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Endokrynologia Polska Jun 2024Not required for Clinical Vignette.
Not required for Clinical Vignette.
PubMed: 38887118
DOI: 10.5603/ep.99387 -
Expert Opinion on Investigational Drugs Jun 2024Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). It begins as an adaptive increase in parathyroid hormone levels to prevent... (Review)
Review
INTRODUCTION
Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). It begins as an adaptive increase in parathyroid hormone levels to prevent calcium and phosphate derangements. Over time, this condition becomes maladaptive and is associated with increased morbidity and mortality. Current therapies encompass phosphate-lowering strategies, vitamin D analogues, calcimimetics and parathyroidectomy. These approaches harbor inherent limitations, stimulating interest in the development of new drugs for SHPT to overcome these limitations and improve survival and quality of life among CKD patients.
AREAS COVERED
This review delves into the main pathophysiological mechanisms involved in SHPT, alongside the treatment options that are currently available and under active investigation. Data presented herein stem from a comprehensive search conducted across PubMed, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP) spanning from 2000 onwards.
EXPERT OPINION
The advancements in investigational drugs for SHPT hold significant promise for enhancing treatment efficacy while minimizing side effects associated with conventional therapies. Although several challenges still hinder their adoption in clinical practice, ongoing research will likely continue to expand the available therapeutic options, refine treatment strategies, and tailor them to individual patient profiles.
PubMed: 38881200
DOI: 10.1080/13543784.2024.2369307 -
JBMR Plus Jul 2024Data on epidemiology and secular trend in primary hyperparathyroidism (PHPT) in adults are relatively limited in Asian countries. This study aims to provide an overview...
Data on epidemiology and secular trend in primary hyperparathyroidism (PHPT) in adults are relatively limited in Asian countries. This study aims to provide an overview of the secular trends in incidence, clinical characteristics, and treatment patterns of PHPT in South Korea. We used Korea's National Health Insurance Claim database (2005-2020) to identify newly diagnosed PHPT cases. Individuals with age below 19, fewer than 2 E21.0 diagnoses, fewer than 2 PTH measurements, secondary hyperparathyroidism, undergoing dialysis or kidney transplantation within a year of diagnosis, parathyroidectomy (PTX) within a year prior to the diagnosis code, and diagnosis of multiple endocrine neoplasm or parathyroid carcinoma were excluded from the analysis. A total of 6837 patients with PHPT (PTX, = 2989; non-surgery, = 3848) were compared with 1:10 age- and sex-matched controls ( = 68 370). The mean age of patients with PHPT was 56.0 years, with 77.4% being women. The annual incidence of PHPT increased from 0.23/100 000 persons in 2005 to 1.75 in 2020, with higher rate in women than in men. Compared with 2005-2010 ( = 675), the number of newly diagnosed PHPT cases increased up to 3.1-fold ( = 2119) in 2011-2015 and 6.0-fold ( = 4043) in 2016-2020 periods. Among all patients with PHPT, 43.7% of patients underwent PTX, with decrement of proportion of bilateral surgery among PTX group across time (11.9% in 2005-2010 to 8.9% in 2016-2020, for trend .033). Among all patients with PHPT, non-surgery group increased from 41.6% in 2005-2010 to 58.0% in 2016-2020 ( for trend <.001). Patients with PHPT had higher odds of osteoporosis (odds ratio [OR] 7.03), renal stones (OR 10.55), chronic kidney diseases (OR 7.42), and cardiovascular, metabolic, and neurological conditions after adjustment for comorbidity index. In summary, the incidence of PHPT increased from 2005 to 2020 with predominance of non-surgical treatment, which calls for research focus on improving non-surgical management.
PubMed: 38868595
DOI: 10.1093/jbmrpl/ziae065 -
Heliyon Jun 2024Hyperparathyroidism is common with African American patients historically experiencing disparate outcomes. With a comprehensive outreach program and systematic treatment...
BACKGROUND
Hyperparathyroidism is common with African American patients historically experiencing disparate outcomes. With a comprehensive outreach program and systematic treatment plans, we sought to evaluate our institution's ability to reduce disparities in hyperparathyroidism.
METHODS
We performed a retrospective review of prospectively collected data at a single medical center for all patients undergoing parathyroidectomy by endocrine surgeons from 2015 to 2021 for primary (PHPT) and tertiary (THPT) hyperparathyroidism. Patient demographics, pre-and post-operative clinical and biochemical data were collected and analyzed by race.
RESULTS
Of the 757 patients included, 675 patients had PHPT with 135 (20 %) African-American (AA) and 528(78 %) female. Of 82 patients with THPT, 44 (53 %) were AA and 34 (32 %) were female. AA patients were younger than Caucasian (CA) patients with a mean age (±SD) of 56 ± 15 vs 60 ± 14 years in PHPT (p < 0.01) and 50 ± 10 vs 55 ± 10 years in THPT (p = 0.02).Median (IQR) preoperative PTH was higher in AA with PHPT 134 (97-190) vs 102 (75-144) pg/mL (p < 0.01) and in AA with THPT 285 (189-544) vs 218 (145-293) (p = 0.01) pg/mL. AA PHPT patients had significantly higher preoperative mean (±SD) calcium levels 10.9 ± 0.8 vs 10.6 ± 0.8 mg/dL(p < 0.001). Biochemical cure rates at 6 months and complication rates were not different between races.
CONCLUSIONS
AA patients with PHPT and THPT disease experienced similar cure rates to their CA counterparts despite having a more severe biochemical disease. Health care disparities may be ameliorated with treatment by high volume surgeons embedded in a comprehensive health care system.
PubMed: 38868057
DOI: 10.1016/j.heliyon.2024.e32244 -
The Journal of Clinical Endocrinology... Jun 2024Primary hyperparathyroidism (PHPT) has initially been implicated in adverse maternal and neonatal outcomes, while subsequent population studies have failed to show an...
CONTEXT
Primary hyperparathyroidism (PHPT) has initially been implicated in adverse maternal and neonatal outcomes, while subsequent population studies have failed to show an association.
OBJECTIVE
To compare maternal, pregnancy, and neonatal outcomes in patients with and without PHPT.
DESIGN
Retrospective matched-cohort study (2005-2020).
SETTING
An integrated healthcare delivery system in Southern California.
PATIENTS
Women aged 18-44 years were included. Patients with biochemical diagnosis of PHPT were matched 1:3 with eucalcemic controls (non-PHPT).
MAIN OUTCOME MEASURES
Achievement of pregnancy, pregnancy outcomes (including rates of abortion, maternal complications), and neonatal outcomes (including hypocalcemia, need for intensive care).
RESULTS
The cohort comprised 386 women with PHPT and 1158 age-matched controls. Pregnancy rates between PHPT and control groups were similar (10.6% vs 12.8%). The adjusted rate ratio of pregnancy was 0.89 (95% CI: 0.64-1.24) (PHPT vs non-PHPT). Twenty-nine pregnancies occurred in women with co-existing PHPT and 191 pregnancies occurred in controls, resulting in 23 (79.3%) and 168 (88.0%) live births, respectively (p=0.023). Neonatal outcomes were similar. Live birth rates were similar (86.4%, 80%, 79.2%) for those undergoing parathyroidectomy prior (n=22), during (n=5), or after pregnancy/never (n=24). Among patients who underwent parathyroidectomy during pregnancy, no spontaneous abortions occurred in women entering pregnancy with peak calcium <11.5 mg/dL [2.9 mmol/L].
CONCLUSIONS
We observed no difference in pregnancy rates between women with or without PHPT. Performing parathyroidectomy before pregnancy or during the second trimester appears to be a safe and successful strategy, and adherence to this strategy may be most critical for patients with higher calcium levels (≥11.5 mg/dL [2.9 mmol/L]).
PubMed: 38867506
DOI: 10.1210/clinem/dgae409 -
BMC Endocrine Disorders Jun 2024Patients with primary hyperparathyroidism (PHPT) are at risk for severe hypocalcemia (SH) following parathyroidectomy (PTX), but limited data exist on the predictors of...
Identification of novel risk factors for postoperative severe hypocalcemia in patients with primary hyperparathyroidism undergoing parathyroidectomy: a case control study.
BACKGROUND
Patients with primary hyperparathyroidism (PHPT) are at risk for severe hypocalcemia (SH) following parathyroidectomy (PTX), but limited data exist on the predictors of SH. We aimed to identify risk factors for early postoperative SH after PTX in patients with PHPT and to evaluate the predictive value of clinical parameters.
METHODS
A retrospective review of patients with PHPT who underwent PTX between January 2010 and December 2022 was performed. A total of 46 patients were included in the study, with 15 (32.6%) experiencing postoperative SH, 19 (41.3%) having calculi in the ureter or kidney, and 37 (80.4%) having osteoporosis. Patients were divided into SH and non-SH groups based on postoperative serum calcium levels. Preoperative biochemical indicators, bone turnover markers, and renal function parameters were analyzed and correlated with postoperative SH.
RESULTS
Statistically significant (P < 0.05) differences were found in preoperative serum calcium (serum Ca), intact parathyroid hormone, serum phosphorus (serum P), serum Ca/P, percentage decrease of serum Ca, total procollagen type 1 intact N-terminal propeptide, osteocalcin (OC), and alkaline phosphatase levels between the two groups. Multivariate analysis showed that serum P (odds ratio [OR] = 0.989; 95% confidence interval [95% CI] = 0.981-0.996; P = 0.003), serum Ca (OR = 0.007; 95% CI = 0.001-0.415; P = 0.017), serum Ca/P (OR = 0.135; 95% CI = 0.019-0.947; P = 0.044) and OC levels (OR = 1.012; 95% CI = 1.001-1.024; P = 0.036) were predictors of early postoperative SH. The receiver operating characteristic curve analysis revealed that serum P (area under the curve [AUC] = 0.859, P < 0.001), serum Ca/P (AUC = 0.735, P = 0.010) and OC (AUC = 0.729, P = 0.013) had high sensitivity and specificity.
CONCLUSION
Preoperative serum P, serum Ca/P and osteocalcin levels may identify patients with PHPT at risk for early postoperative SH after PTX.
Topics: Humans; Hyperparathyroidism, Primary; Female; Male; Parathyroidectomy; Middle Aged; Risk Factors; Retrospective Studies; Case-Control Studies; Hypocalcemia; Postoperative Complications; Aged; Calcium; Prognosis; Biomarkers; Adult; Follow-Up Studies; Parathyroid Hormone
PubMed: 38867205
DOI: 10.1186/s12902-024-01620-6 -
Journal of the ASEAN Federation of... 2024Primary hyperparathyroidism (PHPT) is rare in pregnancy. This condition is challenging to diagnose and manage due to the limited diagnostic and therapeutic options that...
Primary hyperparathyroidism (PHPT) is rare in pregnancy. This condition is challenging to diagnose and manage due to the limited diagnostic and therapeutic options that are safe during pregnancy. If not diagnosed and managed in a timely manner, serious maternal and foetal complications may occur. We report two cases, one with surgical intervention and one without, to show the importance of timely surgical intervention and discuss the challenges in the management of PHPT in pregnancy.
Topics: Humans; Female; Pregnancy; Hyperparathyroidism, Primary; Adult; Pregnancy Complications; Parathyroid Neoplasms; Parathyroidectomy; Pregnancy Complications, Neoplastic; Adenoma; Treatment Outcome
PubMed: 38863924
DOI: 10.15605/jafes.039.01.17 -
Peritoneal Dialysis International :... Jun 2024A man with hyperparathyroidism secondary to kidney failure on peritoneal dialysis underwent a parathyroidectomy with half-gland reimplantation complicated by severe...
A man with hyperparathyroidism secondary to kidney failure on peritoneal dialysis underwent a parathyroidectomy with half-gland reimplantation complicated by severe hungry bone syndrome resulting in severe hypocalcaemia, hypotension and QT prolongation on ECG. He was initially managed with oral calcium and intravenous (IV) calcium chloride. Despite standard supportive treatment, attempts to wean IV therapy were unsuccessful. We report the novel use of intraperitoneal calcium to facilitate the weaning of IV calcium and discharge from hospital. A subsequent peritoneal membrane adequacy study did not demonstrate loss of peritoneal membrane adequacy.
PubMed: 38860361
DOI: 10.1177/08968608241256846 -
International Journal of Surgery Case... Jul 2024Bilateral forms of quadricipital tendon rupture are rare. They are usually associated with predisposing factors, such as secondary hyperparathyroidism due to chronic...
INTRODUCTION
Bilateral forms of quadricipital tendon rupture are rare. They are usually associated with predisposing factors, such as secondary hyperparathyroidism due to chronic renal failure, which need to be treated to avoid recurrence.
PRESENTATION OF CASE
A 38-year-old man with a medical history of chronic kidney failure was presented to the hospital for bilateral quadricipital tendon ruptures after a low-energy trauma. Ruptures were in the midportion of the tendon on the right side and in the level of patellar insertion on the left side. We performed a surgical reparation. One year after surgery, he consulted for a recurrence of the left quadricipital tendon rupture after an impeded extension movement. Biology showed secondary hyperparathyroidism due to chronic renal failure. Surgical reparation and reconstruction by a graft tendon were performed. As for his secondary hyperparathyroidism, he got a sub-parathyroidectomy after medical treatment failure. Recovery was remarkably uneventful.
DISCUSSION
Despite the early diagnosis and treatment of a bilateral quadricipital tendons rupture, our patient had an iterative rupture. His secondary hyperparathyroidism due to chronic renal failure may weaken the tendon system through physiological and histological modifications, as it is reported in the literature. As a result, treating a bilateral rupture as a banal post-traumatic lesion without management of the predisposing factors may lead to recurrences.
CONCLUSION
A non or low-traumatic tendon rupture in a patient with a history of chronic renal failure needs to identify secondary hyperparathyroidism, which must be treated to avoid recurrences.
PubMed: 38852570
DOI: 10.1016/j.ijscr.2024.109892 -
Gland Surgery May 2024
PubMed: 38845838
DOI: 10.21037/gs-23-534