Findings Of Primary Hyperparathyroidism Research Articles

Unexpected first finding in primary hyperparathyroidism; peripheral giant cell granuloma in the mandibula

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Primary Hyperparathyroidism in Pakistan: Challenges and Future Recommendations

Primary hyperparathyroidism (PHPT) is found in one percent of the world’s population. It is considered an asymptomatic disease. Increased serum calcium and parathyroid hormone (PTH) levels are the characteristic laboratory findings in PHPT; however, they are not part of routine investigations in Pakistan’s healthcare system. As a result, correct diagnosis is delayed, and patients present only after significant symptoms are present. Serum calcium level should be routinely performed to make accurate and timely diagnosis of PHPT and checking serum PTH levels should also not be delayed. Hospitals, especially tertiary care, should be equipped with specialized tests such as ultrasound neck, Sistambi scan, and contrast-enhanced computerized tomography. Increased awareness should be created among orthopedic surgeons, urologists, nephrologists, rheumatologists, and general practitioners about the PHPT and other parathyroid disorders. Keywords: Endocrinology disorders; Hypercalcemia; Parathyroid disorders; Parathyroid gland; Parathyroidectomy

Isolated hypophosphataemia as an early marker of primary hyperparathyroidism.

SummaryPrimary hyperparathyroidism (PHPT) is a disease caused by overactive parathyroid glands with consequent hypercalcaemia. The main cause in 85–90% of the cases is the presence of a solitary parathyroid adenoma. The most common presentation is with asymptomatic hypercalcaemia diagnosed on routine biochemical testing. Although low serum phosphate levels are an associated finding in primary hyperparathyroidism, the diagnostic criteria for PHPT remain to be hypercalcaemia, high or inappropriately normal PTH and hypercalciuria. This case report presents a patient who presented with low phosphate levels without any other biochemical evidence of PHPT, who returned several years later with overt primary hyperparathyroidism. This report intends to raise interest among the medical fraternity whether there is a need to consider hypophosphataemia as an early sign of PHPT.Learning pointsPrimary hyperparathyroidism is a relatively common condition with varying clinical and biochemical presentation.The most common presentations still remain as an asymptomatic biochemical abnormality closely related to calcium, PTH and bone metabolism.Not much attention is usually given to associated biochemical abnormalities, and hence they are usually less investigated.Further research is needed to establish if patients need long-term monitoring when no obvious cause for isolated hypophosphataemia has been found.

Does Vitamin D Deficiency Cause Primary Hyperparathyroidism?

Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. It is caused by a single parathyroid adenoma in 85% to 90% of the cases. Vitamin D deficiency (VDD) is a common finding in PHPT with an incidence varying in the literature from 53% to 77%. The aim of our study is to describe a cohort of patients with PHTP with and without VDD.

Review of parathyroid imaging and subsequent surgical findings in primary hyperparathyroidism - do they correlate?

Review of parathyroid imaging and subsequent surgical findings in primary hyperparathyroidism - do they correlate?

Oro-mandibular manifestations of primary hyperparathyroidism

To determine the effects of Primary Hyperparathyroidism on oral cavity in a symptomatic contemporary Indian population by taking note of the following parameters: (1) Radiological alteration of lamina dura, (2) mandibular cortical width, (3) prevalence of brown tumor, and (4) mandibular tori. Twenty-six patients of Primary Hyperparathyroidism were examined clinically and radiologically for extra- and intraoral abnormalities. Loss of lamina dura, mandibular cortical width, presence of mandibular tori, and brown tumors were assessed and correlated with serum Calcium, Phosphate, Parathormone, and Alkaline phosphatase. The results were compared with twenty-six age- and gender-matched control subjects. The data was expressed as mean ± SD, and a probability (p) value of < 0.05 was considered significant. Pearson's statistical method was used to assess the significant correlation between radiological measurements and biochemical values. Generalized absence of the lamina dura was the most consistent finding and there was a significant correlation between its loss and altered parathormone, alkaline phosphatase, and inorganic phosphate, but not with serum calcium or the duration of the disease. Mean values (in mm) for the cortical indices were significantly lower in the patients compared to the controls and correlated significantly with parathormone and alkaline phosphatase. None of the patients had mandibular tori and only one patient had a brown tumor. Loss of lamina dura, ground glass appearance, and mandibular cortical width reduction are common findings in primary hyperparathyroidism and these are significantly correlated with elevated parathormone and alkaline phosphatase. However, the presence of brown tumors and oral tori are less commonly encountered features.

Non-endocrine tumors causing endocrine syndromes: a brief review

In the early decades of the 20th century it was established that some non neuro-endocrine malignant tumors and their metastasis, were secreting substances with biologic properties and causing clinical syndromes similar to the ones caused by naturally occurring hormones. The most known syndromes are caused by substances mimicking the biologic properties of ACTH, erythropoietin, insulin and PTH. Many theories have been postulated in an attempt to explain the synthesis process of hormone mimetic substances. Ectopic secretion of ACTH syndrome comprises 10%-20% of all cases presenting with Cushing's syndrome. The clinical picture manifests in a variable way. The increased plasma levels of cortisol in these cases, cause symptoms distinct from the ones of true Cushing's syndrome. In general these patients have an ominous prognosis. Survival is limited to 6-12 months and is attributed to hypercortisolemia that is known to increase the risk of metastasis. Hypercalcemia syndrome from ectopic secretion of hypercalcemic factors is a severe complication of cancer patients with an incidence of 5-10%. Increased serum calcium is caused either by the osteolytic metastasis of malignant tumors or by their secretions. The clinical picture caused is similar to the findings of primary hyperparathyroidism. Treatment options in case of acute and severe hypercalcemia in patients with malignancy are limited. The endocrine syndromes produced by non-endocrine tumors not only affect patient's quality of life but also occasionally cause severe complications and can disrupt surgical or medical treatment of the primary tumor. Searching for the occurrence of such syndromes demands a high index of suspicion. This paper brings the spotlight back to the clinical syndromes of hypercortisolemia and hypercalcemia caused by ectopic ACTH and hypercalcemic factors respectively, re-iterating the need for early diagnosis and prompt management in such cases.

FDG PET/CT findings in primary hyperparathyroidism mimicking multiple bone metastases

FDG PET/CT findings in primary hyperparathyroidism mimicking multiple bone metastases

Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) and vitamin D insufficiency are common conditions that can occur in combination. However, low plasma 25-hydroxyvitamin D (25OHD) may also enhance the risk of PHPT or modify disease severity. To compare the risk of vitamin D insufficiency and deficiency stratified by age, sex and season between PHPT patients and controls and to assess associations between plasma 25OHD and adenoma weight, biochemical variables, bone mineral density (BMD) and clinical complications. Cross-sectional study. A total of 289 consecutive Caucasian patients with PHPT aged 65.9 (24-92) years, 289 sex-, age- and season-matched normocalcaemic controls and 187 healthy adult blood donors. PHPT diagnosis was confirmed in 214 by neck exploration. Vitamin D insufficiency (plasma 25OHD < 50 nmol/l) was observed in 81% of PHPT patients compared with 60% of sex- and age-matched controls (P < 0.001) and 35% of blood donors (P < 0.001). During summer, 77%vs. 53% (P < 0.001) and 4% (P < 0.001), respectively, had vitamin D insufficiency. Average plasma 25OHD was 41 (range 9-87) nmol/l among 27 PHPT patients compared with 87 (21-173) nmol/l (P < 0.001) among aged-matched blood donors. During winter, 86%vs. 66% (P < 0.001) and 71% (P < 0.05), respectively, had vitamin D insufficiency. Vitamin D deficiency (plasma 25OHD < 25 nmol/l) was observed in 33% of PHPT patients compared with 20% of age- and sex-matched controls (P < 0.001) and 13% of blood donors (P < 0.001). Both PHPT patients and controls showed seasonal variations in 25OHD related to the average number of sun hours, but values were lower in PHPT patients at all calendar months. In PHPT patients low plasma 25OHD was associated with higher plasma levels of calcium, PTH and alkaline phosphatase and with lower renal calcium excretion, femoral neck and forearm BMD. No association was found between plasma 25OHD and adenoma weight (total or divided into tertiles). There was a trend towards increased risk of osteoporotic fractures (P < 0.08) with low plasma 25OHD. Vitamin D insufficiency and deficiency are common findings in PHPT and occur more often than in a sex- and age-matched control group referred from general practice and in normal blood donors irrespective of season. Low plasma 25OHD levels are associated with an aggravated clinical presentation of PHPT but do not affect adenoma size.

The spectrum of radiographic findings in primary hyperparathyroidism

The aim of this study was to assess the spectrum of radiographic findings in primary hyperparathyroidism (PHPT). The study group consisted of 16 women and 7 men whose Ca levels were at least two or three times higher than normal. The average age was 55.3 in women and 49.4 in men. We detected carcinoma in 1, hyperplasia in 1, multiple adenomas in 4, single adenoma in 17 patients. The most common finding in the skeletal system was the decreased bone mineral density (BMD) and the complete loss of the lamina durae dentium. BMD was found lower in women than in men. This result attributed the increased number of postmenopausal patients in our study group. The second most common finding in our study group was subperiosteal bone resorption. Brown tumors (BTs) were located at maxilla in one, widespread in one, mandibula in two, long tubular bones in four patients. Renal stone disease was found in five, spastic colon in two, gastric ulcer in one, mitral valve calcification in one patients. We demonstrated no pathologic changes consistent with PHPT in remaining seven patients.

Management of primary hyperparathyroidism caused by multiple gland disease

Multiple gland parathyroid disease is the pathological finding in primary hyperparathyroidism (HPT) in about 10% to 20% of all patients and in approximately a third of all patients with persistent or recurrent disease. The variability of multiple gland disease spans from 2 adenomas to diffuse hyperplasia in patients with multiple endocrine neoplasia type 1. This variability calls into question the proposed common pathophysiologic background in all of these cases. As primary treatment of multiple gland primary HPT, subtotal parathyroidectomy and thymectomy or total parathyroidectomy and heterotopic autotransplantation including thymectomy can be equally advocated. Recurrent hyperparathyroidism frequently occurs in cases of diffuse parathyroid hyperplasia. This must be considered especially in patient follow up and before each surgical procedure. Thus, a defined but adaptable therapeutic regimen might prevent permanent hypoparathyroidism and persistent hyperparathyroidism.

Calcium and inorganic phosphate in saliva of patients with primary hyperparathyroidism

Mean salivary concentrations of calcium and inorganic phosphate were found to be elevated in a group of patients with primary hyperparathyroidism. Normal values were obtained in groups of patients with idiopathic hypercalciuria or with idiopathic calcium stone formation. Hypercalciuria and hyperphosphaturia [1] are characteristic findings in primary hyperparathyroidism. In the present study we searched for a similar abnormality in the saliva of such patients. The saliva of patients with idiopathic hypercalciuria and those with idiopathic calcium nephrolithiasis was studied for comparison.

Diffusible Serum Calcium

To the Editor.— In a patient with proven hyperparathyroidism, who demonstrated normocalcemia for a 12-month period ( 210 :2063, 1969), repeated total serum calcium values were within the normal range of the reporting laboratory: 8.8 to 11.0 per 100 ml. Though hypercalcemia is considered to be the most constant finding in primary hyperparathyroidism, a few cases have been reported showing a normal serum calcium level. In 1935, McLean and Hastings suggested that ionized serum calcium value increases in hyperparathyroidism. Subsequent reports have indicated that ionized serum calcium level is elevated in cases of primary hyperparathyroidism even though the total serum calcium level may be normal. Ionized serum calcium level can be determined by biological techniques. When it is estimated from the nomogram described by McLean and Hastings, however, 14 out of 35 patients with proven primary hyperparathyroidism had ionized calcium levels within the normal range. Total serum calcium is a composite

Triangular cartilage calcification in the wrists: its incidence in elderly persons.

TRIANGULAR CARTILAGE CALCIFICATION IN THE WRISTS: ITS INCIDENCE IN ELDERLY PERSONSWYLIE J. DODDS, M.D. and HOWARD L. STEINBACH, M.D.Audio Available | Share

Acromioclavicular Changes in Primary and Secondary Hyperparathyroidism

The description of a roentgenologic finding as a presumptive sign is always a matter of general interest, and while no claim of infallibility is made for our observation, we have decided to report it in the hope that it will be checked and commented upon by other workers. We have observed this finding in several cases of hyperparathyroidism, both of the primary type and of the secondary type associated with chronic renal insufficiency (renal rickets, renal osteodystrophy, or osteonephropathy). In one case the observation of the sign in a routine chest film suggested the diagnosis to one of us (L. N.), and this was later confirmed by a roentgen survey of the skeletal system, biochemical analysis of the blood, and by the postmortem finding of a parathyroid adenoma. The bone findings in primary hyperparathyroidism (osteitis fibrosa cystica generalisata) and renal osteodystrophy (or renal rickets, as it is called in the older literature) have been adequately described elsewhere (3, 6, 13, and 14), and it is not our purpose to review them here except as they appear in our cases. We wish merely to call attention to changes which we have observed in the acromioclavicular articulations in these cases, consisting of cupping of the outer end of the clavicle, with fraying due to irregular absorption of the articular surface. Similar though less striking changes may be present in the articular surface of the acromion process, and there may or may not be widening of the acromioclavicular joint space. Although we have never observed an epiphysis in the outer end of the clavicle, nor have we seen one described, the changes simulate the metaphyseal cupping, fraying, and decalcification seen in vitamin D-deficiency rickets. The reason for the localization of these changes is not apparent, but presumably it is related to the activity of the shoulder and its associated joints. Grant (8) has described the motions about the acromioclavicular joint with movement of the scapula, and Oppenheimer (12) has demonstrated roentgenographically that there is motion in the acromioclavicular joint during all movements of the arm except pronation and supination. The latter writer stresses the importance of the joint function, stating that the mobility of the arm depends significantly on the mobility of the scapula, and that the mobility of the scapula in turn depends on the mobility of the shoulder girdle in the sternoclavicular and acromioclavicular joints. The following cases illustrate the changes described as they appear in the various types of hyperparathyroidism. The first case is one of renal osteodystrophy in association with congenital bladder neck obstruction leading to marked bilateral hydronephrosis and hydroureters, with severe impairment of renal function. Case 1: A white male, aged 16 years, was found to have had a congenital urinary defect at the age of five years, when he was investigated for polyuria and enuresis.