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Asymptomatic hyperparathyroidism: is the pendulum swinging back?

https://arctichealth.org/en/permalink/ahliterature197590
Source
CMAJ. 2000 Jul 25;163(2):173-5
Publication Type
Article
Date
Jul-25-2000
Author
K. Siminoski
Author Affiliation
Endocrine Centre of Edmonton.
Source
CMAJ. 2000 Jul 25;163(2):173-5
Date
Jul-25-2000
Language
English
Publication Type
Article
Keywords
Calcium - blood - urine
Canada
Disease Progression
Humans
Hypercalcemia - diagnosis - etiology - metabolism - surgery
Hyperparathyroidism - complications - diagnosis - metabolism - surgery
Parathyroidectomy
United States
Notes
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Comment On: CMAJ. 2000 Jul 25;163(2):184-710934983
PubMed ID
10934981 View in PubMed
Less detail

BMD improvements after operation for primary hyperparathyroidism.

https://arctichealth.org/en/permalink/ahliterature119158
Source
Langenbecks Arch Surg. 2013 Jan;398(1):113-20
Publication Type
Article
Date
Jan-2013
Author
Lars Rolighed
Peter Vestergaard
Lene Heickendorff
Tanja Sikjaer
Lars Rejnmark
Leif Mosekilde
Peer Christiansen
Author Affiliation
Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark. larsrolighed@gmail.com
Source
Langenbecks Arch Surg. 2013 Jan;398(1):113-20
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Adult
Aged
Aged, 80 and over
Bone Density
Calcium - blood
Cohort Studies
Creatinine - blood
Denmark
Female
Humans
Hyperparathyroidism, Primary - blood - surgery
Male
Middle Aged
Parathyroid Hormone - blood
Parathyroidectomy
Postoperative Complications - blood - diagnosis
Young Adult
Abstract
This study aims to quantify bone mineral density (BMD) changes following surgery in patients with primary hyperparathyroidism (PHPT) and to assess their relationship with clinical and biochemical variables.
A historic cohort of 236 PHPT patients with DXA scans pre- and 1-year postoperatively, clinical data, and biochemical data was analyzed.
The mean age was 60 years (range 19-86) and 81 % of the patients were women. A significant postoperative 2.6 % (95 % CI, 2.1; 3.1) increase in lumbar spine BMD was seen. The increase in BMD was positively associated with preoperative plasma PTH (p?=?0.002), Ca(2+) (p?
PubMed ID
23132462 View in PubMed
Less detail

Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden.

https://arctichealth.org/en/permalink/ahliterature294991
Source
Scand J Prim Health Care. 2018 Jun; 36(2):198-206
Publication Type
Journal Article
Date
Jun-2018
Author
Sofia Dalemo
Robert Eggertsen
Per Hjerpe
Erik G Almqvist
Kristina Bengtsson Boström
Author Affiliation
a Institute of Medicine/Dept. of Public Health and Community/Primary Health Care , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
Source
Scand J Prim Health Care. 2018 Jun; 36(2):198-206
Date
Jun-2018
Language
English
Publication Type
Journal Article
Keywords
Absorptiometry, Photon
Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers - blood
Bone Density
Calcium - blood
Case-Control Studies
Female
Humans
Hypercalcemia - blood - complications - metabolism
Hyperparathyroidism, Primary - blood - metabolism
Longitudinal Studies
Male
Middle Aged
Osteoporosis - blood - etiology - metabolism
Parathyroid Hormone - blood
Parathyroidectomy
Primary Health Care
Prospective Studies
Sweden
Young Adult
Abstract
Elevated calcium concentration is a commonly used measure in screening analyses for primary hyperparathyroidism (pHPT) and cancer. Low bone mineral density (BMD) and osteoporosis are common features of pHPT and strengthen the indication for parathyroidectomy. It is not known whether an elevated calcium concentration could be a marker of low BMD in suspected pHPT patients with a normal parathyroid hormone concentration.
To study if low BMD and osteoporosis are more common after ten years in patients with elevated compared with normal calcium concentrations at baseline.
Prospective case control study.
Primary care, southern Sweden.
One hundred twenty-seven patients (28 men) with baseline elevated, and 254 patients (56 men) with baseline normal calcium concentrations, mean age 61 years, were recruited. After ten years, 77% of those still alive (74 with elevated and 154 with normal calcium concentrations at baseline) participated in a dual energy x-ray absorptiometry measurement for BMD assessment and analysis of calcium and parathyroid hormone concentrations.
Association between elevated and normal calcium concentration at base-line and BMD at follow-up. Correlation between calcium and parathyroid hormone concentrations and BMD at follow-up.
A larger proportion of the patients with elevated baseline calcium concentrations who participated in the follow-up had osteoporosis (p value?=?0.036), compared with the patients with normal concentrations. In contrast, no correlation was found between calcium or parathyroid hormone concentrations and BMD at follow-up.
In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%), which highlights the importance of examining these patients further using absorptiometry, even when their parathyroid hormone level is normal. Key Points Osteoporosis is common, difficult to detect and usually untreated. It is not known whether elevated calcium concentrations, irrespective of the PTH level, could be a marker of low bone mineral density. No correlation was found between calcium or parathyroid hormone concentrations and bone mineral density at follow-up. In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%).
Notes
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Cites: Ther Adv Musculoskelet Dis. 2014 Oct;6(5):185-202 PMID 25342997
PubMed ID
29623754 View in PubMed
Less detail

Cardiovascular and Cerebrovascular Events After Parathyroidectomy in Patients on Renal Replacement Therapy.

https://arctichealth.org/en/permalink/ahliterature310552
Source
World J Surg. 2019 08; 43(8):1981-1988
Publication Type
Journal Article
Date
08-2019
Author
Kerstin M Ivarsson
Shahriar Akaberi
Elin Isaksson
Eva Reihnér
Tomasz Czuba
Karl-Göran Prütz
Naomi Clyne
Martin Almquist
Author Affiliation
Clinical Sciences, Lund University, Alwallhuset, Barngatan 2A, 221 85, Lund, Sweden. kerstin.ivarsson@med.lu.se.
Source
World J Surg. 2019 08; 43(8):1981-1988
Date
08-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Case-Control Studies
Cohort Studies
Female
Humans
Hyperparathyroidism, Secondary - etiology - surgery
Incidence
Ischemic Attack, Transient - epidemiology
Kidney Failure, Chronic - complications - therapy
Kidney Transplantation
Male
Middle Aged
Myocardial Infarction - epidemiology
Parathyroidectomy
Proportional Hazards Models
Registries
Renal Dialysis
Risk factors
Stroke - epidemiology
Sweden - epidemiology
Abstract
A majority of patients with end-stage renal disease suffer from secondary hyperparathyroidism, which is associated with osteoporosis and cardiovascular disease. Parathyroidectomy (PTX) is often necessary despite medical treatment. However, the effect of PTX on cardio- and cerebrovascular events (CVE) remains unclear. Data on the effect of PTX from population-based studies are scarce. Some studies have shown decreased incidence of CVE after PTX. The aim of this study was to evaluate the effect of PTX on risk of CVE in patients on renal replacement therapy.
We performed a nested case-control study within the Swedish Renal Registry (SRR) by matching PTX patients on dialysis or with functioning renal allograft with up to five non-PTX controls for age, sex and underlying renal disease. To calculate time to CVE, i.e., myocardial infarct, stroke and transient ischemic attack, control patients were assigned the calendar date (d) of the PTX of the case patient. Crude and adjusted proportional hazards regressions with random effect (frailty) were used to calculate hazard ratios for CVE.
The study cohort included 20,056 patients in the SRR between 1991 and 2009. Among these, 579 patients had undergone PTX, 423 during dialysis and 156 during time with functioning renal allograft. These patients were matched with 1234 dialysis and 736 transplanted non-PTX patients. The adjusted hazard ratio (HR) with 95% confidence interval (CI) of CVE after PTX was 1.24 (1.03-1.49) for dialysis patients compared with non-PTX patients. Corresponding results for patients with renal allograft at d were HR (95% CI) 0.53 (0.34-0.84).
PTX patients on dialysis at d had a higher risk of CVE than patients without PTX. Patients with renal allograft at d on the other had a lower risk after PTX than patients without PTX.
Notes
CommentIn: World J Surg. 2019 Aug;43(8):1989-1990 PMID 31201495
PubMed ID
31087130 View in PubMed
Less detail

[Clinical picture and treatment results in patients with secondary hyperparathyroidism].

https://arctichealth.org/en/permalink/ahliterature263284
Source
Vestn Khir Im I I Grek. 2014;173(6):50-1
Publication Type
Article
Date
2014
Author
N I Bogomolov
P P Pakhol'chuk
N B Prokhorov
Source
Vestn Khir Im I I Grek. 2014;173(6):50-1
Date
2014
Language
Russian
Publication Type
Article
Keywords
Adult
Female
Humans
Hyperparathyroidism, Secondary - blood - etiology - surgery
Kidney Failure, Chronic - therapy
Male
Middle Aged
Parathyroid Hormone - blood
Parathyroidectomy - methods
Renal Dialysis - adverse effects
Retrospective Studies
Siberia
Treatment Outcome
Abstract
The secondary hyperparathyroidism was observed in 23 patients using a program hemodialysis. The parathyroidectomy was applied as a medical aid. A relapse was noted in one case. Clinical signs of hyperparathyroidism were completely terminated by 6 months.
PubMed ID
25823311 View in PubMed
Less detail

[Complex ultrasonic study of parathyroids in diagnostic and surgical treatment of primary hyperparathyroidism].

https://arctichealth.org/en/permalink/ahliterature258800
Source
Khirurgiia (Mosk). 2014;(6):13-20
Publication Type
Article
Date
2014
Author
A F Chernousov
L I Ippolitov
G Kh Musaev
M B Saliba
Source
Khirurgiia (Mosk). 2014;(6):13-20
Date
2014
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Comparative Effectiveness Research
Female
Humans
Hyperparathyroidism, Primary - diagnosis - surgery
Male
Middle Aged
Monitoring, Intraoperative - methods
Moscow
Parathyroid Glands - radionuclide imaging - ultrasonography
Parathyroidectomy - adverse effects - methods
Postoperative Complications - prevention & control
Preoperative Care - methods
Reproducibility of Results
Retrospective Studies
Tomography, Emission-Computed, Single-Photon - methods
Treatment Outcome
Ultrasonography - methods
Abstract
Primary hyperparathyroidism is the most common disease in Russian Federation, cured by endocrine surgeons. Health status after surgical correction of primary hyperparathyroidism depends on availability of screening hypercalciemia, which is still absent in our country. Another problem is a model of surgical management of primary hyperparathyroidism (frozen section, intraoperative monitoring of parathyroid hormone, gamma-detection and so on). Although minimally invasive parathyroidectomy has become the only method of treatment in many countries, it is still crucial to identify and accurately localize parathyroid glands before bilateral neck exploration surgery. The diagnostic efficacy of the various imaging techniques is still the subject of current debate. The usefulness of preoperative parathyroid imaging with both dual scintigraphy-single-photon emission computed tomography (SPECT) Tc 99m and high-resolution ultrasonography (US) was studied in 92 patients undergoing operations for primary hyperparathyroidism. The accuracy of "integrated" ultrasonography ("check-up US", "target US" after SPECT) and "intraoperative US") of parathyroid glands was 92.9%, sensitivity - 91% and positive predictive value - 94%. This study supports an algorithm of obtaining "integrated" ultrasonography as the initial and in most cases the only preoperative localization tests for patients with primary hyperparathyroidism.
PubMed ID
25042185 View in PubMed
Less detail

Cost effectiveness of preoperative ultrasound in primary parathyroid surgery.

https://arctichealth.org/en/permalink/ahliterature23826
Source
Ann Chir Gynaecol. 1994;83(4):279-83
Publication Type
Article
Date
1994
Author
M V Kairaluoma
J. Kellosalo
H. Mäkäräinen
K. Haukipuro
M I Kairaluoma
Author Affiliation
Department of Surgery, Oulu University Hospital, Finland.
Source
Ann Chir Gynaecol. 1994;83(4):279-83
Date
1994
Language
English
Publication Type
Article
Keywords
Adenoma - surgery - ultrasonography
Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis
Double-Blind Method
Female
Follow-Up Studies
Humans
Hyperparathyroidism - surgery - ultrasonography
Male
Middle Aged
Parathyroid Neoplasms - surgery - ultrasonography
Parathyroidectomy - economics
Prospective Studies
Thyroid Diseases - surgery - ultrasonography
Ultrasonography - economics
Abstract
A prospective, randomized, blind study was undertaken to assess whether preoperative ultrasound (US) localization of the abnormal parathyroid glands is cost-effective in patients undergoing initial neck exploration for primary hyperparathyroidism (PHPT). Twenty-eight patients were randomly allocated into two groups. In Group I the results of preoperative US were reported to the surgeon before exploration, and in Group II he was not informed of the US results. All patients underwent bilateral neck exploration, performed by the same surgeon. The operating room time was recorded and the operating room costs calculated. They included the total costs of cervical US in Group I. The cure and morbidity rates in Group I were 100% and 14% and those in Group II 86% and 7%, respectively (P > 0.05). The mean operating room time of 97 +/- 15 min in Group I was significantly lower than that of 113 +/- 23 min in Group II (P 0.4) because the costs of preoperative US, the least expensive of the localization studies, of 497 FIM negated any cost savings achieved by the reduced operating room time. We thus conclude that preoperative US before initial neck exploration for PHPT is not cost-effective.
PubMed ID
7733610 View in PubMed
Less detail

The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism.

https://arctichealth.org/en/permalink/ahliterature274095
Source
Nephrol Dial Transplant. 2015 Dec;30(12):2027-33
Publication Type
Article
Date
Dec-2015
Author
Kerstin M Ivarsson
Shahriar Akaberi
Elin Isaksson
Eva Reihnér
Rebecca Rylance
Karl-Göran Prütz
Naomi Clyne
Martin Almquist
Source
Nephrol Dial Transplant. 2015 Dec;30(12):2027-33
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Female
Humans
Hyperparathyroidism, Secondary - epidemiology - etiology - mortality - surgery
Incidence
Kidney Failure, Chronic - surgery
Kidney Transplantation
Male
Middle Aged
Parathyroidectomy - mortality
Proportional Hazards Models
Registries
Renal Replacement Therapy
Risk factors
Survival Rate
Sweden
Abstract
Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival.
A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions.
There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70).
PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.
Notes
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Comment In: Nephrol Dial Transplant. 2015 Dec;30(12):1944-626275892
PubMed ID
26374600 View in PubMed
Less detail

Emerging trends in the performance of parathyroid surgery.

https://arctichealth.org/en/permalink/ahliterature164242
Source
Laryngoscope. 2007 Jun;117(6):1009-12
Publication Type
Article
Date
Jun-2007
Author
David J Terris
Nan Chen
Melanie W Seybt
Christine G Gourin
Edward Chin
Author Affiliation
Department of Otolaryngology-Head, Medical College of Georgia, Augusta, Georgia 30912-4060, USA.
Source
Laryngoscope. 2007 Jun;117(6):1009-12
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Europe - epidemiology
Humans
Hyperparathyroidism, Primary - epidemiology - surgery
Incidence
Internship and Residency - statistics & numerical data
Otolaryngology - statistics & numerical data - trends
Parathyroidectomy - statistics & numerical data - trends
Prevalence
Treatment Outcome
United States - epidemiology
Abstract
The management of hyperparathyroidism has evolved rapidly in the past decade with the introduction of intraoperative parathyroid hormone testing, radioguided surgery, and endoscopic surgery. Not surprisingly, there is a corresponding movement toward specialization of surgeons providing increasingly sophisticated treatments for head and neck endocrine disorders. We sought to identify trends in the disciplines performing parathyroid surgery.
Nonrandomized, controlled comparison of surgical caseloads and publication volumes.
Two metrics designed to reflect the proportion of parathyroidectomies being performed by otolaryngologist-head and neck surgeons (OHNS) and general surgeons (GS) were chosen: the operative case logs of graduates from American training programs in OHNS and GS from 1996 through 2005 and the number of scientific papers published relating to parathyroid surgery during two timeframes (1991-1995 and 2001-2005).
There was a gradual increase in the mean number of parathyroid surgeries performed by GS residents from 6.0 in 1996 to a peak of 9.2 in 2004; this volume has begun to decline (to 8.5 in 2005). During the same timeframe, the mean number of parathyroidectomies performed by OHNS residents rose sharply and steadily from 1.8 in 1996 to 10.9 in 2005. The number of American GS parathyroid publications from 1991 to 1995 was 41, compared with 108 in the period 2001 to 2005. During the same timeframe, the number of American OHNS parathyroid papers increased from 1 to 27. The relative proportion of parathyroid publications authored by American otolaryngologists rose from 2.4% to 20.0% (P = .006).
Increasingly, otolaryngologists are the primary surgeons in parathyroid operations as indicated by two surrogate metrics. Graduating chief residents in otolaryngology now perform more parathyroid procedures than chief residents in general surgery, and a growing proportion of parathyroid publications are being authored by otolaryngologists.
Notes
Comment In: Laryngoscope. 2008 Jan;118(1):189; author reply 19018165719
PubMed ID
17417105 View in PubMed
Less detail

Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway.

https://arctichealth.org/en/permalink/ahliterature283716
Source
J Clin Endocrinol Metab. 2016 Aug;101(8):3045-53
Publication Type
Article
Date
Aug-2016
Author
Marianne C Astor
Kristian Løvås
Aleksandra Debowska
Erik F Eriksen
Johan A Evang
Christian Fossum
Kristian J Fougner
Synnøve E Holte
Kari Lima
Ragnar B Moe
Anne Grethe Myhre
E Helen Kemp
Bjørn G Nedrebø
Johan Svartberg
Eystein S Husebye
Source
J Clin Endocrinol Metab. 2016 Aug;101(8):3045-53
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
DNA Mutational Analysis
Female
Health status
Humans
Hypoparathyroidism - epidemiology - etiology
Male
Middle Aged
Norway - epidemiology
Parathyroidectomy - adverse effects - statistics & numerical data
Postoperative Complications - epidemiology
Quality of Life
Surveys and Questionnaires
Transcription Factors - genetics
Young Adult
Abstract
The epidemiology of hypoparathyroidism (HP) is largely unknown. We aimed to determine prevalence, etiologies, health related quality of life (HRQOL) and treatment pattern of HP.
Patients with HP and 22q11 deletion syndrome (DiGeorge syndrome) were identified in electronic hospital registries. All identified patients were invited to participate in a survey. Among patients who responded, HRQOL was determined by Short Form 36 and Hospital Anxiety and Depression scale. Autoantibodies were measured and candidate genes (CaSR, AIRE, GATA3, and 22q11-deletion) were sequenced for classification of etiology.
We identified 522 patients (511 alive) and estimated overall prevalence at 102 per million divided among postsurgical HP (64 per million), nonsurgical HP (30 per million), and pseudo-HP (8 per million). Nonsurgical HP comprised autosomal dominant hypocalcemia (21%), autoimmune polyendocrine syndrome type 1 (17%), DiGeorge/22q11 deletion syndrome (15%), idiopathic HP (44%), and others (4%). Among the 283 respondents (median age, 53 years [range, 9-89], 75% females), seven formerly classified as idiopathic were reclassified after genetic and immunological analyses, whereas 26 (37% of nonsurgical HP) remained idiopathic. Most were treated with vitamin D (94%) and calcium (70%), and 10 received PTH. HP patients scored significantly worse than the normative population on Short Form 36 and Hospital Anxiety and Depression scale; patients with postsurgical scored worse than those with nonsurgical HP and pseudo-HP, especially on physical health.
We found higher prevalence of nonsurgical HP in Norway than reported elsewhere. Genetic testing and autoimmunity screening of idiopathic HP identified a specific cause in 21%. Further research is necessary to unravel the causes of idiopathic HP and to improve the reduced HRQOL reported by HP patients.
Notes
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