scholarly journals Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
P. V. Pradeep ◽  
B. Jayashree ◽  
Anjali Mishra ◽  
S. K. Mishra
Keyword(s):  
Primary Hyperparathyroidism ◽  
Western World ◽  
Symptomatic Disease ◽  
Gland Weight ◽  
Vitamin D Levels ◽  
Parathyroid Adenomas ◽  
The Status ◽  
Hungry Bone ◽  
Asymptomatic Disease ◽  
Related Mortality

Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.

scholarly journals Sporadic primary hyperparathyroidism with multiple parathyroid adenomas

2021 ◽  
Vol 67 (6) ◽  
pp. 31-38
Author(s):  
E. E. Bibik ◽  
A. K. Eremkina ◽  
O. A. Knyazeva ◽  
N. G. Mokrysheva
Keyword(s):  
Primary Hyperparathyroidism ◽  
Life Quality ◽  
Dynamic Monitoring ◽  
Postoperative Hypocalcemia ◽  
Target Organs ◽  
Parathyroid Adenomas ◽  
Active Observation ◽  
Sporadic Primary Hyperparathyroidism ◽  
The Right ◽  
Hungry Bone

Multiple lesions of the parathyroid glands (PTG) in primary hyperparathyroidism (PHPT) can be sporadic or develop as part of hereditary syndromes, manifesting at young age. There the description of a severe sporadic PHPT with big parathyroid neoplasms in the young patient is presented. Clinical data made it possible to suspect MEN-1 syndrome or parathyroid carcinomas; however, mutations CDKN, CDC73, MEN1 were excluded. The patient underwent removal of three identified tumors: benign adenomas of the left PTG and hyperplasia of the right one. Postoperative hypocalcemia and severe hungry bone syndrome required the administration of vitamin D and calcium carbonate preparations. However, a year after the operation, a «mild» recurrent disease was confirmed. Taking into account the patient’s refusal to reoperation and a significant improvement of the target organs state, active observation was continued. The patient needs further careful dynamic monitoring by specialists in order to timely identify indications for repeated surgical treatment to improve the life quality and span.

Primary hyperparathyroidism

2011 ◽  
pp. 653-664 ◽  
Author(s):  
Shonni J. Silverberg ◽  
John P. Bilezikian
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
Superior Mediastinum ◽  
Parathyroid Adenomas ◽  
Neck Irradiation ◽  
History Of ◽  
Anatomic Locations ◽  
Salt And Pepper ◽  
Asymptomatic Disease ◽  
Single Versus

Primary hyperparathyroidism is no longer the severe disorder of ‘stones, bones, and groans’ described by Fuller Albright and others in the 1930s (1,2). Osteitis fibrosa cystica, with its brown tumours of the long bones, subperiosteal bone resorption, distal tapering of the clavicles and phalanges, and ‘salt-and-pepper’ appearance of erosions of the skull on radiograph is rare, and kidney stones are seen in only 20% of patients. Asymptomatic disease is the rule in the vast majority of patients, with the diagnosis commonly following the finding of hypercalcaemia on routine serum chemistry analysis (Table 4.3.1) (3–5). Primary hyperparathyroidism is due to a solitary parathyroid adenoma in 80% of patients (5). Most cases are sporadic, although some are associated with a history of neck irradiation, or prolonged use of lithium therapy for bipolar disease (6, 7). Multiple parathyroid adenomas have been reported in 2 to 4% of cases (8). Parathyroid adenomas can be discovered in many unexpected anatomic locations, including within the thyroid gland, the superior mediastinum, and within the thymus. Occasionally, the adenoma may ultimately be identified in the retroesophageal space, the pharynx, the lateral neck, and even the alimentary submucosa of the oesophagus (9). In approximately 15% of patients with primary hyperparathyroidism, all four parathyroid glands are involved. There are no clinical features that differentiate single versus multiglandular disease. In nearly one-half of cases, four-gland disease is associated with a familial hereditary syndrome, such as multiple endocrine neoplasia 1 (MEN 1) or MEN 2a.

Nephrolithiasis in PHPT

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 129
Author(s):  
Raiz Ahmad Misgar ◽  
Arshad Iqbal Wani
Keyword(s):  
Diabetes Mellitus ◽  
Organ System ◽  
Western World ◽  
Thyroid Disorders ◽  
Developing Regions ◽  
Endocrine Disorder ◽  
Symptomatic Disease ◽  
The Third ◽  
Biochemical Evaluation ◽  
Asymptomatic Disease

Sir, Primary hyperparathyroidism (PHPT) is a common disorder and is the third most common endocrine disorder after diabetes mellitus and thyroid disorders.  This common endocrine disorder has scaled down into an asymptomatic disease revealed by routine biochemical evaluation of patients for a variety of skeletal and non-skeletal symptoms in much of the western world. However, in India, and similar developing regions of world it continues to be for the most part an overtly symptomatic disease with skeletal, renal and other organ system manifestations. JMS 2018: 21 (2):129  

scholarly journals Primary Hyperparathyroidism

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1 ◽  
Author(s):  
Leonardo Bandeira ◽  
John Bilezikian
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Presentation ◽  
Screening Tests ◽  
Complete Evaluation ◽  
Symptomatic Disease ◽  
The Past ◽  
Asymptomatic Patients ◽  
Target Organs ◽  
Metabolic Bone ◽  
The Status

Over the past several generations, primary hyperparathyroidism (PHTP) has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation. It is clear that even in asymptomatic patients, evidence for microstructural disease in the skeleton and calcifications in the kidneys can be demonstrated often. Potential non-classical manifestations of PHPT related to neurocognition and the cardiovascular system continue to be of interest. As a result of these advances, revised guidelines for the management of asymptomatic PHPT have been recently published to help the clinician determine whether surgery is appropriate or whether a more conservative approach is acceptable.

scholarly journals P114 Effect of vitamin D on parathyroid hormone, serum calcium and bone mineral density in patients with primary hyperparathyroidism being managed conservatively

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mahrukh Khalid ◽  
Vismay Deshani ◽  
Khalid Jadoon
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Serum Calcium ◽  
Mineral Density ◽  
Neck Of Femur ◽  
Vitamin D Levels ◽  
Significant Difference

Abstract Background/Aims  Vitamin D deficiency is associated with more severe presentation of primary hyperparathyroidism (PTHP) with high parathyroid hormone (PTH) levels and reduced bone mineral density (BMD). We analyzed data to determine if vitamin D levels had any impact on PTH, serum calcium and BMD at diagnosis and 3 years, in patients being managed conservatively. Methods  Retrospective analysis of patients presenting with PHPT. Based on vitamin D level at diagnosis, patients were divided into two groups; vitamin D sufficient (≥ 50 nmol/L) and vitamin D insufficient (≤ 50 nmol/L). The two groups were compared for age, serum calcium and PTH levels at diagnosis and after mean follow up of 3 years. BMD at forearm and neck of femur (NOF) was only analyzed in the two groups at diagnosis, due to lack of 3 year’s data. Results  There were a total of 93 patients, 17 males, mean age 70; range 38-90. Mean vitamin D level was 73.39 nmol/L in sufficient group (n = 42) and 34.48 nmol/L in insufficient group (n = 40), (difference between means -38.91, 95% confidence interval -45.49 to -32.33, p < 0.0001). There was no significant difference in age, serum calcium and PTH at the time of diagnosis. After three years, there was no significant difference in vitamin D levels between the two groups (mean vitamin D 72.17 nmol/L in sufficient group and 61.48 nmol/L in insufficient group). Despite rise in vitamin D level in insufficient group, no significant change was observed in this group in PTH and serum calcium levels. BMD was lower at both sites in vitamin D sufficient group and difference was statistically significant at NOF. Data were analyzed using unpaired t test and presented as mean ± SEM. Conclusion  50% of patients presenting with PHPT were vitamin D insufficient at diagnosis. Vitamin D was adequately replaced so that at 3 years there was no significant difference in vitamin D status in the two groups. Serum calcium and PTH were no different in the two groups at diagnosis and at three years, despite rise in vitamin D levels in the insufficient group. Interestingly, BMD was lower at forearm and neck of femur in those with sufficient vitamin D levels and the difference was statistically significant at neck of femur. Our data show that vitamin D insufficiency does not have any significant impact on PTH and calcium levels and that vitamin D replacement is safe in PHPT and does not impact serum calcium and PTH levels in the short term. Lower BMD in those with adequate vitamin D levels is difficult to explain and needs further research. Disclosure  M. Khalid: None. V. Deshani: None. K. Jadoon: None.

Do patients with atypical parathyroid adenoma need a close follow-up?

2021 ◽  
Author(s):  
Federica Saponaro ◽  
Elena Pardi ◽  
Laura Mazoni ◽  
Simona Borsari ◽  
Liborio Torregrossa ◽  
...  
Keyword(s):  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Good Prognosis ◽  
Histopathological Diagnosis ◽  
Symptomatic Disease ◽  
Asymptomatic Patients ◽  
Parathyroid Adenomas ◽  
Relevant Role ◽  
Atypical Parathyroid Adenoma

Abstract Context Atypical parathyroid adenomas (APAs) are neoplasms with uncertain malignant potential but lack unequivocal histological signs of malignancy. Objective To retrospectively evaluate the clinical and biochemical profiles of patients with APA, the outcome after parathyroidectomy (PTX), and the presence of CDC73 germline and somatic mutations. Design Monocentric study on consecutive patients undergoing PTX for primary hyperparathyroidism (PHPT) between June 2000 and December 2020. Patients Fifty-eight patients with a confirmed histopathological diagnosis of APA. Age and sex-matched controls with parathyroid adenoma (PA) were also included. Results Fifty-four patients had sporadic PHPT and four familial isolated hyperparathyroidism (FIHP). Thirty-four patients (59%) had a symptomatic disease. Serum calcium and PTH levels were significantly higher in symptomatic compared to asymptomatic patients (P=0.048 and 0.008, respectively). FIHP patients were younger than the sporadic counterpart (30±17yr vs. 55±13 yrs). APA patients had significantly higher serum calcium and PTH levels and lower 25(OH)D concentration, BMD and T-score at 1/3 distal radius compared to those with PA. Four of 56 APA patients displayed a CDC73 germline mutation. No somatic CDC73 mutation was identified in 24 tumor specimens. The mean follow-up after surgery was of 60±56.4 months. All but six patients (90%), five with apparently sporadic PHPT and one with FIHP, were cured after surgery. Conclusions The large majority of patients with APA, despite a moderate/severe phenotype, have a good prognosis. Germline CDC73 mutation-positive patients had a higher rate of persistent/recurrent disease. CDC73 gene alterations do not seem to have a relevant role in the tumorigenesis of sporadic APA.

Detection of parathyroid adenomas with 4DCT: Towards a true four-dimensional technique

2021 ◽  
Author(s):  
Steven Raeymaeckers ◽  
Yannick De Brucker ◽  
Tim Vanderhasselt ◽  
Nico Buls ◽  
Johan De Mey
Keyword(s):  
Primary Hyperparathyroidism ◽  
Thyroid Tissue ◽  
Motion Artifacts ◽  
P Value ◽  
Normal Thyroid Tissue ◽  
Dose Length Product ◽  
Normal Thyroid ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Over Time

Abstract Background. 4DCT is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases, instead of three or four different phases. The main aim of this study was to see if this protocol allows for the detection of parathyroid adenomas within dose limits. Our secondary aim was examining the enhancement of parathyroid lesions over time.Methods. For this prospective study, we included 15 patients with primary hyperparathyroidism prior to surgery. We obtain a 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Centered on the thyroid, continuous axial scanning is performed over a fixed 8cm or 16cm coverage volume after start of contrast administration.Results. In all patients an enlarged parathyroid can be demonstrated, mean lesion size is 13.6mm. Mean peak arterial peak enhancement for parathyroid lesions is 384 HU compared to 333 HU for the normal thyroid. No statistical difference could be found. Time to peak (TTP) is significantly earlier for parathyroid adenomas compared to normal thyroid tissue: 30.8s versus 32.3s (p value 0.008). Mean Slope of Increase (MSI) of the enhancement curve is significantly steeper compared to normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). Mean dose length product was 890.7 mGy.cm with a calculated effective dose of 6.7 mSv.Conclusion. We propose a feasible 4DCT scanning-protocol for the detection of parathyroid adenomas. We manage to obtain a multitude of phases, allowing for a dynamic evaluation within an acceptable exposure range when compared to classic helical 4DCT. Our 4DCT protocol may allow for a better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. This way wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available.

How Well Does R2P Travel Beyond the West?

2016 ◽  
Author(s):  
Faith Mabera ◽  
Yolanda Spies
Keyword(s):  
International Relations ◽  
Conceptual Development ◽  
International Politics ◽  
Status Quo ◽  
Western World ◽  
The West ◽  
Deep Roots ◽  
Domain State ◽  
The Status ◽  
Emerging Powers

R2P invokes the power-morality nexus in international relations and interrogates the rules of engagement that anchor international society. Conceptualization of R2P as a liberal Western construct can therefore be divisive, especially when operationalization of the norm—as happened during the 2011 intervention in Libya—feeds into a West-against-the-Rest narrative. This is unfortunate because the R2P doctrine has deep roots in the non-Western world—Africa in particular—and Global South perspectives continue to strengthen its conceptual development. Emerging powers challenge the status quo of structural power and their rhetoric on R2P often invokes mistrust of Western altruism in international politics. Their actions, on the other hand, prove that they are no less prone to realpolitik in the normative domain. State actors in the normative middle of international politics, including developed as well as developing countries, are well placed to bridge the West-versus-the-Rest schism and to provide leadership in the R2P discourse.

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