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primary hyperparathyroidism guidelines

Letizia Guiducci, Silvia Maffei, Laura Sabatino, Luc Zyw, Debora Battaglia, Alessandro Vannucci, Pietro Di Cecco, Cristina Vassalle
INTRODUCTION: Evaluation of calcium status is important in the osteoporotic risk assessment. Although guidelines indicate total calcium (tCa) as first-line measurement, directly measured ionized calcium (m-iCa), considered as the gold standard, is more and more often required. Aim of this study is to evaluate the agreement between m-iCa, tCa and iCa calculated from a formula based on total calcium and albumin (c-iCa) in osteopenic/osteoporotic postmenopausal outpatients. METHODS: A total of 140 postmenopausal outpatients, 41 osteopenic (OPN) and 99 osteoporotic (OP) were enrolled...
January 19, 2017: Gynecological Endocrinology
Huai H Loh, Nor A Kamaruddin, Rozman Zakaria, Norlela Sukor
BACKGROUND: Recent studies showed association between hyperaldosteronism and low bone density among patients with primary aldosteronism (PA) due to secondary hyperparathyroidism. Our objective is to assess bone turnover markers (BTM) and bone mineral density (BMD) of PA patients compared to essential hypertension. METHODS: This was an open-label, prospective, case-controlled study, conducted over 12 months. Fifty-two consecutive patients referred for secondary hypertension were screened...
December 20, 2016: Minerva Endocrinologica
Deva Boone, Douglas Politz, Jose Lopez, Jamie Mitchell, Kevin Parrack, James Norman
BACKGROUND: Guidelines for operative treatment of primary hyperparathyroidism include calcium levels >1 mg/dL above normal. We sought to determine whether greater calcium concentrations were associated with increased symptoms or disease severity. METHODS: A retrospective review of a prospectively maintained database of adults undergoing parathyroidectomy for primary hyperparathyroidism, grouped according to greatest preoperative calcium level: those patients with calcium concentrations between 10...
January 2017: Surgery
Kyle A Zanocco, James X Wu, Michael W Yeh
BACKGROUND: Recent data demonstrate decreased fracture risk after operation for asymptomatic primary hyperparathyroidism. We performed a revised cost-effectiveness analysis comparing parathyroidectomy versus observation while incorporating fracture risk reduction. METHODS: A Markov transition-state model was created comparing parathyroidectomy and guideline-based medical observation for a 60-year-old female patient with mild asymptomatic primary hyperparathyroidism...
January 2017: Surgery
J-C Souberbielle, F Brazier, M-L Piketty, C Cormier, S Minisola, E Cavalier
Well-validated reference values are necessary for a correct interpretation of a serum PTH concentration. Establishing PTH reference values needs recruiting a large reference population. Exclusion criteria for this population can be defined as any situation possibly inducing an increase or a decrease in PTH concentration. As recommended in the recent guidelines on the diagnosis and management of asymptomatic primary hyperparathyroidism, PTH reference values should be established in vitamin D-replete subjects with a normal renal function with possible stratification according to various factors such as age, gender, menopausal status, body mass index, and race...
October 1, 2016: Journal of Endocrinological Investigation
A A Khan, D A Hanley, R Rizzoli, J Bollerslev, J E M Young, L Rejnmark, R Thakker, P D'Amour, T Paul, S Van Uum, M Zakaria Shrayyef, D Goltzman, S Kaiser, N E Cusano, R Bouillon, L Mosekilde, A W Kung, S D Rao, S K Bhadada, B L Clarke, J Liu, Q Duh, E Michael Lewiecki, F Bandeira, R Eastell, C Marcocci, S J Silverberg, R Udelsman, K Shawn Davison, J T Potts, M L Brandi, J P Bilezikian
The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH)...
January 2017: Osteoporosis International
P W Rosário, G F Mourão, M R Calsolari
This study screened for asymptomatic primary hyperparathyroidism (PHPT) by measuring calcium (Ca) before thyroid surgery. The study was prospective. A total of 676 patients without a suspicion of PHPT were studied. PHPT was defined as elevated Ca (in 2 measurements) in the presence of PTH>25 pg/ml and in the absence of hypocalciuria. PHPT was diagnosed in 5 patients (0.74%), all of them women. One of the 5 patients with PHPT had no indication for parathyroidectomy (PTx) according to current guidelines...
September 2016: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
Scott M Wilhelm, Tracy S Wang, Daniel T Ruan, James A Lee, Sylvia L Asa, Quan-Yang Duh, Gerard M Doherty, Miguel F Herrera, Janice L Pasieka, Nancy D Perrier, Shonni J Silverberg, Carmen C Solórzano, Cord Sturgeon, Mitchell E Tublin, Robert Udelsman, Sally E Carty
Importance: Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. Objective: To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. Evidence Review: A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015...
October 1, 2016: JAMA Surgery
Leonardo Bandeira, John Bilezikian
Over the past several generations, primary hyperparathyroidism (PHTP) has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation...
2016: F1000Research
Wouter P Kluijfhout, Toni Beninato, Frederick Thurston Drake, Menno R Vriens, Jessica Gosnell, Wen T Shen, Insoo Suh, Chienying Liu, Quan-Yang Duh
BACKGROUND: Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism...
December 2016: World Journal of Surgery
Roderick Dulfer, Wanda Geilvoet, Annelien Morks, Esther M M van Lieshout, Casper P C Smit, Els J M Nieveen van Dijkum, Klaas In't Hof, Frits van Dam, Casper H J van Eijck, Peter W de Graaf, Tessa M van Ginhoven
BACKGROUND: Physical and mental complaints are common in patients with primary hyperparathyroidism (PHPT) and negatively impact quality of life (QOL). Subjective symptoms in current guidelines are not considered an indication for surgery. The purpose of this study was to assess the effect of parathyroidectomy on QOL in patients with PHPT. METHODS: This multicenter case-control study investigated preoperative and postoperative QOL scores in patients operated for PHPT, measured with the Short Form Health Survey-36 (SF-36) questionnaire...
August 2016: Head & Neck
John P Bilezikian, Natalie E Cusano, Aliya A Khan, Jian-Min Liu, Claudio Marcocci, Francisco Bandeira
Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes...
May 19, 2016: Nature Reviews. Disease Primers
Elena Castellano, Roberto Attanasio, Laura Gianotti, Flora Cesario, Francesco Tassone, Giorgio Borretta
INTRODUCTION: A reduction in bone mineral density (BMD) is common in primary hyperparathyroidism (PHPT), above all at cortical sites. Guidelines for the management of asymptomatic PHPT (aPHPT) recommend a BMD evaluation at the lumbar spine, hip, and forearm. Surgery is recommended for patients with a T-score less than or equal to -2.5 at any of these sites. However, a BMD evaluation at the forearm is not routinely performed. AIM: To evaluate the impact of measuring forearm BMD in the clinical management of aPHPT...
July 2016: Journal of Clinical Endocrinology and Metabolism
Michael W Yeh, Hui Zhou, Annette L Adams, Philip H G Ituarte, Ning Li, In-Lu Amy Liu, Philip I Haigh
BACKGROUND: The comparative effectiveness of surgical and medical treatments on fracture risk in primary hyperparathyroidism (PHPT) is unknown. OBJECTIVE: To measure the relationship of parathyroidectomy and bisphosphonates with skeletal outcomes in patients with PHPT. DESIGN: Retrospective cohort study. SETTING: An integrated health care delivery system. PARTICIPANTS: All enrollees with biochemically confirmed PHPT from 1995 to 2010...
June 7, 2016: Annals of Internal Medicine
Giuseppe Viccica, Filomena Cetani, Edda Vignali, Mario Miccoli, Claudio Marcocci
The purpose of the study was to evaluate the relationship between serum 25(OH)D and the clinical phenotype in 215 consecutive Italian Caucasian women with sporadic primary hyperparathyroidism (PHPT) not taking vitamin D supplements. The study was performed at a single Italian tertiary center. PHPT-related manifestations, serum 25(OH)D, and other parameters of calcium metabolism and bone mineral density (BMD) by DXA were recorded. Serum 25(OH)D was negatively correlated with age (r = -0.18; P = 0.006), BMI (r = -0...
January 2017: Endocrine
Edna E Mancilla, Michael A Levine, N Scott Adzick
BACKGROUND: Guidelines for treatment of primary hyperparathyroidism (PHPT) in young patients recommend surgery. Outcomes of minimally invasive parathyroidectomy (MIP) are well established in adults, but not in pediatric patients. OBJECTIVE: The objective of the study is to determine effectiveness of preoperative imaging and MIP aided by intraoperative PTH (ioPTH) measurement in children with primary hyperparathyroidism (PHPT). METHODS AND DESIGN: This is a retrospective chart review of diagnostic and follow-up data up to 12months post-MIP of patients with PHPT who underwent parathyroidectomy at the Children's Hospital of Philadelphia between January 1, 2009 and March 31, 2015...
January 2017: Journal of Pediatric Surgery
Michał Nieciecki, Marek Cacko, Leszek Królicki
Primary hyperparathyroidism (PH) represents one of the most common endocrine diseases. In most cases, the disorder is caused by parathyroid adenomas. Bilateral neck exploration has been a widely used treatment method for adenomas since the 20's of the twentieth century. In the last decade, however, it has been increasingly replaced by a minimally invasive surgical treatment. Smaller extent, shorter duration and lower complication rate of such a procedure are emphasized. Its efficacy depends on a precise location of parathyroid tissue during the preoperative imaging...
December 2015: Journal of Ultrasonography
Rachel S van Leeuwaarde, Bernadette P M van Nesselrooij, Ad R Hermus, Olaf M Dekkers, Wouter W de Herder, Anouk N van der Horst-Schrivers, Madeleine L Drent, Peter H Bisschop, Bas Havekes, Menno R Vriens, Joanne M de Laat, Carolina R C Pieterman, Gerlof D Valk
OBJECTIVE: Identifying a germline mutation in the multiple endocrine neoplasia type 1 (MEN1) gene in an index case has consequences for a whole family. Eligible family members should be offered genetic counseling and MEN1 mutation testing. Subsequently, clinical screening of mutation carriers according to the guidelines should be initiated. We assessed whether there is a lag time from MEN1 diagnosis of the index case to MEN1 diagnosis of family members. In addition, we determined whether this lag time was associated with an increased morbidity and mortality risk...
March 2016: Journal of Clinical Endocrinology and Metabolism
Jesús Villar-Del-Moral, João Capela-Costa, Antonio Jiménez-García, Antonio Sitges-Serra, Daniel Casanova-Rituerto, José Rocha, Juan Manuel Martos-Martínez, Aitor de la Quintana-Basarrate, Jorge Rosa-Santos, Xavier Guirao-Garriga, José Miguel Bravo-de-Lifante, Óscar Vidal-Pérez, Antonio Moral-Duarte, José Polónia
PURPOSE: Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes. METHODS: An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal...
November 2016: Langenbeck's Archives of Surgery
Michel Mourad, Antoine Buemi, Tom Darius, Dominique Maiter
Over the last two decades, surgery for primary hyperparathyroidism has evolved to offer a panel of procedures based on improvements in imaging, new technology and, consequently, novel surgical techniques. Multiple courses of action are possible, consistent with varying degrees of complexity. From the simplest scenario of a single adenoma localized by at least two preoperative tests in the context of sporadic primary hyperparathyroidism, to revision surgery related to recurrent, persistent or multiglandular disease, the surgeon has the opportunity to adapt his strategy...
October 2015: Annales D'endocrinologie
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