Silent Renal Stones in Primary Hyperparathyroidism: Prevalence and Clinical Features

2014 ◽  
Vol 20 (11) ◽  
pp. 1137-1142 ◽  
Author(s):  
Sara Cassibba ◽  
Micaela Pellegrino ◽  
Laura Gianotti ◽  
Claudia Baffoni ◽  
Enrico Baralis ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Features ◽  
Renal Stones

scholarly journals The PRIMARA study: a prospective, descriptive, observational study to review cinacalcet use in patients with primary hyperparathyroidism in clinical practice

2014 ◽  
Vol 171 (6) ◽  
pp. 727-735 ◽  
Author(s):  
P Schwarz ◽  
J J Body ◽  
J Cáp ◽  
L C Hofbauer ◽  
M Farouk ◽  
...  
Keyword(s):  
Observational Study ◽  
Primary Hyperparathyroidism ◽  
Bone Pain ◽  
Prospective Observational Study ◽  
Renal Stones ◽  
Specialist Care ◽  
Treatment Start ◽  
Clinical Profiles ◽  
First Time ◽  
Time Information

ObjectiveMedical management of primary hyperparathyroidism (PHPT) is important in patients for whom surgery is inappropriate. We aimed to describe clinical profiles of adults with PHPT receiving cinacalcet.DesignA descriptive, prospective, observational study in hospital and specialist care centres.MethodsFor patients with PHPT, aged 23–92 years, starting cinacalcet treatment for the first time, information was collected on dosing pattern, biochemistry and adverse drug reactions (ADRs). Initial cinacalcet dosage and subsequent dose changes were at the investigator's discretion.ResultsOf 303 evaluable patients with PHPT, 134 (44%) had symptoms at diagnosis (mostly bone pain (58) or renal stones (50)). Mean albumin-corrected serum calcium (ACSC) at baseline was 11.4 mg/dl (2.9 mmol/l). The reasons for prescribing cinacalcet included: surgery deemed inappropriate (35%), patient declined surgery (28%) and surgery failed or contraindicated (22%). Mean cinacalcet dose was 43.9 mg/day (s.d., 15.8) at treatment start and 51.3 mg/day (31.8) at month 12; 219 (72%) patients completed 12 months treatment. The main reason for cinacalcet discontinuation was parathyroidectomy (40; 13%). At 3, 6 and 12 months from the start of treatment, 63, 69 and 71% of patients, respectively, had an ACSC of ≤10.3 mg/dl vs 9.9% at baseline. Reductions from baseline in ACSC of ≥1 mg/dl were seen in 56, 63 and 60% of patients respectively. ADRs were reported in 81 patients (27%), most commonly nausea. A total of 7.6% of patients discontinued cinacalcet due to ADRs.ConclusionsReductions in calcium levels of ≥1 mg/dl was observed in 60% of patients 12 months after initiation of cinacalcet, without notable safety concerns.

scholarly journals Renal stones and calcifications in patients with primary hyperparathyroidism: associations with biochemical variables

2012 ◽  
Vol 166 (6) ◽  
pp. 1093-1100 ◽  
Author(s):  
Jakob Starup-Linde ◽  
Elin Waldhauer ◽  
Lars Rolighed ◽  
Leif Mosekilde ◽  
Peter Vestergaard
Keyword(s):  
Primary Hyperparathyroidism ◽  
Renal Stones ◽  
Spiral Ct ◽  
University Hospital ◽  
Plasma Creatinine ◽  
Ct Scans ◽  
Cross Sectional ◽  
Biochemical Variables ◽  
Plasma Creatinine Level ◽  
High Prevalence

ObjectiveTo study the prevalence of renal stones and nephrocalcinosis in patients with primary hyperparathyroidism (PHPT) and to appraise biochemical variables as risk factors for developing renal calcifications.DesignCross-sectional.Materials and methodsAll patients (n=177) undergoing diagnostic evaluation and surgery for PHPT at Aarhus University Hospital between 2007 and 2009. All patients underwent routine spiral CT scans of the abdomen to determine the presence or absence of renal calcifications.ResultsA total of 45 patients (25.4%, 95% confidence intervals: 19.0–31.4%) had renal stones (15.3%) and/or renal calcifications (10.2%) on the CT scans. Compared with those without calcification (n=132), the group with calcification had a significantly lower plasma creatinine level (67.0±25.1 vs 74.6±17.5 μmol/l, 2P=0.03). Moreover, CaE was higher in PHPT patients with renal calcification than in PHPT patients without (0.91±0.28 vs 0.74±0.40 mmol/mmol, 2P=0.02). The other measured or derived biochemical variables were similar in the two groups. No biochemical variable was predictive for renal calcifications in a multiple regression analysis.ConclusionWe found a high prevalence of renal calcifications among PHPT patients but no deterioration of renal function. The occurrence of calcifications was related to low plasma creatinine and a high urine calcium/creatinine ratio. However, biochemical markers in general were poor predictors for the risk of renal stones or nephrocalcinosis indicating that routine image diagnostics may be needed for the identification of these complications in order to establish indication for surgery and ensure proper treatment.

scholarly journals Presentation, diagnostic assessment and surgical outcomes in primary hyperparathyroidism: a single centre’s experience

2018 ◽  
Vol 7 (10) ◽  
pp. 1105-1115 ◽  
Author(s):  
Laura J Reid ◽  
Bala Muthukrishnan ◽  
Dilip Patel ◽  
Mike S Crane ◽  
Murat Akyol ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Evidence Base ◽  
University Hospital ◽  
Clearance Ratio ◽  
Curative Surgery ◽  
History Of ◽  
Surgical Failure

Objective Primary hyperparathyroidism (PHPT) is a common reason for referral to endocrinology but the evidence base guiding assessment is limited. We evaluated the clinical presentation, assessment and subsequent management in PHPT. Design Retrospective cohort study. Patients PHPT assessed between 2006 and 2014 (n = 611) in a university hospital. Measurements Symptoms, clinical features, biochemistry, neck radiology and surgical outcomes. Results Fatigue (23.8%), polyuria (15.6%) and polydipsia (14.9%) were associated with PHPT biochemistry. Bone fracture was present in 16.4% but was not associated with biochemistry. A history of nephrolithiasis (10.0%) was associated only with younger age (P = 0.006) and male gender (P = 0.037). Thiazide diuretic discontinuation was not associated with any subsequent change in calcium (P = 0.514). Urine calcium creatinine clearance ratio (CCCR) was <0.01 in 18.2% of patients with confirmed PHPT. Older age (P < 0.001) and lower PTH (P = 0.043) were associated with failure to locate an adenoma on ultrasound (44.0% of scans). When an adenoma was identified on ultrasound the lateralisation was correct in 94.5%. Non-curative surgery occurred in 8.2% and was greater in those requiring more than one neck imaging modality (OR 2.42, P = 0.035). Conclusions Clinical features associated with PHPT are not strongly related to biochemistry. Thiazide cessation does not appear to attenuate hypercalcaemia. PHPT remains the likeliest diagnosis in the presence of low CCCR. Ultrasound is highly discriminant when an adenoma is identified but surgical failure is more likely when more than one imaging modality is required.

Serum Phosphate: A Neglected Test in the Clinical Management of Primary Hyperparathyroidism

2021 ◽  
Author(s):  
Elena Castellano ◽  
Roberto Attanasio ◽  
Alberto Boriano ◽  
Micaela Pellegrino ◽  
Giorgio Borretta
Keyword(s):  
Bone Density ◽  
Primary Hyperparathyroidism ◽  
Clinical Picture ◽  
Inverse Correlation ◽  
Renal Stones ◽  
Serum Phosphate ◽  
Surgical Indication ◽  
Femoral Site ◽  
Serum Pth ◽  
The Relationship

Abstract Background Although the inverse correlation between serum PTH and phosphate (P) levels in patients with primary hyperparathyroidism (PHPT) is well known, the relationship between P levels and the clinical picture of the disease has not been well investigated. This was thus the aim of this paper. Patients A total of 472 consecutive patients with PHPT attending our center were retrospectively evaluated at diagnosis. Results P levels lower than 2.5 mg/dL (HypoP) were found in 198/472 patients (41.9%). HypoP was mild (2-2.5 mg/dL), moderate (1-1.9 mg/dL), and severe (&lt;1 mg/dL) in 168 (84.9%), 30 (15.1%), and 0 cases, respectively. P levels were lower in males than females. Patients with more severe bone density impairment at the radial (but not the vertebral or femoral) site had P levels significantly lower than other patients. PHPT severity was worse in HypoP patients, both clinically (higher prevalence of renal stones, but not of osteoporosis) and biochemically (higher serum calcium and PTH levels). All patients in the moderate HypoP group were either symptomatic or asymptomatic reaching surgical indication according to the latest guidelines. Conclusions We observed a relationship between P levels and biochemical and clinical features of PHPT severity. In asymptomatic PHPT patients, even moderate HypoP is predictive of surgical indication, regardless of age and hypercalcemia severity.

Clinical features and management of primary hyperparathyroidism discovered by parathyroid incidentaloma

2020 ◽  
Author(s):  
Jaksic Vlatka Pandzic ◽  
Ana Majic ◽  
Jelena Andric ◽  
Berkovic Maja Cigrovski ◽  
Srecko Marusic
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Features
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