Excessive Secretion Of Parathyroid Hormone Research Articles

Assessment of Plasma Levels of Calcium, Creatinine and Glucose among Hypertensive Patients in Edo State, Nigeria

The present study needs to assess the plasma levels of calcium, creatinine and blood glucose among hypertensive patients in Edo State, Nigeria in order to ascertain whether plasma levels of these parameters are associated with hypertension in this population which will provide improved insight on proper management of hypertensive conditions. Several hereditary and lifestyle factors, including nutrition, influence blood pressure. In this regard, sodium is an important mineral that, in addition to its functions in fluid balance, action potential generation, digestive secretions, and nutrient absorption, also plays a key role in blood pressure regulation, with lower sodium intake linked to lower systolic and diastolic blood pressure. patients compared with their non-hypertensive counterparts. This could be as a result of an overactive parathyroid gland leading to excessive secretion of parathyroid hormone and the attendant increase in plasma calcium level. Regular screening for the plasma level of calcium, creatinine and blood glucose should be considered as routine tests for hypertensive patients. Adequate awareness of the risk of ignoring these parameters in hypertensive patients should be ensured.

Bone Disease in Primary Hyperparathyroidism-Changes Occurring in Bone Metabolism and New Potential Treatment Strategies.

Primary hyperparathyroidism (PHPT) is a common endocrinopathy, predominantly caused by a single parathyroid adenoma that is responsible for the excessive secretion of parathyroid hormone (PTH)-the hallmark of disease. Excess of this hormone causes remarkable changes in bone metabolism, including an increased level of bone remodeling with a predominance of bone resorption. Those changes lead to deterioration of bone structure and density, especially in cortical bone. The main treatment for PHPT is surgical removal of the adenoma, which normalizes PTH levels and terminates the progression of bone disease and leads to its regeneration. However, because not all the patients are suitable candidates for surgery, alternative therapies are needed. Current non-surgical treatments targeting bone disease secondary to PHPT include bisphosphonates and denosumab. Those antiresorptives prevent further bone loss, but they lack the ability to regenerate already degraded bone. There is ongoing research to find targeted drugs capable of halting resorption alongside stimulating bone formation. This review presents the advancements in understanding the molecular mechanisms responsible for bone disease in PHPT and assesses the efficacy of new potential therapeutic approaches (e.g., allosteric inhibitors of the PTH receptor, V-ATPase, or cathepsin inhibitors) aimed at mitigating bone loss and enhancing bone regeneration in affected patients.

Molecular Pathophysiology of Parathyroid Tumorigenesis-The Lesson from a Rare Disease: The "MEN1 Model".

Primary hyperparathyroidism represents the third most prevalent endocrine disease in the general population, consisting of an excessive secretion of parathyroid hormone from one or, more frequently, more of the parathyroid glands, leading to a dysregulation of calcium homeostasis. Schematically, its development occurs primarily by pathophysiological events with genetic mutation, at the germline and/or somatic level, that favor the neoplastic transformation of parathyroid cells and promote their aberrant proliferation, and mutations determining the shift in the PTH "set-point", thus interfering with the normal pathways of PTH secretion and leading to a "resetting" of Ca2+-dependent PTH secretion or to a secretion of PTH insensitive to changes in extracellular Ca2+ levels. Familial syndromic and non-syndromic forms of primary hyperparathyroidism are responsible for approximately 2-5% of primary hyperparathyroidism cases and most of them are inherited forms. The history of the genetic/molecular studies of parathyroid tumorigenesis associated with multiple endocrine neoplasia type 1 syndrome (MEN1) represents an interesting model to understand genetic-epigenetic-molecular aspects underlying the pathophysiology of primary hyperparathyroidism, both in relation to syndromic and non-syndromic forms. This minireview aims to take a quick and simplified look at the MEN1-associated parathyroid tumorigenesis, focusing on the molecular underlying mechanisms. Clinical, epidemiological, and observational studies, as well as specific guidelines, molecular genetics studies, and reviews, have been considered. Only studies submitted to PubMed in the English language were included, without time constraints.

Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) from parathyroid gland tumors. Parathyroidectomy (PTE) is the main treatment for PHPT, but it can lead to hypocalcemia in up to 46% of cases. Hypocalcemia is associated with seizures and life-threatening cardiac arrhythmias, and vitamin D deficiency can exacerbate PHPT severity and contribute to «hungry bones syndrome,» resulting in severe and persistent postoperative hypocalcemia. To evaluate the association and determine the strength of the relationship between preoperative cholecalciferol therapy and the occurrence of hypocalcemia within 1-3 days after PTE in patients with PHPT. The study was conducted at the Endocrinology Research Centre, during the periods of 1993-2010 and 2017-2020. The inclusion criteria consisted of patients diagnosed with PHPT who required PTE, had a serum 25-hydroxyvitamin D (25(OH)D) level below 20 ng/mL, and a serum total calcium level below 3 mmol/L. The exclusion criterion was the use of medications that affect calcium-phosphorus metabolism, including cinacalcet, denosumab, or bisphosphonates, either as monotherapy or as part of combination therapy. There were 117 patients, including 110 (94%) females and 7 (6%) males. The median age and interquartile range were 58 [49; 65] years. Among the participants, 21 (18%) received cholecalciferol supplementation for a duration of 2 weeks to 2 months prior to PTE, aiming to address vitamin D deficiency. The remaining 96 (82%) participants did not receive -cholecalciferol supplementation. Both groups, i.e., participants receiving cholecalciferol and those who did not, were similar in terms of anthropometric factors (sex and age at the time of surgery), preoperative clinical characteristics (BMD decrease), and laboratory parameters (PTH, total calcium, phosphorus, ALP, OC, CTX-1, and 25(OH)D levels). The occurrence of postoperative hypocalcemia was significantly lower in participants who received cholecalciferol supplementation (10% vs. 63%, p<0,001, FET2). Cholecalciferol intake showed a negative association with hypocalcemia development (RR=0,15, 95% CI (0,03; 0,51)). Preoperative cholecalciferol supplementation for 2 weeks to 2 months before PTE reduces the risk of postoperative hypocalcemia in patients with PHPT by 2-33 times.

Parathyroid Adenoma with Multiple Bone Fractures: A Case Report

Background: Parathyroid adenoma is a benign neoplasm of the parathyroid glands and can result in hypercalcemia due to excessive secretion of parathyroid hormone (PTH). This elevated PTH can have various manifestations, including bone fractures.
 Case presentation: We report the case of Tn. AB is a 41-year-old man with a series of recurrent bone fractures following minor traumas. Within a span of three years, he suffered from fractures in the right femur, left femur, and left humerus, which led to multiple surgeries, including total hip replacements. Further assessments showed an increased level of PTH and a suspicious lesion in the neck region. A CT scan revealed a potential parathyroid adenoma in the peritracheal region of the right side. Moreover, a Sestamibi scan confirmed an adenoma in the postero-inferior lobe of the right thyroid, consistent with Perrier type C, alongside osteoblastic processes and brown tumours. A subsequent parathyroidectomy confirmed a 2 cm diameter adenoma in the right lower parathyroid lobe. Histopathology from the excised tissue confirmed the diagnosis of parathyroid adenoma.
 Conclusion: Parathyroid adenomas can have significant clinical manifestations, including recurrent bone fractures, due to their metabolic effects on bone integrity. Early detection and surgical intervention can prevent complications and improve the quality of life for these patients.

Hyperparathyroidism in kidney transplant candidates and postoperative parathyroid gland function in recipients

Objective: to evaluate the effects of secondary hyperparathyroidism (HPT) in kidney transplantation (KT) candidates on recipients’ parathyroid gland function in the first postoperative year.Materials and methods. The retrospective cohort study included 210 patients (103 women, 107 men, age 45 ± 9 years) with stage 5 chronic kidney disease (stage 5 CKD, including dialysis-dependent patients), who had undergone cadaveric KT. Biochemical screening before kidney transplantation and in the postoperative period at 3 and 12 months determined serum levels of parathyroid hormone (PTH), calcium, phosphorus, alkaline phosphatase activity, albumin and creatinine using standard methods. PTH levels of 130–595 pg/mL and ≤130 pg/mL were taken as the target level in the pre- and post-transplant periods, respectively.Results. Fifty-six KT candidates (group 1) had HPT and 154 (group 2) had the target PTH levels. PTH level was 897 (722; 1136) and 301 (229; 411) pg/mL, respectively, p < 0.001. PTH decreased in all recipients at 3 months after KT: by 595 (420; 812) in group 1 and 148 (77; 230) pg/ mL in group 2, p < 0.001, to 254 (180; 455) and 150 (118; 212) pg/mL, respectively, p < 0.001; the target level was detected in 10.7% and 42.2% of recipients, respectively, p < 0.001. At 12 months, blood PTH was 171 (94; 239) pg/mL in group 1 and 112 (90; 135) pg/mL in group 2, p = 0.004; target level was found in 48.2% and 73.4% of recipients, respectively, p < 0.001. Kidney graft function was identical in both recipient groups: acute tubular necrosis in 41.1% and 54.5%; at 3 months, median glomerular filtration rates (GFR) of 60 and 65 mL/min (n.d.); at 12 months, 56 and 54 mL/min (n.d.). Post-transplant PTH levels correlated directly with preoperative levels in both groups and inversely with renal graft function in group 2 recipients.Conclusion. HPT in kidney transplant candidates is a major, graft function-independent predictor of excess PTH secretion in recipients, increasing the risk of persistent HPT 1.9-fold, one year after KT.

P-11 Case report of Primary Hyperparathyroidism and Pulmonary Embolism

Abstract Introduction Primary hyperparathyroidism (PHPT) is a disorder characterized by excessive parathyroid hormone secretion, resulting in hypercalcaemia. Patients with PHPT are believed to be in a hypercoagulable state due to the role of calcium in the platelet function and the coagulation pathway. Clinical Case An 82-year-old male with a background history of deep vein thrombosis twelve years ago, was admitted with left leg pain following a fall, he was found to have an intra-capsular left neck of femur fracture for which he underwent left hip hemiarthroplasty at a later stage during his admission. He was also found to have adjusted calcium of 2.9 mmol/L at admission, parathyroid hormone of 15.2 pmol/L, raised urine calcium-creatinine ratio of 0.39 and he was vitamin D replete (vitamin D 50.3 nmol/L). He was treated for delirium and a urinary tract infection and his inflammatory markers continued to worsen, this triggered performing a CT scan of the chest, abdomen and pelvis, which revealed a right parathyroid nodule and an acute pulmonary embolism (PE). He was commenced on prophylactic dose of low molecular weight heparin at admission, it was changed to a therapeutic dose of low molecular weight heparin after the PE diagnosis and then to Apixaban for three months. The patient was assessed to not be suitable for parathyroidectomy, the decision was made to manage the PHPT medically and he is going to be followed up locally at the Endocrinology Clinic. Conclusion There have been few case reports suggesting a correlation between the hypercalcaemic PHPT and the risk of venous thromboembolism. Ionised calcium is necessary for thrombin formation, platelet activation and aggregation, as well as activation of various clotting factors, such as factor VII and factor X. Studies have also shown that these patients have increased protein S activity and fibrinogen levels. This case, among other cases that we have observed in our hospital, highlights that the hypercalcaemia could pose an additional hypercoagulability risk in the presence of other risk factors.

The refractory secondary hyperparathyroidism presenting with retro-orbital brown tumor: a case report

BackgroundTertiary hyperparathyroidism describes the autonomous and excessive secretion of parathyroid hormone (PTH) by the parathyroid glands after longstanding secondary hyperparathyroidism in chronic kidney disease. Brown tumors are a sign of uncontrolled hyperparathyroidism. In this case, we have reported a refractory and destructive hyperparathyroidism storm. Also, it presented with atypical onset and unexpected adenoma location.Case presentationA 37-year-old man was diagnosed with end-stage kidney disease 22 years ago. He has been undergoing dialysis treatment since that time. Recently, he was admitted to the ophthalmology department due to the unilateral anterior bulging of the right eye and drooping of the eyelid. Magnetic resonance imaging exhibited an extraconal mass lesion located in the right orbital posterior superolateral position. Computerized tomography scans considered expansile bone lesion with peripheral calcification and originating from the sphenoid wing. The bone mass lesion was resected via craniotomy due to the compressive effect. The pathological findings were consistent with brown tumors. Plasma intact PTH level was 4557 pg/mL. The patient informed that he underwent parathyroidectomy and two leg fractures operation in a medical query. Parathyroid scintigraphy determined three distinct foci consistent with adenomas and one of them was in mediastenum. Second parathyroidectomy was recommended to the patient but the patient refused surgery. Despite his medication and dialysis regimen being revised, PTH levels were maintained at higher levels in follow-up.ConclusionsWe presented a hyperparathyroidism case that was resistant to all treatments and exhibited all the severe complications in a long-term dialysis patient. Furthermore, this case has revealed the importance and difficulty of secondary hyperparathyroidism management.

A Case of Recurrent Renal Calculi Secondary to Parathyroid Adenoma: A Case Report

Abstract Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and excessive secretion of parathyroid hormone (PTH). We report the case of a 71-year-old woman who presented with intermittent abdominal pain, associated with fever and chills. She also experienced early morning face puffiness, decreased appetite, and nausea for the past 7 days. The patient has a history of recurrent renal calculi. Routine blood investigation showed anemia, as well as thrombocytopenia with deranged renal function with hyperkalemia, hypercalcemia, and low-normal phosphorus levels. A plain CT KUB scan showed bilateral hydroureteronephrosis, which was determined to be secondary to renal calculi, the largest measuring 24 × 16 mm (HU:1300). The patient underwent two sessions of hemodialysis and was then scheduled for bilateral URSL with bilateral DJ stenting. After the procedure, the patient’s serial renal function tests returned to normal. Further evaluation for hypercalcemia revealed very high levels of PTH, and a magnetic resonance imaging of the neck revealed a right parathyroid adenoma. The patient subsequently underwent parathyroidectomy, and post-procedure serial PTH and calcium levels were found to be normal.

Tertiary Hyperparathyroidism and Extra Skeletal Calcification in End Stage Kidney Disease Patients: Case-series and Literature Review

Background:: Tertiary hyperparathyroidism (THPT) is a well-known complication of end-stage kidney disease (ESKD), resulting from a loss of functional renal tissue with subsequent alterations in calcium and phosphate metabolism. Tertiary hyperparathyroidism reflects severe parathyroid hyperplasia with autonomous excessive secretion of parathyroid hormone (PTH) that is no longer responsive to the concentration of plasma calcium and leads to abnormal bone remodelling, soft tissue calcifications, vasculopathy, and other systemic complications. Case Presentation:: The authors, hereby, highlight varied presentations of tertiary hyperparathyroidism (THPT) by presenting 3 interesting cases, describing their clinical course and outcomes. Through sharing these experiences and insights, we hope to contribute to a better understanding of THPT and its optimal management in patients with ESKD. Conclusion:: THPT can have a significant impact on patient health and quality of life. Despite the widespread use of interventions, such as vitamin D analogues, calcimimetics and parathyroidectomy, THPT remains a significant clinical challenge for patients with ESKD.

Primary hyperparathyroidism in children

Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) with upper-normal or elevated blood calcium levels due to primary thyroid gland pathology. PHPT is a rare pathology in children, with a prevalence of 2-5:100,000 children according to the literature. Due to the non-specificity of clinical manifestations at onset (nausea, vomiting, abdominal pain, emotional lability), the disease may remain undiagnosed for a long time. To study the features of the course and molecular genetic basis of primary hyperparathyroidism in children. Retrospective observational study of 49 patients diagnosed with primary hyperparathyroidism. All patients underwent a comprehensive laboratory-instrumental and molecular genetic study at the Institute of Pediatric Endocrinology, Endocrinology Research Center of Russia in the period 2014-2022. The first clinical symptoms of PHPT were noted at the age of 13.8 years [10.6; 1 5.2], among which fatigue, headaches, dyspepsia, lower limb pain, and fractures were the most common. The age of diagnosis was 15.81 years [13.1; 16.8], all children were found to have high levels of PTH, total and ionized calcium, with hypophosphatemia in 93.9% of patients (n=46) and hypercalciuria in 43% (n=21). Five out of 49 patients (10.2%) were found to have ectopy of the thyroid: 3 showed an intrathyroidal location, 2 in the mediastinal region. Molecular genetic study revealed mutations in 32.7% of patients (n=16, CI (21; 47)), mutations inMEN1being the most frequent (n=11). Pathogenic variants inCDC73were detected in 3patients,RET -in 2. Among the operated 39 patients, adenoma of the thyroid was detected in 84.6% of cases (n=33), hyperplasia in 7.7% (n=3), atypical adenoma in 5.1% (n=2), carcinoma in 5.1% of cases (n=2). The paper presents the peculiarities of the course and the results of molecular genetic study of pediatric PHPT. This sample is the largest among those published in the Russian Federation.

Cinacalcet in patients with secondary hyperparathyroidism; a review

Secondary hyperparathyroidism is a common complication of chronic kidney disease characterized by excessive secretion of parathyroid hormone from the parathyroid glands. Cinacalcet is a calcimimetic medication that reduces parathormone levels by increasing the sensitivity of the calcium-sensing receptors on the parathyroid glands. This review aims to summarize the existing literature on the use of cinacalcet in patients with secondary hyperparathyroidism.

Metabolic syndrome in parathyroid diseases

Metabolic syndrome is a cluster of metabolic abnormalities, including central obesity, insulin resistance, dyslipidemia, and hypertension. Parathyroid diseases are a group of disorders that affect the parathyroid glands’ function, which regulates the body’s calcium and phosphorus levels. There is growing evidence that parathyroid diseases may be associated with metabolic syndrome. There is a growing body of evidence suggesting a possible association between parathyroid diseases and metabolic syndrome. Hyperparathyroidism and secondary hyperparathyroidism are associated with insulin resistance and dyslipidemia, while hypoparathyroidism is associated with hypocalcemia-induced metabolic abnormalities. Further studies are needed better to understand the relationship between parathyroid diseases and metabolic syndrome and to develop effective treatment strategies. Hyperparathyroidism is a common parathyroid disease characterized by excessive secretion of parathyroid hormone (PTH). Parathormone plays a crucial role in calcium homeostasis and bone metabolism. However, excessive PTH secretion can lead to hypercalcemia, which can cause metabolic abnormalities such as insulin resistance and dyslipidemia. Studies have shown that patients with primary hyperparathyroidism have a higher metabolic syndrome prevalence than the general population. Secondary hyperparathyroidism is another parathyroid disease in patients with chronic renal failure. Chronic kidney disease leads to impaired renal function, which results in decreased vitamin D synthesis and increased PTH secretion. Secondary hyperparathyroidism is associated with bone mineral disorders and cardiovascular disease. Studies have also shown that secondary hyperparathyroidism is associated with metabolic abnormalities such as insulin resistance and dyslipidemia.

Robotic resection of ectopic mediastinal parathyroid adenoma in multiple endocrine neoplasia 1

BackgroundHyperparathyroidism in patients with multiple endocrine neoplasia 1 is attributed to the excessive secretion of parathyroid hormone (PTH) from multiple parathyroid glands. This can be successfully treated through complete resection of the parathyroid glands; however, subsequent surgery is often required because of the presence of supernumerary or ectopic parathyroid glands. Therefore, identifying the locations of all functional glands is crucial for precise resection. Here, we report a case of ectopic mediastinal parathyroid adenoma that was successfully resected using robot-assisted thoracoscopic surgery.Case presentationA 53-year-old woman underwent a total parathyroidectomy with autotransplantation for multiple endocrine neoplasia 1-associated primary hyperparathyroidism. The patient previously underwent laparoscopic distal pancreatectomy for a pancreatic neuroendocrine tumor. She also presented with a mediastinal tumor and nonfunctional pituitary adenoma that could be followed up. Blood tests before total parathyroidectomy showed high levels of intact PTH (183 pg/mL) and calcium (Ca; 10.3 mg/dL); however, postoperative blood tests still revealed high levels of intact PTH (103 pg/mL) and Ca (11.4 mg/dL). Computed tomography and magnetic resonance imaging revealed a 45-mm-sized mass in the right upper mediastinum as a well-defined solid and cystic lesion, whereas 99mTc-methoxyisobutylisonitrile scintigraphy indicated a strong accumulation of tracers, suggesting an ectopic lesion in the mediastinum. Persistent hyperparathyroidism after total parathyroidectomy via neck incision was attributed to an ectopic parathyroid tumor in the mediastinum. Thus, we decided to resect the tumor using robot-assisted thoracoscopic surgery to perform the procedure gently and carefully. During surgery, a mediastinal tumor was identified as it was detected radiographically. Because it did not invade the surrounding tissues, it could be completely resected without injuring the capsule. The patient was discharged without complications. Postoperatively, Ca and intact PTH levels decreased back to normal. The final pathological diagnosis confirmed that the mass was an ectopic mediastinal parathyroid adenoma.ConclusionsMinimally invasive surgical resection of a remnant ectopic lesion was successfully performed in a patient with multiple endocrine neoplasia 1 using robot-assisted thoracoscopic surgery.

Submandibular Ectopic Parathyroid Adenoma: A Case Report.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and elevated or abnormally normal parathyroid hormone (PTH) levels, due to excessive secretion of PTH by 1 or more parathyroid glands. In this report, we discuss the diagnostic and therapeutic challenges posed by ectopic parathyroid adenomas, a rare but atypical presentation of PHPT. We present the case of a 36-year-old female with PHPT due to an ectopic parathyroid adenoma located in the submandibular region. The patient presented with bone pain and was initially evaluated with routine imaging studies, which were negative. [18F] F-choline positron emission tomography (PET)/Computed tomography revealed the ectopic adenoma, leading to successful surgical management. Ectopic parathyroid adenomas are rare but can occur in various locations, and functional imaging modalities such as choline PET can aid in their detection. Surgical resection remains the definitive treatment for parathyroid adenomas, with intraoperative PTH monitoring guiding the extent of resection. Proper evaluation and management of PHPT is essential to avoid significant morbidity. Our case adds to the growing body of literature on the importance of considering ectopic locations of parathyroid adenomas in patients with PHPT.

Primary hyperparathyroidism in a 14-year-old boy – a case report

IntroductionPrimary hyperparathyroidism (PHPT) is an unusual childhood disease characterized by an excessive secretion of parathyroid hormone (PTH). Its presentation may consist of nonspecific symptoms. Consequently, physicians have trouble diagnosing the disease as they fail to check the level of calcium or PTH.AimTo describe a case of a paediatric patient with primary hyperparathyroidism, who was successfully diagnosed and treated.Case studyA 14-year-old boy was admitted to the Paediatric Department with suspected PHPT after performing tests at the Endocrinology Outpatient Clinic, which revealed hypercalcaemia and high PTH level. The ordering of tests was motivated by non-specific symptoms that could indicate PHPT. The ultrasonography, single photon emission computed tomography of the neck and Tc-99m MIBI parathyroid scintigraphy of the neck and upper thorax were performed, which revealed the presence of hypoechogenic structure and focal accumulation of a marker, consistent with the presence of adenoma. The patient was qualified for surgical treatment, which resulted in a resolution of pathological symptoms.Results and discussionBecause PHPT is a rare disease among paediatric patients, and is initially characterised by non-specific clinical picture, it is usually diagnosed when advanced organ changes occur. Screening tests, such as calcium and PTH determinations, are also not routinely ordered in this age group. Once the diagnosis is made, the treatment is largely supportive and includes prevention of life-threatening complications.ConclusionsA rare case of a boy with parathyroid adenoma was successfully managed with a multidisciplinary approach combining input from paediatric endocrinologists, radiologists and surgeons.

ODP078 An Unsolved Mystery of Hyperparathyroidism for 12 Years

Abstract Introduction Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone (PTH). It results from excessive secretion of PTH from one or more of the parathyroid glands. The number and location of the parathyroid glands can be variable. The organogenesis of the parathyroids determines the definitive location in adulthood. We hereby present an interesting case of primary hyperparathyroidism caused by the ectopic parathyroid gland. Clinical case 85-year-old Black female with papillary thyroid cancer status post total thyroidectomy and RAI in 2011, hypertension, hyperlipidemia, osteoporosis, long standing PHPT referred to ER for hypercalcemia from a physician's office. A review of the system was significant for unintentional 40 lb. weight loss over the past several months and increased urinary frequency. She denied confusion, abdominal pain, constipation, paresthesia. On physical exam she was afebrile, BP 144/63 mm Hg, pulse 56/min and respiratory rate of 18. The rest of the detailed physical examination was unremarkable. She was initially diagnosed with primary hyperparathyroidism in 2009 based on PTH- 196 pg /ml (n 10-65 pg/ml), and corrected calcium- 11. 0 mg/dl (n 8.5-10.1 mg/dL) . Laboratory on this admission (2021) revealed PTH - 411.8 pg/ml (n 10-65 pg/ml), corrected calcium - 12.9 mg/dL (n 8.5-10.1 mg/dL) with albumin 4 g/dl (3.4-5. 0 g/dL), ionized calcium-7.30 mg/dL (n 4.5-5.3 mg/dL), 1,25-(OH) 2 vitamin D level -50.2 pg /mL (n 20-82 pg/mL),25-(OH) vitamin D level of 37.2 ng/mL (n 30-100 ng/mL) and GFR-40 mL/min/1.73m 2 (n >=60. 0 mL/min/1.73m 2). She underwent a total of 4 Sestamibi scans and 1 MRI chest with and without contrast since 2009 that failed to localize defective parathyroid gland . But on this admission an incidental finding of right neck mass measuring 3. 0×1.2×2.7 cm was noted in MRI cervical spine that led to US head and neck soft tissue. It showed a solid and cystic mass with a concern for ectopic parathyroid gland posterior to the right submandibular gland. ENT was consulted, and the patient underwent right neck exploration with the removal of the neck mass. Pathology resulted as hyperplastic parathyroid tissue most congruent with a parathyroid adenoma. Conclusion Ectopic parathyroid glands occur in approximately 15% of patients with PHPT. Embryologically, the third pharyngeal pouch gives rise to the inferior parathyroid glands, and the superior parathyroids arise from the fourth pharyngeal pouch. It can occur from the angle of the mandible to the mediastinum according to the developmental and migratory aberrations. Parathyroidectomy remains the definitive cure for PHPT and is recommended in all symptomatic patients. Presentation: No date and time listed

ODP102 Indicators for the effects of calcimimetics on hypercalcemia in the elderly patients with primary hyperparathyroidism.

Abstract Primary hyperparathyroidism (PHPT) is the most common disorder causing hypercalcemia, in which parathyroid hormone (PTH) is excessively secreted from a parathyroid tumor. PHPT occurs mainly in elderly women, and patient with PHPT present symptoms including nephrolithiasis, bone fracture, and cognitive impairment or can be asymptomatic. Excessive secretion of PTH leads to elevated serum levels of alkaline phosphatase as well as calcium and decreased serum inorganic phosphate level. Parathyroid surgery is the only established treatment, and the treatment reduces elevated serum levels of calcium and PTH, increases bone mineral density, reduces the occurrence of bone fractures, and decreases the risk of renal stones. However, some PHPT patients, especially elderly patients, refuse to undergo surgical therapy for various reasons including perceived risk. Calcimimetic treatment, including cinacalcet and evocalcet administration, has also been reported to be effective for reducing serum calcium level in patients with PHPT. However, the relationship between the efficacy of calcimimetic treatment for PHPT and patient characteristics related to the effectiveness of calcimimetics remains to be elucidated. To investigate the relevance of clinical parameters to the effectiveness of calcimimetics for PHPT, we retrospectively analyzed patients with PHPT who received calcimimetic treatment in our department. We included nine patients including 8 females (88.9%) and one male (11.1%) in the study. The median age of the patients was 81 years (interquartile range (IQR): 61-86 years). Laboratory tests before calcimimetic treatment revealed that median level of serum corrected calcium (cCa) was high (11.1 (IQR: 10.5-12.7) mg/dL), serum inorganic phosphate was low (2.3 (2.3-2.4) mg/dL), and plasma intact PTH was high (251. 0 (198.3-498.5) pg/mL). The fractional excretion of calcium was higher than 1% (1.3% (1.12-1.48%)), %tubular reabsorption of phosphate was low (79.9% (77.1-83.9%)), nephrogenous cyclic adenosine monophosphate (cAMP) was high (3.4 (2.4-4. 0) nmoL/dL GF), and urinary cAMP was normal (4.3 (4. 0-5.3) μmoL/day). Median reduction rate of serum cCa level due to calcimimetic treatment was 5.8% (0-13.4%) at the first follow-up (median treatment duration: 22 (20-29) days). Notably, reduction rate of serum cCa level had significant correlations with age (R=0.95), dual energy X-ray absorptiometry % young adult mean (DEXA %YAM) in the femoral neck (R=-0.92), and urinary cAMP level (R=-0.85). Thus, the present study suggested that elevated serum cCa levels may be reduced by treatment with calcimimetics more effectively in PHPT patients of relatively advanced age, patients with low DEXA %YAM, and patients with low urinary cAMP. Presentation: No date and time listed

Bilateral ureteral lithiasis in a patient with primary hyperparathyroidism

Description of the clinical case: A 62-year-old female comes to our unit with oppressive pain in the bilateral lumbar area. Bilateral ureteral lithiasis was diagnosed those conditions severe bilateral hydronephrosis and it was decided to divert the urinary tract to later perform a definitive treatment. Due to the findings in the laboratory and cabinet studies, primary hyperparathyroidism was diagnosed as the cause of the bilateral ureteral lithiasis. Relevance: The presence of stones indicates the need for parathyroidectomy in patients diagnosed with primary hyperparathyroidism with hypercalcemia or normocalcemia unless there are contraindications. Patients with nephrolithiasis should explore strategies to prevent stone formation even after parathyroidectomy. Clinical implications: The most common consequences of excessive parathyroid hormone secretion are hypercalciuria and kidney stones. They occur in 8-20% of patients with primary hyperparathyroidism and are the most common complication of the disease. They can be silent in 7-11% and bilateral in 16.4% of patients. It is very important to be able to identify patients with this disease to avoid multiple complications. Conclusions: Patients with primary hyperparathyroidism have a high risk of developing kidney complications. We must analyze all the factors that made us suspect in a primary hyperparathyroidism in patients who debut with renal or ureteral stones and thus avoid the recurrence of the same

Parathyroid Imaging: Past, Present, and Future.

The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. A variety of imaging approaches have been evaluated and utilized over the years for this purpose. Ultrasound relies solely on structural features and is without radiation, however is limited to superficial evaluation. 4DCT and 4DMRI provide enhancement characteristics in addition to structural features and dynamic enhancement has been investigated as a way to better distinguish parathyroid from adjacent structures. It is important to recognize that 4DCT provides valuable information however results in much higher radiation dose to the thyroid gland than the other available examinations, and therefore the optimal number of phases is an area of controversy. Single-photon scintigraphy with 99mTc-Sestamibi, or dual tracer 99mTc-pertechnetate and 99mTc-sestamibi with or without SPECT or SPECT/CT is part of the standard of care in many centers with availability and expertise in nuclear medicine. This molecular imaging approach detects cellular physiology such as mitochondria content found in parathyroid adenomas. Combining structural imaging such as CT or MRI with molecular imaging in a hybrid approach allows the ability to obtain robust structural and functional information in one examination. Hybrid PET/CT is widely available and provides improved imaging and quantification over SPECT or SPECT/CT. Emerging PET imaging techniques, such as 18F-Fluorocholine, have the exciting potential to reinvent parathyroid imaging. PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid. A targeted agent specific for a parathyroid tissue biomarker remains to be identified.