METHOD OF PRIMARY HYPERPARATHYROIDISM VERIFICATION

A method is proposed for the integral biochemical diagnostic of primary hyperparathyroidism to obtain reliable information about the functional state of the parathyroid glands, which allows one to assess changes in phosphorus-calcium metabolism, to predict the presence or absence of primary hyperparathyroidism, and also to control the pathological process and the effectiveness of the treatment. To determine a single integral indicator - the index of primary hyperparathyroidism (IPHPT), the ratio of calcium and phosphorus to parathyroid hormone was determined. Measurements were performed in volunteers who don’t suffer from any endocrine pathology (19 patients) and in the group of patients with primary hyperparathyroidism before and after surgical treatment (19 patients). As a result of the study, it was found that the value of IPHPT ≤ 2.46 reliably indicates the presence of primary hyperparathyroidism, and the value of IHPT > 2.46 is a measure for the absence of the parathyroid glands pathology. Thus, the proposed method for the integral biochemical diagnosis of primary hyperparathyroidism could be a reliable quantification technique of the parathyroid glands function, allowing the assessing changes in phosphorus-calcium metabolism, to predict the presence or absence of primary hyperparathyroidism, and also to be used as an objective measure for the effectiveness of the treatment.

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Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Hormone and Metabolic Research ◽

10.1055/a-0859-1020 ◽

2019 ◽

Vol 51 (04) ◽

pp. 243-247 ◽

Cited By ~ 2

Author(s):

Pedro Rosário ◽

Maria Calsolari

Keyword(s):

Primary Hyperparathyroidism ◽

Prospective Study ◽

Adult Population ◽

Parathyroid Glands ◽

Hydroxyvitamin D ◽

Biochemical Diagnosis ◽

History Of ◽

25 Hydroxyvitamin D ◽

The Impact ◽

Diagnostic Criterion

AbstractThe prevalence and the diagnostic criterion of “normocalcemic” primary hyperparathyroidism (NPHPT) are still uncertain and there is no consensual definition. This prospective study evaluated the prevalence of NPHPT in 676 adults without a history of fractures or nephrolithiasis and who would be submitted to thyroidectomy, the impact of adopting different cut-off values for 25-hydroxyvitamin D and estimated glomerular filtration rate (eGFR), and the agreement between biochemical diagnosis and the surgical finding of altered parathyroid glands. NPHPT was diagnosed in patients with normal total and ionized calcium and elevated PTH (in 2 measurements) and without a known cause of secondary HPT, including eGFR<40 ml/min/1.73 m2 and 25-hydroxyvitamin D<20 ng/dl. The 4 parathyroid glands were fully explored in these patients. Forty-six patients (6.8%) had a laboratory diagnosis of NPHPT. Altered parathyroid glands were detected in only 4 patients, corresponding to 0.6% of all patients and to 8.7% of those with a biochemical diagnosis of NPHPT. The latter was confirmed in 0/174 men, 1/252 premenopausal women, and 3/250 postmenopausal women. Among the 42 patients with elevated PTH and without altered parathyroid glands, 25 had 25-hydroxyvitamin D between 20 and 30 ng/dl, 7 had eGFR between 40 and 60 ml/min/1.73 m2, and 9 had both. The prevalence of NPHPT was 0.74% in this adult population without a history of nephrolithiasis or fractures. The diagnostic criterion using eGFR>60 ml/min/1.73 m2 and 25-hydroxyvitamin D>30 ng/dl was more appropriate considering the agreement with the surgical finding of altered parathyroid glands.

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PARATHYROID HORMONE SECRETION IN DISORDERS OF CALCIUM METABOLISM STUDIED BY MEANS OF EDTA

Acta Endocrinologica ◽

10.1530/acta.0.0750286 ◽

1974 ◽

Vol 75 (2) ◽

pp. 286-296 ◽

Cited By ~ 10

Author(s):

J. H. Lockefeer ◽

W. H. L. Hackeng ◽

J. C. Birkenhäger

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Calcium Metabolism ◽

Hormone Secretion ◽

Parathyroid Tissue ◽

Small Mass ◽

Idiopathic Hypercalciuria ◽

List Type ◽

Immunoreactive Parathyroid Hormone ◽

Pth Level

ABSTRACT In 22 of 28 cases of primary hyperparathyroidism (PHP) the rise in the serum immunoreactive parathyroid hormone (IRPTH or PTH) level observed in response to lowering of the serum calcium by EDTA, exceeded that obtained in 8 control subjects. In 5 of these 22 patients who were studied again after parathyroidectomy the supranormal response was abolished. Fifteen of these 22 hyper-responsive PHP patients had basal IRPTH levels not exceeding the highest level in the controls and that of other groups of patients investigated (idiopathic hypercalciuria, non-parathyroid hypercalcaemia, operated PHP). Fourteen of the 22 hyper-reactive patients with PHP did not show hypocalcaemia during the infusion of EDTA. The extent of the release of PTH elicited by EDTA in cases of PHP does not as yet allow a prediction of the amount of pathological parathyroid tissue present, although all the PHP patients showing a normal release of PTH had a relatively small mass of parathyroid tissue (up to about 1 g) subsequently removed. In 9 cases of nephrolithiasis (8 of whom had idiopathic hypercalciuria) and in 7 cases of non-parathyroid hypercalcaemia, a normal PTH release was found.

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Parathyroid glands in primary hyperparathyroidism: An ultrastructural study of 50 cases

Human Pathology ◽

10.1016/s0046-8177(86)80088-0 ◽

1986 ◽

Vol 17 (10) ◽

pp. 1036-1046 ◽

Cited By ~ 10

Author(s):

Saverio Cinti ◽

Giacomo Colussi ◽

Ernesto Minola ◽

G. Richard Dickersin

Keyword(s):

Primary Hyperparathyroidism ◽

Ultrastructural Study ◽

Parathyroid Glands

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Advances in the diagnosis and the management of primary hyperparathyroidism

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211015965 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110159

Author(s):

Ana Kashfia Islam

Keyword(s):

Renal Function ◽

Parathyroid Hormone ◽

Bone Loss ◽

Primary Hyperparathyroidism ◽

Kidney Stones ◽

Parathyroid Glands ◽

Definitive Treatment ◽

Indications For Surgery ◽

Musculoskeletal Complaints ◽

Parathyroid Cancer

The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

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Bone and Mineral Metabolism Phenotypes in MEN1-Related and Sporadic Primary Hyperparathyroidism, before and after Parathyroidectomy

Cells ◽

10.3390/cells10081895 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1895

Author(s):

Francesca Marini ◽

Francesca Giusti ◽

Federica Cioppi ◽

Davide Maraghelli ◽

Tiziana Cavalli ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Bone Mass ◽

Bone Metabolism ◽

Mineral Metabolism ◽

Parathyroid Tissue ◽

Young Patients ◽

Surgical Removal ◽

Mineral Density ◽

Bone Mass Loss ◽

Before And After

Primary hyperparathyroidism (PHPT) is the most common endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Persistent levels of increased parathyroid hormone (PTH) result in a higher incidence of osteopenia and osteoporosis compared to the general population. Surgical removal of hyper-functioning parathyroid tissue is the therapy of choice. This retrospective study evaluated the effect of parathyroidectomy (PTX) on bone metabolism and bone mass in two series of patients with MEN1 PHPT and sporadic PHPT (sPHPT) by comparing bone metabolism-related biochemical markers and bone mineral density (BMD) before and after surgery. Our data confirmed, in a higher number of cases than in previously published studies, the efficacy of PTX, not only to rapidly restore normal levels of PTH and calcium, but also to normalize biochemical parameters of bone resorption and bone formation, and to improve spine and femur bone mass, in both MEN1 PHPT and sPHPT. Evaluation of single-patient BMD changes after surgery indicates an individual variable bone mass improvement in a great majority of MEN1 PHPT patients. In MEN1 patients, PTX is strongly suggested in the presence of increased PTH and hypercalcemia to prevent/reduce the early-onset bone mass loss and grant, in young patients, the achievement of the bone mass peak; routine monitoring of bone metabolism and bone mass should start from adolescence. Therapy with anti-fracture drugs is indicated in MEN1 patients with BMD lower than the age-matched normal values.

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S178 – Utility of CT-Sestamibi Fusion in Parathyroid Exploration

Otolaryngology ◽

10.1016/j.otohns.2008.05.352 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P135-P136

Author(s):

Michael J Clark ◽

Phillip Pellitteri

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Image Fusion ◽

Fusion Imaging ◽

Parathyroid Glands ◽

Preoperative Localization ◽

Minimally Invasive Surgical ◽

Sestamibi Imaging ◽

Invasive Surgical Approach ◽

Operative Findings

Objectives 1) Delineate the role of CT-technetium 99m sestamibi (CT-MIBI) fusion in directed parathyroidectomy. 2) Determine the clinical situations where CT-MIBI fusion would be strongly recommended. Methods Charts from 190 patients with primary hyperparathyroidism who underwent CT-MIBI mage fusion as a part of a scan directed, minimally invasive parathyroid exploration protocol were reviewed. The results of conventional sestamibi imaging and CT-MIBI image fusion were compared with operative findings. Results CT-MIBI image fusion accurately localized solitary hyperfunctional parathyroid glands in 70% of patients imaged; 55% of patients were localized with conventional sestamibi imaging. CT-MIBI fusion imaging was most accurate and predictive when conventional images suggested that the solitary gland was separated from the thyroid or when the adenoma was located in the retro-thyroidal/ retro-esophageal plane or mediastinum. Conclusions CT-MIBI image fusion is not superior to conventional sestamibi imaging when utilized for routine localization of hyperfunctional parathyroid glands. CT-MIBI fusion is of greatest benefit in guiding the directed approach to solitary glands, which are separate from the thyroid or ectopically located, regions where conventional imaging has proven to be less accurate. This imaging technique will augment the minimally invasive surgical approach in selected patients with primary hyperparathyroidism in order to further refine the focused technique. Its utility as the standard preoperative localization modality is not yet established and requires further investigation. Evaluation of differences in facility utilization with CT-MIBI image fusion and conventional sestamibi imaging may be helpful in determining its role in preoperative localization for hyperparathyroidism.

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Imaging of the parathyroid glands in primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/eje-15-0565 ◽

2016 ◽

Vol 174 (1) ◽

pp. D1-D8 ◽

Cited By ~ 21

Author(s):

Salvatore Minisola ◽

Cristiana Cipriani ◽

Daniele Diacinti ◽

Francesco Tartaglia ◽

Alfredo Scillitani ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Invasive Procedure ◽

Parathyroid Glands ◽

Definitive Treatment ◽

Preoperative Imaging ◽

Disease Etiology ◽

Minimally Invasive Surgical ◽

Asymptomatic Patients ◽

Surgical Expertise

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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