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Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.
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The incidence of parathyroid hyperfunction is high and its clinical manifestations are diverse. Some patients develop chest tightness and palpitations as the main discomfort, which may be caused by the hypocalcemia and hypercalcemia related to negative calcium balance and parathyroid hyperfunction. We report a case of 53 years old male with parathyroid hyperfunction who was diagnosed with osteoporosis before and received conventional regular supplementation of vitamin D and calcium supplements. However, his condition worsened and he developed chest tightness and palpitation. After 1 month of sufficient supplementation of calcium, the symptoms of chest tightness and palpitation disappeared completely. Then we continued to provide the patients enough vitamin D and calcium supplementation actively. After 1 year of follow-up, the patient's condition was stable. His discomfort of chest tightness and palpitation never recurred, and all the bone metabolism indicators returned to normal.
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Osteoporosis is a common age-related disease which has become a severe public health problem in China. Anti-osteoporosis drug is important to treat osteoporosis, but some patients have poor efficacy after using anti-osteoporosis drugs, which may be associated with anti-osteoporosis drugs related parathyroid hyperfunction or hyperparathyroidism. As a emergency drug for hypercalcemia crisis, anti-osteoporosis drug can cause a significant decrease in serum calcium. With the current recommended doses of vitamin D and calcium supplementation, some patients presented with a decreased level of serum calcium and negative calcium balance after receiving anti-osteoporosis drugs, stimulating parathyroid hyperplasia and enlargement, leading to parathyroid hyperfunction or hyperparathyroidism. During the treatment of anti-osteoporosis drugs, sufficient vitamin D and calcium supplementation on the basis of closely monitoring of serum calcium, parathyroid hormone (PTH) and related bone metabolism indicators is beneficial to maintain the stability of serum calcium and PTH, preventing anti-osteoporosis drugs related parathyroid hyperfunction or hyperparathyroidism. Furthermore, it can efficiently prevent and treat bone loss, fractures, height shortening, hunchback, systemic musculoskeletal and joints pain, metastatic vascular calcification and calcinosis universalis, improve the efficacy of anti-osteoporosis drugs, reduce adverse reactions, comprehensively improve the prognosis of osteoporosis patients, and protect people’s health.
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Anti-osteoporosis drug is important to treat osteoporosis. However, systemic musculoskeletal and joints pain and other adverse events in some patients are unrelieved or even aggravated after using anti-osteoporosis drugs, which may be associated with anti-osteoporosis drug related parathyroid hyperfunction or hyperparathyroidism. We report a case of 78 years old female with osteoporosis who, on the basis of conventional regular supplementation of Vitamin D and calcium supplements, presented with a decreased level of serum calcium and negative calcium balance after receiving anti-osteoporosis drugs, resulting in hyperparathyroidism, significant pain in bilateral knee joints and inability of walking independently. After sufficient supplementation of vitamin D and calcium, the pain was significantly relieved, bone metabolism indicators returned to normal, the patient was able to walk without assistance and had no recurrence after 1 year of follow-up.
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The lifetime prevalence of nephrolithiasis is 15% for men, with a 5-year recurrence rate of 35% to 50% after an initial event. Although it was initially recommended to limit calcium intake in these patients, a number of studies have reported association between lower total dietary calcium intake and increased risk of incident kidney stones, and that increased calcium intake might reduce the risk of incident kidney stones. We report a 35-year-old male who presented recurrent 8-years of nephrolithiasis and urine crystal with calcium intake restriction, and had no recurrence after 5 years of follow-up after intensive calcium and vitamin D supplementation.
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Metastatic vascular calcification and calcinosis universalis, as severe complications of parathyroid hyperfunction and hyperparathyroidism, have attracted more attention in patients with renal secondary hyperparathyroidism and primary hyperparathyroidism. But, they are of little concern in patients with long-term negative calcium balance related parathyroid hyperfunction or hyperparathyroidism caused by calcium and/or vitamin D insufficiency (CVI). CVI is common in the population. Relatively low level of serum calcium and negative calcium balance caused by long-term CVI result in parathyroid hyperfunction or hyperparathyroidism, which may cause secretion of PTH beyond the physiological level, leading to bone absorption and release of a large amount of bone calcium into the blood. It may not only cause bone loss and osteoporosis, but also form metastatic vascular calcification or calcinosis universalis presented by cardiovascular diseases and other multi-organ lesions. Early calcium deposition can gradually fade after reasonable treatment, but middle arterial calcification is not easy to fade once it occurs. Therefore, vascular calcification and calcium deposition should be actively prevented and early screened and diagnosed. The early prevention, diagnosis and treatment of parathyroid hyperfunction or hyperparathyroidism can prevent, delay, or even reverse the occurrence and development of metastatic vascular calcification and calcinosis universalis, which is significant for disease prevention and protecting the patients' health influenced by these diseases.
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Differentiated thyroid cancer is one of the most common endocrine malignant tumors, and thyroidectomy is its basic treatment measures. Insufficient attention is paid to its postoperative bone hungry syndrome and parathyroid hyperfunction or hyperparathyroidism, which will seriously affect the patient’s life quality and prognosis. This paper will explore the etiology, dangers, diagnosis, prevention, and treatment for hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy.
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Osteoporosis (OP) is a common systemic bone disease which has become a serious public health problem in China. In clinical practice, we found that some primary osteoporosis may be due to parathyroid hyperfunction (subclinical hyperparathyroidism) or hyperparathyroidism which is the result of negative calcium balance and hypocalcemia caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, which is preventable and controllable. Therefore, we call this kind of osteoporosis parathyroid hyperfunction or hyperparathyroidism associated osteoporosis. The daily calcium intake of Chinese people is generally insufficient, and vitamin D deficiency/insufficiency is also a worldwide public health problem. Parathyroid hyperfunction or hyperparathyroidism associated osteopenia and osteoporosis which are results of hypocalcemia and negative calcium balance caused by long-term insufficient calcium intake and/or vitamin D deficiency/insufficiency exist extensively in clinical practice. Its prevention and treatment can effectively prevent and treat osteopenia and osteoporosis, so as to effectively prevent and treat diseases such as short stature, rachiokyphosis, backache, fatigue, bone pain, fracture, metastatic vascular calcification and systemic calcinosis, improve people’s health and help achieve the goal of "Healthy China 2030" .
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Metabolic-dysfunction associated fatty liver disease (MAFLD) is a common concomitant disease of breast cancer. It is one of the main causes of liver damage during chemotherapy and also an important cause of liver damage during endocrine therapy or follow-up, which seriously affects the quality of life and prognosis of breast cancer patients. Nonalcoholic fatty liver disease was renamed as MAFLD, which changed the original "exclusive diagnosis" to "inclusive diagnosis" and the non-negligible role of metabolic factors in the occurrence and development of fatty liver disease was recognized, but the clinical attention is not enough at present. More attention should be paid to the diagnosis and treatment of MAFLD in breast cancer patients because the proportion and risk of metabolic disorders are higher than that in general people. In this article, we will focus on the clinical significance, prevention and treatment of the new definition of MAFLD in the comprehensive management of concomitant diseases of breast cancer, so as to further improve the quality of life and prognosis of breast cancer patients.
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Objective:To evaluate the clinical feasibility, safety, and advantages of small lateral cervical incision for parathyroid exploration and resection.Methods:A total of 31 consecutive patients who underwent parathyroidectomy with a small lateral cervical incision, in the Department of Endocrinology and Breast Surgery of the First Affiliated Hospital of Chongqing Medical University from Apr. to Nov. 2021, including 11 males and 20 females, aged (49.32±13.79) years, ranging from 28 to 86 years, were selected to make retrospective statistical analysis of the surgical time, hospital stay, intraoperative blood loss, postoperative drainage and postoperative complications of the patients. All patients were injected with carbon nanoparticles suspension injection guided by color ultrasound to locate the enlarged parathyroid gland before surgery. EXCEL 2019 software was used for statistical analysis.Results:Thirty-one patients underwent parathyroidectomy through a small lateral cervical incision. Primary hyperparathyroidism was performed in 19 cases (including 2 cases with bilateral small lateral cervical incision, 2 cases with unilateral excision of thyroid mass combined with parathyroidectomy, 1 case with resection of huge parathyroid adenoma, and 1 case with local anesthesia) . Twelve patients with secondary hyperparathyroidism underwent total parathyroidectomy through bilateral small lateral cervical incision and forearm autogenous parathyroid transplantation (including bilateral thyroid mass resection combined with bilateral total parathyroidectomy and forearm autogenous parathyroid transplantation in 2 cases, local anesthesia and cervical plexus nerve block in 2 cases, and ectopic parathyroid gland in thyroid in 1 case) . Among them, the average operative time of patients with primary hyperparathyroidism was (54.74±27.71 & 74.14±31.73) min, the average intraoperative blood loss was (8.11±5.05 & 14.43±10.94) ml, the average postoperative drainage was (14.37±24.64 & 26.36±32.87) ml, the average postoperative parathyroid hormone was (11.59±16.46 & 26.65±56.38) pg/ml, the average hospital stay was (10.00±5.09 & 10.96±4.55) d, and the postoperative complication rate was (3.2% & 0%) .Conclusions:Parathyroid gland exploration and resection through small lateral cervical incision is a safe and effective surgical method and can also complete thyroid exploration and parathyroidectomy at the same time. Appropriate anesthesia should be selected after a full assessment of the patient’s basic condition.
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Hyperparathyroidism is a common endocrine disease that seriously affects human health, depending on its etiology, which can be divided into three types: primary, secondary and tertiary. In clinical practice, we found that some primary hyperparathyroidism may be secondary or tertiary hyperparathyroidism caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, and become a common type of hyperparathyroidism. The daily calcium intake of Chinese people is generally insufficient. Vitamin D can promote the absorption of calcium, but vitamin D deficiency/insufficiency is also a worldwide public health problem. Long-term hypocalcemia will stimulate parathyroid hyperplasia and secrete excessive parathyroid hormone, resulting in parathyroid hyperfunction (pre-hyperparathyroidism) and then secondary hyperparathyroidism, both of which may damage bone and release calcium into blood, leading to diseases of multiple organs and tissues. The detection of bone metabolism indexes such as calcium, magnesium, phosphorus, parathyroid hormone and vitamin D may be helpful for the early diagnosis of pre-hyperparathyroidism and hyperparathyroidism. Supplementation of calcium and vitamin D in early stage can control the development of the disease and change "unpreventable and uncontrollable" into "preventable and controllable" . The health screening of bone metabolism indexes and parathyroid ultrasonography should be advocated, and the prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism should be strengthened, so as to greatly improve the bone health, urinary calculus, metastatic vascular calcification and systemic abnormal calcium migration and precipitation in the population.
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Vitamin D deficiency can be a trigger factor for recurrent oral ulcers. This article combining two cases of recurrent oral ulcers in patients with vitamin D deficiency who were cured by active vitamin D supplementation emphasizes that 25-hydroxyvitamin D and other indicators should be screened in patients with recurrent oral ulcers, so as to improve the understanding of the disease and the ability of clinical diagnosis and treatment for it.
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With the development of various laboratory testing techniques such as serum calcium and parathyroid hormone (PTH) , a large number of asymptomatic or normocalcemic primary hyperparathyroidism (PHPT) can be diagnosed early. PHPT has become the third most common endocrine disease affecting human health. Currently, most PHPT, especially normocalcemic primary hyperparathyroidism, are not primary diseases and may be related to vitamin D deficiency/insufficiency and/or insufficient calcium supplementation. That is, the relative hypocalcemia caused by long-term vitamin D deficiency/insufficiency and/or insufficient calcium supplementation leads to parathyroid hyperfunction, stimulates parathyroid hyperplasia, and secretes excessive parathyroid hormone to compensate for the regulation of calcium and phosphorus balance. When it is in the initial reversible stage, it can be cured by internal medicine; if it progresses freely, long-term hypocalcemia stimulation will lead to excessive parathyroid hyperplasia and even tumor occurrence with the formation of so-called PHPT and parathyroidectomy has to be performed. Therefore, routine screening of bone mineral density, calcium, magnesium, phosphours, 25-hydroxyvitamin D, parathyroid hormone and other bone metabolism indicators in the physical examination of general population is beneficial to the prevention and treatment of bone metabolism diseases, urinary stones and hyperparathyroidism. At the same time, attention should be paid to identifying the stage of prehyperparathyroidism in which vitamin D deficiency/insufficiency and insufficient calcium supplementation will stimulate parathyroid hyperfunction. Active intervention on prehyperparathyroidism is an effective way to avoid the development of primary hyperparathyroidism.
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In Oct. 2016, the Central Committee of the Communist Party of China and the State Council issued the "Outline for Healthy China 2030" , which planned to achieve chronic disease management for the entire population and the overall 5-year survival rate of cancer increasing by 15% by 2030. In Jan. 2019, the "2618 Glycolipid Project" was launched, which promoted the comprehensive management of blood glucose, blood pressure and blood lipids in the grassroots. Breast cancer is the most common malignant tumor in women. With the improvement of its diagnosis and treatment, most of the patients survive for a long time in a state of chronic disease. Diabetes, dyslipidemia, and hypertension have a higher prevalence in breast cancer patients, and are most common concomitant diseases of breast cancer. Breast cancer patients also have a higher proportion of carotid plaques and carotid intima thickening. However, there is no obvious symptoms, and there is a lack of clinical understanding of its harm, which will inevitably affect the treatment and prognosis of breast cancer patients. This article will explore the significance and implementation of "2618 Glycolipid Project" in the management of patients with breast cancer, in order to further improve the life quality and the prognosis of breast cancer patients.
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Vitamin D deficiency/insufficiency has become a worldwide public health problem, especially in breast cancer patients. Vitamin D is a fat-soluble vitamin necessary for human body, which has important physiological functions such as regulating calcium and phosphorus metabolism and affecting cell proliferation and differentiation. Vitamin D deficiency/insufficiency is closely related to the occurrence of bone diseases and various extra-bone diseases, and is also a risk factor for the occurrence, development and poor prognosis of breast cancer. Vitamin D deficiency/insufficiency and low blood calcium are the main cause of enhanced parathyroid function or secondary hyperparathyroidism, but are often overlooked due to the absence of early clinical manifestations. Bone problems of breast cancer patients are more obvious than those of general population because of the systemic treatment such as chemotherapy and endocrine therapy and changes in menstrual state, and vitamin D deficiency and secondary hyperparathyroidism will further aggravate their bone health problems. Therefore, it is necessary to strengthen the monitoring of blood calcium, parathyroid hormone and bone metabolism indicators in breast cancer patients, so as to make targeted supplementation of vitamin D and calcium. We should pay attention to the prevention and treatment of vitamin D deficiency/insufficiency associated hyperparathyroidism and bone health problems to improve the quality of life and prognosis of patients.
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Breast cancer (BC) and cardiovascular diseases (CVD) are two important “killers” threatening women's life and health.There are several overlapping risk factors and interactive control measures between BC and CVD.BC patients have a higher rate of mental and psychological problems,which may lead to behavior degeneration and treatment interruption,or even affect the body status of and rehabilitation progress,finally result in a bad effect on the life quality and prognosis of breast patients.Crossing field between cardiovasology and psychology has formed a new discipline named psychocardiology,which emphasizes the treatment of CVD while paying great attention to patients' mental-psychological problems.Long-term pain and stress caused by breast cancer and cardiovascular disease can affect patients' psychological state and even lead to anxiety and depression.CVD and mental disorders often coexist in breast cancer patients.Therefore,the clinical practice of breast cancer should strengthen the construction of “double heart medicine”,that is,the construction of breast cancer psychological cardiology and multidisciplinary collaboration.
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Genitourinary syndrome of menopause (GSM),is a common disease in postmenopausal women.It is reported that the incidence of GSM in breast cancer patients (79％-95％) was higher than that in normal counterparts (more than 50％).GSM significantly reduced the quality of life in breast cancer patients,but was not given enough attention,and most of breast cancer patients with GSM were not diagnosed and treated.In addition,chemotherapy and endocrine therapy for breast cancer may increase the incidence and severity of GSM.Hence,prevention and treatment of GSM should be strengthened in breast cancer patients.
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Objective To evaluate the clinical feasibility and advantages of ultrasound guided mammo-tome biopsy for micro-calcifications visible in mammography. Methods A total of 12 patients with mammogra-phy-revealed micro-calcifications examined by ultrasound guided vacuum-assisted biopsy in our hospital from Jun. 2017 to Dec. 2018 were enrolled in this study and their medical records data were analyzed. Results All 12 patients had accepted pre-biopsy ultrasound localization and all micro-calcifications were successfully excised. A-mong 12 cases, 4 were revealed as benign breast diseases and 8 were diagnosed as breast cancer. Conclusions Ul-trasound guided mammotome biopsy is found to be an alternative method to stereotactic biopsy in patients with US-detectable micro-calcifications, and re-scan ultrasonography focusing on the specific microcalcification area may be helpful for improving the ultrasound detection rate of micro-calcifications.
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Chronic kidney disease,especially in patients with end-stage renal disease (ESRD),is prone to causing secondary hyperparathyroidism,and part of refractory secondary hyperparathyroidism patients require treatment with parathyroidectomy.Parathyroidectomy makes the thyroid inevitably subject to mechanical stimulation,leading to transient mechanical thyroiditis,hyperthyroxinemia and postoperative transient thyrotoxicosis,causing dysfunction in multiple systems of the body,and even inducing or aggravating water and electrolyte disorders (such as hyperkalemia),arrhythmia and cardiovascular events.However,this complication has not yet received sufficient clinical attention.This article will discuss the prevention and treatment of thyrotoxicosis or hyperthyroidism,one of the postoperative complications,in secondary hyperparathyroidism patients with ESRD,based on the relevant documents and our own clinical practice.
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The incidence of thyroid carcinoma is increasing.Because of the special location,patients usually have cosmetic requirements for thyroid surgery.Compared with open surgery,improved Miccoli surgery,total endoscopic surgery,radiofrequency ablation and other minimally invasive surgery have obvious advantages in cosmetology,but the surgical indications are limited.Through incision design and protection,appropriate suture materials,standard suture methods and negative pressure drainage measures,we can effectively reduce the scar formation of open surgery,and improve the cosmetic results.Preoperative individualized treatment should be formulated according to the patient's actual situation,tumor nature,cosmetic needs,hospital conditions and other comprehensive factors.