conclusion:The modified syringe forearm quantitative injection method for transplantation of parathyroid gland is relatively simple to operate, saves time, and enables the transplanted parathyroid gland to function faster. It is worthy of being widely used.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia , Antebraço , Humanos , Glândulas Paratireoides , Hormônio Paratireóideo , Recidiva , Transplante Autólogo
10.
Georgian Med News ; (303): 93-97, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32841188

RESUMO

The aim of work was to evaluate the efficacy of combination therapy with vitamin D metabolites on mineral bone density and markers of bone remodeling in postmenopausal women with arterial hypertension, obesity and vitamin D deficiency working in adverse environmental conditions. We examined 95 women aged from 48 to 60 years, 79 people (main group) had arterial hypertension, obesity and deficiency vitamin D and worked in adverse conditions of production, 16 were healthy women. The main group depending on the conducted treatment were divided into 3 groups: А group - received standard antihypertensive therapy, Cholecalciferol and Alfacalcidol; group B - standard antihypertensive therapy and Cholecalciferol; group C - standard antihypertensive therapy. The examination included anthropometric measurements (body weight, height, calculation of body mass index, waist circumference, hip circumference, calculation of index waist circumference / hip circumference), measurement of blood pressure, laboratory tests - determination of the 25-hydroxyvitamin D, parathyroid hormone, C-terminal telopeptide, osteocalcin, osteoprotegerin, instrumental study of mineral density of bone tissue (the definition of T-criterion). The dynamics of the level of 25-hydroxyvitamin D, parathyroid hormone, C-terminal telopeptide, osteocalcin, osteoprotegerin and mineral density of bone tissue after 6 and 12 months. The results showed a positive effect of Cholecalciferol and Alfacalcidol on the level of 25-hydroxyvitamin D, markers of bone formation in serum and parameters of mineral bone density in women. However, combination therapy with vitamin D metabolites showed a more pronounced effect on the processes of bone formation and mineral density of bone tissue (p<0.05). Found that the lack of correction of deficiency and insufficiency of vitamin D contributes to the progressive decrease in mineral density of bone tissue and disruption of the processes of bone formation. Combination therapy with vitamin D metabolites is effective (p<0.05) and pathogenetically justified in the treatment of vitamin D deficiency and structural and functional changes of bone tissue in postmenopausal women with arterial hypertension and obesity, working in adverse environmental conditions.


Assuntos
Hipertensão , Deficiência de Vitamina D , Densidade Óssea , Osso e Ossos , Colecalciferol , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade , Hormônio Paratireóideo , Vitamina D
11.
Neurology ; 95(9): e1117-e1125, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759193

RESUMO

OBJECTIVE: To assess the effect of vitamin D and calcium supplementation in preventing recurrences of benign paroxysmal positional vertigo (BPPV). METHODS: We performed an investigator-initiated, blinded-outcome assessor, parallel, multicenter, randomized controlled trial in 8 hospitals between December 2013 and May 2017. Patients with confirmed BPPV were randomly assigned to the intervention (n = 518) or the observation (n = 532) group after successful treatment with canalith repositioning maneuvers. The primary outcome was the annual recurrence rate (ARR). Patients in the intervention group had taken vitamin D 400 IU and 500 mg of calcium carbonate twice a day for 1 year when serum vitamin D level was lower than 20 ng/mL. Patients in the observation group were assigned to follow-ups without further vitamin D evaluation or supplementation. RESULTS: The intervention group showed a reduction in the ARR (0.83 [95% confidence interval (CI), 0.74-0.92] vs 1.10 [95% CI, 1.00-1.19] recurrences per 1 person-year) with an incidence rate ratio of 0.76 (95% CI, 0.66-0.87, p < 0.001) and an absolute rate ratio of -0.27 (-0.40 to -0.14) from intention-to-treat analysis. The number needed to treat was 3.70 (95% CI, 2.50-7.14). The proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs 46.7%, p = 0.005). CONCLUSIONS: Supplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV.


Assuntos
Vertigem Posicional Paroxística Benigna/prevenção & controle , Carbonato de Cálcio/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Acidentes por Quedas/estatística & dados numéricos , Idoso , Vertigem Posicional Paroxística Benigna/sangue , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/terapia , Cálcio/sangue , Suplementos Nutricionais , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Membrana dos Otólitos , Hormônio Paratireóideo/sangue , Posicionamento do Paciente , Fósforo/sangue , Recidiva , Prevenção Secundária , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações
12.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32765831

RESUMO

Hypoparathyroidism is a rare endocrine disorder which leads to hypocalcemia, hypercalciuria, and hyperphosphatemia. Complications include nephrocalcinosis with renal dysfunction, reduced quality of life, and abnormal skeletal properties. Conventional therapy with calcium and vitamin D analogs addresses hypocalcemia but has important limitations. Parathyroid hormone (PTH) therapy is a fundamental advance, although the effects of PTH on long-term complications require additional testing. Continuous PTH therapy is likely to be particularly advantageous for addressing renal, quality of life, and skeletal complications. Overall, much progress has been made, yet more information is needed to improve our understanding and management of hypoparathyroidism.


Assuntos
Hipocalcemia , Hipoparatireoidismo , Cálcio , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Hipoparatireoidismo/tratamento farmacológico , Hormônio Paratireóideo , Qualidade de Vida
14.
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
15.
Artigo em Inglês | MEDLINE | ID: mdl-32630653

RESUMO

BACKGROUND: Depression and osteoporosis are severe public health problems. There are conflicting findings regarding the influence of depression on bone metabolism. The aim of the presented study was to compare bone turnover markers and vitamin D levels between patients treated for depression and healthy controls. PATIENTS AND METHODS: We determined a concentration of osteocalcin, carboxy-terminal telopeptide of type I collagen (ß-CTX), 25-hydroxyvitamin D (25OHD) and 1,25(OH)2D3 in 99 patients, aged 46.9 ± 11 years, treated for depression, as well as in 45 healthy subjects. Depressive status was determined with the Hamilton Depression Scale (HDRS). RESULTS: In patients treated for depression, we demonstrated significantly lower osteocalcin concentrations (p < 0.03) and higher concentration of ß-CTX (result on the border of significance; p = 0.08). Those relationship were stronger in women. The level of 25OHD and 1,25(OH)2D3 did not differ significantly between the examined groups. We observed a negative correlation between the 25OHD and HDRS score after treatment in all patients treated for depression and in subgroups of women and subjects with recurrent depression. CONCLUSIONS: Our results indicate that depression is related to disturbances in bone metabolism, especially in women and patients with recurrent depression, suggesting its role in context of osteoporosis development.


Assuntos
Remodelação Óssea , Osso e Ossos/metabolismo , Depressão/fisiopatologia , Adulto , Biomarcadores , Densidade Óssea , Colágeno Tipo I/metabolismo , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteocalcina , Hormônio Paratireóideo , Vitamina D
16.
Zhonghua Wai Ke Za Zhi ; 58(8): 626-630, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727195

RESUMO

Objective: To examine the value serum calcium and intact parathyroid hormone (iPTH) levels measured on the first day after total thyroidectomy on prediction for permanent hypoparathyroidism. Methods: Totally 546 patients with thyroid cancer and benign thyroid lesions who underwent total thyroidectomy at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from February 2008 to December 2018 were analyzed retrospectively. There were 158 males and 388 females aging (50.9±13.2) years (range: 19.0 to 79.2 years). Serum calcium and iPTH levels were collected before surgery, on the first day and 6 months after surgery. Logistic regression was used to analyze the correlation between each data and the occurrence of permanent hypoparathyroidism after surgery.The area under the receiver operating characteristic curve was used to evaluate the predictive power of iPTH for postoperative occurrence of permanent hypoparathyroidism. Results: Among the 546 cases of total thyroidectomy, 22 cases of permanent hypoparathyroidism occurred, with an incidence of 4.0% (22/546). Multivariate analysis showed that iPTH levels on the first day after total thyroidectomy (OR=2.932, 95%CI: 1.129 to 7.616, P=0.027) and serum calcium levels (OR=2.584, 95%CI: 1.017 to 6.567, P=0.046) were independent prognosis factors for postoperative permanent hypoparathyroidism. When the threshold value of iPTH at 24 hours after total thyroidectomy was 5.51 ng/L, the AUC was 0.956 (95%CI: 0.936 to 0.972, P=0.000), sensitivity was 100%, specificity was 85.1%, positive predictive value was 22%, negative predictive value was 100%. When the threshold value of serum calcium at 24 hours after total thyroidectomy was 1.93 mmol/L, the AUC was 0.733 (95%CI: 0.694 to 0.770, P=0.000), sensitivity was 63.6%, specificity was 78.1%, positive predictive value of 10.8% and negative predictive value of 98.1%. Conclusions: Serum iPTH and calcium levels on the first day after total thyroidectomy were related to the occurrence of permanent hypoparathyroidism postoperatively. The predictive value of iPTH level is higher than that of serum calcium level.


Assuntos
Cálcio/sangue , Hipoparatireoidismo/sangue , Hormônio Paratireóideo/sangue , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Doenças da Glândula Tireoide/sangue , Tireoidectomia/métodos , Adulto Jovem
17.
Medicine (Baltimore) ; 99(28): e20886, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664081

RESUMO

Due to the great difficulty in being preserved in site for the variable positions, the inferior parathyroid glands were advised to being routinely autotransplanted to prevent permanent hypoparathyroidism. The aim of this study was to compare the performance in the function of the superior parathyroid glands preserved in site with that of the inferior parathyroid glands preserved in site.We conducted a retrospective study including patients who underwent thyroid surgery for papillary thyroid carcinoma at our department between January 2014 and June 2018. According to the number and original position of the autoplastic parathyroid gland(s), patients were divided into group 1 (1 superior parathyroid gland), group 2 (1 inferior parathyroid glands), group 3 (1 superior parathyroid gland and 1 inferior parathyroid gland) and group 4 (2 inferior parathyroid glands). The postoperative complications and serum parathyroid hormone and calcium were analyzed.A total of 368 patients were included in the study, among them 27, 243, 40, and 58 patients were divided into group 1, group 2, group 3, and group 4, respectively. Compared with those in group 2, the serum parathyroid hormones were higher at 1 week (2.98 ±â€Š1.52 vs 2.42 ±â€Š0.89, P = .049) and 2 weeks (3.49 ±â€Š1.42 vs 2.8 ±â€Š0.81, P = .019) postoperatively in group 1. There was also significantly different in the serum parathyroid hormone at 2 weeks postoperatively between group 3 and group 4 (2.95 ±â€Š0.98 vs 2.58 ±â€Š0.82, P = .047).The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site.


Assuntos
Glândulas Paratireoides/fisiologia , Glândulas Paratireoides/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/patologia , Transplante Autólogo/efeitos adversos , Adulto , Cálcio/sangue , Feminino , Humanos , Hipoparatireoidismo/prevenção & controle , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/anatomia & histologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Transplante Autólogo/métodos
19.
PLoS One ; 15(7): e0235082, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634148

RESUMO

Kidney donation results in reductions in kidney function and lasting perturbations in phosphate homeostasis, which may lead to adverse cardiovascular sequelae. However, the acute effects of kidney donation on bone mineral parameters including regulators of calcium and phosphate metabolism are unknown. We conducted a prospective observational controlled study to determine the acute effects of kidney donation on mineral metabolism and skeletal health. Biochemical endpoints were determined before and after donation on days 1, 2 and 3, 6 weeks and 12 months in donors and at baseline, 6 weeks and 12 months in controls. Baseline characteristic of donors (n = 34) and controls (n = 34) were similar: age (53±10 vs 50±14 years, p = 0.33), BMI (26.3±2.89 vs 25.9±3.65, p = 0.59), systolic BP (128±13 vs 130±6 mmHg, p = 0.59), diastolic BP (80±9 vs 81±9 mmHg, p = 0.68) and baseline GFR (84.4±20.2 vs 83.6±25.2 ml/min/1.73m2, p = 0.89). eGFR reduced from 84.4±20.2 to 52.3±17.5 ml/min/1.73m2 (p<0.001) by day 1 with incomplete recovery by 12 months (67.7±22.6; p = 0.002). Phosphate increased by day 1 (1.1(0.9-1.2) to 1.3(1.1-1.4) mmol/L, p <0.001) but declined to 0.8(0.8-1.0) mmol/L (p<0.001) before normalizing by 6 weeks. Calcium declined on day 1 (p = 0.003) but recovered at 6 weeks or 12 months. PTH and FGF-23 remained unchanged, but α-Klotho reduced by day 1 (p = 0.001) and remained low at 6 weeks (p = 0.02) and 1 year (p = 0.04). In this study, we conclude that kidney donation results in acute disturbances in mineral metabolism characterised by a reduced phosphate and circulating α-Klotho concentration without acute changes in the phosphaturic hormones FGF23 and PTH.


Assuntos
Densidade Óssea , Transplante de Rim , Minerais/metabolismo , Doadores de Tecidos , Adulto , Estudos de Casos e Controles , Feminino , Fatores de Crescimento de Fibroblastos/metabolismo , Glucuronidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/metabolismo , Fosfatos/metabolismo , Estudos Prospectivos , Fatores de Tempo
20.
Georgian Med News ; (302): 109-113, 2020 May.
Artigo em Russo | MEDLINE | ID: mdl-32672701

RESUMO

The aim - to determine the bone metabolism status and bone mineral density (BMD) in children with recurrent bronchitis (RB). 120 children aged 6 to 10 years were examined. Formed 2 groups: 1st group - children with RB (n=60); 2nd group - children occasionally suffering of upper respiratory tract infections (n=60). The average age was 8 years 2 months. Among children with RB, compared with children of the 2nd group, an increase in the number of patients with an increase in alkaline phosphatase activity (by 35.0%) (p<0.05), and serum osteocalcin level (by 66.7%) (p<0.05) was revealed, collagen type 1 degradation products (by 15.0%) (p<0.05), parathyroid hormone (by 13.3%) (p<0.05), decrease of serum 25(OH)D less than 30 ng/ml (by 59.3%) (p<0.05). A DXA in children with RB showed the presence of 24 (40.0%) episodes of decreased BMD in the L1, 25 (41.7%) episodes in L2, 24 (40.0%) episodes in L3, 27 (45.0%) episodes in L4, 28 (46.7%) cases in the left femur neck, 22 (36.7%) cases in the right femur neck. In children with RB was established activation of bone resorption on background of vitamin D deficiency and BMD decrease.


Assuntos
Bronquite , Deficiência de Vitamina D , Densidade Óssea , Criança , Humanos , Osteocalcina , Hormônio Paratireóideo
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