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Radiologic Clinics of North America Nov 2020Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. Surgery remains the first-line curative... (Review)
Review
Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. Surgery remains the first-line curative therapy in PHPT. Imaging plays a vital role in presurgical localization of parathyroid adenomas. Ultrasound provides a safe and quick imaging modality free of ionizing radiation, but is operator dependent. Sestamibi scan offers comparable sensitivity to ultrasound, improved with concurrent tomographic imaging. 4DCT remains a problem-solving technique in challenging cases and after failed neck exploration. We present an overview of various parathyroid imaging modalities, including protocols and findings, in addition to relevant pearls and pitfalls.
Topics: Diagnostic Imaging; Female; Humans; Hyperparathyroidism, Primary; Imaging, Three-Dimensional; Male; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Prognosis; Radiographic Image Enhancement; Radiopharmaceuticals; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler
PubMed: 33040849
DOI: 10.1016/j.rcl.2020.07.006 -
Seminars in Nuclear Medicine Jul 2023Primary hyperparathyroidism (1° HPT) is a relatively common endocrine disorder usually caused by autonomous secretion of parathormone by one or several parathyroid... (Review)
Review
Primary hyperparathyroidism (1° HPT) is a relatively common endocrine disorder usually caused by autonomous secretion of parathormone by one or several parathyroid adenomas. 1° HPT causing hypercalcemia, kidney stones and/or osteoporosis should be treated whenever possible by parathyroidectomy. Accurate preoperative location of parathyroid adenomas is crucial for surgery planning, mostly when performing minimally invasive surgery. Cervical ultrasonography (US) is usually performed to localize parathyroid adenomas as a first intention, followed by Tc- sestamibi scintigraphy with SPECT/CT whenever possible. 4D-CT is a possible alternative to Tc- sestamibi scintigraphy. Recently, F-fluorocholine positron emission tomography/computed tomography (F-FCH PET/CT) has made its way in the clinics as it is the most sensitive method for parathyroid adenoma detection. It can eventually be combined to 4D-CT to increase its diagnostic performance, although this results in higher dose exposure to the patient. Other forms of hyperparathyroidism consist in secondary (2° HPT) and tertiary hyperparathyroidism (3° HPT). As parathyroidectomy is not usually part of the management of patients with 2° HPT, parathyroid imaging is not routinely performed in these patients. In patients with 3° HPT, total or subtotal parathyroidectomy is often performed. Localization of hyperfunctional glands is an important aid to surgery planning. As F-FCH PET/CT is the most sensitive modality in multigland disease, it is the preferred imaging technic in 3° HPT patients, although its cost and availability may limit its widespread use in this setting.
Topics: Humans; Positron Emission Tomography Computed Tomography; Parathyroid Neoplasms; Parathyroid Glands; Hyperparathyroidism; Technetium Tc 99m Sestamibi; Radiopharmaceuticals
PubMed: 36922339
DOI: 10.1053/j.semnuclmed.2023.02.004 -
Frontiers in Endocrinology 2023We successfully developed a broad spectrum of patient-derived endocrine organoids (PDO) from benign and malignant neoplasms of thyroid, parathyroid, and adrenal glands....
INTRODUCTION
We successfully developed a broad spectrum of patient-derived endocrine organoids (PDO) from benign and malignant neoplasms of thyroid, parathyroid, and adrenal glands. In this study, we employed functionally intact parathyroid PDOs from benign parathyroid tissues to study primary hyperparathyroidism (PHPT), a common endocrine metabolic disease. As proof of concept, we examined the utility of parathyroid PDOs for bioenergetic and metabolic screening and assessed whether parathyroid PDO metabolism recapitulated matched PHPT tissues.
METHODS
Our study methods included a fine-needle aspiration (FNA)-based technique to establish parathyroid PDOs from human PHPT tissues (n=6) in semi-solid culture conditions for organoid formation, growth, and proliferation. Mass spectrometry metabolomic analysis of PHPT tissues and patient-matched PDOs, and live cell bioenergetic profiling of parathyroid PDOs with extracellular flux analyses, were performed. Functional analysis cryopreserved and re-cultured parathyroid PDOs for parathyroid hormone (PTH) secretion was performed using ELISA hormone assays.
RESULTS AND DISCUSSION
Our findings support both the feasibility of parathyroid PDOs for metabolic and bioenergetic profiling and reinforce metabolic recapitulation of PHPT tissues by patient-matched parathyroid PDOs. Cryopreserved parathyroid PDOs exhibited preserved, rapid, and sustained secretory function after thawing. In conclusion, successful utilization of parathyroid PDOs for metabolic profiling further affirms the feasibility of promising endocrine organoid platforms for future metabolic studies and broader multiplatform and translational applications for therapeutic advancements of parathyroid and other endocrine applications.
Topics: Humans; Parathyroid Glands; Biopsy, Fine-Needle; Thyroid Gland; Organoids
PubMed: 37492197
DOI: 10.3389/fendo.2023.1223312 -
Advances in Experimental Medicine and... 2020Parathyroid tumors are the second most common endocrine neoplasia, and it is almost always associated with hypersecretion of the parathormone (PTH), involved in calcium... (Review)
Review
Parathyroid tumors are the second most common endocrine neoplasia, and it is almost always associated with hypersecretion of the parathormone (PTH), involved in calcium homeostasis, causing primary hyperparathyroidism (PHPT). Parathyroid neoplasia has a stromal component particularly represented in atypical adenomatous and carcinomatous lesions. Recently, data about the features and the function of the parathyroid tumor microenvironment (TME) have been accumulated. Parathyroid TME includes heterogeneous cells: endothelial cells, myofibroblasts, lymphocytes and macrophages, and mesenchymal stem cells have been identified, each of them presenting a phenotype consistent with tumor-associated cells. Parathyroid tumors overexpress proangiogenic molecules including vascular endothelial growth factor (VEGF-A), fibroblast growth factor-2 (FGF-2), and angiopoietins that promote both recruitment and proliferation of endothelial cell precursors, thus resulting in a microvessel density higher than that detected in normal parathyroid glands. Moreover, parathyroid tumor endocrine cells operate multifaceted interactions with stromal cells, partly mediated by the CXCL12/CXCR4 pathway, while, at present, the immune landscape of parathyroid tumors has just begun to be investigated. Studies about TME in parathyroid adenomas provide an example of the role of TME in benign tumors, whose molecular mechanisms and functions comprehension are limited.
Topics: Humans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Tumor Microenvironment
PubMed: 32030674
DOI: 10.1007/978-3-030-36214-0_3 -
Surgical Oncology Clinics of North... Oct 2022During cervical surgery, localization and identification of parathyroid glands is key to both the removal of abnormal hyperfunctioning glands and the preservation of... (Review)
Review
During cervical surgery, localization and identification of parathyroid glands is key to both the removal of abnormal hyperfunctioning glands and the preservation of normal glands. The challenging nature of parathyroid localization has fostered innovation in imaging techniques to localize glands both before and during cervical operations. Advances in preoperative imaging include PET-based imaging modalities paired with computed tomography or MRI for anatomic correlation. During surgery, both parathyroid autofluorescence and contrast-enhanced fluorescence techniques are useful adjuncts for intraoperative identification.
Topics: Choline; Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 36243498
DOI: 10.1016/j.soc.2022.06.004 -
FP Essentials Mar 2022Parathyroid hormone (PTH) helps regulate calcium homeostasis in a complex relationship with the gastrointestinal tract, kidneys, bone, and parathyroid glands....
Parathyroid hormone (PTH) helps regulate calcium homeostasis in a complex relationship with the gastrointestinal tract, kidneys, bone, and parathyroid glands. Abnormalities in PTH production can result in many conditions, including hypoparathyroidism, and primary, secondary, and tertiary hyperparathyroidism. Management of each abnormality centers on maintaining normal or near-normal serum calcium values to prevent complications. Most cases of hypoparathyroidism are caused by neck surgery and may result in acute hypocalcemia. Patients with chronic hypoparathyroidism are treated with a combination of calcium, vitamin D analogs, and, occasionally, exogenous PTH. A single parathyroid adenoma causes most cases of primary hyperparathyroidism, with multiglandular disease and cancer as other possible etiologies. All patients with symptomatic primary hyperparathyroidism and many with asymptomatic hyperparathyroidism undergo partial or full parathyroidectomy to correct the underlying condition. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is the most common cause of secondary and tertiary hyperparathyroidism, in which hypocalcemia stimulates PTH production. Most patients with CKD-MBD are treated medically with phosphate binders, vitamin D analogs, and calcimimetics, but rare cases are managed with parathyroidectomy. Severe calcium or vitamin D deficiency also causes secondary hyperparathyroidism and is managed with calcium and vitamin D replacement.
Topics: Calcium; Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Thyroid Gland; Vitamin D
PubMed: 35235284
DOI: No ID Found -
Medical Sciences (Basel, Switzerland) Mar 2022: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by... (Review)
Review
: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be the solution. A systematic literature review is conducted in the present paper, with the aim of outlining the possibilities of parathyroid allotransplantation and to calculate its efficacy. Additionally, various transplantation characteristics are linked to success. This review is carried out according to the PRISMA statement and checklist. Relevant articles were searched for in medical databases with the most recent literature search performed on 9 December 2021. In total, 24 articles involving 22 unique patient cohorts were identified with 203 transplantations performed on 148 patients. Numerous types of (exploratory) interventions were carried out with virtually no protocols that were alike: there was the use of (non-) cryopreserved parathyroid tissue combined with direct transplantation or pretreatment using in vitro techniques, such as culturing cells and macro-/microencapsulation. The variability increased further when considering immunosuppression, graft histology, and donor-recipient compatibility, but this was found to be reported in its entirety by exception. As a result of the large heterogeneity among studies, we constructed our own criterium for transplantation success. With only the studies eligible for our assessment, the pooled success rate for parathyroid allotransplantation emerged to be 46% (13/28 transplantations) with a median follow-up duration of 12 months (Q1-Q3: 8-24 months). Manifold possibilities have been explored around parathyroid allotransplantation but are presented as a double-edged sword due to high clinical diverseness, low expertise in carrying out the procedure, and unsatisfactory study quality. Transplantations carried out with permanent immunosuppression seem to be the most promising, but, in its current state, little could be said about the treatment efficacy with a high quality of evidence. Of foremost importance in pursuing the answer whether parathyroid allotransplantation is a suitable treatment for hypoparathyroidism, a standardized definition of transplantation success must be established with a high-quality trial.
Topics: Humans; Hypoparathyroidism; Immunosuppression Therapy; Parathyroid Glands; Tissue Donors; Treatment Outcome
PubMed: 35323218
DOI: 10.3390/medsci10010019 -
Acta Clinica Croatica Jun 2020The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry... (Review)
Review
INTRODUCTION
The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry risks which can be classified as minor or major.
DISCUSSION
In this overview, we present minor (seroma, scarring) and major complications of thyroid surgery (recurrent nerve injury, hypoparathyroidism, and bleeding). We discuss the possibilities of prevention and treatment of each of those complications.
CONCLUSION
In recent years, thyroid surgery is becoming safer due to the development of new surgical, hemostatic, and other techniques such as intraoperative monitoring of the recurrent laryngeal nerve and parathyroid gland detection.
Topics: Humans; Hypocalcemia; Intraoperative Complications; Parathyroid Glands; Postoperative Complications; Thyroid Gland; Thyroidectomy
PubMed: 34219888
DOI: 10.20471/acc.2020.59.s1.10 -
Journal of Bone and Mineral Research :... Dec 2022The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of...
The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Topics: Humans; Hypoparathyroidism; Parathyroid Hormone; Quality of Life; Parathyroid Glands
PubMed: 36153665
DOI: 10.1002/jbmr.4714 -
The Surgical Clinics of North America Aug 2019This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing... (Review)
Review
This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing gland, when to perform a unilateral versus bilateral exploration for cure, approaches to secondary hyperparathyroidism, management of familial hyperparathyroidism, and the treatment of parathyroid cancer. The management of intraoperative complications, such as recurrent laryngeal nerve injury and devascularization of parathyroid glands, also is discussed.
Topics: Decision Making; Humans; Hyperparathyroidism, Primary; Intraoperative Period; Parathyroid Glands; Parathyroidectomy
PubMed: 31255199
DOI: 10.1016/j.suc.2019.04.008