Parathyroid Adenoma Weight Research Articles

Vitamin D status and parathyroid adenoma weight in patients with primary hyperparathyroidism

Vitamin D status and parathyroid adenoma weight in patients with primary hyperparathyroidism

Correlation between mass of parathyroid adenoma and biochemical indicators of bone turnover in patients with primary hyperparathyroidism.

We related the weight of the parathyroid adenoma to biochemical variables of bone turnover in 53 patients submitted to parathyroidectomy for primary hyperparathyroidism. There was a positive correlation (r = 0.61, p less than 0.01) between iPTH (c-assay) and adenoma weight. No correlations were found between either concentration of circulating iPTH or weight of parathyroid adenoma and severity of skeletal change expressed by total activity of serum alkaline phosphatase and its bone isoenzyme and urinary excretion of hydroxyproline. We conclude that the severity of bone changes in individual patients with primary hyperparathyroidism does not result from the direct tissue effect of a single hormone (parathyroid hormone).

The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism

Background Concomitant thyroid nodules are the most common reason for false-positive ultrasonography (US) results in primary hyperparathyroidism. The aims of this prospective clinical study were to evaluate false-positive US results according to the characteristics of concomitant thyroid nodules and to determine which characteristics of thyroid nodules are important. Study design This prospective study included 120 consecutive patients with primary hyperparathyroidism. The patients were divided into 2 groups according to preoperative US results. Group 1 consisted of 32 patients with false-positive US results and group 2 consisted of 88 patients with true-positive US results. Results The risk for false-positive US result was increased 25-fold for patients with parathyroid adenoma weight of more than 500 mg (odds ratio [OR], 25; 95% confidence interval [CI], 8.6–74.5), 75-fold for more than 1 posteriorly located thyroid (OR, 75; 95% CI, 19.3–293.4), 358-fold for the presence of exophytic thyroid nodules (OR, 358; 95% CI, 42.3–3036), and 423-fold for the presence of posteriorly located thyroid nodules (OR, 423; 95% CI, 49–3662). Conclusion Although there was no particular characteristic of concomitant thyroid nodules that contributes to false-positive US results, the posteriorly located thyroid nodules were the strongest correlate for the false-positive US results to other features.

Correlation of Plasma 25-Hydroxyvitamin D Levels With Severity of Primary Hyperparathyroidism and Likelihood of Parathyroid Adenoma Localization on Sestamibi Scan

To determine the relationship between preoperative plasma 25-hydroxyvitamin D (25[OH]D) levels and severity of primary hyperparathyroidism (PHPT) and to explore whether presurgical 25(OH)D levels could predict the likelihood of positive results on technetium Tc 99m sestamibi scintigraphy. Retrospective analysis. Tertiary university referral center. A total of 421 consecutive patients underwent preoperative sestamibi scintigraphy and parathyroid exploration. Patients with cholecalciferol (vitamin D) deficiency, defined as plasma levels lower than 25 ng/mL, were compared with patients having no vitamin D deficiency. We explored the relationship between 25 (OH)D levels and intact parathyroid hormone (iPTH) levels, alkaline phosphatase (ALKP) levels, adenoma weight, binary sestamibi scan results, and postoperative serum calcium levels (at 1 week and 6 months). We hypothesized that severity of hypovitaminosis D would correlate with severity of PHPT and predict the likelihood of a positive finding on sestamibi scan. Concentrations of iPTH and ALKP and parathyroid adenoma weight were significantly higher in patients with lower 25(OH)D levels (P < .01 for all). Patients with hypovitaminosis D had a greater percentage decrease in serum calcium levels 1 week and 6 months postoperatively (P < .05). Median 25(OH)D levels were lower in patients with positive sestamibi scan results (P < .001). Patients with hypovitaminosis D present with more advanced indices of PHPT. Parathyroid sestamibi scanning is more likely to show positive results for this subset of patients who may then benefit from sestamibi scan-directed surgical intervention.

Impact of Adenoma Weight and Ectopic Location of Parathyroid Adenoma on Localization Study Results

Although the sensitivity of preoperative localization techniques is high for solitary parathyroid adenomas, negative imaging study results are inevitable. The weight and location of the parathyroid adenoma may contribute to the negative results. We aimed to study the impact of adenoma weight and ectopic location of the parathyroid adenoma on ultrasonography and sestamibi scan results. The patients were divided into two groups according to adenoma location. Group 1 consisted of 36 patients with ectopic location, and group 2 consisted of 149 patients with normal location. Parathyroid adenoma weight and the results of imaging studies were determined in all patients. Of 185 patients operated on for hyperparathyroidism, 36 (19.4%) had ectopic parathyroid glands. There was a positive correlation between adenoma weight and positive imaging studies, whereas ectopic location did not correlate with negative imaging study results. There was no significant difference between the ectopic adenoma ratio of patients with negative and positive imaging study results. The weight of the ectopic parathyroid adenoma was significantly lower in patients with negative imaging study results than in patients with positive imaging study results (p = 0.001). According to the analysis of variance, patients with higher-weight adenomas have positive imaging study results irrespective of ectopic location. For both normal and ectopic adenoma locations, adenoma weight was found only to be a factor that positively influences imaging study results.

Could We Predict Adenoma Weight And Postoperative Serum Calcium Level With Preoperative Serum Biochemical Markers In Patients With Primary Hyperparathyroidism?

Aims To determine the relationship of serum phosphate, serum calcium, and serum parathyroid hormone levels with respect to parathyroid adenoma weight and postoperative serum calcium in primary hyperparathyroidism. Materials and methods Eighty patients with single parathyroid adenoma entered the study. Preoperative serum calcium, phosphate, parathyroid hormone, alkaline phosphatase, weight of adenomas and postoperative serum calcium were recorded. Results With respect to adenoma weight, there was a significant correlation with serum calcium and parathyroid hormone (p = 0.003 and p = 0.0001, respectively).There was no correlation between postoperative serum calcium and serum alkaline phosphatase (p = 0.3), serum parathyroid hormone (p = 0.3) and adenoma weight (p = 0.1). Conclusion Adenoma weight has a positive impact on preoperative serum calcium, parathyroid hormone and alkaline phosphatase. Preoperative serum markers and adenoma weight are unreliable to predict serum calcium level postoperatively, but we can estimate the calcium decline postoperatively with preoperative serum calcium, PTH, alkaline phosphatase level and adenoma weight.

The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism

Background Although the sensitivity of sestamibi scanning (MIBI) is high in patients with solitary parathyroid adenomas, negative sestamibi scan results are inevitable. The exact mechanism of visualization of abnormal and hyperfunctioning parathyroid tissue is not yet clear. The aims of this clinical study were (1) to evaluate positive and negative sestamibi scan results with regard to adenoma weight and oxyphil cell content and (2) to compare the effects of adenoma weight and oxyphil cell content on the results of sestamibi scanning. Patients The patients were divided in 2 groups according to their sestamibi scan results. Group 1 consisted of 27 patients with positive sestamibi scan results, and group 2 consisted of 20 patients with negative sestamibi scan results. Parathyroid adenoma weight and oxyphil cell content were determined in all patients. Results The weight and oxyphil cell content of the parathyroid adenomas in the patients of group 1 were significantly higher than those in the patients of group 2 ( P = .001). An adenoma weight >600 mg and an oxyphil cell content >20% increased the rate of obtaining a positive sestamibi scan result 10- and 4-fold, respectively. Conclusions Both adenoma weight and oxyphil cell content were found to significantly correlate with positive sestamibi scan results. In patients with high-weight adenomas, adenoma weight was the most significant factor in obtaining positive MIBI scan results, whereas in patients with low adenoma weights, high oxyphil cell content was the most significant factor in obtaining positive MIBI scan results.

Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size

To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism. Retrospective evaluation of consecutive patients undergoing minimally invasive parathyroidectomy with iPTH measurement. Data collected include preoperative serum calcium, ionized calcium, and serum parathyroid hormone (PTH) levels, iPTH levels at baseline, 5 minutes, and 10 minutes, and parathyroid adenoma weight. Adenoma volume was calculated using an equation for the volume of a spheroid object. Thirty patients underwent minimally invasive parathyroidectomy with iPTH measurement for a single parathyroid adenoma between March 2004 and January 2006. There were 8 men and 22 women, with a mean age of 59.3 (range 26-92) years. A significant correlation between preoperative serum calcium and ionized calcium levels and parathyroid adenoma weight was identified (P = .0008 and P = .03, respectively). A significant correlation was also shown between baseline iPTH measurements and parathyroid adenoma volume (P = .03). There was no correlation between baseline iPTH levels and parathyroid adenoma weight. There was a significant correlation between parathyroid adenoma weight and percentage decrease of iPTH levels at 10 minutes compared to baseline (P = .04). Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10-minute postparathyroidectomy interval.

Primary hyperparathyroidism: do perioperative biochemical variables correlate with parathyroid adenoma weight or volume?

To investigate the relationship between clinical variables and biochemical markers of calcium homeostasis and parathyroid adenoma size, in patients undergoing surgery for primary hyperparathyroidism. To determine the potential clinical utility of the findings in preoperative planning and prediction of postoperative hypocalcaemia. Retrospective data analysis. Ninety-two patients treated surgically for primary hyperparathyroidism caused by a solitary parathyroid adenoma between 1996 and 2006. Complete data was obtained for 77 participants including patient demographics, perioperative calcium, parathyroid hormone and phosphate levels, adenoma weight and histological dimensions. Multiple and binary logistic regression analyses were used to investigate the relationship between clinical and biochemical variables and adenoma weight and volume. Similar analysis was used to identify predictors of postoperative hypocalcaemia. University Teaching Hospital Otolaryngology Department. The mean age at presentation was 59 years. The mean preoperative calcium and PTH levels were 2.86 +/- 0.2 mmol/L and 17.2 +/- 12.3 ng/L, respectively, falling to 2.3 +/- 0.01 and 4.1 +/- 2.7 postoperatively. The mean adenoma weight was 1.71 +/- 1.41 g. No correlation existed between clinical variables and preoperative biochemical markers of calcium homeostasis and adenoma weight or volume. There was a weak correlation between the preoperative to postoperative change in calcium and PTH levels {[deltaCa(2)+] vs. [deltaPTH]} (r = 0.24; P < 0.05) but no predictors of postoperative hypocalcaemia could be identified. Biochemical parameters will not accurately predict the size of a parathyroid adenoma. The size of a parathyroid adenoma does not correlate with postoperative calcium levels and is therefore not useful as a predictor of postoperative hypocalcaemia.

Correlations between Parathyroid Adenoma Weight and Biochemical Values

Correlations between Parathyroid Adenoma Weight and Biochemical Values

ARE BIOCHEMICAL VALUES PREDICTIVE OF ADENOMA’S WEIGHT IN PRIMARY HYPERPARATHYROIDISM?

Preoperative laboratory findings may carry some predictive value about the size of the abnormal parathyroid tissue that needs to be removed in primary hyperparathyroidism. In a retrospective study from 1988 to 2003, records of 71 patients with parathyroid adenoma were reviewed. The correlation between preoperative serum calcium, phosphate and parathyroid hormone (PTH) with adenoma's weight was analysed separately. There was a significant correlation between preoperative serum PTH and calcium with adenoma's weight (P < 0.001 and P = 0.03, respectively). The correlation between preoperative serum phosphate and adenoma's weight was not significant (P = 0.1). Preoperative PTH level cannot be used as a definite guide to the parathyroid adenoma's weight. Large parathyroid adenomas seem to secrete less PTH per unit weight than small adenomas. Calcium and phosphate do not seem to be of much value in predicting adenoma's weight in primary hyperparathyroidism.

Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study

Primary hyperparathyroidism (PHPT) is associated with reduced plasma 25-hydroxyvitamin D (P-25OHD) and usually increased plasma 1alpha,25-dihydroxyvitamin D (P-1,25(OH)2D). Parathyroid tissue expresses the vitamin D receptor and it is thought that circulating 1,25(OH)2D participate in the regulation of parathyroid cell proliferation, differentiation and secretion. To investigate the relations between circulating levels of 1,25(OH)2D and 25OHD respectively and parathyroid adenoma weight (AW), plasma-parathyroid hormone (P-PTH) and PTH secretion expressed as P-PTH/AW. Cross-sectional study. One hundred and seventy-one consecutive hypercalcaemic caucasian patients aged 19-87 years (median 63, 84% females) with surgically proven parathyroid adenoma. A weak positive correlation was found between P-25OHD and P-1,25(OH)2D (r=0.24, P<0.005). AW depended on sex and body mass index. Following adjustment, it was correlated positively to P-PTH, calcium (Ca) and alkaline phosphatase (AP) and inversely to plasma phosphate in a multiple regression model. AW was not associated with vitamin D metabolites. Preoperative P-PTH correlated positively to plasma levels of Ca and AP, but inversely to phosphate and 25OHD (P<0.001) levels. P-PTH was not associated with P-1,25(OH)2D (P=0.65). The P-PTH:AW ratio correlated inversely to P-25OHD (P<0.05), but showed no relations to plasma levels of Ca, phosphate or 1,25(OH)2D (P=0.22). In this material, low levels of 25OHD were related to higher levels of P-PTH and higher PTH:AW ratios in patients with PHPT suggesting that vitamin D deficiency increase PTH secretion activity. Neither PTH secretion nor AW was associated with circulating levels of 1,25(OH)2D.

Impact of Gland Morphology and Concomitant Thyroid Nodules on Preoperative Localization of Parathyroid Adenomas

Primary hyperparathyroidism (pHPT) is a common endocrine disease. The aim of this study was to assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism. A series of 125 patients with pHPT who underwent low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was reviewed retrospectively. Patients were divided in two groups depending on the presence or absence of thyroid nodules. The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas. In patients with parathyroid adenoma, the sensitivity of imaging studies correlates with the presence of thyroid nodules, adenoma weight, and ectopic localization.

Correlations between Vitamin D Status and Biochemical/Clinical and Pathological Parameters in Primary Hyperparathyroidism

To determine the prevalence of vitamin D deficiency and the effects of vitamin D status on parathyroid adenoma weight, clinical and biochemical indices in patients with primary hyperparathyroidism (pHPT) were studied. Eighty patients with pHPT who underwent surgical treatment and in whom the presence of parathyroid adenoma were confirmed histopathologically were studied retrospectively from recorded data files. Patients were divided into three groups: patients with 25-hydroxyvitamin D (25-OHD) concentrations < 15 ng/ml (group 1, n = 44), patients with 25-OHD concentrations > 15-25 ng/ml (group 2, n = 9), and patients with 25-OHD concentrations > 26 ng/ml (group 3, n = 27). Serum calcium, phosphate, alkaline phosphatase, creatinine, and albumin levels and urinary calcium excretion were determined by auto-analyzer. Plasma 25-OHD and parathyroid hormone (PTH) levels were determined by immunoradiometric assay using commercially available kits. No statistically significant differences were observed with respect to serum calcium, phosphorus, albumin, and creatinine concentrations between these groups. Serum PTH, alkaline phosphatase concentrations, urinary calcium excretion, parathyroid adenoma weight, and postoperative sixth month PTH concentrations were significantly higher in group 1 patients than in group 2 and group 3 patients. Significant correlations were observed between parathyroid adenoma weight and serum 25-OHD concentrations (r = -0.348, P = 0.020); parathyroid adenoma weight and urinary calcium excretion (r = 0.348, P = 0.021). Multiple regression analysis revealed that parathyroid adenoma weight, serum 25-OHD, and preoperative PTH concentrations correlated independently and significantly with postoperative sixth month PTH concentrations. Vitamin D deficiency leads to more severe bone disease, increased parathyroid tumor growth, and delayed postoperative recovery of parathyroid function in patients with primary hyperparathyroidism.

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.

Correlation of biochemical parameters with single parathyroid adenoma weight and volume.

To determine the relationship of the biochemical parameters serum phosphate, serum calcium, and serum parathyroid hormone levels with respect to parathyroid adenoma weight and volume in primary hyperparathyroidism. Retrospective review of 63 cases of primary hyperparathyroidism from 1992 to 1998. Single parathyroid adenomas were identified from surgical pathology reports. Preoperative calcium, phosphate, and parathyroid hormone levels were collected from charts. The volume of the adenoma was calculated using a mathematical equation for the volume of an ellipsoid object. The data were analyzed using a multiple analysis of variance, and a correlation coefficient was calculated. The level of significance was set at p < or = .05. With respect to adenoma volume, there was a significant correlation with serum calcium and parathormone levels (p = .0001 and p = .0001, respectively). There was no significant correlation between serum phosphate and adenoma volume. With respect to adenoma weight, there was a significant correlation with serum calcium and parathormone levels (p = .0001 and p = .0001, respectively). There was no significant correlation between serum phosphate and adenoma weight. Preoperative serum calcium and parathormone levels may be able to predict adenoma weight and volume in primary hyperparathyroidism for a single adenoma.

Effect of Vitamin D Nutrition on Parathyroid Adenoma Weight: Pathogenetic and Clinical Implications

Effect of Vitamin D Nutrition on Parathyroid Adenoma Weight: Pathogenetic and Clinical Implications

Increased risk of death from primary hyperparathyroidism--an update.

The aim of this study was to investigate the risk of death among patients treated for primary hyperparathyroidism during the past decade. Using the national patient register, all patients operated on for primary hyperparathyroidism in Sweden during 1987-94 were identified and then searched for in the national register of deaths and causes of death during the same period. The control group was the whole Swedish population, matched for age, sex and calendar year. We found that patients treated for primary hyperparathyroidism run an increased risk of death. The risk ratios for death from cardiovascular disease were 1.71 for male and 1.85 for female patients. These estimations are of high precision because of the large patient series (n = 4461), with 95% confidence limits of 1.34-2.15 and 1.62-2.11 for men and women respectively. This finding, together with previous findings that parathyroid adenoma weight, serum calcium level and parathyroid hormone level are predictive of the risk of death, suggests the possibility that surgery in patients with primary hyperparathyroidism may offer not only relief from signs and symptoms but also improved prognosis.

Parathyroid adenoma weight and the risk of death after treatment for primary hyperparathyroidism.

Patients operated on for primary hyperparathyroidism run an increased risk of death, as was found in a previous long-term follow-up of 896 patients. In the present study the adenoma weight was determined in 713 patients with single parathyroid gland disease operated on between 1956 and 1982 and followed up in 1986. The adenoma weight was investigated for its usefulness as a prognostic factor. The analysis showed that the adenoma weight was significantly related to the risk of death (p < 0.001). Also a relationship was noted between glandular weight and preoperative serum calcium level (p < 0.001), although the serum calcium level had no predictive value in relation to the risk of death beyond that of the adenoma weight. The risk increase was also estimated as a function of adenoma weight. A moderate adenoma weight increase in a patient with primary hyperparathyroidism was found to imply an increased risk of death, corresponding to the increased risk of smokers as compared with nonsmokers. The results of this study support surgical treatment at an early stage of primary hyperparathyroidism.

The relationship between adenoma weight and intact (1–84) parathyroid hormone level in primary hyperparathyroidism

The relationship between preoperative serum levels of intact parathyroid hormone (PTH), serum calcium, and the weight of parathyroid adenoma has been investigated in 44 patients undergoing surgery for primary hyperparathyroidism due to single gland disease. There was no significant correlation between preoperative serum calcium and either intact PTH concentration or adenoma weight (r = 0.465 and 0.381, respectively). Although there was a significant correlation between PTH concentration and adenoma weight (r = 0.850, p < 0.0005), this correlation was lost when two unusually heavy adenomas weighing 10.98 and 15.23 g were removed from the analysis. Clearly, a preoperative direct prediction of gland weight determined from PTH level was not possible. Patients with adenomata heavier than 750 mg had a significantly lower circulating PTH level per mg of adenoma than patients with glands lighter than 750 mg. PTH secretion in vitro in low calcium medium by adenoma cells from glands weighing less than 1 g was higher than secretion by cells from adenomas heavier than 1 g. Larger parathyroid adenomata appear to secrete less PTH per unit weight in vivo and per unit cell in vitro under conditions of maximal stimulation.