scholarly journals Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

2009 ◽  
Vol 94 (2) ◽  
pp. 351-365 ◽  
Author(s):  
Shonni J. Silverberg ◽  
E. Michael Lewiecki ◽  
Leif Mosekilde ◽  
Munro Peacock ◽  
Mishaela R. Rubin
Keyword(s):  
Natural History ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Task Force ◽  
International Workshop ◽  
Normal Serum ◽  
Mineral Density ◽  
The Third ◽  
History Of ◽  
Asymptomatic Primary Hyperparathyroidism

Abstract Background: At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (PHPT) in May 2008, recent data on the disease were reviewed. We present the results of a literature review on issues arising from the clinical presentation and natural history of PHPT. Methods: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was reviewed, and the questions of the International Task Force were addressed by the Consensus Panel. Conclusions: 1) Data on the extent and nature of cardiovascular involvement in those with mild disease are too limited to provide a complete picture. 2) Patients with mild PHPT have neuropsychological complaints. Although some symptoms may improve with surgery, available data remain inconsistent on their precise nature and reversibility. 3) Surgery leads to long-term gains in spine, hip, and radius bone mineral density (BMD). Because some patients have early disease progression and others lose BMD after 8–10 yr, regular monitoring (serum calcium and three-site BMD) is essential in those followed without surgery. Patients may present with normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism). Data on the incidence and natural history of this phenotype are limited. 4) In the absence of kidney stones, data do not support the use of marked hypercalciuria (>10 mmol/d or 400 mg/d) as an indication for surgery for patients. 5) Patients with bone density T-score −2.5 or less at the lumbar spine, hip, or distal one third radius should have surgery.

scholarly journals Medical Management of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

2009 ◽  
Vol 94 (2) ◽  
pp. 373-381 ◽  
Author(s):  
Aliya Khan ◽  
Andrew Grey ◽  
Dolores Shoback
Keyword(s):  
Hormone Replacement Therapy ◽  
Primary Hyperparathyroidism ◽  
Bone Turnover ◽  
Replacement Therapy ◽  
Serum Calcium ◽  
Medical Management ◽  
Task Force ◽  
International Workshop ◽  
Hormone Replacement ◽  
The Third

Abstract Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that is frequently asymptomatic. The 2002 International Workshop on Asymptomatic PHPT addressed medical management of asymptomatic PHPT and summarized the data on nonsurgical approaches to this disease. At the Third International Workshop on Asymptomatic PHPT held in May 2008, this subject was reviewed again in light of data that have since become available. We present the results of a literature review of advances in the medical management of PHPT. Methods: A series of questions was developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies evaluating the management of PHPT with bisphosphonates, hormone replacement therapy, raloxifene, and calcimimetics was conducted. Existing guidelines and recent unpublished data were also reviewed. All selected relevant articles were reviewed, and the questions developed by the International Task Force were addressed by the Consensus Panel. Results: Bisphosphonates and hormone replacement therapy are effective in decreasing bone turnover in patients with PHPT and improving bone mineral density (BMD). Fracture data are not available with either treatment. Raloxifene also lowers bone turnover in patients with PHPT. None of these agents, however, significantly lowers serum calcium or PTH levels. The calcimimetic cinacalcet reduces both serum calcium and PTH levels and raises serum phosphorus. Cinacalcet does not, however, reduce bone turnover or improve BMD. Conclusions: Bisphosphonates and hormone replacement therapy provide skeletal protection in patients with PHPT. Limited data are available regarding skeletal protection in patients with PHPT treated with raloxifene. Calcimimetics favorably alter serum calcium and PTH in PHPT but do not significantly affect either bone turnover or BMD. Medical management of asymptomatic PHPT is a promising option for those who are not candidates for parathyroidectomy.

Normocalcemic primary hyperparathyroidism — «new era» in diagnosis of an old disease

2017 ◽  
Vol 63 (4) ◽  
pp. 236-244
Author(s):  
Irina A. Baranova ◽  
Tatyana A. Zykova
Keyword(s):  
Primary Hyperparathyroidism ◽  
Early Stage ◽  
International Workshop ◽  
Normal Serum ◽  
Mineral Density ◽  
New Era ◽  
Increased Risk ◽  
Normal Serum Calcium ◽  
History Of ◽  
Symptomatic Form

During the last century, primary hyperparathyroidism (PHPT) passed from the category of rare severe diseases to a common endocrine disorder with a prevalence of mild forms. Over the last 10—20 years, widespread screening for osteoporosis has led to the «new era» in diagnosis of PHPT when patients are diagnosed at the stage of an isolated elevated parathyroid hormone with stable normal serum calcium levels and the absence of secondary causes of hyperparathyroidism. This phenomenon was called normocalcemic primary hyperparathyroidism (nPHPT); according to the literature data, its prevalence varies from 0.4 to 16.7% due to the lack of unified diagnostic criteria. The clinical picture and natural history of the disease are poorly explored, and it is still unclear if nPHPT is a separate disease entity or if it is an early stage of hypercalcemic PHPT. A number of studies have shown that complications of nPHPT (osteoporosis and urolithiasis) are similar to those of the symptomatic form of PHPT despite stable normocalcemia. However, these patients were often referred to specialized metabolic centers due to a decrease in the bone mass or nephrolithiasis, therefore the rate of complications in them may be overestimated. There are also controversial data on an increased risk of cardiovascular diseases due to metabolic disorders in this pathology. As a new clinical nosology, normocalcemic PHPT was first officially recognized at the Third International Workshop on Management of Asymptomatic PHPT in 2008, but there have been yet no common recommendations for its treatment. Some studies have shown a response to medical therapy and improved indicators of bone mineral density after parathyroidectomy in these patients. According to the experts of the Fourth International Workshop in 2014, nPHPT remains one of the key topics for further research.

scholarly journals High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism

2019 ◽  
Vol 44 (5) ◽  
pp. 1189-1195 ◽  
Author(s):  
Alyne Layane Pereira Lemos ◽  
Sergio Ricardo de Lima Andrade ◽  
Lívia Laeny Henrique Pontes ◽  
Patricia Moura Cravo Teixeira ◽  
Elba Bandeira ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Kidney Stones ◽  
Urinary Calcium ◽  
Normal Serum ◽  
Urinary Calcium Excretion ◽  
High Rate ◽  
Calcium Excretion ◽  
History Of ◽  
Serum Pth

Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT.

scholarly journals Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History

2020 ◽  
Vol 105 (4) ◽  
pp. e1171-e1186 ◽  
Author(s):  
Marian Schini ◽  
Richard M Jacques ◽  
Eleanor Oakes ◽  
Nicola F A Peel ◽  
Jennifer S Walsh ◽  
...  
Keyword(s):  
Vitamin D ◽  
Natural History ◽  
Outcome Measures ◽  
Serum Calcium ◽  
Density Measurement ◽  
Control Group ◽  
Mineral Density ◽  
History Of ◽  
Using Data ◽  
Normocalcemic Hyperparathyroidism

Abstract Context Normocalcemic hyperparathyroidism (NPHPT) is characterized by persistently normal calcium levels and elevated parathyroid hormone (PTH) values, after excluding other causes of secondary hyperparathyroidism. The prevalence of the disease varies greatly and the data on the natural history of this disease are sparse and inconclusive. Objectives The objectives of this study are to describe the prevalence of NPHPT and its natural history in a referral population and to compare the variability of serum calcium with a group of patients with primary hyperparathyroidism (PHPT). Design A retrospective study was conducted over 5 years. Setting The setting for this study was a metabolic bone referral center. Patients A total of 6280 patients were referred for a bone mineral density measurement (BMD). Main Outcome Measures The prevalence and natural history of NPHPT and variability of calcium were the main outcome measures. Results We identified NPHPT patients using data from the day of the BMD measurement. We excluded patients with low estimated glomerular filtration rate (eGFR) or vitamin D, or with no measurements available. Based on the evaluation of their medical files, we identified 11 patients with NPHPT (prevalence 0.18%). Only 4 patients had consistent normocalcemia throughout their follow-up, with only 2 also having consistently high PTH. None had consistently normal eGFR or vitamin D. Intermittent hypercalcemia was present in 7 of the 11 NPHPT patients. The mean adjusted calcium was found to be significantly lower in the NPHPT group compared with the PHPT group but higher than the control group. PTH was similar for NPHPT and PHPT. These 2 groups had similar variability in serum calcium. Conclusions NPHPT patients often have episodes of hypercalcemia. We believe that NPHPT is a mild form of PHPT.

scholarly journals Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

2021 ◽  
Vol 12 ◽  
pp. 204201882199537
Author(s):  
Nivaran Aojula ◽  
Shahab Khan ◽  
Neil Gittoes ◽  
Zaki Hassan-Smith
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Fragility Fractures ◽  
Renal Stones ◽  
Careful Consideration ◽  
Normal Serum ◽  
Mineral Density ◽  
Normal Serum Calcium ◽  
To Receive

Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration.

scholarly journals Surgery for Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

2009 ◽  
Vol 94 (2) ◽  
pp. 366-372 ◽  
Author(s):  
Robert Udelsman ◽  
Janice L. Pasieka ◽  
Cord Sturgeon ◽  
J. E. M. Young ◽  
Orlo H. Clark
Keyword(s):  
Primary Hyperparathyroidism ◽  
International Workshop ◽  
The Third ◽  
Asymptomatic Primary Hyperparathyroidism
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