Applying the Guidelines for Primary Hyperparathyroidism

When the National Institutes of Health convened the first workshop devoted to the diagnosis and management of primary hyperparathyroidism (pHPT) in 1990, astute clinicians had already appreciated that the classic presentation of this disorder, established decades before as symptomatic and progressive, was no longer the typical face of the disease. Primary hyperparathyroidism was being diagnosed with increasing frequency in asymptomatic patients and those for whom reduced bone mass was the main clinical finding. Guidelines published in 1991 from that first National Institutes of Health conference outlined the diagnostic criteria and management recommendations for both symptomatic and asymptomatic pHPT and laid down a framework for proposing when surgery should be pursued in asymptomatic disease. Over the next 24 years, these recommendations were updated at least 3 times (in 2002, 2009, and 2014). At present, the indications for surgical intervention in patients with asymptomatic pHPT include age 50 years or less, serum calcium 1 mg/dL or more above the upper limit of normal, urinary calcium more than 400 mg/24 hours, estimated glomerular filtration rate less than 60 mL/min/1.73 m2, osteoporosis as measured by dual energy x-ray absorptiometry, and nephrolithiasis or nephrocalcinosis as measured by imaging studies. Admittedly, these indications are based largely on expert opinion rather than data from randomized trials, because few such studies have ever been conducted in patien...
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research

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Ryan R. Kelly1,2†, Lindsay T. McDonald1,2†, Nathaniel R. Jensen1,2, Sara J. Sidles1,2 and Amanda C. LaRue1,2* 1Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States 2Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States The significant biochemical and physiological effects of psychological stress are beginning to be recognized as exacerbating common diseases, including osteoporosis. This review discusses the current evidence for psychological stress-associated mental health disorders as risk factors for os...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
Abstract CONTEXT: Primary Hyperparathyroidism (PHPT) has a prevalence of 0.86% and is associated with increased risk of nephrolithiasis and osteoporosis. PHPT may also be associated with an increased risk of cardiovascular disease and mortality. OBJECTIVE: To identify risk factors for nephrolithiasis, osteoporosis and mortality in PHPT. DESIGN: Retrospective cohort study. SETTING: University teaching hospital. PATIENTS: PHPT presenting between 2006 - 2014 (n = 611). MAIN OUTCOME MEASURES: Assessment of nephrolithiasis, osteoporosis and mortality. RESULTS: 13.9% of PHPT patients had ne...
Source: The Journal of Clinical Endocrinology and Metabolism - Category: Endocrinology Authors: Tags: J Clin Endocrinol Metab Source Type: research
Horm Metab Res 2018; 50: 797-802 DOI: 10.1055/a-0752-4533Normocalcemic primary hyperparathyroidism (NPHPT) is a formally recognized variant of primary hyperparathyroidism (PHPT), characterized by normal total and ionized serum calcium concentrations and elevated parathyroid hormone (PTH) levels, in the absence of secondary causes for hyperparathyroidism. NPHPT has been studied previously, but data are limited and confounded. We aimed to compare the clinical and biochemical data of normocalcemic and hypercalcemic subjects in a hospital-based population.We retrospectively analysed the medical records of 131 subjects diagnose...
Source: Hormone and Metabolic Research - Category: Endocrinology Authors: Tags: Endocrine Care Source Type: research
Abstract Unexplained kidney stones, osteoporosis, or certain subtle clues may point to hyperparathyroidism. These tests and imaging options can help you to be sure. PMID: 30481255 [PubMed - in process]
Source: The Journal of Family Practice - Category: Practice Management Authors: Tags: J Fam Pract Source Type: research
This study’s purpose is to determine if the calcium levels correlate with prevalence of symptoms and surgical treatment in patients with primary HPT.MethodPatients treated in 2006-2015 with serum calcium≥10.0mg/dL and PTH>65pg/mL were identified and stratified based on calcium level: 10.0-10.3 (normocalcemia), 10.4-11.2 (moderate), and ≥11.3 (severe) mg/dL. Clinical variables and rates of surgery were compared between the three groups.ResultsA total of 2,266 patients were identified: 303 with normocalcemia, 1513 with moderate hypercalcemia, and 450 with severe hypercalcemia. All three groups had similar rate...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom.MethodsClinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), c omplications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT.Resul...
Source: Endocrine - Category: Endocrinology Source Type: research
Abstract Hereditary hypophosphatemic rickets with hypercalciuria (HHRH; OMIM: 241530) is a rare autosomal recessive disorder with an estimated prevalence of 1:250,000 that was originally described by Tieder et al. Individuals with HHRH carry compound-heterozygous or homozygous (comp/hom) loss-of-function mutations in the sodium-phosphate co-transporter NPT2c. These mutations result in the development of urinary phosphate (Pi) wasting and hypophosphatemic rickets, bowing, and short stature, as well as appropriately elevated 1,25(OH)2D levels, which sets this fibroblast growth factor 23 (FGF23)-independent disorder ...
Source: Pflugers Archiv : European Journal of Physiology - Category: Physiology Authors: Tags: Pflugers Arch Source Type: research
The ectopic parathyroid tissue found in 9 –20% of patients with primary hyperparathyroidism. Abnormalities in the number and anatomical position are common. The differentiation of benign and malignant parathyroid tumors is difficult. Report: Female,63-year-old, with nephrolithiasis, osteoporosis. Primary hyperparathyroidism by adenomas di agnosed by surgery. LAB POSTQX: Ca: 14mg/dl, PTH: 597pg/ml, P: 2mg/dl, Mg: 1.70mg/dl, VitD: 16ng/ml. It is referred, with symptoms of severe symptomatic hypercalcemia, cardiovascular disorders, refractory to treatment.
Source: Bone - Category: Orthopaedics Authors: Tags: C ódigo: 29 Source Type: research
Abstract Primary hyperparathyroidism is a disease that occurs more frequently than generally thought and is often overlooked. Classical symptoms are bone pain and osteoporosis, renal calculi and peptic ulcers. Many patients are asymptomatic or have unspecific complaints. It is easy to establish the biochemical diagnosis based on calcium and parathormone (PTH) levels and 24-h urine calcium excretion. The most sensitive localization procedures for parathyroid adenomas are sonography and Tc-99(m)-MIBI scintigraphy. The indication for surgery is undisputed in symptomatic patients; however, there is controversy co...
Source: Der Chirurg - Category: Surgery Authors: Tags: Chirurg Source Type: research
GENDER DIFFERENCE IN THE CLINICAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM:INFLUENCE OF MENOPAUSAL STATUS. J Clin Endocrinol Metab. 2017 Sep 07;: Authors: Castellano E, Attanasio R, Boriano A, Pellegrino M, Garino F, Gianotti L, Borretta G Abstract Background: Female to male ratio in primary hyperparathyroidism (PHPT) is 3:1, but data on gender impact on the clinical presentation are limited. Methods: We evaluated retrospectively gender difference in biochemistry and clinical presentation at diagnosis in a monocentric series of 417 patients with PHPT: 93 men (58.6 ±14.5 years), and 324 ...
Source: The Journal of Clinical Endocrinology and Metabolism - Category: Endocrinology Authors: Tags: J Clin Endocrinol Metab Source Type: research
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