Mild primary hyperparathyroidism—to treat or not to treat?

2018 ◽  
Vol 129 (1) ◽  
pp. 53-67
Author(s):  
Zaki K Hassan-Smith ◽  
Sherwin Criseno ◽  
Neil J L Gittoes
Keyword(s):  
Primary Hyperparathyroidism ◽  
Mild Primary Hyperparathyroidism

scholarly journals The effect of surgery on fat mass, lipid and glucose metabolism in mild primary hyperparathyroidism

2018 ◽  
Vol 7 (8) ◽  
pp. 941-948 ◽  
Author(s):  
Kristin Godang ◽  
Karolina Lundstam ◽  
Charlotte Mollerup ◽  
Stine Lyngvi Fougner ◽  
Ylva Pernow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Glucose Metabolism ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular Risk Factors ◽  
Outcome Measures ◽  
Fat Mass ◽  
Lipid Lowering ◽  
Mild Primary Hyperparathyroidism ◽  
Over Time

Context Mild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors. Objective To assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism. Design, patients, interventions, main outcome measures 119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization. Results In the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected. Conclusion In mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.

scholarly journals The cardiovascular system in patients with symptomatic and mild primary hyperparathyroidism

2009 ◽  
Vol 55 (3) ◽  
pp. 25-29 ◽  
Author(s):  
I V Voronenko ◽  
N G Mokrysheva ◽  
L Ya Rozhinskaya ◽  
A L Syrkin
Keyword(s):  
Parathyroid Hormone ◽  
Left Ventricular Hypertrophy ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular System ◽  
Qt Interval ◽  
Ventricular Hypertrophy ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Mild Primary Hyperparathyroidism

The cardiovascular system was analyzed in patients with symptomatic (n = 31) and mild primary hyperparathyroidism (n = 34) whose mean age was 54.6 years; 95% females). In the patients with symptomatic primary hyperparathyroidism, the PQ interval was longer and the QT interval was significantly shorter than those in patients with mild hyperparathyroidism. Left ventricular hypertrophy was noted in 45.2% of patients with symptomatic and in 15.2% of those with mild hyperparathyroidism (p = 0.013). Left ventricular diastolic dysfunction was also more common in the group of symptomatic hyperparathyroidism. There was a statistically significant correlation between the levels of parathyroid hormone, total and ionized calcium and the duration of QT interval and the determinants of diastolic function and left ventricular hypertrophy. The revealed cardiovascular disorders in patients with primary hyperparathyroidism are presumed to depend on the increase rate of parathyroid hormone and total and ionized calcium.

scholarly journals Lower quality of life in longstanding mild primary hyperparathyroidism

2013 ◽  
Vol 57 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Andreia Veras ◽  
Juliana Maia ◽  
Patricia Mesquita ◽  
Catia Eufrazino ◽  
Francisco Bandeira
Keyword(s):  
Quality Of Life ◽  
Primary Hyperparathyroidism ◽  
Functional Capacity ◽  
General Health ◽  
Sf 36 ◽  
Significant Difference ◽  
Mild Primary Hyperparathyroidism ◽  
Recent Diagnosis ◽  
Time Since Diagnosis

OBJECTIVE: To describe the non-classical manifestations and quality of life in patients with primary hyperparathyroidism (PHPT). SUBJECTS AND METHODS: We evaluated non-classical manifestations and quality of life of 22 patients with PHPT using the SF-36 questionnaire according to the time since diagnosis. RESULTS: In the scores of quality of life, a significant difference was found comparing the groups with previous and recent diagnosis of PHPT in terms of functional capacity (39 + 22.83 vs. 76.25 + 22.37; p = 0.001), limitation of physical aspects (30 + 38.73 vs. 75 + 21.32; p = 0.006), general health (57.20 + 19.16 vs. 77.75 + 15.70; p = 0.012), and vitality (49.00 + 21.19 vs. 70.00 + 24.12; p = 0.044). CONCLUSION: We found a significant difference in quality of life in relation to the time of the diagnosis of PHPT.

scholarly journals Skeletal Effects of Interventions in Mild Primary Hyperparathyroidism: A Meta-Analysis

2010 ◽  
Vol 95 (4) ◽  
pp. 1653-1662 ◽  
Author(s):  
Shyam Sankaran ◽  
Greg Gamble ◽  
Mark Bolland ◽  
Ian R. Reid ◽  
Andrew Grey
Keyword(s):  
Primary Hyperparathyroidism ◽  
Meta Analysis ◽  
Mild Primary Hyperparathyroidism ◽  
Skeletal Effects

Should ‘Mild Primary Hyperparathyroidism’ be reclassified as ‘insidious’: is it time to reconsider?

2011 ◽  
Vol 75 (6) ◽  
pp. 730-737 ◽  
Author(s):  
David P. Macfarlane ◽  
Ning Yu ◽  
Peter T. Donnan ◽  
Graham P. Leese
Keyword(s):  
Primary Hyperparathyroidism ◽  
Mild Primary Hyperparathyroidism

scholarly journals Surgery for ‘asymptomatic’ mild primary hyperparathyroidism improves some clinical symptoms postoperatively

2013 ◽  
Vol 169 (5) ◽  
pp. 665-672 ◽  
Author(s):  
Claire Blanchard ◽  
Muriel Mathonnet ◽  
Frédéric Sebag ◽  
Cécile Caillard ◽  
Antoine Hamy ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Improvement ◽  
Clinical Symptoms ◽  
Clinical Score ◽  
Symptom Improvement ◽  
Asymptomatic Group ◽  
Postoperative Symptom ◽  
International Panel ◽  
Asymptomatic Patients ◽  
Mild Primary Hyperparathyroidism

Objective and backgroundMost primary hyperparathyroidism (pHPT) patients do not conform to the guidelines for parathyroidectomy established by an international panel of specialists and have a mild pHPT. This group is typically defined as ‘asymptomatic’. The primary aim of this study was to determine symptom improvement in this ‘asymptomatic’ group after parathyroidectomy. Secondly, we aimed to create a preoperative clinical score predicting postoperative symptom resolution.DesignA prospective nonrandomized study included patients with mild pHPT.MethodsA questionnaire (22 items) was given to ‘asymptomatic’ patients preoperatively and at 3, 6, and 12 postoperative months. A logistic regression was performed to create a preoperative clinical score.ResultsOne hundred and sixteen patients were included. Postoperatively, HPT was resolved in 98% of patients. Twelve of 22 nonspecific symptoms were improved at 1 year. Subgroups analysis showed a greater improvement in patients <70 years and those with a serum calcium level ≥2.6 mmol/l preoperatively. A clinical score, based on age and five symptoms, was established to predict the clinical improvement after surgery in mild pHPT patients with a positive predictive value of 81%.ConclusionPatients with asymptomatic pHPT have clinical improvement of their symptoms postoperatively even after 1 year. Younger patients and those with higher preoperative calcium levels show the best improvement.

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