Surgery Best to Reduce Fractures in HyperparathyroidismSurgery Best to Reduce Fractures in Hyperparathyroidism
Surgically removing the tumor significantly reduces fracture risk over time in primary hyperparathyroidism, whereas bisphosphonate therapy increases fracture risk despite improving bone-mineral density. Medscape Medical News
AbstractPurpose of the reviewThere is an increasing body of evidence that the trabecular bone score (TBS), a surrogate of bone microarchitecture extracted from spine DXA, could play an important role in the management of patients with osteoporosis or at risk of fracture. The current paper reviews this published body of scientific literature on TBS and answers the most relevant clinical questions.Recent findingsTBS has repeatedly been proven to be predictive of fragility fractures, current and future, and this is largely independent of BMD, CRF, and the FRAX, and when used in conjunction with any one of these measures, it c...
Discussion: Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA. This is based on in-vitro studies showing PTH increased aldosterone secretion from adrenocortical cells in a concentration dependent manner. Gene expression and immunohistochemistry studies show PTH receptors in aldosterone-producing adenomas and MR receptors in parathyroid cells, suggesting a bi-directional relationship. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.
CONCLUSIONS: In this article, we summarize the pathophysiology, clinical aspects and the new diagnostic tools to better understand bone impairment in acromegaly. PMID: 28880058 [PubMed - as supplied by publisher]
A 76-year-old woman with type 2 diabetes, incident on hemodialysis, presented with extremely painful necrotic ulcers on both legs and gluteal muscles, persistently worsening for 2 months despite care. Her admission blood test results showed normocalcemia (8.0 mg/dl), normophosphatemia (4.2 mg/dl), and a low parathyroid hormone level (PTH, 28 pg/ml). Five months earlier, she had been treated with paricalcitol and calcium carbonate due to secondary hyperparathyroidism (PTH, 1100 pg/ml) and hyperphosphatemia (6.9 mg/dl); both were discontinued 3 months later after dialysis was started.
We describe a case of a 65-year-old woman admitted to the hospital for suspected of epileptic crisis. She was affected by diabetes and hiatal hernia for which she was taking Proton Pump Inhibitors (PPIs) for about 8 years. She showed hypocalcaemia, hypomagnesaemia, hyperparathyroidism and severe hypovitaminosis D. We exclude malabsorption and magnesium loss. After restored vitamin D levels, stopped use of PPI, start calcium and magnesium supplementation normal values of the ions were restored. This case underlies the importance of evaluate magnesium routinely, other than calcium and vitamin D, and use PPI more carefully. ...
Conclusion Vitamin D deficiency may present as a spectrum of clinical pictures, representing a continuum ranging from asymptomatic/subtle conditions to overt rickets/osteomalacia. Immigrant families are at high risk for vitamin D deficiency at every age. If a case of symptomatic vitamin D deficiency is recognized, then the evaluation of the all family members is recommended, as they can have the same and/or other risk factors for vitamin D deficiency. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
Conclusion The current study showed that adynamic bone disease is prevalent even in pre-dialysis CKD population. High bone turnover disease may not be the most prevalent type in diabetic CKD. However, it could contribute to the development of osteoporosis in CKD subjects. Serum total ALP can serve as a biochemical marker to identify pattern of bone turnover where intact PTH is not available.
Abstract BACKGROUND: To evaluate the value of preoperative dipyridamole thallium-201 scintigraphy for reducing cardiovascular complication in secondary hyperparathyroidism (SHPTH) patients. METHODS: Thallium scintigraphy was arranged for all dialysis patients who underwent parathyroidectomy from Jan 2011 to July 2015. Management of defects on thallium scintigraphy included cardiac catheterization and ultrasonography. Analysis includes 30-day mortality, morbidity and the predicting factors for thallium scintigraphy defect. RESULTS: Of 249 patients with SHPTH, 19 (7.6%) had defects on thallium scintigraphy...
Thiazides may be a safe and effective treatment alternative for patients with primary hyperparathyroidism when surgery is not an option.Journal of Clinical Endocrinology &Metabolism
CONCLUSIONS: Our data suggest that a subgroup of dialysis patients, namely those with moderate sHPT, younger age and without diabetes benefit from cinacalcet with reduced overall and cardiovascular mortality. These findings may help to identify populations for further controlled trials and may allow a more individualized sHPT treatment using cinacalcet in specific patient subgroups. PMID: 28499709 [PubMed - as supplied by publisher]