scholarly journals The clinical practice guidelines for primary hyperparathyroidism, short version

2021 ◽  
Vol 67 (4) ◽  
pp. 94-124
Author(s):  
N. G. Mokrysheva ◽  
A. K. Eremkina ◽  
S. S. Mirnaya ◽  
J. A. Krupinova ◽  
I. A. Voronkova ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Western Europe ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Short Version ◽  
Blood Calcium ◽  
Special Groups ◽  
Increased Risk ◽  
Excessive Secretion ◽  
System Disorder

Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.

scholarly journals Primary Hyperparathyroidism: Modern Conception and Clinical Observation

2020 ◽  
Vol 10 (2) ◽  
pp. 94-101
Author(s):  
L. M. Farkhutdinova
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Developed Countries ◽  
Severe Form ◽  
Mineral Density ◽  
Target Organs ◽  
Increased Risk

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

scholarly journals Primary Hyperparathyroidism: Modern Conception and Clinical Observation

2020 ◽  
Vol 10 (2) ◽  
pp. 94-101
Author(s):  
L. M. Farkhutdinova
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Clinical Manifestations ◽  
Premature Death ◽  
Developed Countries ◽  
Severe Form ◽  
Mineral Density ◽  
Target Organs ◽  
Increased Risk

The article is devoted to one of the actual medical and social problems — primary hyperparathyroidism, the late diagnosis of which leads to the development of severe complications and an increased risk of premature death. Unlike developed countries, where 80% of cases are represented by mild forms of the disease, in the Russian Federation this indicator does not exceed 30%, while 70% are manifest forms. Widespread awareness of doctors of various specialties in the diagnosis of parathyroid adenoma is necessary for the timely detection of the disease. The article reflects the main stages of the study of the disease, the pathogenesis of the clinical manifestations of primary hyperparathyroidism, the classic symptoms of which are changes in the target organs of the parathyroid hormone — bone tissue, urinary system and gastrointestinal tract, is considered. Bone disorders are the most common manifestation of hyperparathyroidism and are characterized by increased bone metabolism with a progressive decrease in bone mineral density. Typical changes in the kidneys include nephrolithiasis and nephrocalcinosis, causing the formation of renal failure. Gastrointestinal signs of hyperparathyroidism are erosion and ulcers of the stomach and duodenum, prone to bleeding, recurrent pancreatitis. Diagnosis of the disease is based on laboratory results, characterized by elevated levels of calcium and parathyroid hormone in the blood. Visualization of the paradenomas in most cases is provided by ultrasound and scintigraphy. Removal of parathyroid adenoma is the most effective treatment. A clinical case of a severe form of the disease is presented, indicating an urgent need to take measures to solve the problem of primary hyperparathyroidism.

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 CLINICAL MANIFESTATIONS OF PARATHYROID CANCER IN 29 YEARS OLD MAN

2019 ◽  
Vol 21 (1) ◽  
pp. 98-101
Author(s):  
A F Romanchishen ◽  
A V Gostimsky ◽  
Z S Matveeva ◽  
I V Karpatsky
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Endocrine Surgery ◽  
Rapid Progression ◽  
Parathyroid Tumor ◽  
Parathyroid Cancer ◽  
Electrolyte Disorders ◽  
Blood Calcium

Parathyroid cancer is an extremely rare cause of primary hyperparathyroidism, accounting less than 1% of cases. The neoplasm is detected in people 40-50 years old. Ratio of men and women is 1: 1, in contrast to hyperparathyroidism caused by adenoma of epithelial bodies, when there are 3-4 times more women than men among the patients. Due to the rarity of this disease, surgeons and morphologists may have difficulties in verification of the tumor. Distinctive features of the course of the disease include the extremely rapid progression of bone changes, the development of hypercalcemic crises with a high level of blood calcium and serum parathyroid hormone. Radical surgery involves the removal of malignant parathyroid tumor in a single block with the ipsilateral thyroid gland, as well as paratracheal lymph nodes. The aim of investigation is to show a rare observation of bone manifestations of parathyroid cancer. Material and methods. Parathyroid cancer was diagnosed in 2 (0.7%) of 283 patients with primary hyperparathyroidism, operated in the Center of Endocrine Surgery. Male 29 years old was operated on in January 2016. Disease duration was about 2 years. The clinical picture was characterized by multiple bone fractures, generalized cystic osteodistorofy, renal failure, severe electrolyte disorders, cachexia. The diagnosis was confirmed by high values of total calcium and blood parathyroid hormone. The patient underwent removal of the parathyroid tumor, during the histological and immunohistochemical study of which parathyroid cancer was verified. The patient was able to sit on his own after 3 months, get up with support after 6 months and walk with the help 10 months later after the operation. In May 2017 an increase of parathyroid hormone to 1900 pg / ml was detected with a normal value of blood calcium, which indicates recurrence of parathyroid cancer. Findings. The high grade of the disease is due to both the aggressive course of parathyroid cancer and the late diagnosis.

scholarly journals Diagnosis and treatment of primary hyperparathyroidism (20 years of own experience and literature review)

2021 ◽  
Vol 17 (5) ◽  
pp. 377-384
Author(s):  
Yu.I. Karachentsev ◽  
M.E. Sazonov ◽  
V.V. Khaziev ◽  
V.N. Dubovik ◽  
O.A. Goncharova ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Large Scale ◽  
Stone Formation ◽  
Osteoporotic Fractures ◽  
Steady Increase ◽  
Positive Contribution ◽  
Blood Calcium ◽  
Surgical Department ◽  
Number Of Patients ◽  
Increased Risk

Background. Currently, primary hyperparathyroidism (pHPT) is the third most common endocrine disease after thyroid gland pathology and diabetes mellitus. Untimely diagnosis leads to a severe course of the disease with the development of disabling deformations — osteoporotic fractures, recurrent stone formation in the urinary tract, gastrointestinal bleeding, etc., as well as to an increased risk of premature death. The purpose of the study is to assess the dynamics of detection of thyroid disease (thyroid) for the period 2000–2019. Materials and methods. Since 2000, based on the surgical department of the clinic of the State Institution “V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine”, 205 surgeries have been carried out for pHPT (in 188 women and 17 men: 91.7 and 8.3 %). Results. Since 2008, there has been a steady increase in the number of cases. The incidence of pHPT in women increases with age and becomes significantly higher at the age of 50–69 years. At the same time, the gap between women and men is widening, the reason for which needs to be studied. The proportional ratio of the number of patients with asymptomatic and clinically pronounced course persists for 20 years and is approximately 2 : 1. In countries where blood calcium screening has been introduced, the proportion of asymptomatic forms reaches 80 %. The obtained data confirm the fact of untimely diagnosis of pHPT in Ukraine, which requires the introduction of large-scale population screening in the form of a questionnaire survey and study of serum calcium. Conclusions. A positive contribution to the timely detection of pHPT can be made by activating the work of postgraduate (continuous) education institutions in this direction, primarily the departments of endocrinology based on endocrinological clinics with surgical departments.

Structure and frequency of clinical manifestations of primary hyperparathyroidism

2013 ◽  
Author(s):  
Elena Brutskaya-Stempkovskaya ◽  
Alla Shepelkevich ◽  
Irina Bilodid ◽  
Ekaterina Kliausova ◽  
Veronika Lobashova
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Manifestations

A CLINICAL CASE OF PRIMARY HYPERPARATHYROIDISM OF THE OSTEO-VISCERAL FORM

2020 ◽  
pp. 155-161
Author(s):  
Poselyugina O.B. ◽  
Kulish A.S. ◽  
Vasiliev D.F.
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Case ◽  
Early Stage ◽  
Diagnostic Errors ◽  
Epidemiological Studies ◽  
Medical Documentation ◽  
Screening Methods ◽  
Internal Organs ◽  
Blood Calcium ◽  
Slow Development

Introduction. Primary hyperparathyroidism is an endocrine disease resulting from a primary pathology of the parathyroid gland, characterized by increased secretion of parathyroid hormone and increased blood calcium levels. Among the endocrine diseases, primary hyperparathyroidism is the third most common after diabetes mellitus and thyroid disease. In Russia, according to epidemiological studies, primary hyperparathyroidism is found in 1% of the population, women suffer 2-3 times more often than men do, and the average age of diagnosis is 54-59 years. In the absence of a timely diagnosis, primary hyperparathyroidism causes systemic damage to internal organs: renal impairment, nephrolithiasis, esophageal affection, cardiovascular and nervous system involvement, and it leads to a violation of bone tissue integrity. The aim is to demonstrate a clinical case of a patient with primary hyperparathyroidism and to analyze the stages of diagnosis of the disease and treatment. Material and methods. The review of medical literature on the problem of diagnostics and treatment of primary hyperparathyroidism was performed, as well as an analysis of the patient’s medical documentation with this pathology. Results and discussion. A variant of complicated course of primary hyperparathyroidism of bone and visceral form is considered. About 15 years passed from the moment of appearance of the first symptoms of the disease to the development of complications of renal and bone system. Despite the slow development of the disease and availability of screening methods, hyperparathyroidism was detected at the stage of complications. This article provides a detailed analysis of the primary hyperparathyroidism history, as well as analyzes the possibilities of diagnosis, treatment and prevention of this pathology. The efficacy of the therapy has been assessed, and ways of correction have been outlined. The analysis of the reasons that made it difficult to diagnose this pathology at an early stage, before the development of serious complications of internal organs, has been carried out. Conclusions: It can be assumed that the presented clinical case will increase the awareness of physicians, especially therapists, about the primary manifestations of this pathology and the peculiarities of its detection and routing the patient, which will allow avoiding many diagnostic errors.

Comparative analysis of polymorphic variants of IL-17A and MMP-1 genes with the risk of developing chronic periodontitis in petrochemical workers

2020 ◽  
Vol 60 (10) ◽  
pp. 687-693
Author(s):  
Iskander I. Zaidullin ◽  
Denis O. Karimov ◽  
Lilija K. Karimova ◽  
Milyausha F. Kabirova ◽  
Rasima R. Galimova ◽  
...  
Keyword(s):  
Ethylene Oxide ◽  
Chronic Periodontitis ◽  
Periodontal Diseases ◽  
Clinical Manifestations ◽  
Control Group ◽  
Periodontal Tissues ◽  
Dental Examination ◽  
Number Of Patients ◽  
Increased Risk ◽  
Harmful Substances

The susceptibility to the development and progression of inflammatory periodontal diseases, which depends on genetic and external factors (smoking, stress, oral hygiene), varies widely. In the development of these diseases, an important role is played not only by the presence of periodontal pathogenic microorganisms, but also by the presence of congenital or acquired immunodeficiency, immunoregulatory defects. The immune system plays a key role in the physiological and pathological processes of periodontal tissues. In this regard, IL17, produced by CD4+ Th cells, which has both Pro-inflammatory and protective activity, is of particular interest in the pathogenesis of periodontitis. The aim of study was to identify the relationship between polymorphic loci of the IL-17A (rs2275913) and MMP-1 (rs1799750) genes and clinical manifestations of chronic periodontitis in petrochemical workers. Dental examination was performed in 92 ethylene oxide production workers with chronic periodontitis and 74 patients with chronic periodontitis who did not come into contact with chemical factors (control group). Genotyping of polymorphisms rs2275913 of the IL17A gene and rs1799750 of the MMP1 gene was performed by allele-specific real-time polymerase chain reaction (PCR). Hygienic assessment of the degree of air pollution of the working area with harmful substances was carried out by gas chromatography according to the guidelines for the determination of harmful substances in the air № 5098-89, № 3119-84. When comparing the results of studies of both groups, there were no statistically significant differences in the frequency distributions of allelic variants and genotypes of the IL-17A and MMP-1 genes. The AA/AG genotypes of the IL-17A gene were associated with an increased risk of severe disease compared to the GG genotype in workers in the main group (OR=6.1; 95% CI 1.33-28.5; p=0.021) and in the control group (OR=7.26; 95% CI 1.34-39.25; p=0.016). Carriers of the A allele in the control group increased the risk of severe chronic periodontitis by 2.4 times compared to carriers of the G allele (OR=2.41; 95% CI 1.19-4.87; p=0.014). During the dental examination of employees of the ethylene oxide plant, the clinical course of periodontal diseases was more severe in comparison with the control group, and the number of patients with severe periodontitis was twice as high. It was found that the AA/AG genotypes of the IL-17A gene and the carrier of the A allele are associated with increased susceptibility to the development of severe chronic periodontitis. The association between the MMP-1 gene polymorphism and the risk of severe forms of chronic periodontitis has not been established. A risk factor for the development of inflammatory periodontal diseases in employees of the petrochemical complex is a complex of harmful production factors.

scholarly journals Nutritional Status Measurement Instruments for Diabetes: A Systematic Psychometric Review

2020 ◽  
Vol 17 (16) ◽  
pp. 5719
Author(s):  
Pedro Montagut-Martínez ◽  
David Pérez-Cruzado ◽  
José Joaquín García-Arenas
Keyword(s):  
Nutritional Status ◽  
Dietary Intake ◽  
Psychometric Properties ◽  
Premature Death ◽  
Diabetes Mellitus Type 1 ◽  
Measurement Properties ◽  
Cochrane Library ◽  
Individual Treatment ◽  
Measurement Instruments ◽  
Increased Risk

Background: Diabetes is a serious chronic disease associated with a large number of complications and an increased risk of premature death. A dietary evaluation is of utmost importance for health promotion, disease prevention and individual treatment plans in patients with diabetes. Methods: An exhaustive search was carried out in various databases—Medline, Web of Science, Open Gray Cochrane Library and Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN)—for systematic review of the measurement properties of instruments that evaluate the dietary intake of people with diabetes mellitus type 1 and/or 2 according to COSMIN standards. Results: Seven instruments were identified. There was no instrument measuring nutritional status for which all the psychometric properties were evaluated. The methodological quality for each of the psychometric properties evaluated was ‘inadequate’ or ‘doubtful’ for all instruments. The Food Frequency Questionnaire (FFQ) evaluated the most psychometric characteristics and with a better score in terms of quality of the evidence. Conclusions: Several instruments have been developed for the evaluation of dietary intake in people with diabetes. Evaluation of this construct is very useful, both in clinical practice and in research, requiring new knowledge in this area. The FFQ is the best instrument available to assess dietary intake in people with diabetes.

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