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Endocrinology and Metabolism Clinics of... Dec 2018The parathyroid glands are essential for regulating calcium homeostasis in the body. The genetic programs that control parathyroid fate specification, morphogenesis,... (Review)
Review
The parathyroid glands are essential for regulating calcium homeostasis in the body. The genetic programs that control parathyroid fate specification, morphogenesis, differentiation, and survival are only beginning to be delineated, but are all centered around a key transcription factor, GCM2. Mutations in the Gcm2 gene as well as in several other genes involved in parathyroid organogenesis have been found to cause parathyroid disorders in humans. Therefore, understanding the normal development of the parathyroid will provide insight into the origins of parathyroid disorders.
Topics: Animals; Gene Expression Regulation; Humans; Nuclear Proteins; Parathyroid Glands; Parathyroid Hormone; Transcription Factors
PubMed: 30390809
DOI: 10.1016/j.ecl.2018.07.002 -
Annals of Saudi Medicine 2023Neonatal severe hyperparathyroidism (NSHPT) is a rare disease that can be lethal. Most patients require parathyroidectomy. (Review)
Review
BACKGROUND
Neonatal severe hyperparathyroidism (NSHPT) is a rare disease that can be lethal. Most patients require parathyroidectomy.
OBJECTIVE
Report experience in managing this severe disease.
DESIGN
Retrospective chart review of case series.
SETTING
Tertiary health care center.
PATIENTS AND METHODS
We reviewed data on patients managed for NSHPT from June 2001 to January 2023. Demographic, clinical, and follow-up data were collected, and descriptive data were generated.
MAIN OUTCOME MEASURES
Pre- and postoperative levels of parathyroid hormone (PTH) and serum calcium, and effect of autotransplantation.
SAMPLE SIZE
19.
RESULTS
The 13 males and 6 females had a a mean age of 46 days at referral. The mean preoperative parathyroid hormone (PTH) and serum calcium levels were 996 ng/L and 4.54 mmol/L, respectively. Twelve patients underwent ultrasonography preoperatively. Of these, six had prominent glands, while no glands were seen in the other six. A Sestamibi scan was done for 15 patients, of which nine showed negative results and six showed positive results, with three glands observed in the neck and three in the sublingual area. Nineteen patients underwent renal ultrasonography, with nine showing nephrocalcinosis. The mean age at surgery was 5.2 months. Total parathyroidectomy (four glands) was performed in 17 patients, and 15 underwent concurrent auto-transplantation. One patient had three glands removed, in addition to auto-transplantation. Another underwent single gland excision as a redo-surgery after previous surgery elsewhere. The mean postoperative follow-up duration was 6 years. The mean postoperative PTH and calcium levels were 25 ng/L and 1.64 mmol/L, respectively. Ultimately, all the patients were required to initiate calcium and vitamin D supplements, except for two patients who had undergone auto-transplantation. Molecular genetic screening of the calcium-sensing receptor gene reported likely pathogenic/pathogenic mutations in 16 of 19 patients (13 were homozygous, two were heterozygous, one was negative, and data was unavailable for the remaining three patients).
CONCLUSIONS
Surgical treatment of NSHPT is effective. Preoperative radiological localization studies did not impact the treatment plan. Auto-transplantation proved ineffective in maintaining independence from medical supplements.
LIMITATIONS
The retrospective nature of the study may imply inaccuracybut since the data are gathered from electronic medical records, we believe it is highly accurate. The small sample size limits generalizability.
Topics: Male; Infant, Newborn; Female; Humans; Infant; Parathyroid Glands; Calcium; Retrospective Studies; Hyperparathyroidism, Primary; Parathyroid Hormone
PubMed: 37916585
DOI: 10.5144/0256-4947.2023.01.11.1200 -
Frontiers in Endocrinology 2023The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in... (Review)
Review
The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them intraoperatively undamaged.
Topics: Humans; Parathyroid Glands; Thyroid Gland; Hypoparathyroidism; Thyroidectomy; Neck
PubMed: 37324265
DOI: 10.3389/fendo.2023.1173950 -
Frontiers in Endocrinology 2023This mini review summarizes the controversies regarding routine parathyroid identification reviews publications that assess visual scores to predict parathyroid function... (Review)
Review
This mini review summarizes the controversies regarding routine parathyroid identification reviews publications that assess visual scores to predict parathyroid function after thyroidectomy during the pre-ICG era.
Topics: Indocyanine Green; Parathyroid Glands; Thyroidectomy
PubMed: 37455929
DOI: 10.3389/fendo.2023.1217795 -
Molecules (Basel, Switzerland) Apr 2020Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment... (Meta-Analysis)
Meta-Analysis Review
Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands' localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the 'ideal' approach for the diagnosis of parathyroid adenomas.
Topics: Clinical Decision-Making; Disease Management; Humans; Intraoperative Care; Multimodal Imaging; Parathyroid Glands; Parathyroid Neoplasms; Preoperative Care; Radiopharmaceuticals; Spectrum Analysis, Raman; Technetium Tc 99m Sestamibi; Theranostic Nanomedicine
PubMed: 32283730
DOI: 10.3390/molecules25071724 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2020The aim: To study the forms of anatomical variability of the external structure of the upper and lower parathyroid glands in the fetal period of human ontogenesis.
OBJECTIVE
The aim: To study the forms of anatomical variability of the external structure of the upper and lower parathyroid glands in the fetal period of human ontogenesis.
PATIENTS AND METHODS
Materials and methods: The study involved 48 specimens of human fetuses with 81,0-375,0 mm of crown-rump length (CRL). The study was conducted by means of macromicroscopic preparation, morphometry and variation statistics method.
RESULTS
Results: The age and individual anatomical variability, complex way of development and formation of synotopic embryotropographic correlations of the upper and lower parathyroid glands in the prenatal period of human ontogenesis create numerous prerequisites for the emergence of variants of their external structure and topography in the fetuses of both different and the same age groups.
CONCLUSION
Conclusions: There is a significant anatomical variability of the upper and lower parathyroid glands in 4-10-month-old fetuses, which is manifested by varieties of their shape and topical location. Aplasia of the upper parathyroid glands, which was found in two human fetuses aged 7 months, was due to the fetures of their organogenesis and the formation of syntopy in the embryonic and prefetal periods of their development. Parathyroid glands are mainly supplied with blood by the branches of the inferior thyroid artery. The branches of the upper thyroid artery and the arteries of adjacent organs: larynx, trachea and esophagus are involved in the blood supply. The right and left inferior thyroid veins are tributaries of the corresponding brachiocephalic vein, paired (right and left) superior and middle thyroid veins are those for the internal jugular vein.
Topics: Brachiocephalic Veins; Female; Fetus; Humans; Jugular Veins; Parathyroid Glands; Pregnancy; Thyroid Gland
PubMed: 32124806
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Mar 2021Endoscopic thyroid and parathyroid surgery was first described by Gagner in 1996, and Henry subsequently proposed a lateral endoscopic approach in 1999. Technical...
Endoscopic thyroid and parathyroid surgery was first described by Gagner in 1996, and Henry subsequently proposed a lateral endoscopic approach in 1999. Technical progress in the fields of optics, endoscopy, digital imaging and laparoscopy has gradually enhanced the feasibility and clinical utility of this technique for the treatment of benign and malignant lesions. To date, published paediatric cases have only concerned thyroid surgery. In the light of two clinical cases, this article describes our lateral endoscopic approach applied to paediatric parathyroid surgery.
Topics: Child; Endoscopy; Humans; Minimally Invasive Surgical Procedures; Parathyroid Glands; Parathyroidectomy; Thyroid Gland
PubMed: 32798132
DOI: 10.1016/j.anorl.2020.08.001 -
Endocrinology and Metabolism Clinics of... Dec 2018Hypoparathyroidism is characterized by hypocalcemia and hyperphosphatemia and is due to insufficient levels of circulating parathyroid hormone. Hypoparathyroidism may be... (Review)
Review
Hypoparathyroidism is characterized by hypocalcemia and hyperphosphatemia and is due to insufficient levels of circulating parathyroid hormone. Hypoparathyroidism may be an isolated condition or a component of a complex syndrome. Although genetic disorders are not the most common cause of hypoparathyroidism, molecular analyses have identified a growing number of genes that when defective result in impaired formation of the parathyroid glands, disordered synthesis or secretion of parathyroid hormone, or postnatal destruction of the parathyroid glands.
Topics: Humans; Hypoparathyroidism; Parathyroid Diseases; Parathyroid Glands; Parathyroid Hormone
PubMed: 30390815
DOI: 10.1016/j.ecl.2018.07.007 -
Asian Journal of Surgery Apr 2023Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this...
UNLABELLED
Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this study, we evaluated parathyroid autotransplantation into the brachioradialis muscle and its survival rate.
OBJECTIVES
To evaluate autologous parathyroid gland left forearm brachioradial muscle transplantation and its survival rate.
SUMMARY BACKGROUND DATA
The most commonly used transplantation site is the sternocleidomastoid muscle, but transplant survival cannot be confirmed using this method. Autologous parathyroid gland left forearm brachioradial muscle transplantation solves this problem, and we evaluate the transplant survival using this method.
METHODS
We followed-up patients who underwent thyroidectomy and autologous parathyroid left forearm brachioradial muscle transplantation in our center from September 2013 to January 2018. The last follow-up date was January 2021; all enrolled patients underwent at least 3 years of follow-up. We calculated the transplant survival rate at several time points.
RESULTS
We evaluated 238 transplanted cases, for which the long-term survival rate was 85.7% (204/238), and the short-term survival rate was 86.1% (205/238). Sixty-five cases had two parathyroid glands transplanted into the left forearm brachioradialis muscle. The long-term survival rate was 92.3% (60/65), and the short-term survival rate was 95.4% (62/65).
CONCLUSIONS
Autologous parathyroid gland left brachioradialis transplantation is a reliable, measurable method with good survival rate, and we recommend this method for consideration for transplanting parathyroid glands in thyroidectomy.
Topics: Humans; Parathyroid Glands; Follow-Up Studies; Hypoparathyroidism; Forearm; Transplantation, Autologous; Thyroidectomy
PubMed: 36085124
DOI: 10.1016/j.asjsur.2022.08.078 -
Proceedings of the National Academy of... Jul 2023Patients with permanent hypoparathyroidism require lifelong replacement therapy to avoid life-threatening complications, The benefits of conventional treatment are...
Patients with permanent hypoparathyroidism require lifelong replacement therapy to avoid life-threatening complications, The benefits of conventional treatment are limited, however. Transplanting a functional parathyroid gland (PTG) would yield better results. Parathyroid gland cells generated from pluripotent stem cells in vitro to date cannot mimic the physiological responses to extracellular calcium that are essential for calcium homeostasis. We thus hypothesized that blastocyst complementation (BC) could be a better strategy for generating functional PTG cells and compensating loss of parathyroid function. We here describe generation of fully functional PTGs from mouse embryonic stem cells (mESCs) with single-step BC. Using CRISPR-Cas9 knockout of (), we efficiently produced aparathyroid embryos for BC. In these embryos, mESCs differentiated into endocrinologically mature PTGs that rescued mice from neonatal death. The mESC-derived PTGs responded to extracellular calcium, restoring calcium homeostasis on transplantation into mice surgically rendered hypoparathyroid. We also successfully generated functional interspecies PTGs in rat neonates, an accomplishment with potential for future human PTG therapy using xenogeneic animal BC. Our results demonstrate that BC can produce functional endocrine organs and constitute a concept in treatment of hypoparathyroidism.
Topics: Humans; Animals; Mice; Rats; Parathyroid Glands; Calcium; Hypoparathyroidism; Calcium, Dietary; Blastocyst
PubMed: 37379351
DOI: 10.1073/pnas.2216564120