scholarly journals Primary hyperparathyroidism with PTH values within the reference range: clinical case of a patient with recurrent nephrolithiasis

2019 ◽  
Vol 16 (3) ◽  
pp. 104-109
Author(s):  
Olga O. Golounina ◽  
Gyuzel E. Runova ◽  
Valentin V. Fadeyev ◽  
Anna S. Pogorelova ◽  
Gilyana V. Boldyreva
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Case ◽  
Serum Levels ◽  
Mineral Density ◽  
Endocrine Disease ◽  
Patient Complaints ◽  
Calcium Phosphorus ◽  
Excessive Secretion ◽  
Recurrent Nephrolithiasis

Hyperparathyroidism is an endocrine disease characterized by excessive secretion of parathyroid hormone (PTH) by the parathyroid glands. Primary hyperparathyroidism (PHPT) can be diagnosed biochemically with the combination of hypercalcemia and upper-normal or elevated levels of PTH. There are few descriptions of PHPT with normal intact PTH secretion in the literature. The incidence of PHPT among patients with recurrent urolithiasis is 28%. We present a clinical case of diagnosing PHPT in a 64-year-old female patient with rare variant of the disease. Before establishing the diagnosis, the main patient complaints were long-term recurrent nephrolithiasis and nephrocalcinosis. Surgical treatment made it possible to achieve rapid normalization of biochemical parameters of calcium-phosphorus metabolism, increase bone mineral density in the lumbar spine, improve the general condition of the patient. This clinical case demonstrates errors and late diagnosis of PHPT associated with poor knowledge of the manifestations of hyperparathyroidism and its masks. The authors recommend to determine the concentrations of total calcium, albumin, serum levels of PTH in patients with clinical picture of PHPT, in order to exclude the disease.

scholarly journals Primary Hyperparathyroidism Due to Parathyroid Adenoma: Clinical Case

2021 ◽  
Vol 11 (1) ◽  
pp. 76-80
Author(s):  
A. E. Shklyaev ◽  
A. M. Khisamutdinova ◽  
A. G. Bessonov ◽  
O. V. Muravtseva ◽  
A. V. Kobelev ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Phosphorus Metabolism ◽  
Elevated Blood ◽  
Blood Calcium ◽  
Endocrine Disease ◽  
Calcium Phosphorus ◽  
Excessive Secretion ◽  
Indication For Surgical Treatment

Primary hyperparathyroidism (PGPT) is an endocrine disease characterized by excessive secretion of parathyroid hormone (PTH) in upper — normal or elevated blood calcium levels due to primary parathyroid gland pathology (osch). Primary hyperparathyrosis, depending on the clinical manifestations, can occur in the normocalcemic, mild and manifest form. This article presents a clinical case of the development of the manifest form by the type of visceral disorders. Which appeared in the form of pathology of the gastrointestinal tract. This form of the disease is an indication for surgical treatment and further correction of calcium-phosphorus metabolism.

scholarly journals Low serum vitamin B12 levels are associated with degenerative rotator cuff tear

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jae Hwa Kim ◽  
Go-Tak Kim ◽  
Siyeoung Yoon ◽  
Hyun Il Lee ◽  
Kyung Rae Ko ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Rotator Cuff ◽  
Univariate Analysis ◽  
Serum Vitamin ◽  
Serum Levels ◽  
Control Group ◽  
Mineral Density ◽  
Calcium Phosphorus ◽  
Healthy Control ◽  
Low Serum

Abstract Background Vitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. The purpose of this study was to investigate whether serum Vit B12 levels were correlated with degenerative rotator cuff (RC) tear. Methods Eighty-seven consecutive patients with or without degenerative RC tear were enrolled as study participants. Possible risk factors (age, sex, medical history, bone mineral density, and serum chemistries including glucose, magnesium, calcium, phosphorus, zinc, homocysteine, Vitamin D, Vit B12, homocysteine, and folate) were assessed. Significant variables were selected based on the results of univariate analyses, and a logistic regression model (backward elimination) was constructed to predict the presence of degenerative RC tear. Results In the univariate analysis, the group of patients with degenerative RC tear had a mean concentration of 528.4 pg/mL Vit B12, which was significantly lower than the healthy control group (627.1 pg/mL). Logistic regression analysis using Vit B12 as an independent variable revealed that Vit B12 concentrations were significantly correlated with degenerative RC tear (p = 0.044). However, Vit B12 levels were not associated with tear size. Conclusion Low serum levels of Vit B12 were independently related to degenerative RC tear. Further investigations are warranted to determine if Vit B12 supplementation can decrease the risk of this condition.

CTRP3 is Significantly Decreased in Patients with Primary Hyperparathyroidism and Closely Related with Osteoporosis

2019 ◽  
Vol 128 (03) ◽  
pp. 152-157
Author(s):  
Derya Demirtas ◽  
Fettah Acıbucu ◽  
Filiz Alkan Baylan ◽  
Erdinc Gulumsek ◽  
Tayyibe Saler
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Levels ◽  
Dual Energy ◽  
Control Group ◽  
Mineral Density ◽  
Urine Calcium ◽  
X Ray ◽  
Complement C1q ◽  
Necrosis Factor

Abstract Background Adipokines derived from adipocytes are one of the important factors that act as circulating regulators of bone metabolism. Complement C1q/tumor necrosis factor-related protein-3 (CTRP3), a paralog of adiponectin, is are member of the CTRP superfamily. The aim of this study was to investigate the role of serum CTRP3 in the development of osteoporosis in patients with primary hyperparathyroidism. Methods This study included 53 patients with diagnosed primary hyperparathyroidism and 30 healthy controls. Laboratory tests for the diagnosis of primary hyperparathyroidism and serum levels of CTRP3 measured for all patients. Bone mineral density was obtained on lumbar spine 1 and 4 by dual energy X-ray absorptiometry. Results Serum CTRP3 levels were lower in patients with primary hyperparathyroidism than in the control group (p<0.001). In addition, primary hyperparathyroidism patients are were divided into two groups as, with and without osteoporosis; the levels of CTRP3 were lower in patients with osteoporosis than in patients without osteoporosis (p=0.004). In logistic regression analysis, only CTRP3 levels independently determined the patients to be osteoporosis (p<0.05). According to this analysis, decreased CTRP3 (per 1 ng/mL) levels were found to increase the risk of patients for osteoporosis by 6.9%. When the CTRP3 cut-off values were taken as 30 ng/mL, it determined osteoporosis with 76.4% sensitivity and 73.2% specificity. CTRP3 and urine calcium levels were independently associated with T score in dual energy X-ray absorptiometry. Conclusions CTRP3 levels were significantly decreased in patients with primary hyperparathyroidism, and it is also related to osteoporosis.

scholarly journals The Natural History of Primary Hyperparathyroidism with or without Parathyroid Surgery after 15 Years

2008 ◽  
Vol 93 (9) ◽  
pp. 3462-3470 ◽  
Author(s):  
Mishaela R. Rubin ◽  
John P. Bilezikian ◽  
Donald J. McMahon ◽  
Thomas Jacobs ◽  
Elizabeth Shane ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Observation Time ◽  
Mineral Density ◽  
Skeletal Disease ◽  
Asymptomatic Patients ◽  
Long Term Follow Up ◽  
History Of ◽  
New Guidelines ◽  
Biochemical Indices

Context: Primary hyperparathyroidism (PHPT) often presents without classical symptoms such as overt skeletal disease or nephrolithiasis. We previously reported that calciotropic indices and bone mineral density (BMD) are stable in untreated patients for up to a decade, whereas after parathyroidectomy, normalization of biochemistries and increases in BMD ensue. Objective: The objective of the study was to provide additional insights in patients with and without surgery for up to 15 yr. Design: The study had an observational design. Setting: The setting was a referral center. Patients: Patients included 116 patients (25 men, 91 women); 99 (85%) were asymptomatic. Intervention: Fifty-nine patients (51%) underwent parathyroidectomy and 57 patients were followed up without surgery. Main Outcome Measure: BMD was measured. Results: Lumbar spine BMD remained stable for 15 yr. However, BMD started to fall at cortical sites even before 10 yr, ultimately decreasing by 10 ± 3% (mean ± sem; P &lt; 0.05) at the femoral neck, and 35 ± 5%; P &lt; 0.05 at the distal radius, in the few patients observed for 15 yr. Thirty-seven percent of asymptomatic patients showed disease progression (one or more new guidelines for surgery) at any time point over the 15 yr. Meeting surgical criteria at baseline did not predict who would have progressive disease. BMD increases in patients who underwent surgery were sustained for the entire 15 yr. Conclusions: Parathyroidectomy led to normalization of biochemical indices and sustained increases in BMD. Without surgery, PHPT progressed in one third of individuals over 15 yr; meeting surgical criteria at the outset did not predict this progression. Cortical bone density decreased in the majority of subjects with additional observation time points and long-term follow-up. These results raise questions regarding how long patients with PHPT should be followed up without intervention.

scholarly journals Successful Parathyroidectomy May Not Resolve Hypercalciuria in Patients With Primary Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A226-A226
Author(s):  
Neriy Izkhakov ◽  
Heranmaye Prasad ◽  
Nicholas John Vernetti ◽  
Samer Nakhle
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Clinical Case ◽  
Case Series ◽  
Urinary Calcium ◽  
Long Term Effects ◽  
Normal Range ◽  
History Of ◽  
Average Serum

Abstract Background: Hypercalciuria, with twenty-four-hour urinary calcium of &gt;400 mg/day, is one of the indications for parathyroidectomy in patients with primary hyperparathyroidism. We report five cases where hypercalciuria is not resolved following a successful parathyroidectomy (normalization of serum calcium) in such patients. Here resolution of hypercalciuria is defined as twenty-four-hour urinary calcium of less than 200 mg/day. Clinical Case: This is a case series of five patients who remained hypercalciuric at 6 to 19 months after successful parathyroidectomy. Pre-parathyroidectomy, average PTH was 95 pg/dL (Min 69 pg/dL, Max 120 pg/dL), average serum calcium was 11.0 mg/dL (min 10.3 mg/dL, max 12.0 mg/dL), and average twenty-four-hour urinary calcium was 455 mg/day (min 386 mg/day, max 551 mg/day). Calcium levels were corrected to normal range post-parathyroidectomy and remained in normal range. However, hypercalciuria did not resolve. Post-parathyroidectomy, average PTH was 44 pg/dL (min 25 pg/dL, max 69 pg/dL), average serum calcium was 9.6 mg/dL (min 9.3 mg/dL, max 9.8 mg/dL), and average twenty-four-hour urinary calcium was 284 mg/day (min 201 mg/day, max 376 mg/day). Two patients who had history of nephrolithiasis prior to parathyroidectomy continued to develop nephrolithiasis at six and sixteen months after successful parathyroidectomy. Conclusions: This case series showed that hypercalciuria may not resolve following a successful parathyroidectomy in patients with primary hyperparathyroidism and elevated twenty-four-hour urinary calcium at 6 to 19 months after surgery. Further observations to evaluate long term effects of parathyroidectomy on hypercalciuria is needed.

Long-Term Skeletal Outcomes of Primary Hyperparathyroidism Patients After Treatment with Parathyroidectomy: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 50 (03) ◽  
pp. 242-249 ◽  
Author(s):  
Lu Zhang ◽  
Xiaomei Liu ◽  
Hongwei Li
Keyword(s):  
Lumbar Spine ◽  
Primary Hyperparathyroidism ◽  
Fracture Risk ◽  
Weighted Mean Difference ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Mineral Density ◽  
Risk Of Fracture ◽  
Statistical Heterogeneity

AbstractThe aim of the study was to assess and define the association between parathyroidectomy (PTX) and long-term skeletal outcomes in primary hyperparathyroidism (PHPT) patients. PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were systematically searched up to June 31, 2017, without language restriction. Any study comparing skeletal outcomes [fracture risk or bone mineral density (BMD)] of PHPT patients after more than 12 months of PTX treatment versus non-PTX treatment was included. Pooled relative risks or odds ratios with 95% confidence intervals and weighted mean difference were calculated using random-effects models irrespective of statistical heterogeneity assessed by I2 statistic. Finally, 5 randomized controlled trials (RCTs, n=584) and 10 cohort studies (CSs, n=12202) were included. CSs suggest PTX treatment versus non-PTX treatment is significantly associated with 36% reduction in the risk of fracture, with no heterogeneity, and an increase in the lumbar spine change by 0.55 WMD, with no heterogeneity. RCTs indicate PTX treatment versus non-PTX treatment is significantly associated with BMD change of 0.97 WMD at the lumbar spine with substantial heterogeneity, and 1.23 WMD at the femoral neck with no heterogeneity. The existing CSs indicate PTX-treatment versus non-PTX-treatment might reduce the risk of fracture in PHPT patients. The existing RCTs do not provide sufficient or precise evidence that PTX-treatment affects the fracture risk of PHPT patients, but offer data that subsets of patients who could potentially benefit from PTX-treatment can be identified.

scholarly journals Clinical Characteristics of Primary Hyperparathyroidism: 15-Year Experience of 457 Patients in a Single Center in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaoyun Lin ◽  
Youben Fan ◽  
Zhenlin Zhang ◽  
Hua Yue
Keyword(s):  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Bone Pain ◽  
Serum Levels ◽  
Single Center ◽  
Mineral Density ◽  
Total Hip ◽  
Turnover Markers ◽  
Serum Pth

ObjectivePrimary hyperparathyroidism (PHPT) is a common endocrine disorder of calcium metabolism. However, data concerning a large cohort of PHPT patients in the Chinese population are scarce. Thus, the objective of this study was to determine the general clinical signatures of 457 Chinese PHPT patients and explore the clinical characteristic differences between benign and malignant PHPT.MethodsA single-center retrospective study was designed. Medical records between preoperation and postoperative follow-up, were assessed and statistical analysis of the clinical data was performed.ResultsPatients with PHPT aged 12–87 years, with a mean onset age of 56.16 ± 14.60 years, were included. Most patients (68.7%) in our center had symptomatic patterns described as bone pain (74.8%), urolithiasis (25.5%), fatigue (17.5%), and pathological fracture (13.1%), but an increasing tendency has been established in the proportion of patients with asymptomatic forms. Correlation analysis revealed that patients with higher serum levels of parathyroid hormone (PTH) and calcium presented higher serum levels of bone turnover markers (BTMs) and lower 25-hydroxy-vitamin D (25OHD) values (P&lt;0.001). Gains in bone mineral density (BMD) at L1–4, the femoral neck and the total hip were observed 1–2 years after parathyroidectomy (9.6, 5.9, and 6.8%). Parathyroid carcinoma patients presented prominently higher serum PTH and calcium levels and BTMs and lower BMD at femoral neck and total hip than benign PHPT patients (P&lt;0.05), while no significant differences in age, sex, and serum 25OHD concentration were observed between benign and malignant PHPT patients.ConclusionsPHPT should be paid attention to in the patients with bone pain. While, BMD and BTMs can differentiate parathyroid carcinoma from parathyroid adenoma and hyperplasia to some extent. In addition, anti-osteoporosis drugs could be used when necessary to avoid hip fractures in patients with parathyroid carcinoma.

scholarly journals Primary hyperparathyroidism: case report

2021 ◽  
Vol 14 (2) ◽  
pp. 21-24
Author(s):  
Leila M. Farkhutdinova ◽  
Salam Yu. Mohammad ◽  
Ildar M. Yamaev ◽  
Bulat I. Abdulguzhin
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Case ◽  
Severe Form ◽  
Laboratory Studies ◽  
Mineral Density ◽  
Severe Osteoporosis ◽  
Multiple Fractures ◽  
Endocrine Diseases ◽  
The Russian Federation ◽  
The Common

Primary hyperparathyroidism is one of the common endocrine diseases, which is an actual medical and social problem. Bone disorders are the most common manifestations of primary hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in mineral density and a high risk of fractures. In the Russian Federation, most cases are manifest forms of the disease (70%), which is mainly due to the low level of diagnosis, including due to the lack of awareness of doctors. At the same time, timely detection of the disease is based on relatively accessible laboratory studies, characterized by elevated levels of calcium and parathyroid hormone in the blood, and ultrasound and scintigraphy in most cases provide visualization of the paraadenoma. A clinical case of a severe form of primary hyperparathyroidism, the late diagnosis of which caused the development of severe osteoporosis with multiple fractures, is considered. The presented case indicates that an important role in the timely detection of the disease belongs to the analysis of the clinical picture.

scholarly journals Low sclerostin levels after long-term remission of acromegaly

Endocrine ◽  
2021 ◽  
Author(s):  
Kim M. J. A. Claessen ◽  
Iris C. M. Pelsma ◽  
Herman M. Kroon ◽  
Antoon H. van Lierop ◽  
Alberto M. Pereira ◽  
...  
Keyword(s):  
Bone Health ◽  
Serum Levels ◽  
Elisa Assay ◽  
Healthy Controls ◽  
Mineral Density ◽  
Lower Plasma ◽  
X Ray ◽  
Current Growth ◽  
Biochemical Remission

Abstract Purpose Bone health is compromised in acromegaly resulting in vertebral fractures (VFs), regardless of biochemical remission. Sclerostin is a negative inhibitor of bone formation and is associated with increased fracture risk in the general population. Therefore, we compared sclerostin concentrations between well-controlled acromegaly patients and healthy controls, and assessed its relationship with bone mineral density (BMD), and VFs in acromegaly. Methods Seventy-nine patients (mean age 58.9 ± 11.4 years, 49% women) with controlled acromegaly, and 91 healthy controls (mean age 51.1 ± 16.9 years, 59% women) were included. Plasma sclerostin levels (pg/mL) in patients were measured with an ELISA assay, whereas in controls, serum levels were converted to plasma levels by multiplication with 3.6. In patients, VFs were radiographically assessed, and BMD was assessed using dual X-ray absorptiometry. Results Median sclerostin concentration in controlled acromegaly patients was significantly lower than in healthy controls (104.5 pg/mL (range 45.7–234.7 pg/mL) vs 140.0 pg/mL (range 44.8–401.6 pg/mL), p < 0.001). Plasma sclerostin levels were not related to age, current growth hormone (GH) or insulin-like factor-1 (IGF-1) levels, gonadal state, treatment modality, remission duration, or BMD, VF presence, severity or progression. Conclusion Patients with long-term controlled acromegaly have lower plasma sclerostin levels than healthy controls, as a reflection of decreased osteocyte activity. Further longitudinal studies are needed to establish the course of sclerostin during different phases of disease and its exact effects in acromegalic osteopathy.

scholarly journals P196 Predictors of fracture in patients with primary hyperparathyroidism

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Demetris Mariannis ◽  
Marwan Bukhari
Keyword(s):  
Primary Hyperparathyroidism ◽  
Trabecular Bone ◽  
Logistic Models ◽  
Female Gender ◽  
Mineral Density ◽  
Steroid Use ◽  
Risk Of Fracture ◽  
Dexa Scan ◽  
Increased Risk

Abstract Background Primary hyperparathyroidism (PHPT) is a recognised risk factor for fractures as the persistently elevated parathyroid hormone levels are associated with lower bone mineral density (BMD). In early osteoporosis (&lt;65 years), there is mainly trabecular bone loss while with increasing age, the largest loss of absolute bone mass occurs in cortical sites. Our aim was to compare cortical versus trabecular bone sites to determine which sites better predict fracture in PHPT patients referred for dual-energy X-ray absorptiometry (DEXA) scan in an observational cohort. Methods 508 patients with PHPT referred for DEXA scan at Royal Lancaster Infirmary (UK) between 2006-2016 were included in a retrospective data analysis. Data collected included femoral and lumbar BMD, age, gender, height, weight, BMI, rheumatoid arthritis, smoking, alcohol, family history of fractures, secondary osteoporosis and long-term steroid use and was used to look at predictors of fractures using BMD at different sites. Simple statistics using independent t-tests and chi-squared tests were initially used and subsequently, logistic models were fitted unadjusted and adjusted confounding variables. Results 97 males (19%) and 411 females (81%) were included, with 111 patients sustaining at least one fracture (21.9%). Mean age was 65 years (SD 0.55). Advanced age, female gender and a reduced BMD were all statistically significant factors associated with an increased risk of fractures. Smoking and long-term steroid use were also shown to increase risk of fracture however these were non-statistically significant. Adjusting for age and gender, a reduced L4 BMD was the strongest statistically significant predictor of fracture (OR 0.139, 95% CI: 0.112-0.782). Multivariate analysis revealed that a reduced L3 BMD was the strongest statistically significant predictor of fracture (OR 0.170, 95% CI: 0.071-0.72). Conclusion Overall, our study suggests that a reduced BMD at trabecular sites is a stronger predictor of fracture compared to cortical sites [Table 1]. Older age and female gender significantly increased the risk of fracture in PHPT patients. To the best of our knowledge, this is the first study looking at specific bone sites as independent predictors of fracture in PHPT patients. This analysis should be repeated using a larger cohort to validate our results. Disclosures D. Mariannis None. M. Bukhari None.

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