Mean Serum Parathyroid Hormone Research Articles

Application of mitoxantrone hydrochloride in lymph node imaging during radical thyroidectomy

Objective: To investigate the clinical application value of the new tracer mitoxantrone hydrochloride in imaging of cervical lymph nodes and identifying of parathyroid, recurrent laryngeal nerve during thyroid cancer radical surgery. Methods: A prospective controlled study was conducted between January 2022 and April 2024 at Tianjin First Central Hospital, recruiting 180 patients with thyroid cancer, including 54 males and 126 females, aged from 26 to 69 years. The patients were randomly divided into three groups: the mitoxantrone hydrochloride lymph node tracing group (MHI group), the nanocarbon lymph node tracing group (nanocarbon group), and the control group without lymph node tracers, with 60 cases in each group. All patients underwent total thyroid resection and regional lymph node dissection. The number of detected lymph nodes and positive metastatic lymph nodes and surgical field clarity scores and the identification rate of parathyroid glands and the instances of inadvertent excision were compared between the groups. Serum calcium and parathyroid hormone (PTH) levels at different perioperative time points and treatment-related complications were analyzed. One-way ANOVA, chi-square test and two independent sample non-parametric tests, were employed for statistical analyses. Results: The mean operation time, neck drainage volume and hospital stay in the MHI group and the nanocarbon group were respectively significantly lower than those in the control group (P<0.05). The mean staining intensity score, tracer success rate and surgical field clarity score in MHI group were respectively significantly higher than those in nanocarbon group (P<0.05). The mean numbers of dissected lymph nodes positive metastatic nodes and identification rates of parathyroid glands in MHI group were respectively significantly higher than those in both the nanocarbon and control groups (P<0.05). The rates of inadvertent parathyroid excision in both MHI group and nanocarbon group were significantly lower than those in control group (P<0.05). On postoperative day 1 and day 5, mean serum calcium and PTH levels in MHI group were respectively significantly higher than those in nanocarbon group and control groups. However, on postoperative day 1, there was no difference in mean serum calcium levels between the nanocarbon group and the control group (P>0.05), though PTH level in the nanocarbon group was higher than that in the control group. By postoperative day 5, both serum calcium and PTH levels were higher in the nanocarbon group compared to the control group (P<0.05). On postoperative days 30, there were no differences in serum calcium and PTH levels between the MHI group and the nanocarbon group (P>0.05). The risks of facial numbness, hand and foot tetany and choking during drinking were lower in both the MHI and nanocarbon groups compared to the control group (P<0.05). Conclusion: MHI demonstrates advantages in rapid targeted delivery and clear staining of the surgical field during regional lymph node dissection in radical thyroidectomy for thyroid cancer, effectively reducing the risk of collateral damage to the recurrent laryngeal nerve and parathyroid glands.

The retrospective clinical study of asymptomatic primary hyperparathyroidism

Objective: To summarize and analyze the diagnostic and therapeutic characteristics of asymptomatic primary hyperparathyroidism (aPHPT). Methods: A retrospective analysis was conducted on the clinical data of 103 patients with aPHPT admitted to the Chinese PLA General Hospital from January 2012 to September 2023. The clinical characteristics, treatment modes, and prognoses of the patients were analyzed. GraphPad Prism 8.0 software was used for statistical analysis. Results: Among the 103 cases, there were 37 males and 66 females, aged from 25 to 78 years, with an average age of (53.81±11.34) years. Ninety-eight cases (95.15%) visited due to abnormal findings during physical examination and 5 cases (4.85%) due to hypertension, diabetes or other diseases. All patients underwent minimally invasive parathyroidectomy with small incision, with 96 cases (93.20%) pathologically diagnosed as adenomas and 7 cases as hyperplasia (6.80%). Postoperative mean serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) levels were respectively significantly lower than preoperative levels, while postoperative serum phosphorus level was significantly higher than preoperative level (P<0.05). The mean lesion volume was (3.32±6.72)cm3 (range 0.05-49.50 cm3). Patients with different lesion volumes had significant differences in preoperative serum calcium, PTH and ALP levels. Lesion volume was positively correlated to preoperative serum calcium(ρ=0.36, P<0.01), PTH(ρ=0.50, P<0.01) and ALP(ρ=0.39, P<0.01). Among 103 patients, 94 cases were followed up (91.26%), 9 cases were lost (8.74%), and the mean follow-up period was (60.15±29.23) months. The followed-up patients were alive and had no recurrence of lesions or complications, and their blood calcium levels were normal. Conclusion: aPHPT can be preliminarily diagnosed through blood biochemistry and imaging examination, and minimally invasive surgery can offer good prognosis without serious complications.

Comparison of Serum Vitamin D Level between Outdoor and Indoor Working Professionals and Its Correlation with Serum Parathyroid Hormone Level

Background: Parathyroid hormone (PTH) is functionally linked to vitamin D for calcium homeostasis in our body. Objective: To compare serum vitamin D level between outdoor and indoor working professionals of Dhaka city, Bangladesh, and observe its correlation with serum PTH level. Methods: This cross-sectional, analytical study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh, from July 2018 to June 2019. A total of 101 indoor and outdoor professional workers of both sexes working in different sectors living in Dhaka city participated in this study. They were divided into two groups –outdoor workers (n=35) and indoor workers (n=66) Estimations of both serum vitamin D3 and PTH were done using chemiluminescence microparticle immunoassay method. Statistical analysis was done by students unpaired t tests and Pearson correlation coefficient test. Results: Among outdoor workers, mostly hailed from Traffic Police Services (83%) and the rest (17%). were street hawkers. Indoor workers were recruited from the hospital – nurses (32%), doctors (27%), administrative employees (21%), hospital ward assistants (12%) and medical technicians (8%). Sufficient and insufficient levels of serum D3 were observed more in outdoor professional workers than indoor (P&lt;0.05) whereas deficient levels of serum D3 was found more in indoor workers than outdoor workers (P&lt;0.001). Mean serum vitamin D3 level was found significantly (P&lt;0.001).higher in outdoor workers than that of indoor workers (19.35±5.67ng/ml vs. 14.17±4.18ng/ml) but mean serum PTH level was not significantly different (P&gt;0.05)r in outdoor workers than that of indoor workers (42.35±18.27 vs. 37.78±17.54); Moreover, there was no significant correlation between serum vitamin D and parathyroid hormone levels in both outdoor (r= +0.290; p &gt;0.05) and indoor (r= –0.206; p&gt;0.05) groups .Conclusion: Our data concluded that indoor working professionals were more prone to develop vitamin D deficiency although outdoor working professionals may be affected with vitamin D insufficiency. In addition, there may be no relationship between serum vitamin D and parathyroid hormone levels even in D deficient indoor workers. J Bangladesh Soc Physiol 2022;17(2): 78-84

Relationship Between Calcium and Vitamin D Level and Bone Stress Fracture in Young Athletes

Objective: To determine the association of vitamin D and serum calcium with stress fractures in young athletes. Methods: In this prospective case-control study, we included 160 young athletes who presented to the department of orthopedics, CMH Abbottabad from June-2022 to January-2023. Among those there were 80 patients who presented with stress fractures and 80 patients were those who presented with lower extremity fractures other than stress fractures. Serum calcium and vit. D levels were determined in all patients. Results: Mean age in patients with stress fractures (cases) was 20.3±6.1 years while those in control group was 21.7±8.4 years (p-value 0.22). Mean vit. D levels were significantly lower in cases group; 24.64±11.2 ng/mL versus 30.2±14.7 ng/mL in control group (p-value 0.007). Mean serum PTH levels were no statistically significantly different between the groups; 3.2±1.3 pmol/L versus 3.4±1.7 pmol/L in cases and control group respectively, p-value 0.40. Serum calcium levels in cases were lower; 1.9±0.8 mmol/L in comparison to control group; 2.1±0.7 mmol/L, with p-value 0.01. Conclusion: There is a significant association of serum calcium and vitamin D levels with stress fractures. So regular intake of vitamin D containing foods and milk products should be advised to young athletes to reduce the risk of stress fractures. Keywords: Stress fractures, Athletes, calcium, Vitamin D.

The preliminary study on cardiac structure and function in Chinese patients with primary hyperparathyroidism.

Recent evidences show that primary hyperparathyroidism (PHPT) patients have a high prevalence of cardiovascular diseases. However, the reported changes in cardiac status are inconsistent in previous studies. The present work evaluated the cardiac structure and function in PHPT patients by echocardiography. PHPT patients and age- and sex-matched healthy controls were enrolled in this case-control study. Biochemical parameters were retrospectively collected from PHPT patients. Cardiac function and structure were assessed in all subjects using echocardiography. A total of 153 PHPT patients and 51 age- and sex-matched healthy controls were enrolled in this study. The mean serum calcium and parathyroid hormone (PTH) levels in PHPT patients were 2.84 ± 0.28mmol/L and 206.9 (130.0, 447.5) pg/ml, respectively. Left ventricular ejection fraction (LVEF) and early to late mitral annular velocity (E/A) were significantly lower in PHPT patients than in healthy controls (68.2 ± 6.0 vs. 70.7 ± 16.7%, 1.0 ± 0.5 vs. 1.4 ± 0.5, respectively, p both < 0.05). The left ventricular mass index (LVMI) and the relative wall thickness (RWT) were not significantly different between the two groups. However, the difference in LVEF between PHPT patients without hypertension and diabetes and the control groups disappeared. The majority of PHPT patients had normal cardiac geometry; however, a proportion of them exhibited concentric remodeling (normal LVMI, RWT≥0.42). Serum calcium, corrected calcium, ionized calcium and PTH were inversely related to E/A, whereas serum phosphorus and 24-hour urine calcium were positively related to E/A. Furthermore, biochemical parameters were not correlated with LVEF. These findings demonstrate that PHPT patients exhibit diastolic cardiac dysfunction reflected by decreased E/A, as well as possible cardiac structural abnormalities. The serum calcium, phosphorus, and parathyroid hormone levels may influence cardiac structure and function.

Role of plasma calcium, phosphorus, alkaline phosphatase, and parathyroid ‎hormone in the prediction of vitamin D deficiency‎

Vitamin D deficiency is a highly prevalent medical condition associated with various clinical and biochemical outcomes although these outcomes might be absent in a significant percentage of patients. Altered serum calcium, phosphorus, parathyroid hormone and alkaline phosphatase activity are expected but not proven by many research. The current study aims to investigate the possibility of these biomarkers to be used as indicators of vitamin D deficiency or insufficiency. The study enrolled 150 randomly selected participants who have no acute or chronic medical condition with various levels of serum vitamin D ranging from normal to severely deficient. They were investigated for serum total calcium, phosphorus, parathyroid hormone and alkaline phosphatase activity. The results were statistically compared among the studied groups and correlated with serum vitamin D levels. There was no significant difference in mean serum calcium, phosphorus and alkaline phosphatase activity among the groups with poor correlation with vitamin D. Mean serum parathyroid hormone has shown a significant difference among the studied groups with a strong negative correlation with vitamin D. This difference was apparent even in patients with vitamin D insufficiency. Serum calcium, PO4 and ALP activity seem to have a poor correlation with vitamin D concentration. In addition, serum PTH might be considered a sensitive marker of both vitamin D deficiency and insufficiency.

Vitamin D Status in Pediatric Patients with Dilated Cardiomyopathy

Child heart failure is frequently brought on by dilated cardiomyopathy and it is characterized by impaired contraction and left ventricular or biventricular dilation. Evidence from recent years has demonstrated that vitamin D is crucial in a number of cardiovascular illnesses that are now more well recognized. This study evaluated vitamin D status in pediatric patients with dilated cardiomyopathy and compared it with that of healthy controls. This study is an observational case-control study, which included 23 patients with dilated cardiomyopathy aged less than 21 years of both genders, and a control group that included 45 healthy people who were matched for age, sex, and body mass index at the surgical specialty hospital-cardiac center in Erbil, Iraq. From each one, a blood sample was taken to evaluate the serum level of 25-hydroxyvitamin D3, parathyroid hormone, phosphorus, calcium, troponin I and creatin kinase-MB levels. The study revealed that the mean serum vitamin D3 level and mean serum calcium were significantly lower in dilated cardiomyopathy patients than controls, and significantly higher mean serum PTH and serum creatin kinase-MB in patients than controls. The difference in serum troponin I levels was not significant between the two groups. Furthermore, the study's outcomes revealed a substantial, moderately significant negative correlation between hypovitaminosis D and the dimensions of the left ventricle's end diastole and end systole in children with dilated cardiomyopathy

RF18 | PSAT165 Effect of Age, Gender, &amp; Ethnicity on the Prevalence of Vertebral fractures in Patients with Primary Hyperparathyroidism

Abstract Background Primary hyperparathyroidism (PHPT) is one of the known causes of secondary osteoporosis. PHPT is associated with increased bone turnover, low bone density and quality; but there have been conflicting results on the risk of fractures. There is limited information on the effects of age, gender, and ethnicity on fracture risk in PHPT. Objective To determine the prevalence of vertebral fractures (VFx) and associated risk factors in patients with PHPT Design: Retrospective cross-sectional study Setting: Academic medical center in a community setting Main outcome measured: 1) Bone mineral density (BMD), and T- and Z-scores of the lumbar spine (LS). 2) Vertebral morphometry was assessed using the Genant method to identify asymptomatic vertebral fractures (VFx) on CT spine images. 3) Biochemical measurements included serum PTH, Creatinine (Cr) and Calcium (Ca). Results In this retrospective study of consecutive 560 PHPT patients verified by surgery [447 women with a median age of 62y; 362 Caucasians (65%), 142 African Americans (AA, 25%) and 22 unspecified race (10%)] were included. Prevalence of VFx was 13% (n=75), other sites 15% (n=84), wrist fractures 3% (n=16) and hip fractures 1% (n=6). Fracture prevalence at all sites was higher in women, but significant only for VFx (71% vs 29%, p=0.04). In subgroup analysis by age (above or below 50y) and gender, there was no significant difference in LS BMD, T- or Z-score values, serum PTH, Ca and Cr in patients with and without VFx. In subgroup analysis by ethnicity: i) prevalence of all fractures was higher in Caucasians compared to AA and others ii) mean serum PTH (±SD) level was significantly higher in AA vs Caucasian patients with VFx (190 ± 124 vs 121 ± 57 pg/mL, p=0.03) and iii) no significant differences were noted in LS BMD, T-or Z-scores, serum Ca and Cr in patients with VFx. In multivariate analysis (age, serum Ca, PTH &amp;gt;100, and LS BMD) to predict risk of VFx in all patients, only age [OR 1.07, CI 1.03-1.11) and serum Ca [OR 1.7, CI 1.03–2.79] were significant factors. In women, multivariate analysis identified increasing age to be the only significant risk factor to predict risk of VFx. [OR 1.107, CI 1.03-1.12]. Conclusion Vertebral fractures (VFx) is more prevalent in comparison to wrist and hip fractures in patients with PHPT. Serum PTH is significantly higher in African American PHPT patients with VFx. Increasing age and serum calcium ≥11.1 mg/dL are significant predictors of VFx in PHPT patients. Presentation: Saturday, June 11, 2022 12:42 p.m. - 12:47 p.m., Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Clinical and Laboratory Findings by Serum Vitamin D Levels in Children with COVID-19.

The studies on children with COVID-19 are very limited. The aim of this study is to reveal the effect of serum 25-hydroxy vitamin D level on clinical and laboratory parameters. The study included 74 children (35 boys and 39 girls) diagnosed with COVID-19. The retrospective data were obtained from the file records of the patients. Seventy-four patients were divided into 3 groups (group 1, deficient; group 2, insufficient; and group 3, sufficient) according to their serum 25-hydroxy vitamin D levels. The mean age of all patients was 113.25 ± 64.55 months. The mean leucocyte count was substantially higher in group 3 compared to groups 1 and 2 (P = .05 and P = .002, respectively). The mean lymphocyte and platelet count in group 3 was remarkably higher than both groups 1 and 2 (P = .001 and P = .002; and P = .04 and P = .01, respectively). The mean serum parathyroid hormone concentration in group 1 was markedly higher than both groups 2 and 3 (P=.003 and P = .002, respectively) while the mean serum 25-hydroxy vitamin D level in group 1 was remarkably lower than both groups 2 and 3 (P=.001 and P=.001, respectively). Serum 25-hydroxy vitamin D concentrations were positively correlated with leucocyte, lymphocyte, and platelet counts (r=0.221, P=.05; r=0.396, P=.001; and r=0.249, P=.03, respectively) while there was a negative correlation with parathyroid hormone concentrations (r=-0,436, P=.001). This study suggests that COVID-19 has a benign course in children and that serum 25-hydroxy vitamin D concentration may have a role in the lymphocyte count.

Initial experience with 4DCT: Apt Choice for Parathyroid Localization?

Abstract Aims Optimal modality for pre-operative radiological parathyroid localization in primary hyperparathyroidism (PHPT) is controversial. Four-dimensional computed tomography (4DCT) is a newer imaging technique that can provide detailed anatomic information. We aimed to evaluate the performance of 4DCT as a localization tool for patients with PHPT. Methods Between 03/2018 and 05/2021, 121 patients were operated for primary hyperparathyroidism at our institution. 4DCT was used as a second line investigation in patients &amp;lt;60 years due to concerns about radiation. Electronic patient records including operation notes and pathology were reviewed. 80(66%) had 4DCT for localization. Results Mean age of the study population was 68.4 years (Range27–88). Mean tumour size on CT was 16.13mm (range 4–38). Mean serum calcium and PTH levels were 2.89mmol/L and 20.76pmol/L. 4DCT identified a lesion in 61 patients (sensitivity 76.2%) and correctly lateralized a pathological parathyroid in 58/61 patients (specificity 95.1%). Hyperplasia and smaller gland size were non-significantly associated with non-detection (p&amp;gt;0.05). Of the 61 patients with a positive 4DCT, 4 (6.5%) developed persistent disease – in two a lymph node/thyroid nodule was excised and two had multigland disease. In this study 4DCT correctly localized recurrent disease in 4 of 5 patients, and 12 of 15 patients with negative Sestamibi SPECT CT scan. Discussion 4DCT offers accurate localization of abnormal glands in first-time parathyroidectomy for PHPT. Advantages include simplicity and speed of scan. Using 4DCT for first-time localisation is changing conventional practice of ultrasound+sestamibi scanning. It may have an added role in localizing disease in recurrent HPT and in patients who have a negative nuclear scan.

Comparative Effectiveness of Dialysis Modality on Laboratory Parameters of Mineral Metabolism

Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are prevalent in patients undergoing maintenance dialysis. Yet, there are limited and mixed evidence on the effects of different dialysis modalities involving longer treatment times or higher frequencies on CKD-MBD markers. Methods: This cohort study used data from 132,523 incident dialysis patients treated with any of the following modalities: conventional thrice-weekly in-center hemodialysis, nocturnal in-center hemodialysis (NICHD), home hemodialysis (HHD), or peritoneal dialysis (PD) from 2007 to 2011. We used marginal structural models fitted with inverse probability weights to adjust for fixed and time-varying confounding and informative censoring. We estimated the average effects of treatments with different dialysis modalities on time-varying serum concentrations of CKD-MBD markers: albumin-corrected calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) using pooled linear regression. Results: Most of the cohort were exclusively treated with conventional in-center hemodialysis, while few were ever treated with NICHD or HHD. At the baseline, PD patients had the lowest mean and median values of PTH, while NICHD patients had the highest median values. During follow-up, compared to hemodialysis patients, patients treated with NICHD had lower mean serum PTH (19.8 pg/mL [95% confidence interval: 2.8, 36.8] lower), whereas PD and HHD patients had higher mean PTH (39.7 pg/mL [31.6, 47.8] and 51.2 pg/mL [33.0, 69.3] higher, respectively). Compared to hemodialysis patients, phosphate levels were lower for patients treated with NICHD (0.44 mg/dL [0.37, 0.52] lower), PD (0.15 mg/dL [0.12, 0.19] lower), or HHD (0.33 mg/dL [0.27, 0.40] lower). There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. Conclusion: In incident dialysis patients, compared to treatment with conventional in-center hemodialysis, treatments with other dialysis modalities with longer treatment times or higher frequency were associated with different patterns of serum phosphate and PTH. Given the recent growth in the use of dialysis modalities other than hemodialysis, the associations between the treatment and the CKD-MBD markers warrant additional study.

Calcium and Phosphate Homeostasis in Patients with Recurrent Nephrolithiasis

Objective: The aim of the study was to evaluate the Calcium (Ca) and Phosphate (Ph) homeostasis and their association with plasma 25(OH)2 vitamin D3 (VitD3) and parathyroid hormone (PTH) in patients with recurrent nephrolithiasis. Methodology: A cross-sectional involved 100 confirmed patients with renal stones (RS). Their serum levels of Ca, PTH, Ph, and VitD3 had assessed. Biochemical analysis of renal calculi and crystals had been investigated also. The summary measures had described as mean+/-SD for continuous variables and frequencies/percentage for nominal variables. The mean serum Ca, Ph, PTH, and VitD3 were (8.01±2.2mg/dl, 2.9±1.2mg/dl, 56.7±24.7pg/dl, and 7.03±4.2pg/ml), respectively. Results: Almost all patients (97%) had a positive history of the previous RS with a predominant family history in most instances (82%). There was a positive non-significant correlation between VitD3 with serum Ph and Ca. Whereas an inverse non-significant correlation between PTH with serum Ca and VitD3 had observed. Urinary crystals analysis revealed that uric acid represented 53% of the total crystals, followed by Ca-oxalate. Stone analyses revealed that around 3/4th of the cases had Ca-oxalate stone, followed by Ca-oxalate with uric acid, then Ca-phosphate and the least type was mixed stone types. Conclusion: There was a positive non-significant correlation between VitD3 with serum Ph and Ca. There was an inverse non-significant correlation between PTH with serum Ca and VitD3. Serum Ca, and Ph were non-significant predictors of renal stones and/or urinary crystals.

Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study

BackgroundThe occurrence of hypomagnesemia in patients with primary hyperparathyroidism (PHPT) has been noted previously; however, the association of hypomagnesemia and severity of primary hyperparathyroidism remains unknown. The present study aimed to evaluate the association of hypomagnesemia with biochemical and clinical manifestations in patients with PHPT.MethodsThis was a retrospective study conducted at a tertiary hospital. We obtained data from 307 patients with PHPT from January 2010 through August 2020. Data on demographics, history, laboratory findings, bone densitometry findings, and clinical presentation and complications were collected and were compared in normal magnesium group vs hypomagnesemia group.ResultsAmong the 307 patients with PHPT included in our study, 77 patients (33/102 [32.4%] males and 44/205 [21.5%] females) had hypomagnesemia. Mean hemoglobin levels in the hypomagnesemia group were significantly lower than those in the normal magnesium group in both males and females. In contrast, patients with hypomagnesemia had a higher mean serum calcium and parathyroid hormone than individuals with normal magnesium. The typical symptoms of PHPT, such as nephrolithiasis, bone pain/fractures, polyuria, or polydipsia, were more common in the hypomagnesemia group. In addition, patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis. Even after adjusting for potential confounders, including age, sex, body mass index, estimated glomerular filtration rate, and parathyroid hormone levels, these associations remained essentially unchanged.ConclusionBiochemical and clinical evidence indicates that patients with PHPT with hypomagnesemia have more severe hyperparathyroidism than those without hypomagnesemia. In addition, PHPT patients with hypomagnesemia had a higher prevalence of osteoporosis, anemia, and hypercalcemic crisis.

El valor de la gammagrafía paratiroidea en la detección de lesiones en pacientes con hiperparatiroidismo primario normocalcémico

ObjectivePrimary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases. Most of the patients with PHPT are asymptomatic, and only 20% of them become symptomatic with increasing levels of calcium. It has been reported that normocalcemic primary hyperparathyroidism (NPHPT) may be the incipient period of PHPT where calcium (Ca) levels are in normal range, and it may advance to overt PHPT. Early diagnosis of PHPT is important in order to prevent its complications. In this retrospective study, we aimed to evaluate the role of 99mTc-MIBI parathyroid scintigraphy on lesion detection in patients with NPHPT. Material and methodsThe parathyroid scintigraphy database was reviewed retrospectively in patients with PHPT. 117 patients who underwent 99mTc-MIBI scintigraphy were recruited to the study. Serum calcium level above 10.5mg/dl was considered as hypercalcemia. ResultsA total of 117 patients’ (female/male:98/19) mean serum PTH levels (mean±SD) were 149±97 pg/ml in normocalcemic group (Ca:9.6±0.6mg/dL, n:38) and 189±135 pg/ml in hypercalcemic group (Ca:11.4±0.6mg/dL, n:79) (p:0.072). The sex and ages were not different between the scintigraphy positive and negative groups, but the lesion detection rates with parathyroid scintigraphy were 42% in normocalcemic group and 81% in hypercalcemic group (p<0.0001). ConclusionsSeveral factors including serum Ca, the imaging protocol, existence of multiglandular disease, the size and MIBI biokinetics of the adenoma may influence lesion detectability in parathyroid scintigraphy. Although high serum Ca level is an important parameter in predicting its success, parathyroid scintigraphy remains a valuable diagnostic method even in patients with NPHPT.

Secondary Hyperparathyroidism, Bone Density and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Introduction: Although malabsorption of nutrients and changes in intestinal adipokines and gut hormones induced by Roux-en-Y gastric bypass (RYGB) are considerably different than sleeve gastrectomy (SG), little is known about the consequences on bone health resulted by these two procedures. Objective: to compare the prevalence of secondary hyperparathyroidism (SHPT), bone mineral density (BMD), bone turnover markers and serum leptin in obese patients undergoing RYGB and SG, according to the time of surgery and percent weight loss. Methods: we studied 117 patients (91% female, 51% RYGB, mean age 41.8 ± 6.7 years, mean time of surgery 4.3 ± 3.4 years) who were divided into two groups according to the surgical procedure adopted (SG vs. RYGB). They were evaluated at different times after surgery (1–2 years, > 2 and <5 years and ≥5 years) and according to the percentage of weight loss (10–20%, >20% and <40%, ≥40%). Anthropometric measurements, body composition and BMD, bone parameters (PTH, corrected serum calcium, 25OHD, alkaline phosphatase -AP, C-telopeptide - CTX), and biochemical tests were compared. Results: The prevalence of SHPT (PTH ≥ 65pg/ml) was 26%, higher in the RYGB vs. SG (35% vs. 17%, respectively, p = 0.039), despite no significant differences in serum 25OHD (28.5 ± 7.3 vs. 27.6 ± 7.7 ng/ml, p=0.519) and corrected serum calcium (9.8 ± 0.6 vs. 9.8 ± 0.5 mg/dl, p = 0.466) between the groups. Mean serum PTH, CTX and AP was higher in the RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/mL, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/mL; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/L, respectively). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. After 5 years of surgery, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151g/cm2, -8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267g/cm2, - 11.7%, p = 0.007). Mean serum leptin was lower in the RYGB group, when compared to SG (7.6 ± 5.8ng/mL vs. 14.0 ± 9.9, p = 0.001), with no correlation with BMD in any site. There were no significant differences between the RYGB and SG regarding the other metabolic parameters. Conclusion: We found a more deleterious effect of RYGB on bone health up to 5 years postoperatively in comparison with SG.

Relationship between the extent of central node dissection and parathyroid function preservation in thyroid cancer surgery.

The risk and effect of hypocalcemia following surgery of different magnitudes remains unclear. Thus, we assessed whether different extents of central lymph node dissection (CLND) and status of preserved parathyroid glands can influence parathyroid function in differentiated thyroid carcinoma (DTC) patients with initial surgical resection. Participants were categorized into 6 groups based on the extent of the surgical procedures, number of parathyroid glands preserved in situ, and parathyroid autotransplantation. The frequencies of hypocalcemia, serum calcium (Ca) levels, and parathyroid hormone (PTH) levels among the different groups were analyzed. The prevalence of hypocalcemia, number and status of parathyroid glands preserved in situ, and parathyroid autotransplantation were inversely related to extensive CLND (r=-0.18; P<0.05). The decrease of serum Ca and PTH was most severe on postoperative days (POD) 1-7. The incidence of hypocalcemia was higher in Group C than in Group B and A (P<0.05). The average postoperative serum Ca and PTH levels in Group C were significantly lower than group A on POD 1-7 (P<0.05). The incidence of hypocalcemia was obviously increased in Group D compared to Groups E and F (P<0.05). The mean serum Ca and PTH levels in Group D were significantly lower than in Group F (P<0.05), and the same results could be observed between Groups D and E (P<0.05). However, through parathyroid autotransplantation, there was no significant difference that could be found between Groups E and F on POD 1-7 (P>0.05). With the expansion of CLND scope, postoperative parathyroid function will be affected, increasing the risk of postoperative hypocalcemia. When at least 1-2 parathyroid glands were reserved in situ plus at least 1 parathyroid gland autotransplantation, there was little effect on postoperative parathyroid function.

Vitamin D and parathyroid hormone status in community-dwelling elderly patients with mild-to-moderate kidney impairment.

Evidence on vitamin D and parathyroid hormone (PTH) status in patients with early kidney impairment is limited. We aimed to determine the associations among kidney function, vitamin D, and PTH status in community-dwelling elderly patients with mild-to-moderate kidney impairment. Community-dwelling elderly patients were enrolled in this Institutional Review Board approved cross-sectional study. The eligibility criteria were as follows: age > 60years, no recent hospitalization within the past 12months, no conditions that affect vitamin D status including vitamin D supplementation, and eGFR > 30mL/min/1.73m2. Serum 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) levels were assessed. A total of 226 patients were enrolled. Data were expressed as mean ± SD. The mean serum 25(OH)D was 26.61 ± 10.44ng/mL and the mean serum PTH was 50.67 ± 22.67pg/mL. The prevalence of vitamin D deficiency [25(OH)D < 20ng/mL] and secondary hyperparathyroidism [PTH > 65pg/mL] were 25.3% and 18.1%, respectively. Patients with eGFR 30- < 60mL/min/1.73m2 had significantly higher prevalence of 25(OH)D < 20ng/mL (33.7% versus 19.4%, p < 0.05) than patients with eGFR ≥ 60mL/min/1.73m2. Multiple regression analysis showed independent negative association of serum PTH level with eGFR (mL/min/1.73m2, β: - 0.261, 95% CI [- 0.408, - 0.114]) and serum 25(OH)D (ng/mL, β: - 0.499, 95% CI [- 0.775, - 0.223], adjusted for possible confounders). The prevalence of vitamin D deficiency was higher in patients with eGFR 30 - < 60mL/min/1.73m2 than those with eGFR ≥ 60mL/min/1.73m2. Both decreased serum 25(OH)D levels and decreased eGFR were independently associated with increased serum PTH levels among these patients.

The value of parathyroid scintigraphy on lesion detection in patients with normocalcemic primary hyperparathyroidism

ObjectivePrimary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases. Most of the patients with PHPT are asymptomatic, and only 20% of them become symptomatic with increasing levels of calcium. It has been reported that normocalcemic primary hyperparathyroidism (NPHPT) may be the incipient period of PHPT where calcium (Ca) levels are in normal range, and it may advance to overt PHPT. Early diagnosis of PHPT is important in order to prevent its complications. In this retrospective study, we aimed to evaluate the role of 99mTc-MIBI parathyroid scintigraphy on lesion detection in patients with NPHPT. Material and methodsThe parathyroid scintigraphy database was reviewed retrospectively in patients with PHPT. 117 patients who underwent 99mTc-MIBI scintigraphy were recruited to the study. Serum calcium level above 10.5mg/dl was considered as hypercalcemia. ResultsA total of 117 patients (female/male:98/19) mean serum PTH levels (mean±SD) were 149±97pg/ml in normocalcemic group (Ca:9.6±0.6mg/dl, n:38) and 189±135pg/ml in hypercalcemic group (Ca:11.4±0.6mg/dl, n:79) (p:0.072). The sex and ages were not different between the scintigraphy positive and negative groups, but the lesion detection rates with parathyroid scintigraphy were 42% in normocalcemic group and 81% in hypercalcemic group (p<0.0001). ConclusionsSeveral factors including serum Ca, the imaging protocol, existence of multiglandular disease, the size and MIBI biokinetics of the adenoma may influence lesion detectability in parathyroid scintigraphy. Although high serum Ca level is an important parameter in predicting its success, parathyroid scintigraphy remains a valuable diagnostic method even in patients with NPHPT.

Prevalence and risk factors for postrenal transplant hyperparathyroidism: A cross-sectional study

Introduction: Chronic kidney disease (CKD) commonly results in secondary hyperparathyroidism. Even after a successful renal transplant, residual parathyroid overactivity persists. We studied its prevalence and risk factors in Indian patients. Patients and Methods: Patients who underwent renal transplantation in our unit from 2013 to 2019 and completed 3 months of the posttransplant period were included. We excluded patients with advanced allograft dysfunction and those on medications with the potential impact of divalent cations. A detailed history, physical examination, and laboratory parameters were obtained. Results: There were 110 subjects, of whom 78% were male. The mean age group was 38 ± 12 years. Chronic glomerulonephritis was the most common etiology of CKD (54%). Posttransplant vintage was 48 ± 44 months. The mean serum parathyroid hormone (PTH) level was 135 ± 176 pg/ml. Sixty-seven percent of them had raised serum PTH levels above 70 pg/ml. The patients were asymptomatic. Hypercalcemia and hypophosphatemia were rare. The mean 25 OH Vitamin D levels were low (23 ± 8 ng/ml) with 41% of the subjects showing either deficiency or insufficiency. Higher serum PTH levels were significantly associated with female sex, lower estimated glomerular filtration rate, and lower serum 25 OH Vitamin D levels. Serum parathormone levels were significantly negatively correlated with serum calcium (r 2 = −0.39. P = 0.0003) and Vitamin D levels (r 2 = −0.50. P = 0.002). Conclusions: Posttransplant hyperparathyroidism (PTHP) persists even after many years of normal allograft function. Hypercalcemia and hypophosphatemia are insensitive tests to identify the condition. Vitamin D deficiency has a strong correlation with PTHP.

Frailty syndrome in patients with chronic kidney disease at a dialysis Centre from Santander, Colombia

Background &amp; aims. Frailty syndrome, characterized by loss of functional reserves and vulnerability to acute stressors, conditionate a higher risk of adverse outcomes and mortality. Its prevalence is mainly high (65%) in patients with End Stage Kidney Disease, receiving renal replacement therapy. Methods. Cross-sectional study with a non-probabilistic sampling of adult patients with chronic kidney disease stage 5 that initiated renal replacement therapy at a dialysis centre from Santander, Colombia. The main objective was to estimate the prevalence of frailty syndrome and to describe the clinical and functional characteristics of the studied population. The frailty syndrome was defined through the FRAIL Questionnaire. Results. Sixty-six subjects were included. The median age was 65 years (IQR 58-69). 54.55% were frail. The median age in frail patients was higher than the one in non-frail (p = 0.019). The prevalence of frailty syndrome was higher in women than in men (p = 0.045). Frail patients had a higher Charlson comorbidity index (p =&lt; 0.01). The mean serum creatinine, parathyroid hormone (PTH), and albumin were lower in frail patients, with statistically significant differences. Conclusions. The prevalence of frailty in patients that initiate renal replacement therapy in Santander, Colombia, is similar to that reported in other latitudes. Although the FRAIL Scale is based on the self-report, it counts with studies that endorse its reproductivity. Albumin and creatinine serum levels are decreased in subjects with frailty syndrome, behaving as frailty biomarkers in our research.