Symptoms Of Primary Hyperparathyroidism Research Articles

Age-related peculiarities of the symptom complex of the increased risk of primary hyperparathyroidism development

Objective — to analyze the peculiarities of the structure of non‑specific complaints in groups aged ≤50 years and >50 years with application of the questionnaire for early detection of individuals at increased risk of the primary hyperparathyroidism (PHPT) development. The questionnaire was developed by specialists of the Danylevsky Institute of Problems of Endocrine Pathology, NAMS of Ukraine.
 Materials and methods. The analysis was performed on the data of questionnaire survey of 50 patients who were examined for PHPT in the years 2020—2021. The control group consisted of patients with thyropathology who applied for medical assistance to the clinical units of the Danylevsky Institute of Problems of Endocrine Pathology. The frequency of each complaint, included in the questionnaire, was determined in the subgroups aged ≤50 years and >50 years. The factors, presented against the PHPT background and associated with the development of this pathology have been established. Statistical processing of the obtained data was carried out by the methods of variational statistics using the standard package of statistical calculations Microsoft Excel and Statistica 6.0. The probability of differences in mean values was determined by the Student’s t test.
 Results. Identifying the features of the symptom complex associated with an increased risk of PHPT development in different age periods, made it possible to determine the set of factors that are the most dangerous for the development of PHPT, including: the presence of relatives with diseases related to calcium metabolism disorders, deterioration of memory, attention, pain in bones and joints, chronic pain in the upper and lower limbs, chronic pancreatitis in people under 50 years of age. The most typical, “classic” symptom complex was revealed in patients of the older age group.
 Conclusions. The presence of only non‑specific symptoms of PHPT in a significant number of patients complicates the diagnosis of the disease at early stages and leads to the development of complications of the disease. The testing of the version of the questionnaire developed by the authors made it possible to determine the list of the most dangerous symptom complex of non‑specific complaints regarding the high risk of PHPT development in the groups ≤50 years and over 50 years. The implementation of this list in the everyday practice of the medical practitioners can increase the effectiveness of efforts for early detection of the disease.

Primary hyperparathyroidism: clinical manifestations, diagnosis and evaluation according to the Fifth International Workshop guidelines.

Primary hyperparathyroidism (PHPT) is a frequent endocrine disease which mainly affects the skeletal system and kidney. Some of its signs and symptoms are similar to those seen in rheumatic diseases such as rheumatoid arthritis, Sjögren's disease, fibromyalgia, polymyalgia rheumatica, gout or systemic lupus erythematosus. Coexistence of primary hyperparathyroidism with those pathologies potentiate their effects on muscles, bones and joints, increasing the risk of complications such as osteoporosis and fractures. Therefore, rheumatologists should be familiar with symptoms and diagnostic criteria of PHPT and consider it in the differential diagnosis of rheumatic diseases. In 2022 the Fifth International Workshop guidelines on the PHPT evaluation and management were published. They are based on a profound analysis of advances in research concerning multiple fields, that include genetics, outcomes and new imaging modalities of PHPT. They have led to revision of previous renal indications for parathyroidectomy in PHPT. There is also more evidence for the other recommendations regarding evaluation of the disease. This article summarizes the most relevant elements of these recommendations and refers them to Polish realities. I focus on the symptoms of primary hyperparathyroidism and its diagnosis as I consider these areas to be the most important for non-endocrinologists.

Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy.

Primary hyperparathyroidism is the third most common endocrine disorder following diabetes and thyroid disease. Women are affected by primary hyperparathyroidism twice as often as men. The first reported case of hyperparathyroidism during pregnancy was in 1931. More recent data suggests that hyperparathyroidism during pregnancy is diagnosed in .5-1.4% of women. Symptoms of primary hyperparathyroidism, such as fatigue, lethargy, and proximal muscle weakness are nonspecific and could be mistaken as complaints naturally present during pregnancy; however, maternal complications in patients with hyperparathyroidism can be as high as 67%. We present a case of a pregnant patient who presented in hypercalcemic crisis with a concomitant diagnosis of primary hyperparathyroidism.

Molecular and Clinical Spectrum of Primary Hyperparathyroidism.

Recent data suggest an increase in the overall incidence of parathyroid disorders with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder. PHPT is associated with morbidities (fractures, kidney stones, chronic kidney disease) and increased risk of death. The symptoms of PHPT can be non-specific, potentially delaying the diagnosis. Approximately 15% of patients with PHPT have an underlying heritable form of PHPT which may be associated with extra-parathyroidal manifestations, requiring active surveillance for these manifestations as seen in multiple endocrine neoplasia type 1 and 2A. Genetic testing for heritable forms should be offered to patients with multi-glandular disease, recurrent PHPT, young onset PHPT (age ≤ 40 years) and those with a family history of parathyroid tumors. However, the underlying genetic cause of majority of patients with heritable forms of PHPT remains unknown. Distinction between sporadic and heritable forms of PHPT is useful in surgical planning for parathyroidectomy and has implications for family. The genes currently known to be associated with heritable forms of PHPT account for approximately half of the sporadic parathyroid tumors. But the genetic cause in approximately half of the sporadic parathyroid tumors remains unknown. Furthermore, there is no systemic therapy for parathyroid carcinoma, a rare but potentially fatal cause of PHPT. Improved understanding of the molecular characteristics of parathyroid tumors will allow us to identify biomarkers for diagnosis and novel targets for therapy.

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.

Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management.

Parathyroid hormone (PTH) is secreted from four parathyroid glands situated behind the thyroid gland. PTH regulates calcium and phosphate levels by its promotion of phosphate excretion and calcium reabsorption in the kidneys; stimulation of osteoclastic activity in the bone resulting in raised serum calcium; and increased intestinal absorption of calcium. Hyperparathyroidism is excessive secretion of PTH and can be primary, secondary, or tertiary: This article summarises the new National Institute for Health and Care Excellence (NICE) guideline for the diagnosis, assessment, and initial management of primary hyperparathyroidism (PHPT).2 This article highlights areas of particular importance for primary care. The causes and management of hypercalcaemia outside of the diagnosis and management of PHPT are beyond the scope of this article. The signs and symptoms of PHPT are predominantly brought about by hypercalcaemia and include thirst, increased …

Symptoms of Primary Hyperparathyroidism in Men and Women: The Same but Different?

Introduction and Objective: Typical symptoms for primary hyperparathyroidism (pHPT) include osteoporosis, bone or joint pain, and nephrolithiasis, as well as fatigue, depression, gastritis, and cardiovascular disease. The female:male ratio was 3:1. The aim of this retrospective study was to evaluate the possible influence of gender-specific aspects of these symptoms. Methods: From February 2018 to November 2019, parathyroid surgery was performed in 125 patients with pHPT (age: 23–83 years); 95 (76%) were female, and 30 (24%) were male. Preoperatively, a standardized medical history including 7 typical symptoms of pHPT was used for routine clinical documentation according to the StuDoQ Thyroid and Parathyroid Registry. Results: For both groups (mean age: 60.4 years for females and 60.2 years for males), no sex differences were found in serum calcium or parathyroid hormone levels. For females, there was a tendency towards smaller hyperfunctioning parathyroid glands (16.8 vs. 20.5 mm) with less weight (1.14 vs. 1.52 g) and multiglandular disease. Nephrolithiasis was significantly more frequent in men than in women (36.7 vs. 16.8%, respectively; p = 0.036), but the difference in hypertension was not significant (60% in men vs. 47.4% in women, p = 0.230). Women reported significantly more often bone and joint pain (44.2% in women vs. 20% in men, p = 0.053) and depressive episodes (32.6% in women vs. 10% in men, p = 0.016). Conclusion: 91.2% of patients transferred for parathyroidectomy described typical symptoms of pHPT. However, an unexpected high gender difference was found following the analysis of symptoms documented in the StuDoQ Registry.

Functioning lipoadenoma of parathyroid in ectopic location

Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Parathyroid lipoadenoma is a rare and well-documented clinico-histological variant of parathyroid adenoma which owing to its bulky nature is found at aberrant locations and generally extends into the mediastinum, thus posing difficulty in diagnosis and surgical exploration. Here we present a young lady with classical signs and symptoms of primary hyper-parathyroidism who underwent excision of the single adenoma, and histologically diagnosed as a lipoadenoma. Here, we discuss the presentation and management of this rare variant.

Rapidly Progressive Dementia as the First Symptom of Primary Hyperparathyroidism: A Case Report

Rapidly Progressive Dementia as the First Symptom of Primary Hyperparathyroidism: A Case Report

Lipoadenoma of parathyroid gland : report of a rare case

AbstractParathyroid adenoma is a rare disease. It is the most common cause of primary hyperparathyroidism. Patients are commonly mis-diagnosed and treated symptomatically rather than addressing the main cause. Parathyroid lipo-adenoma is a rare clinico-histological variant of parathyroid adenoma which owing to its bulky nature is found at aberrant locations and generally extends into the mediastinum, thus posing difficulty in diagnosis and surgical exploration. Here we present a young lady with classical signs and symptoms of primary hyper-parathyroidism who underwent excision of the single adenoma, and histologically was a lipoadenoma. This case report highlights the importance of appropriate pre-operative and intra-operative planning and execution for better recovery of the patients.

Digestive tract symptoms of primary hyperparathyroidism

Digestive tract symptoms of primary hyperparathyroidism

Functional Parathyroid Cyst as a Rare Cause of Primary Hyperparathyroidism: A Case Report

Parathyroid Cysts (PC) comprise rare lesions commonly located in the neck and anterior mediastinal region, being either non-functioning or functioning. Functioning PC can be manifested with signs and symptoms of Primary Hyperparathyroidism (PHPT). We report a case of 59-year-old female patient with symptomatic PHPT, caused by a functioning PC, successfully treated with parathyroidectomy.

Acute pancreatitis associated with primary hyperparathyroidism

Coexistence of primary hyperparathyroidism and acute pancreatitis has widely been reported in literature, but a causal relationship remains controversial. A case of acute pancreatitis as a first symptom of primary hyperparathyroidism with severe hypercalcemia is reported. In this patient a reduction of serum calcium level was obtained with medical therapy and resulted in the resolution of acute pancreatitis symptoms within 10 days. At the same time a parathyroid adenoma was clinically identified and elective parathyroidectomy was performed with complete normalization of intact parathyroid hormone and serum calcium level. At three-year follow-up, no recurrence or complications of pancreatitis were documented. The presented case suggests a cause and effect relationship between acute pancreatitis and severe hypercalcemia which should be kept in mind in the differential diagnosis of non-biliary, non-alcoholic acute pancreatitis. Reduction of hypercalcemia with medical treatment can represent a good chance for elective surgical neck exploration.

The role of calcimimetics in the treatment of hyperparathyroidism

Calcimimetics reduce serum levels of parathyroid hormone (PTH) and calcium, with a leftward shift in the set-point for calcium-regulated PTH secretion. The aim of this publication is to review the data available for calcimimetics in primary, secondary and tertiary hyperparathyroidism (HPT). Parathyroidectomy (PTX) is currently the only curative treatment for primary HPT, and recommended for patients with moderate-to-severe disease, as defined by a 2002 National Institute's of Health summary statement. In general, patients with primary HPT not meeting these surgical criteria, as well as those with contraindication or refusal for surgery, are monitored for signs and symptoms of primary HPT. There are currently no non-surgical therapies approved for use in primary HPT, although bisphosphonates are used in some patients, in an effort to control serum calcium levels. Calcimimetics decrease PTH and calcium levels and are a potential alternative for patients contraindicated for PTX, or who have failed previous PTX and have recurrent primary HPT. Secondary HPT develops early in chronic kidney disease and is present virtually in all patients with end-stage renal disease (ESRD). Secondary HPT is a progressive disease and is associated with several systemic complications, including renal osteodystrophy, soft tissue and vascular calcifications, and adverse cardiovascular outcomes. In ESRD patients, calcimimetics were shown to simultaneously reduce PTH, calcium, phosphate and calcium x phosphate product. In addition, observational analyses of use of calcimimetics in the ESRD population have shown a reduction of important clinical outcomes. In renal allograft recipients with tertiary HPT and hypercalcaemia, calcimimetics are a promising treatment option to control the parameters of calcium phosphate metabolism and may be a valid alternative to PTX. Based on its unique mechanism of action, the calcimimetic cinacalcet may play a role in the medical treatment of primary and tertiary forms of HPT, in addition to the registered indication for the treatment of secondary HPT.

Severe Acute Pancreatitis as a First Symptom of Primary Hyperparathyroidism

Severe Acute Pancreatitis as a First Symptom of Primary Hyperparathyroidism

Asymptomatic hyperparathyroidism – need for multicentre studies

Long-term follow-up is initially considered appropriate for the majority of patients with primary hyperparathyroidism (PHPT) having small increases in calcium levels (< 2.8 mmol/l) and lacking the 'classical' symptoms of PHPT. The supportive reasoning is that many such patients never progress to more severe biochemical or clinical disease. There are, however, arguments in favour of early surgical treatment of such patients but adequately powered studies have not been carried out in this subgroup of patients to asses the impact of PHPT on their quality of life, cardiovascular risk and bone density. Progressive loss in bone mineral density and an increased risk of bone fracture become increasingly significant in an ageing population. Left ventricular hypertrophy, an increased risk of arrhythmia and/or myocardial infarction in addition to changes in atherogenic lipid profile and impaired glucose tolerance may translate into an increased risk of premature death in this group of patients. Changes in the quality of life identified using standardized questionnaires are sometimes recognized by patients only in retrospect (i.e. after resolution of symptoms following successful parathyroidectomy). In addition, many series fail to assess and record accurately such symptoms. Multicentre cohort studies of patients with asymptomatic PHPT randomized to immediate or delayed surgical treatment could address some of the debated issues highlighted in this review. Until such studies are set up, most surgeons would consider that parathyroid surgery should represent the first choice of treatment for all patients, but many physicians would favour a long-term follow-up. Nevertheless, the threshold for referral for surgical treatment has been lowered since the introduction of scan-directed minimally invasive parathyroidectomy, which enables the experienced parathyroid surgeon to successfully treat patients with PHPT with a minimum of complications as a day-case operation. In the context of improved surgical treatment, we need more data on the benefits or otherwise in so-called asymptomatic patients with a thorough assessment of their bone quality, cardiovascular risk and quality of life.

Severe Acute Pancreatitis As A First Symptom Of Primary Hyperparathyroidism: A Rare Case Report

Severe Acute Pancreatitis As A First Symptom Of Primary Hyperparathyroidism: A Rare Case Report

Novel 1113delC menin gene mutation in a Polish family with multiple endocrine neoplasia type 1 syndrome

We report the case of a 32-year-old male with hypercalcemia and recurrent nephrolithiasis as a symptom of primary hyperparathyroidism, hypoglycemia due to insulinoma, microprolactinoma, and a large, partially calcified tumor of the upper right leg. The patient underwent several surgical interventions including subtotal parathyreoidectomy, partial pancreatectomy, and percutaneous nephrolithotrypsy. Regular treatment with bromocriptine was required for normalization of serum prolactin concentration. His only sibling, a 26-year-old sister, suffered from microprolactinoma and had been treated with bromocriptine for 6 years. Their father had suffered from recurrent kidney stones and peptic ulcer and died at the age of 34. A novel 1113delC mutation within exon 7 of the menin gene was found in both siblings. This mutation results in a frame-shift with missense translation of the subsequent residual acids and preterm termination of the peptide at codon 357.

Stress fractures of the feet as symptoms of primary hyperparathyroidism: treatment by parathyroidectomy followed by teriparatide injections

Stress fractures of the feet as symptoms of primary hyperparathyroidism: treatment by parathyroidectomy followed by teriparatide injections

Friedrich Daniel von Recklinghausen Biographie und Bedeutung seiner osteopathologischen Arbeiten nach mehr als 100 Jahren

Even today the name of F.D. von Recklinghausen is often mentioned in connection with primary and secondary hyperparathyroidism. He was one of the first physicians and scientists to render outstanding services to the classification of structural changes of bones, and in many aspects his work remains valid today. He succeeded through precise and comparative studies in making the disease and symptoms of primary hyperparathyroidism known and thus distinguishing it from other known structural bone diseases. He also described the phenomenon of "bone remodeling" which has become relevant today again. Although his written macroscopic and microscopic observations include meticulously precise differentiations which make it difficult to study them today, they are still of interest in order to follow his basic ideas. This article does not constitute a comprehensive biography, but it contains a description of F.D. von Recklinghausen's important work on bone pathology against the background of the main stages of his life.