scholarly journals Effectiveness of surgical treatment of primary hyperparathyroidism with urolithiasis: correction of symptoms, laboratory parameters and stone-forming risk

2018 ◽  
Vol 11 (4) ◽  
pp. 191-200
Author(s):  
Sergey V. Sergiyko ◽  
Dmitriy S. Rogozin
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Symptoms ◽  
Stone Formation ◽  
Urinary Calculi ◽  
Urine Excretion ◽  
Blood Calcium ◽  
Laboratory Parameters ◽  
Risk Of Stone Formation

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism

2001 ◽  
Vol 182 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Anne Denizot ◽  
Marco Pucini ◽  
Christophe Chagnaud ◽  
Geneviève Botti ◽  
Jean-François Henry
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Hormone Levels

scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

scholarly journals Senile parathyroid dysfunction: Characteristics of its diagnosis and treatment

2013 ◽  
Vol 1 (1) ◽  
pp. 32-35
Author(s):  
Shuang-Tong Yan ◽  
Hui Tian
Keyword(s):  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Early Identification ◽  
The Elderly ◽  
Blood Calcium ◽  
The Common ◽  
Parathyroid Dysfunction ◽  
End Stage ◽  
Pth Level

AbstractSenile parathyroid dysfunction is mainly seen in primary or secondary hyperparathyroidism (pHPT or sHPT). pHPT in the elderly usually occurs in women, with fatigue and osteoporosis as the common symptoms. Screening of blood calcium and further evaluation of parathyroid hormone (PTH) for subjects with serum calcium >2.6 mmol/L can be helpful for early identification of patients. For pHPT patients with no contraindications to surgery and whose lesions can be well-localized, surgical treatment can be more beneficial. sHPT is mainly found in patients with end-stage chronic renal dysfunction necessitating hemodialysis or peritoneal dialysis. For these patients, monitoring of PTH level, early supplement of calcium preparations and use of large-dose calcitriol will facilitate maintaining levels of blood calcium and PTH.

scholarly journals Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

2015 ◽  
Vol 9 (4) ◽  
pp. 330
Author(s):  
Andrea Percivale ◽  
Paola Gnerre ◽  
Giulio Damonte ◽  
Sandra Buscaglia ◽  
Mario Monachesi ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Presentation ◽  
Definitive Treatment ◽  
Diagnostic Tools ◽  
Current Management ◽  
Knowledge Based ◽  
Relevant Role

Primary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

Urinary Calculi and Primary Hyperparathyroidism: Simultaneous Surgical Treatment

1987 ◽  
Vol 137 (6) ◽  
pp. 1221-1222 ◽  
Author(s):  
Robert A. Pathroff ◽  
Jon A. van Heerden ◽  
Joseph W. Segura
Keyword(s):  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Urinary Calculi

scholarly journals Primary Hyperparathyroidism - Case Report of a Female Patient with Hypercalcemic Crisis

2021 ◽  
Vol 5 (6) ◽  
pp. 01-02
Author(s):  
Rizwan Khalid ◽  
Sidra Rizwan
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Parathyroid Glands ◽  
Daily Activities ◽  
Common Cause ◽  
Hypercalcemic Crisis

Primary hyperparathyroidism is a result of increased and uncontrolled function of the parathyroid hormone caused by hyperfunction of one or more parathyroid glands. The cause of hyperfunction of the parathyroid glands could be adenoma, hyperplasia, and carcinoma. Primary Hyper parathyroidism is the most common cause of Hypercalcemia in outpatient population. The paper presents the case report of a 60years old female treated in our Hospital in March 2013. She presented in outpatient department with complaints of joints pain, Hypertension and renal failure for last 8years. After clinical, laboratory and radiological examination she was diagnosed as a case of PHPT due to a Giant Parathyroid Adenoma. After supportive, symptomatic and surgical treatment, the patient was back to normal daily activities without any signs of disease.

scholarly journals Predictive Factors for Postoperative Severe Hypocalcaemia after Parathyroidectomy for Primary Hyperparathyroidism

2012 ◽  
Vol 78 (3) ◽  
pp. 352-358 ◽  
Author(s):  
Nicola Crea ◽  
Giacomo Pata ◽  
Claudio Casella ◽  
Carlo Cappelli ◽  
Bruno Salerni
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Predictive Factors ◽  
Clinical Symptoms ◽  
Several Variables ◽  
Group A ◽  
Group B ◽  
Intraoperative Parathyroid Hormone ◽  
Severe Hypocalcaemia ◽  
Postoperative Hypocalcaemia

Hypocalcaemia is a complication of parathyroidectomy. We retrospectively analyzed data on patients who underwent parathyroidectomy for primary hyperparathyroidism (pHPT) to identify predictive factors for severe postoperative hypocalcaemia. Since 2004 we performed 87 parathyroidectomies for pHPT. We divided the patients into two groups: subjects who presented with postoperative hypocalcaemia (group B) or otherwise (group A). We looked for a correlation between several variables and the incidence of postoperative hypocalcaemia. The median calcemia in group B (19 patients) was 6.9 mg/dL on the first postoperative day and 7.6 mg/dL on the third day. We observed hypocalcemia related clinical symptoms in every patient. In all 19 cases the reduction of intraoperative parathyroid hormone above 85 per cent after parathyroidectomy was related to the development of severe postoperative hypocalcaemia ( P = 0.042). We found that the reduction of intraoperative parathyroid hormone over 85 per cent after parathyroidectomy can be considered a reliable predictive factor of postoperative hypocalcaemia after parathyroidectomy for primary hyperparathyroidism.

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