Low Parathyroid Hormone Levels Research Articles

DISCORDANT CALCIUM AND PARATHYROID HORMONE WITH PRESUMED EPILEPTIC SEIZURES

Epileptic seizures are a neurological condition characterized by abnormal electrical activity in the brain, leading to involuntary and unpredictable movements, changes in consciousness, and other symptoms. The study's main objective is to find the discordant calcium and parathyroid hormone with presumed epileptic seizures. This study aims to investigate the association between discordant calcium and parathyroid hormone (PTH) levels and presumed epileptic seizures in a cohort of 200 patients. The study was conducted between June 2022 and December 2022. The study was conducted in collaboration with the neurology department. Patients admitted to the hospital with presumed epileptic seizures were included in the study. This study found that out % of the 200 patients who met the inclusion criteria, 65% had discordant calcium and PTH levels. Among these patients, 80% had low calcium and high PTH levels, while 20% had high calcium and low PTH levels. The logistic regression analysis showed a significant association between discordant calcium and PTH levels and presumed epileptic seizures (p<0.05). In conclusion, the results of this study suggest that abnormalities in calcium and parathyroid hormone (PTH) levels are not a major contributor to the development of epileptic seizures in most patients. While patients with hypocalcemia appeared to have a higher risk of seizures than those with normal calcium levels, most patients with hypocalcemia did not experience seizures.

#2600 INCIDENCE RATE, OUTCOMES, AND RISK FACTORS ASSOCIATED WITH COVID-19 INFECTION IN FULLY MRNA-VACCINATED HEMODIALYSIS PATIENTS

Abstract Background and Aims Despite the high efficacy of vaccines against coronavirus disease (COVID-19), some people continue to become infected with SARS-CoV-2 after vaccination. Older age, immunosuppression, and severe comorbidities are associated with the occurrence of COVID-19 and adverse outcomes in the general population of vaccinated patients. However, because of the above factors, hemodialysis (HD) patients may be at higher risk for postvaccination SARS-CoV-2 infection than the general population, and risk factors associated with COVID-19 in fully vaccinated HD patients have never been studied. The present study aimed to determine the incidence rate, outcomes, and risk factors for SARS-CoV-2 infection in fully vaccinated HD patients. Method In this multicenter case-control cohort study, we followed HD patients for 1 year after SARS-CoV-2 vaccination and compared incidence rates and outcomes of COVID-19 with unvaccinated patients selected by propensity score matching based on potentially confounding variables (age, diabetes, and dialysis vintage). Patients who had been fully vaccinated against COVID -19 with either Pfizer-BNT-162b2 or Moderna-mRNA-1273 vaccine and had at least one positive SARS-CoV-2 PCR test > 14 days after the second dose were defined as cases. Unvaccinated HD patients who had not been infected with COVID-19 before study enrollment and had at least one positive test thereafter were defined as controls. The outcomes studied were COVID-19-related hospitalizations, oxygen maintenance, and death. Demographic data and routine blood tests (the last measurements before COVID -19) were analyzed as possible risk factors for COVID -19 infection in vaccinated HD patients. Data were presented as incidence rate or proportion and compared with the chi-square (χ2) test. Univariate logistic regression analysis was used to determine risk factors for SARS-CoV-2 infection after vaccination and presented as odds ratio (OR) and 95% confidence interval (CI). Results Among a total cohort of HD patients (n = 327) aged 52 ± 9.4 years with a dialysis vintage of 44 (21-76.6) months, 133 (40.7%) HD patients were fully vaccinated. During the 12-month follow-up period, the incidence rate of SARS-CoV-2 infection was significantly lower in the vaccinated group compared with the matched unvaccinated group: 0.29 (95% CI 0.18; 0.42) vs 0.59 (95% CI 0.46; 0.74) per patient-year (p < 0.0001). Proportions of COVID-19-associated hospitalization (χ2 = 20.1, p < 0.0001), oxygen demand (χ2 = 27.8, p < 0.0001), and death (χ2 = 7.6, p = 0.004) were also significantly lower in the case group compared to unvaccinated matched controls. In risk factor analysis, older age, obesity, dialysis duration of more than 5 years, arterial hypertension, elevated C-reactive protein, anemia, and low levels of parathyroid hormone and high-density lipoprotein cholesterol were associated with postvaccination SARS-CoV-2 infection (Fig. 1). Conclusion Vaccinated HD patients had a significantly lower incidence of SARS-CoV-2 infection and associated adverse outcomes compared to the unvaccinated group. HD patients aged ≥ 65 years with Kt/V <1.2, obesity, dialysis duration of more than five years, arterial hypertension, elevated C-reactive protein, and low levels of hemoglobin, parathyroid hormone, and high-density lipoprotein cholesterol had a higher risk of infection following vaccination.

Paricalcitol and Extended Release Calcifediol for Treatment of Secondary Hyperparathyroidism in Non-Dialysis Chronic Kidney Disease: Results From a Network Meta-Analysis.

Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD) affecting mineral and bone metabolism and characterized by excessive parathyroid hormone (PTH) production and parathyroid hyperplasia. The objective of this analysis was to compare the efficacy and adverse effects of extended release calcifediol (ERC) and paricalcitol (PCT) by assessing their effect on biomarkers PTH, calcium and Phosphate in patients with non-dialysis CKD (ND CKD). A systematic literature research (SLR) was performed in PubMed to identify randomized control trials (RCTs). Quality assessment was done with the GRADE method. The effects of ERC vs PCT were compared using random effects in a frequentist setting. Nine RCTs comprising 1426 patients were included in the analyses. The analyses were performed on two overlapping networks, due to non-reporting of outcomes in some of the included studies. No head-to-head trials were identified. No statistically significant differences in PTH reduction were found between PCT and ERC. Treatment with PCT showed statistically significant increases in calcium compared to ERC (0.2 mg/dl increase, 95% CI: -0.37 to -0.05 mg/dl). No differences in effects on phosphate were observed. This NMA showed that ERC is comparable in lowering PTH levels vs PCT. ERC displayed avoidance of potentially clinically relevant increases in serum calcium, offering an effective and well tolerated treatment option for the management of SHPT in patients with ND CKD.

A-207 IMPACT OF THE USE OF AUTOFLUORESCENCE FOR DETECTION OF PARATHYROID GLANDS DURING THYROIDECTOMY: A RANDOMISED CONTROLLED TRIAL

Abstract Background Hypoparathyroidism is the most frequent complication to thyroid surgery. Recently techniques for auto fluorescence have been introduced in order to visualise and protect the parathyroid glands during surgery. Only a few randomised controlled trials have been reported. Methods A multi-center randomised controlled trial to investigate the use of FluobeamÒLX to visualise the parathyroid glands during first time surgery with total thyroidectomy compared to no use. There was no restriction in the indication for thyroid surgery. The primary endpoint was the rate parathyroid hormone (PTH) levels below the lower reference limit the day after surgery. Results Some 486 patients were randomised to the use of FluobeamÒLX (n=246) or controls (n=240). Mean age was 51 (s.d. 15) years and 389 (80.0 per cent) were women. The rate of low levels of PTH on the first postoperative day was 64 (26.0 per cent) in the FluobeamÒgroup and 77 (32.1 per cent) in the control group (p=0.141). Sub-analysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18.3 per cent) patients in the FluobeamÒgroup and 31 of 92 (33.7 per cent) in the control group (p=0.021) had low levels of PTH the day after surgery. Conclusion The use of auto-fluorescence to detect parathyroid glands during thyroidectomy did not reduce the rate of low PTH levels at postoperative day one significantly. However, it was beneficial in sub-groups of patients.

The Association Between Environmental Cadmium Exposure and Parathyroid Hormone Levels.

Cadmium exposure is associated with renal dysfunction and bone damage. Chronic kidney disease and bone loss are also related to parathyroid hormone (PTH). However, whether cadmium exposure affect PTH level is not completely understood. In this study, we observed the association between environmental cadmium exposure and PTH levels in a Chinese population. A ChinaCd study was performed in China in 1990s which included 790 subjects living in heavily, moderately and low cadmium polluted area. 354 of them (121 men and 233 women) also had the data of serum PTH. The cadmium levels in blood (BCd) and urine (UCd) were determined by flame atomic absorption spectrometry. Serum PTH was detected by immunoradiometric assay. Renal function was assessed based on urinary N-acetyl-β-d-glucosaminidase (UNAG), β2-microglobulin (UBMG) and urinary albumin (UALB). The median BCd and UCd levels were 4.69 μg/L and 5.50 μg/g creatinine. The BCd, UCd, UNAG, UBMG and UALB levels in subjects with low PTH (< 5.0 ng/L) were significantly higher than those with PTH ≥ 5.0 ng/L (p < 0.05 or p < 0.01). Spearman correlation analysis also showed that UCd level was negatively correlated to PTH levels (r = -0.17, p = 0.008)in women. A weak correlation was also observed between PTH level and BCd in women (r = -0.11, p = 0.09) and UBMG in total population(r = -0.114, p = 0.07). Univariable and mutivariable logistic regression analysis both demonstrated that high BCd (> 10 μg/L) (odds ratio (OR) = 2.26, 95% confidence interval (CI):1.10-4.63; OR = 2.36, 95%CI: 1.11-5.05) and UCd level (> 20 μg/g cr) (OR = 2.84, 95% CI:1.32-6.10; OR = 2.97, 95%CI: 1.25-7.05) were associated with high risk of low PTH. Our data showed that environmental cadmium exposure was associated with low PTH level.

Abstract #1393925: An Interesting Case of Bisphosphonate Resistant Hypercalcemia in Acute Myelogenous Leukemia (AML)

Hypercalcemia of malignancy (HCM), a PTH-independent process, usually occurs in solid tumors, multiple myeloma, and occasionally lymphomas. It generally results from excess secretion of parathyroid hormone related protein (PTHrP) by the tumor, osteolytic metastases, or rarely, tumor production of 1,25-(OH)2 vitamin D. We present an unusual case of HCM in a patient with refractory acute myelogenous leukemia (AML) without a defined mechanism that was resistant to bisphosphonate therapy. A 49-year-old woman with refractory AML presented acutely with altered mental status, decreased appetite, nausea, and fatigue. She was found to have HCM with a low intact parathyroid hormone (PTH) level. Her PTHrP and 25-(OH) vitamin D levels were normal, and her 1,25-(OH)2 vitamin D level was suppressed. Other labs were unrevealing, and imaging showed no new osseous lesions. Her hypercalcemia was treated with normal saline, intravenous furosemide, calcitonin, and two doses of pamidronate. Her calcium level normalized but then rebounded and remained elevated despite pamidronate therapy. Denosumab was considered, but due to rapid clinical deterioration, the patient’s family pursued comfort care. AML is an extremely rare cause of HCM. This is the eighth reported case of AML-related HCM since 2000 and the first known case with bisphosphonate resistance. Our patient’s HCM was not explained by typical mechanisms. Based on similar cases, one plausible mechanism for our patient's hypercalcemia was upregulation of receptor activator of nuclear factor κB ligand (RANKL) on osteoblasts due to elevated proinflammatory cytokines. RANKL binds to receptor activator of nuclear factor κB (RANK) on osteoclasts to promote their maturation and thus bone resorption. Regarding treatment, several case reports have demonstrated that denosumab can successfully treat bisphosphonate resistant HCM and is a potential therapeutic option.

Severe hypercalcemia in elderly patient with asymptomatic pulmonary tuberculosis: a case report

Hypercalcemia presents itself as a challenging disorder in clinical practice, with hyperparathyroidism and malignancies accounting for 90% of the causes. The case report describes a married 78-year-old white rural male worker with low level of education. Given the social isolation brought on by the COVID-19 pandemic, the patient initially received antidepressants for a history of adynamia, muscle weakness, and inappetence for a year. Four months before admission, he had an aggravation of the clinical picture, presenting mental confusion, and becoming dependent for all daily life activities. He was hospitalized with adynamia and intense fatigue, muscle weakness, inappetence with weight loss, splenomegaly and severe hypercalcemia (15.9 mg/mL; corrected by serum albumin - reference value: 8.8 to 10.3 mg/dL) and low parathyroid hormone level. This is a rare case of severe hypercalcemia in an elderly patient with asymptomatic pulmonary tuberculosis with late diagnosis and renal impairment, possibly aggravated by hypercalcemia.

Evaluation of T helper17 as skeletal homeostasis factor in peripheral blood mononuclear cells and T helper cells of end-stage renal disease cases with impaired parathyroid hormone.

Chronic renal failure is mainly connected with high and low parathyroid hormone (PTH) levels and immunological impairments. The present study aimed to evaluate T helper 17 (Th17) cells as a crucial modulator of the immune system and skeletal homeostasis in hemodialysis patients with impaired intact PTH (iPTH). In this research, blood samples were taken from ESRD patients with high (> 300 pg/mL), normal (150-300 pg/mL), and low (< 150 pg/mL) serum intact parathyroid hormone (iPTH( levels (n = 30 in each group). The frequency of Th17 (CD4+ IL17+) cells was evaluated by flow cytometry in each group. The expression levels of Th17 cell-related master transcription factors, cytokines in peripheral blood mononuclear cells (PBMC), and Th cells, and the level of the mentioned cytokines were determined in the supernatant of PBMCs. The number of Th17 cells remarkably increased in subjects with high iPTH against low and normal iPTH. Also, RORɣt and STAT3 levels were significantly higher in high iPTH ESRD patients than in other groups in the expression of mRNA and protein levels. These findings are confirmed by evaluating the IL-17 and IL-23 in the supernatant of cultured PBMCs and isolated Th cells. Our findings indicated that increased serum PTH levels in hemodialysis cases may be involved in increasing the differentiation of CD4 + cells to Th17 cells in PBMC.

Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial.

The purpose of this single-blinded, 2-centre, randomized controlled trial was to test if near-infrared (NIR) autofluorescence image guidance for parathyroid gland (PG) detection during total thyroidectomy can reduce the incidence of hypoparathyroidism in both malignant and benign cases. Patients admitted for primary or completion total thyroidectomy were randomized to either the NIR intervention group or the standard care NONIR (no near infrared) group. The primary endpoint was the rate of hypoparathyroidism at the 3-month follow-up, defined as hypocalcemia and inappropriately low parathyroid hormone levels and/or continuous treatment with active vitamin D. The secondary endpoint was the PG identification rate. A total of 147 patients were included of whom 73 were allocated to NIR. Primary or completion thyroidectomy was conducted in 84 and 63 cases, respectively. A total of 130 completed 3months follow-up. Postoperative hypoparathyroidism in the NIR group at 12h, 1month and 3months was, respectively, 31.8, 14.1, 6.5% compared with 35.9, 18.9, 11.8% in the NONIR group (all p > 0.46). In the NIR group, the identification rate of PGs was 69.5% (146 of 210 PGs), and 9% (19 of 210 PGs) were identified only due to additional use of NIR. For 15 out of 69 patients (21.7%) additionally PGs was found. Hypoparathyroidism was nominally less frequent in the NIR group, although not statistically significant. Further studies are needed to confirm if NIR may be a supportive PG identification tool to minimize the number of PG which would have been otherwise missed, especially during more complicated thyroid procedures. ClinicalTrials.gov: NCT04193332. Registration date: 16.08.2019.

A Curious Case of Hypervitaminosis D-related Hypercalcemia

Abstract Hypercalcemia can manifest with various symptoms and poses diagnostic challenges due to its multifactorial etiology. This case highlights a 74-year-old patient with hypercalcemia of complex origin. The patient had a history of chronic liver disease, chronic kidney disease, and a previous episode of hypercalcemia associated with excessive oral Vitamin D intake. On admission, the patient presented with disorientation and increased drowsiness. Further evaluation revealed persistently high serum calcium levels, low parathyroid hormone levels, and elevated levels of Vitamin D. Investigations identified a duodenal nodule with multiple lymph node enlargement, suggesting a malignancy as the underlying cause. Other potential factors contributing to hypercalcemia, such as a granulomatous disease, prolonged immobilization, and a deactivating mutation of the 24-hydroxylase gene (CYP24A1), were also considered. Despite interventions, including hemodialysis and denosumab administration, the patient’s condition deteriorated due to sepsis and hypotensive shock, ultimately resulting in death. This case emphasizes the importance of considering multiple etiologies in cases of hypercalcemia in the elderly and the challenges involved in managing severe symptomatic hypercalcemia. Medical professionals must employ sound clinical reasoning and comprehensive diagnostic approaches to accurately identify and address the underlying cause. Hemodialysis may be necessary in refractory cases to achieve serum calcium normalization.

Parathyroid Carcinoma with Low Values of Elevated Parathyroid Hormone: A Case Report

Parathyroid Carcinoma (PC) is a rare endocrine malignancy, accounting for &lt;1% of sporadic Primary Hyperparathyroidism (PHPT) cases. A preoperative and even intraoperative diagnosis of PC is rarely reported due to its close resemblance to parathyroid adenoma with respect to symptoms- hypercalcaemia, renal stones and/or failure, osteoporosis, and cardiac/neurocognitive dysfunction. The mean serum calcium in PC is reported to be greater than 14 mg/dL along with serum Parathyroid Hormone (PTH) levels often above 1000 pg/mL. When serum PTH levels are 10 times the upper limit of the normal, it is considered diagnostic of PC. Surgical en-bloc resection without capsular breach is the only definitive cure for PC. The present case report included two patients who presented with features of single parathyroid glandular enlargement, hypercalcaemia, its consequences and with normal ionised calcium, but relatively low levels of elevated serum PTH (&lt;300 pg/mL). They were operated and identified postoperatively as having PC. This rare presentation of PC where the preoperative serum PTH values were lower than usually seen in carcinoma, should alert endocrinologists and surgeons that lower levels of elevated serum PTH do not primarily exclude the possibility of carcinoma.

Perioperative outcomes in children with Hashimoto's thyroiditis undergoing total thyroidectomy

BackgroundHashimoto's thyroiditis (HT) affects 1–2 % of the pediatric population. In adults with HT, thyroidectomy is considered challenging and prone to postoperative complications due to the chronic inflammatory process. However, the complications of thyroidectomy among children with HT have not been established. The objective of our study was to evaluate whether children with HT undergoing total thyroidectomy for presumed thyroid cancer have higher complication rates than children without HT. MethodsA retrospective cohort study of children who underwent total thyroidectomy by high-volume pediatric otolaryngologists between 2014 and 2021. Results111 patients met inclusion criteria, 15 of these were diagnosed with HT preoperatively. Operative time and length of admission were similar among the groups. Postoperatively, patients with HT were more likely to have low levels of parathyroid hormone (60 % vs 26 %, p = 0.014) and transient hypocalcemia compared to non-HT patients, present with symptomatic hypocalcemia (67 % vs 27 %, p = 0.006), demonstrate EKG changes (20 % vs 6.3 %, p = 0.035) within 24 h of surgery, and to require both oral and intravenous calcium supplements (80 % vs 35 %, p = 0.001 and 60 % vs 22 % p = 0.004 respectively). Persistent hypocalcemia at 6 months follow-up, and recurrent laryngeal nerve paralysis rates were similar between groups. Parathyroid tissue was found in the thyroid specimen of 9 (60 %) HT patients vs 34 (35 %) non-HT patients (p = 0.069). ConclusionsThe risk of permanent complications among children with HT following thyroidectomy is low. However, patients with HT are more likely to develop symptomatic transient hypocalcemia and to require oral and intravenous calcium supplements in the immediate post-operative period compared to non-HT patients. Tailoring a perioperative treatment protocol to optimize calcium levels may be considered for children with HT.

Lithium induced hypercalcemia: an expert opinion and management algorithm

BackgroundLithium is the gold standard prophylactic treatment for bipolar disorder. Most clinical practice guidelines recommend regular calcium assessments as part of monitoring lithium treatment, but easy-to-implement specific management strategies in the event of abnormal calcium levels are lacking.MethodsBased on a narrative review of the effects of lithium on calcium and parathyroid hormone (PTH) homeostasis and its clinical implications, experts developed a step-by-step algorithm to guide the initial management of emergent hypercalcemia during lithium treatment.ResultsIn the event of albumin-corrected plasma calcium levels above the upper limit, PTH and calcium levels should be measured after two weeks. Measurement of PTH and calcium levels should preferably be repeated after one month in case of normal or high PTH level, and after one week in case of low PTH level, independently of calcium levels. Calcium levels above 2.8 mmol/l may require a more acute approach. If PTH and calcium levels are normalized, repeated measurements are suggested after six months. In case of persistent PTH and calcium abnormalities, referral to an endocrinologist is suggested since further examination may be needed.ConclusionsStandardized consensus driven management may diminish the potential risk of clinicians avoiding the use of lithium because of uncertainties about managing side-effects and consequently hindering some patients from receiving an optimal treatment.

Recurrent seizures as manifestation of hypoparathyroidism-related hypocalcemia in a patient with post-subtotal thyroidectomy

Background: Hypocalcemia, a condition where the serum calcium concentration or total serum calcium is below normal, could be associated with various manifestations including severe symptoms requiring immediate hospitalization. The condition can cause by several causes including iatrogenic thyroidectomy. Here, we report a patient of hypocalcemia associated with hypoparathyroidism due to post-thyroidectomy. Case presentation: A 32-year-old woman admitted to the hospital complained of stiffness and tingling in the extremities accompanied by recurrent seizures. The serum calcium level was low and this hypocalcemia condition was associated with low parathyroid hormone levels after subtotal thyroidectomy surgery. Laboratory examination indicated calcium 4.8 mg/dL and parathyroid hormone 2.21 pg/ml. The patient had bradycardia with prolonged QT on electrocardiography (ECG) and developed cataracts in both eyes which could be associated with chronic hypocalcemia. The patient's condition improved after correction of hypocalcemia. After discharge, the patient was given calcium and levothyroxine supplementation due to hypothyroid conditions. Conclusion: The hypocalcemia condition in the patient was associated with low parathyroid hormone level post-subtotal thyroidectomy surgery. This case highlights the impotence of detailed analyses of hormonal, radiological and histological investigations of patients with thyroid gland diseases to diagnose such conditions early and to ensure timely management.

The calcium-sensing receptor in inflammation: Recent updates.

The Calcium-Sensing Receptor (CaSR) is a member of the class C of G-proteins coupled receptors (GPCRs), it plays a pivotal role in calcium homeostasis by directly controlling calcium excretion in the kidneys and indirectly by regulating parathyroid hormone (PTH) release from the parathyroid glands. The CaSR is found to be ubiquitously expressed in the body, playing a plethora of additional functions spanning from fluid secretion, insulin release, neuronal development, vessel tone to cell proliferation and apoptosis, to name but a few. The present review aims to elucidate and clarify the emerging regulatory effects that the CaSR plays in inflammation in several tissues, where it mostly promotes pro-inflammatory responses, with the exception of the large intestine, where contradictory roles have been recently reported. The CaSR has been found to be expressed even in immune cells, where it stimulates immune response and chemokinesis. On the other hand, CaSR expression seems to be boosted under inflammatory stimulus, in particular, by pro-inflammatory cytokines. Because of this, the CaSR has been addressed as a key factor responsible for hypocalcemia and low levels of PTH that are commonly found in critically ill patients under sepsis or after burn injury. Moreover, the CaSR has been found to be implicated in autoimmune-hypoparathyroidism, recently found also in patients treated with immune-checkpoint inhibitors. Given the tight bound between the CaSR, calcium and vitamin D metabolism, we also speculate about their roles in the pathogenesis of severe acute respiratory syndrome coronavirus-19 (SARS-COVID-19) infection and their impact on patients' prognosis. We will further explore the therapeutic potential of pharmacological targeting of the CaSR for the treatment and management of aberrant inflammatory responses.

The value of intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and varying baseline parathyroid hormone levels.

When applying intraoperative parathyroid hormone monitoring (IOPTH) to patients with primary hyperparathyroidism (PHPT), there are established criteria predicting biochemical cure in patients with basal parathyroid hormone (PTH) levels in the medium range (100-400 pg/ml); however, there is a challenge concerning patients with low (less than 100 pg/ml) or high (more than 400 pg/ml) basal PTH levels. The aim of this study was to investigate the value of the 'Vienna criterion' applied during IOPTH in patients with PHPT and various basal PTH concentrations. Consecutive patients between 1999-2009 with a biochemical diagnosis of PHPT who underwent surgical parathyroidectomy were included. Based on preoperative PTH levels they were divided into three groups: group 1 (low) (<100 pg/ml), group 2 (medium) (100-400 pg/ml) and group 3 (high) (>400 pg/ml) basal PTH. PTH was measured at the start of the operation, when the gland was excised and then at 5, 10 and 15 min after. Calcium and PTH levels were measured at 7 days and 12 months postoperatively. Sensitivity, specificity, positive and negative predictive value, as well as accuracy of IOPTH were calculated for the different groups postoperatively. 675 patients with PHPT were analysed. Sensitivity and specificity were 83.7 per cent and 66.7 per cent in group 1 (n = 187), 90.7 per cent and 69.2 per cent in group 2 (n = 433), and 94.4 per cent and 100 per cent in group 3 (n = 55) to predict cure. Preoperative creatinine (p = 0.002) showed significant statistical difference between the groups but was not related to intraoperative PTH decline. At 12 months follow-up normocalcaemia was documented in 98.9 per cent in group 1, 99.0 per cent group 2, and 98.0 per cent of group 3 patients. Normocalcaemia was predicted intraoperatively by applying the 'Vienna criterion' in 98 to 100 per cent and was confirmed after 12 months follow-up in up to 99.0 per cent of patients. Low specificity and a high false-negative rate in patients with low basal PTH show that other criteria might be better suited for this group.

COVID-19 clinical outcomes and risk factors in fully vaccinated hemodialysis patients: A single-center prospective cohort study

Hemodialysis patients (HD) are at high risk for coronavirus infection (COVID-19) and associated adverse outcomes compared with the general population. Although vaccination against SARS-CoV-2 has played an important role in stemming the spread of COVID-19 in the general population, the characterization of vaccine efficacy in dialysis patients is based primarily on humoral responses, whereas clinical data are generally not available. The aim of this study was to determine the incidence of COVID-19, clinical outcomes, and risk factors for SARS-CoV-2 infection in fully vaccinated HD patients.&#x0D; Methods. Of 186 HD patients treated at Link-Medital LLC Medical Center (Odesa, Ukraine) between March 2020 and March 2022, 170 patients aged 53.5 (44-63.5) years were enrolled in this prospective observational cohort study and followed up one year after completion of vaccination. Among them were 67 (39.4%) HD patients who were fully vaccinated against COVID-19 with BNT162b2 (Pfizer-BioNTech) or Moderna-mRNA-1273 mRNA vaccines and 103 (60.6%) unvaccinated HD patients. The outcomes assessed were COVID-19 morbidity and severity, hospitalization, and death associated with COVID-19.&#x0D; Results. During the 12-month follow-up, nearly half of 83/170 (48.8%) patients became infected with SARS-CoV-2, including 18/67 (26.7%) vaccinated patients and 65/103 (63.1%) unvaccinated patients (χ2 = 10.8; p = 0.001). The incidence rate of COVID-19 was 27 (95% CI 16, 42) in vaccinated patients at our center and 63 (95% CI 49, 80) per 100 patient-years (p = 0.001) in unvaccinated patients.&#x0D; Cox proportional hazards regression analysis showed that vaccinated HD patients had a statistically significant lower risk of hospitalization [HR = 0.2 (95%CI 0.1;0.4)] and need for oxygen support [HR = 0.19 (95%CI 0.09; 0.38)] compared with unvaccinated patients. Kaplan-Meyer analysis of COVID-19-associated mortality demonstrated a significantly higher survival of vaccinated HD patients compared with unvaccinated (χ2 = 4.6, log-rank p = 0.03).&#x0D; Further multivariate logistic analysis showed that age over 65 years, obesity, low adequacy of HD and duration of more than 5 years, anemia, low levels of parathyroid hormone (PTH) and high-density lipoprotein cholesterol (HDL-C), elevated CRP, arterial hypertension, and other cardiovascular diseases (CVD) significantly increased the risk of SARS-CoV-2 infection in fully vaccinated HD patients.&#x0D; Conclusions. Vaccination against COVID-19 is associated with a reduction in morbidity, hospitalization rates, and mortality in HD patients. Age over 65 years, obesity, low adequacy of HD and its duration of more than 5 years, anemia, low PTH and HDL-C levels, elevated CRP, arterial hypertension, and other CVDs significantly increased the risk of SARS-CoV-2 infection in fully vaccinated HD patients.

Level of parathyroid hormone in the early postoperative period as a prognostic factor for persistent manifestations of clinical hypocalcemia

Objective — to determine the level of parathyroid hormone (PTH) in the early postoperative period in patients after the thyroid gland surgery, which enables to define the risk of persistent postoperative hypoparathyroidism with clinical manifestations of hypocalcemia.&#x0D; Materials and methods. The study involved 303 patients who were operated in the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organ and Tissue due to various thyroid pathologies in the period of January, 2020 through June, 2021. The scope of the operation was thyroidectomy with/without lymph node dissection. The PTH level in blood serum was determined for all patients in the morning after the surgery (16 — 22 hours later). Clinical signs of hypocalcemia due to hypoparathyroidism (PTH level &lt; 15 pg/ml) were revealed in 147 (48.5 %) subjects. Moving forward, such patients were examined for blood serum PTH levels after 3 months (first stage of examinations) and 6 months (second stage of examinations).&#x0D; Results. After 3 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 126 patients (85.7 %); 21 patients (14.3 %) had low PTH levels (&lt; 15 pg/ml) with clinical manifestations of hypocalcemia. The use of ROC‑analysis to predict the normalization of PTH levels after 3 months revealed the cut‑off threshold 2.8 pg/ ml. After 6 months, normalization of PTH levels and no clinical hypocalcemia manifestations were defined in 136 (92.5 %) patients, whereas 11 (7.4 %) subjects demonstrated the reduced PTH levels and clinical manifestations of hypocalcemia. Results of ROC‑analysis prediction of the normalization of PTH levels after 6 months post‑surgery, the cut‑off threshold 1.6 pg/ml.&#x0D; Conclusions. Postoperative PTH levels &gt; 2.8 pg/ml after 3 months after surgery and &gt; 1.6 pg/ml after 6 months established to be a predictor of normalization serum PTH levels. A PTH level &lt; 1.6 pg/ml can be considered a predictor of persistent hypoparathyroidism, and allows the physician to recognize patients with possible long‑term specific treatment.

Relationship between serum parathyroid hormone levels and abdominal aortic calcification in patients starting hemodialysis who have never taken calcium tablets, calcitriol, or vitamin D analogs

Background Vascular calcification (VC) and secondary hyperparathyroidism (SHPT) are important causes of the high incidence of cardiovascular events in chronic kidney disease (CKD) patients. The relationship between parathyroid hormone (PTH) and VC is very complex. The aim of this study was to determine the correlation between PTH levels and abdominal aortic calcification (AAC) in patients starting hemodialysis who had not received calcium tablets, calcium-containing phosphorus binders, calcitriol, or vitamin D analogs. Methods Seventy-one patients were included. Latero-lateral X-ray lumbar radiography, serum intact PTH (iPTH) levels, and predialysis biochemical parameters were obtained. The degree of AAC was evaluated according to the methods described previously by Kauppila et al. Results We found that there was a strong negative correlation between serum PTH and AAC (Spearman’s rho −0.76, p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that low serum PTH level could predict the presence and extent of AAC (area under the curve values were 0.9013 [p < 0.0001] and 0.780 [p = 0.0041], respectively). Conclusions Our results indicate that serum PTH level is significantly negatively correlated with AAC within a certain concentration range in patients starting hemodialysis who had not received calcium tablets, calcium-containing phosphorus binders, calcitriol, or vitamin D analogs.

Autosomal dominant hypocalcemia with a novel CASR mutation: a case study and literature review.

Autosomal dominant hypocalcemia type 1 (ADH1) is a rare inherited disorder characterized by hypocalcemia with low parathyroid hormone (PTH) levels and high urinary calcium. Its clinical presentation varies from mild asymptomatic to severe hypocalcemia. It is caused by gain-of-function mutations in the calcium-sensing receptor gene (CASR) which affect PTH secretion from the parathyroid gland and calcium resorption in the kidney. Here, we describe a case who presented with symptoms of recurrent seizure caused by hypocalcemia with a novel CASR variant. We comprehensively analyzed the phenotypic features of this presentation and reviewed the current literature to better understand clinical manifestations and the genetic spectrum.