Cinacalcet in Primary HyperparathyroidismCinacalcet in Primary Hyperparathyroidism
How effective is this calcium-sensing receptor modulator in reducing serum calcium? Therapeutic Advances in Endocrinology and Metabolism
The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Is single gland excision a viable option for the treatment of MEN1-associated primary hyperparathyroidism? How does it compare with other treatment methods?Clinical Endocrinology
How does the clinical presentation of primary hyperparathyroidism differ between younger and older adults, and what are the implications for management?Journal of the Endocrine Society
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and concentrations of parathyroid hormone (PTH) that are inappropriately high for the hypercalcemic state . Accumulating evidence suggests an increased prevalence of metabolic disorders, including Impaired Glucose Tolerance (IGT) and Type 2 Diabetes, among patients with PHPT . In addition, amelioration of glucose intolerance and insulin resistance has been documented in individuals with PHPT following successful parathyroidectomy [3 –8].
CONCLUSION: Two-thirds of cinacalcet initiated patients experienced hypocalcaemia with 9% being severe. Hypocalcemia was mostly asymptomatic, transient (with and without targeted intervention to correct it) and not associated with an increase in cardiovascular events or deaths. PMID: 31848883 [PubMed - as supplied by publisher]
Abstract INTRODUCTION: Severe uncontrolled secondary hyperparathyroidism and kidney transplantation history are both risk factors for fractures in hemodialyzed patients. Moreover, patients who return to dialysis after transplant failure have more severe infections/anemia and higher mortality risk than transplant-naive patients starting dialysis with native kidneys. In this context, our aim was to test the hypothesis that transplant failure patients have more secondary hyperparathyroidism than transplant-naive patients. METHODS: We retrospectively compared 29 transplant failure patients to 58 transpl...
Could certain biomarkers help detect subtle kidney damage in primary hyperparathyroidism?Clinical Endocrinology
Conclusion Patients with PA frequently have primary or secondary hyperparathyroidism, which is alleviated by correction of PA by surgical or medical means. Patients affected by secondary hyperparathyroidism seem to have a more severe phenotype of PA and have a trend towards more cardiovascular co-morbidities. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
Abstract PURPOSE: Diabetic nephropathy (DN) is a major complication of diabetes. Paricalcitol is a vitamin D analog that is typically used for secondary hyperparathyroidism in patients with chronic kidney disease but may have some beneficial effect on DN. This review evaluates the effect of paricalcitol in combination with renin-angiotensin-aldosterone system inhibitor therapy in managing DN. METHODS: A literature search was conducted of PubMed and ClinicalTrials.gov. Limits were set to include only clinical trials in humans written in English. The search terms used were paricalcitol and diabetic nephropathy....
ConclusionsWe found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.