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Primary hyperparathyroidism

Paul Glendenning, S A Paul Chubb, Samuel Vasikaran
Bone turnover marker (BTM's) concentrations in blood and urine reflect bone-remodelling activity, and may be useful adjuncts in the diagnosis and management of metabolic bone diseases. Newer biomarkers, mainly bone regulatory proteins, are currently being investigated to elucidate their role in bone metabolism and disease and may in future be useful in clinical diagnosis and management of metabolic bone disease. BTM concentrations increase around menopause in women, and at a population level the degree of increase in BTM's reflect bone loss...
March 12, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Emanuela Traini, Rocco Bellantone, Serena Elisa Tempera, Salvatore Russo, Carmela De Crea, Celestino Pio Lombardi, Marco Raffaelli
PURPOSE: Indications and advantages of parathyroidectomy in patients with normocalcemic primary hyperparathyroidism (NHPT) are still matter of debate. We aimed to compare clinical presentation and surgical outcome between normocalcemic and hypercalcemic forms in a consecutive series of patients who underwent parathyroidectomy for primary hyperparathyroidism. METHODS: Data of 731 consecutive patients were reviewed and retrospectively compared according to normocalcemic (group A) and hypercalcemic (group B) phenotypes...
March 14, 2018: Langenbeck's Archives of Surgery
Léopoldine Bricaire, Capucine Richard, Mathieu Gauthé, Béatrix Cochand-Priollet, Sébastien Gaujoux
We present the case of a severe familial primary hyperparathyroidism related to a germline deletion in the HRPT2 (CDC73) gene. Morphological explorations revealed 2 potential hyperfunctioning parathyroid glands: a left cervical lesion on the neck ultrasound, and an ectopic mediastinal lesion on the parathyroid scintigraphy using Tc-methoxyisobutylisonitrile and on F-fluorocholine PET/CT. Surgery removal and histopathological examination determined that the mediastinal mass corresponded to a thymoma and the cervical lesion to a parathyroid adenoma...
March 13, 2018: Clinical Nuclear Medicine
P F Alesina, B Meier, J Hinrichs, W Mohmand, M K Walz
PURPOSE: Visualization and precise dissection of the parathyroid glands are a crucial step of thyroidectomy. Moreover, identification of parathyroid adenoma in patients with primary hyperparathyroidism can be challenging due to the possible abnormal location of the enlarged parathyroid. Near-infrared fluorescence (NIR) can be adopted during video-assisted neck surgery in addition to standard endoscopic magnification to enhance the visualization of the parathyroid tissue. METHODS: Between July and August 2017, five patients (one male, four females) underwent video-assisted neck surgery at our hospital...
March 13, 2018: Langenbeck's Archives of Surgery
Caroline Bachmeier, Chirag Patel, Peter Kanowski, Kunwarjit Sangla
Primary hyperparathyroidism (PH) is a common endocrine abnormality and may occur as part of a genetic syndrome. Inactivating mutations of the tumour suppressor gene CDC73 have been identified as accounting for a large percentage of hyperparathyroidism-jaw tumour syndrome (HPT-JT) cases and to a lesser degree account for familial isolated hyperparathyroidism (FIHP) cases. Reports of CDC73 whole gene deletions are exceedingly rare. We report the case of a 39 year-old woman with PH secondary to a parathyroid adenoma associated with a large chromosomal deletion (2...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Jacob Enell, Haytham Bayadsi, Ewa Lundgren, Joakim Hennings
PURPOSE: To evaluate whether patients presenting with laboratory results consistent with primary hyperparathyroidism (pHPT) are managed in accordance with guidelines. METHODS: The laboratory database at a hospital in Sweden, serving 127,000 inhabitants, was searched for patients with biochemically determined pHPT. During 2014, a total of 365 patients with biochemical laboratory tests consistent with pHPT were identified. Patients with possible differential diagnoses or other reasons for not being investigated according to international guidelines were excluded after scrutinizing records, after new blood tests, and clinical assessments by endocrine surgeons...
March 12, 2018: World Journal of Surgery
Danica Popovik-Monevska, Suzana Bozovik-Dvojakovska, Vladimir Popovski, Alberto Benedetti, Aleksandar Grchev, Filip Koneski
BACKGROUND: The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT...
February 15, 2018: Open Access Macedonian Journal of Medical Sciences
Trine B Andersen, Ramune Aleksyniene, Søren K Boldsen, Michael Gade, Henrik Bertelsen, Lars J Petersen
OBJECTIVE: The aim of this study was to investigate the contribution of contrast-enhanced computed tomography (CE-CT) to the localization of parathyroid adenomas compared with the dual-phase Tc-99m MIBI SPECT with low-dose CT (LD-CT). PATIENTS AND METHODS: This retrospective study included consecutive patients with primary hyperparathyroidism who underwent a preoperative dual-phase MIBI SPECT/CT followed by surgical resection. The standard of care was dual-phase MIBI SPECT/CT, acquired with LD-CT in the early phase and CE-CT in the late phase (SPECT/CE-CT)...
March 6, 2018: Nuclear Medicine Communications
Mohsen Beheshti, Lukas Hehenwarter, Zeinab Paymani, Gundula Rendl, Larisa Imamovic, Rupert Rettenbacher, Oleksiy Tsybrovskyy, Werner Langsteger, Christian Pirich
PURPOSE: In this prospective study we compared the accuracy of18 F-fluorocholine PET/CT with that of99m Tc-MIBI or99m Tc-tetrofosmin SPECT/CT in the preoperative detection of parathyroid adenoma in patients with primary hyperparathyroidism. We also assessed the value of semiquantitative parameters in differentiating between parathyroid hyperplasia and adenoma. METHODS: Both18 F-fluorocholine PET/CT and99m Tc-MIBI/tetrofosmin SPECT/CT were performed in 100 consecutive patients with biochemical evidence of primary hyperparathyroidism...
March 8, 2018: European Journal of Nuclear Medicine and Molecular Imaging
Masaya Ikuno, Takayuki Yamada, Yasumoto Shinjo, Tsuyoshi Morimoto, Reiko Kumano, Kunihiro Yagihashi, Takuyuki Katabami, Yasuo Nakajima
Background: Selective venous sampling (SVS) is an invasive localization study for persistent or recurrent hyperparathyroidism. Purpose: To assess the role of SVS in addition to non-invasive imaging for primary hyperparathyroidism (pHPT). Material and Methods: This study was approved by the institutional review board and included 14 patients who underwent SVS and subsequent parathyroidectomy between January 2014 and April 2017 following a clinical diagnosis of pHPT...
February 2018: Acta Radiologica Open
Abdullah A Alharbi, Fahad M Alshehri, Abdulrahman A Albatly, Bert-Ram Sah, Christoph Schmid, Gerhard F Huber, Martin W Huellner
PURPOSE: The aim of the study was to investigate the relationship between [18 F]fluoromethyl-dimethyl-2-hydroxyethylammonium ([18 F]FCh) positron emission tomography (PET) parameters, laboratory parameters, and postoperative histopathological results in patients with primary hyperparathyroidism (pHPT) due to parathyroid adenomas. PROCEDURES: This retrospective study was conducted in 52 patients with biochemically proven pHPT. [18 F]FCh-PET parameters (maximum standardized uptake value: SUVmax) in early phase (after 2 min) and late phase (after 50 min), metabolic volume, and adenoma-to-background ratio (ABR), preoperative laboratory results (PTH and serum calcium concentration), and postoperative histopathology (location, size, volume, and weight of adenoma) were assessed...
March 5, 2018: Molecular Imaging and Biology: MIB: the Official Publication of the Academy of Molecular Imaging
Israel Ugalde, Manuel Bello Segura, Sabrina Oneto, Ari Ciment
An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13...
March 5, 2018: BMJ Case Reports
R J Egan, H Iliff, M J Stechman, D M Scott-Coombes
BACKGROUND: Parathyroid hormone (PTH) has a short half-life and is cleared by the liver and kidneys. This study examined whether declining estimated glomerular filtration rate (eGFR) affects application of the Miami criterion for intraoperative PTH (ioPTH) decline during parathyroidectomy for primary hyperparathyroidism (pHPT). METHODS: A retrospective review of consecutive patients undergoes parathyroidectomy for pHPT. Patients with multi-gland disease, without ioPTH, failure-to-cure and those <18 years were excluded...
March 1, 2018: World Journal of Surgery
Prateush Singh, Yehudit Bauernfreund, Pallavi Arya, Esha Singh, Justin Shute
Primary hyperparathyroidism (PHPT) can cause hypercalcaemia secondary to a pathologically high secretion of parathyroid hormone. Rarely this can first manifest as acute psychosis. It is imperative to exclude organic causes of psychosis before labelling the psychosis as primarily psychological. If hypercalcaemia is revealed, investigation is required to elucidate the underlying cause whilst instigating treatment to lower serum calcium levels. If PHPT is the underlying pathology, subsequent treatment involves surgical exploration and resection of the parathyroid adenoma or hyperplasia...
February 2018: Journal of Surgical Case Reports
Kiyobumi Ota, Sayo Koseki, Kenji Ikegami, Iichiroh Onishi, Hiyoryuki Tomimitsu, Shuzo Shintani
75 years old woman presented with 6-month history of progressive dropped head syndrome. Neurological examination revealed moderate weakness of flexor and extensor of neck and mild weakness of proximal appendicular muscles with normal deep tendon reflexes. The needle electromyography showed short duration and low amplitude motor unit potential. No fibrillation potentials or positive sharp waves were seen. Biopsy of deltoid muscle was normal. Laboratory studies showed elevated levels of serum calcium (11.8 mg/dl, upper limit of normal 10...
February 28, 2018: Rinshō Shinkeigaku, Clinical Neurology
Moska Hamidi, Michael Sullivan, George Hunter, Leena Hamberg, Nancy L Cho, Atul A Gawande, Gerard M Doherty, Francis D Moore, Matthew A Nehs
BACKGROUND: Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT...
February 26, 2018: Annals of Surgical Oncology
James Koh, Joyce A Hogue, Sanziana A Roman, Randall P Scheri, Hèléne Fradin, David L Corcoran, Julie A Sosa
The clinical presentation of primary hyperparathyroidism (PHPT) varies widely, although the underlying mechanistic reasons for this disparity remain unknown. We recently reported that parathyroid tumors can be functionally segregated into two distinct groups on the basis of their relative responsiveness to ambient calcium, and that patients in these groups differ significantly in their likelihood of manifesting bone disability. To examine the molecular basis for this phenotypic variation in PHPT, we compared the global gene expression profiles of calcium-sensitive and calcium-resistant parathyroid tumors...
April 2018: Endocrine-related Cancer
Wu Bo, Karen E Schoedel, Sally E Carty, Lisa A Radkay, N Paul Ohori, Yuri E Nikiforov, Marina N Nikiforova, Linwah Yip
BACKGROUND: Parathyroid glands can mimic thyroid follicular lesions on fine-needle aspiration (FNA) cytology and can lead to unnecessary or incorrect surgery. Newer molecular panel tests using next-generation sequencing (NGS) include analysis of cell type-specific gene expression profiles such as parathyroid. The study aim is to determine the frequency and clinical implications of parathyroid tissue identification by molecular testing in cytologically indeterminate "thyroid" lesions...
February 22, 2018: World Journal of Surgery
Antonio Matrone, Alessandro Brancatella, Piero Marchetti, Enrico Vasile, Ugo Boggi, Rossella Elisei, Filomena Cetani, Claudio Marcocci, Paolo Vitti, Francesco Latrofa
Absence of neoplastic disease in the organ-recipient is required in order to allow organ transplantation. Due to its rarity, no data regarding management of patients with Multiple endocrine neoplasia type 1 (MEN1) and end-stage renal failure candidates for kidney transplantation are available. A 36 year-old man was referred to the present hospital with MEN1, with a neuroendocrine pancreatic tumor and primary hyperparathyroidism and associated Alport syndrome with end stage renal failure. The present study aimed to establish the eligibility of the patient for a kidney transplantation...
March 2018: Molecular and Clinical Oncology
L Tripto-Shkolnik, A Jaffe, Y Liel
Background: There is ample evidence associating vitamin D deficiency in primary hyperparathyroidism (PHP) patients with more severe disease manifestations and increased risk of postoperative hypocalcemia. Yet, there is limited data regarding the safety of vitamin D repletion in these patients. Aim: To assess the safety of vitamin D repletion in PHP patients in a real-world setting. Design: We included patients with asymptomatic PHP and few symptomatic patients who declined surgery, followed in our clinic, and treated on a routine basis with 2000 IU/day of vitamin D3...
February 1, 2018: QJM: Monthly Journal of the Association of Physicians
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