scholarly journals Is surgery necessary for ‘mild’ or ‘asymptomatic’ hyperparathyroidism?

2015 ◽  
Vol 173 (3) ◽  
pp. D13-D20 ◽  
Author(s):  
Bruno Niederle ◽  
Jean-Louis Wémeau

A large majority of the currently diagnosed patients with hyperparathyroidism (PHPT) are mild or asymptomatic, mainly women after menopause. Following the debate held at the 16th European Congress of Endocrinology in Wroclaw (Poland) from May 3–7, 2014, arguments are here presented by a surgeon and a medical practitioner considering these situations rather have to profit from surgery, or simply from survey. For the trained endocrine surgeon, it is evident that parathyroidectomy confirms the diagnosis and undoubtedly reduces the discomfort felt by certain patients, prevents all risks of complications, removes patients and medical teams from the monitoring and represents a real individual financial benefit. On the other hand, the medical practitioner considers that mild or asymptomatic PHPT is commonly stable, and very rare are the subjects at risk of complications, particularly of fractures; prevention of vascular and metabolic disorders, nephrolithiasis and bone rarefaction justify regular physical exercise, a safe alimentation, a sufficient calcium and high water intake, the correction of the frequent deficit in vitamin D; finally has also to be considered the impossibility to refer to specialized (endocrine) surgeons, the enormous cohort of subjects more than 50 years with ‘mild’ or ‘asymptomatic’ PHPT. The surgeon and the medical practitioner agree to consider that in patients with ‘mild’ or ‘asymptomatic’ disease, there is no place for medical treatments, in particular calcimimetics and bisphophonates. Both agree that further studies are needed to clarify the long-term prognosis of operated and non-operated PHPT in term of fractures, cardiovascular risk and mortality. Individual and collective cost/benefit ratios of surgery or survey are also still imperfectly evaluated.

Author(s):  
Šubat-Dežulović Mirna ◽  
Pelčić Gordana ◽  
Valković Ana ◽  
Flajšman-Raspor Sanja ◽  
Pelčić Goran ◽  
...  

Cystic Fibrosis (CF) is a common inherited disease with reported mean prevalence of 0.737/10,000 in 27 EU countries (Farrell J Cyst Fibros. 2008). Still, many EU countries have not implemented CF in the Newborn Screening (NBS) programme, including our country. We report the case of a 7-month-old boy whose presenting signs of CF were life-threatening neurological symptoms caused by severe metabolic alkalosis and hypoelectrolytemia. By presenting this case, we argue hoping to persuade the authorities in any country that the available newborn screening for CF is the cost benefit procedure in preventing life treating consequences with the obvious impact on the long-term prognosis of this chronic disease.


Author(s):  
Els LLM De Schryver ◽  
Ingrid Blom ◽  
Kees PJ Braun ◽  
L Jaap Kappelle ◽  
Gabriël JE Rinkel ◽  
...  

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