Profile Of Primary Hyperparathyroidism Research Articles

Hyperparathyroidism and Asthenia. A New Deal?

The profi le of primary hyperparathyroidism (PHPT) changed profoundly over the course of the twentieth century. The highly symptomatic forms reported in the 1960s have progressively been replaced by forms with few symptoms and in some cases totally asymptomatic forms.

Clinical and laboratory profile of primary hyperparathyroidism in Kashmir Valley: A single-center experience.

Background:Although primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the West, in India, PHPT is still an uncommonly diagnosed, overtly symptomatic disease with skeletal, muscular, and renal manifestations.Aims:To describe the profile and surgical outcome of 78 consecutive PHPT patients over a period of two decades at a single center.Materials and Methods:All patients who underwent evaluation and surgery for PHPT from January 1996 to December 2015 were included. Evaluation included measurement of serum total calcium, inorganic phosphorus, alkaline phosphatase, intact parathyroid hormone, 25-hydroxy Vitamin D, 24 hour urinary calcium and radiological survey. Ultrasonography neck and technetium-99m sestamibi scan were used for preoperative localization.Results:A total of 78 patients were identified during the two decades of whom 29 patients were studied retrospectively and 49 patients prospectively. Mean age of patients was 44.72 ± 12.46, and male:female ratio was 1:6. The most common presenting features were nephrolithiasis and/or nephrocalcinosis (64.10%), bone pain (44.1%), abdominal pain (39%), constipation (26%), and myopathy (14.10%). Fractures were present only in 10.25%, and brown tumors in 6.41% patients. The cure rate in our series was 96.15%. The mean parathyroid gland weight was 2.05 ± 3.03 g. None of the 41 patients in whom long-term follow-up was available, had recurrence of PHPT.Conclusions:The profile of PHPT is changing with older age at presentation, and emergence of renal stone disease and decline in overt skeletal disease as common presentation. The parathyroid weight in our study resembles that reported from developed countries.

Changing clinical profile of primary hyperparathyroidism in Indian patients

Changing clinical profile of primary hyperparathyroidism in Indian patients

Successful Treatment of Osteitis Fibrosa Cystica from Primary Hyperparathyroidism

Osteitis Fibrosa Cystica (OFC) is defined as the classic skeletal manifestation of advanced primary hyperparathyroidism. With the increased detection by means of routine calcium screening, the clinical profile of primary hyperparathyroidism in Western countries has shifted from symptomatic disease to one with subtle or no specific symptoms (“asymptomatic” primary hyperparathyroidism). The authors describe a classical feature of advanced primary hyperparathyroidism due to a parathyroid adenoma and its successful treatment.

EPIDEMIOLOGIChESKIE ASPEKTY PERVIChNOGOGIPERPARATIREOZA V ROSSII

Primary hyperparathyroidism (PHPT) is the third most frequent endocrine disorder and has a variable clinical presentation. Asymptomatic PHPT became the predominant form of the disease with increase of its incidence after the introduction of automated serum calcium measurement in North America and Europe. Data from Russia is lacking. Aim: To present the clinical profile of PHPT in Russia. Materials and Methods: This retrospective study was conducted at endocrinology centers in 8 regions of Russia. We analyzed the clinical presentation, and treatment options in patients with confirmed PHPT (1995-2010). Results: 738 patients (F: M-8:1) with age ranging from 13 to 83,4 years (mean 54,3) were analyzed. 54% was from Moscow (n=397), 11% - from Moscow region (n=79) and 35% - from 53 regions of Russia (n=262). Symptomatic PHPT was the most common form (74%) and was revealed with osteoporosis in 56%, nephrolithiasis - in 45% and ulcer disease - in 18%. Our data showed an increase in the incidence of PHPT (especially mild PHPT) after 2005 compared with earlier period. 64,9% of patients were treated surgically, 17 patients undergone repeated parathyroid surgery. 28,3% received bisphosphonates, calcitonin and/or cinacalcet . 11,5% was observed without treatment. Conclusions: This data analyzes some causes of delayed diagnosis of PHPT in Russia, characterized age and gender distribution of patients with PHPT and demonstrates the changes in clinical profile of disease from 1995 to 2010. PHPT still remains symptomatic disorder in our country most frequently with skeletal and renal manifestations.

Surgical indications of primary hyperparathyroidism

Clinical profile of primary hyperparathyroidism (PHPT) had shifted from symptomatic disorder, with hypercalcemic symptoms, kidney stones, overt bone disease, or a specific neuromuscular dysfunction toward a more asymptomatic state. Patients with symptomatic PHPT absolutely require parathyroidectomy (PTX). Surgical treatment is the well established and definitive treatment for PHPT. Consensus Conference at National Institute of Health (NIH) proposed the guidelines for PTX in asymptomatic PHPT. They included (1) serum calcium level was 1.0 mg/dL above upper limit of normal, (2) 24-h urinary calcium was over 400 mg, (3) creatinine clearance is reduced by 30%, (4) bone mineral density (T-score) reduced 2.5 SD below the peak bone mass at any site, and (5) patients under 50 years of age, and (6) patients for whom medical surveillance was either not desirable or not possible. Because in about 25% of patients asymptomatic PHPT will show progression, because it is important to monitor patients who are not undergoing PTX. Normocalcemic PHPT has been frequently found in patients whose bone mineral density is reduced. This diagnostic consideration requires that all potential causes of secondary HPT. The surgical procedure has been progressive induced by the developments of preoperative image diagnosis and intraoperative PTH assay. Minimally invasive PTX could expand surgical indications in patients with mild asymptomatic PHPT.