-
BJS Open Dec 2018The majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise... (Review)
Review
BACKGROUND
The majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise to minimally invasive parathyroidectomy (MIP), with lower complication rates in comparison with bilateral neck exploration. Misdiagnosis and undertreatment of multiglandular disease, leading to potentially higher recurrence rates, remains a concern. This study evaluated risks of long-term (1 year or more) recurrence following 'targeted' MIP in PHPT.
METHODS
Multiple databases were searched for studies published between January 2004 and March 2017, looking at long-term outcomes (1 year or more) following targeted MIP for PHPT. English-language studies, with at least 50 patients and a mean follow-up of 1 year, were included.
RESULTS
A total of 5282 patients from 14 studies were included. Overall mean recurrence and cure rates were 1·6 (range 0-3·5) and 96·9 (95·5-100) per cent respectively. Mean follow-up was 33·5 (1-145) months. When intraoperative parathyroid hormone (PTH) measurements were not done, cure rates were higher (99·3 per cent versus 98·1 per cent with use of intraoperative PTH measurement; P < 0·001) and recurrence rates lower (0·2 versus 1·5 per cent respectively; P < 0·001).
CONCLUSION
Targeted MIP for a presumed single overactive adenoma was associated with very low recurrence rates, without the need for intraoperative PTH measurement when preoperative imaging studies were concordant. Targeted MIP should be encouraged.
PubMed: 30511037
DOI: 10.1002/bjs5.77 -
The Journal of Clinical Endocrinology... Dec 2014The distinctive presentation of primary hyperparathyroidism (PHPT) in adults and youths suggest that PHPT is a fundamentally different disease in these two groups. (Comparative Study)
Comparative Study Meta-Analysis Review
CONTEXT
The distinctive presentation of primary hyperparathyroidism (PHPT) in adults and youths suggest that PHPT is a fundamentally different disease in these two groups.
OBJECTIVE
To understand the difference in PHPT between adults and youths we compared the biochemistry of PHPT in these two groups.
DESIGN
This study is a systematic review and meta-analysis of retrospective studies published 1966-2014 on PHPT.
DATA SOURCES
All studies were obtained through Medline (1966-2014).
STUDY SELECTION AND DATA EXTRACTION
Only studies that included post-surgical subjects and that explicitly described biochemical results from more than one decade were included. Data were extracted from each article to generate the mean and SE for multiple biochemical parameters.
DATA SYNTHESIS
We analyzed 16 studies describing 268 unique youths and 2405 adults with PHPT. Youths with PHPT had significantly (P < .05) greater serum and urinary calcium than adults with PHPT (3.2 ± 0.1 mmol/L vs 2.8 ± 0.0 mmol/L for serum calcium, and 9.95 ± 1.26 mmol/d vs 7.15 ± 0.56 mmol/d for urine calcium, [mean ± SEM]). There were no significant differences in serum intact PTH, phosphorus, or alkaline phosphatase.
CONCLUSIONS
Juvenile PHPT has greater hypercalcemia and hypercalciuria than adult PHPT at similar concentrations of serum intact PTH. These observations suggest that there are differences in the pathophysiology of PHPT between juvenile and adult patients who reflect an apparent decrease in the sensitivity of the parathyroid adenoma to negative feedback by calcium and increased sensitivity of target tissues to the effects of PTH.
Topics: Adolescent; Adult; Aged; Aging; Child; Humans; Hyperparathyroidism, Primary; Middle Aged
PubMed: 25181388
DOI: 10.1210/jc.2014-2268 -
Gland Surgery Jan 2024Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While... (Review)
Review
BACKGROUND
Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While parathyroidectomy is the standard treatment, non-operative intervention such as radiofrequency ablation (RFA) has been adopted as an alternative for the management of pHPT, as it has been utilized in other endocrine glands such as thyroid and adrenal. In this literature review, we aim to evaluate the current practice of RFA for pHPT.
METHODS
A systematic literature search using PubMed, Web of Science, and Embase through June 2022 was conducted. Studies included in the review consisted of patient cohorts who had an unequivocal diagnosis of pHPT and underwent the treatment of pHPT with RFA. When more than one study was published from a similar cohort of patients, only the study with the most number of patients was considered. Studies included were assessed for bias using the critical appraisal instruments from the Joanna Briggs Institute (JBI) System.
RESULTS
A total of 14 studies describing 167 parathyroid glands treated in 163 patients were reviewed. The overall cure rate was 91.2%, with 5 patients undergoing more than one ablation. The most common adverse effect encountered was temporary dysphonia. Incomplete ablation and missed multiglandular disease were the most common reasons for RFA treatment failure.
CONCLUSIONS
RFA may be an effective and safe alternative to parathyroidectomy in select patients with a well-localized, well-located parathyroid adenoma. Additional long-term data are needed to refine its role in the pHPT treatment algorithm.
PubMed: 38323227
DOI: 10.21037/gs-22-546 -
Langenbeck's Archives of Surgery Nov 2016The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers.
METHODS
A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) post-surgical and pathological diagnosis as the gold standard. Performance was expressed in sensitivity and PPV.
RESULTS
Twenty-four papers were included subdivided by radiopharmaceutical: 14 studies investigated L-[C]Methionine (11C-MET), one [C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[F]fluoro-D-glucose (18F-FDG), one 6-[F] fluoro-L-DOPA (18F-DOPA), and three N-[(F)Fluoromethyl]-2-hydroxy-N,N-dimethylethanaminium (18F-FCH). The 14 studies investigating MET included a total of 327 patients with 364 lesions. Sensitivity for the detection of a lesion in the correct quadrant had a pooled estimate of 69 % (95 % CI 60-78 %). Heterogeneity was overall high with I of 51 % (p = 0.01) for all 14 studies. Pooled PPV ranged from 91 to 100 % with a pooled estimate of 98 % (95 % CI 96-100 %). Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance.
CONCLUSIONS
The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPV and may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.
Topics: Carbon Radioisotopes; Humans; Hyperparathyroidism, Primary; Methionine; Parathyroidectomy; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 27086309
DOI: 10.1007/s00423-016-1425-0 -
World Journal of Surgery Nov 2022
Meta-Analysis
Topics: Humans; Hyperparathyroidism, Primary; Multiple Endocrine Neoplasia Type 1; Multiple Endocrine Neoplasia Type 2a; Neoplasm Recurrence, Local; Parathyroid Glands; Parathyroidectomy
PubMed: 36042033
DOI: 10.1007/s00268-022-06707-6 -
Medicine May 2018Parathyroid hormone (PTH) is one of the principal regulators of calcium homeostasis, crucial for normal functioning of the kidneys, bones, heart, and nervous system.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Parathyroid hormone (PTH) is one of the principal regulators of calcium homeostasis, crucial for normal functioning of the kidneys, bones, heart, and nervous system. Different pathologic conditions can affect serum PTH level resulting in hyperparathyroidism or hypoparathyroidism. Our study assessed the association of previously reported polymorphisms with the level of PTH (expressed in pg/mL) among individuals with different pathologic conditions affecting PTH level.
METHODS
We searched Web of Science, MEDLINE, and Scopus to identify relevant articles published up to July 2017. The search yielded 6967 publications of which 44 fulfilled the inclusion criteria. We conducted meta-analyses for calcium-sensing receptor gene (CaSR) rs1801725 polymorphism in patients with primary hyperparathyroidism and vitamin D receptor gene (VDR) rs1544410 polymorphism in patients with end-stage renal disease (ESRD).
RESULTS
None of the polymorphisms were significantly associated with PTH levels in the overall population. In subgroup analysis by ethnicity for VDR rs1544410 gene polymorphism, we found significant differences under dominant model (SMD: -0.18 [-0.32, -0.05], P < .01) and AA versus GG comparison (SMD: -0.29 [-0.52, -0.06], P < .01) in Asian patients with ESRD, while nominally significant results (P < .05) were observed for AG versus GG and AA versus GG comparisons in European individuals with ESRD.
CONCLUSION
Scientific evidence of genetic association of serum PTH level among individuals with different pathologic conditions remains deficient and published results provide weak evidence. Further well-conducted studies on larger sample sets designed according to evidence-based principles are warranted to assure clinically applicable findings.
Topics: Asian People; Calcium; Genotype; Humans; Hyperparathyroidism, Primary; Kidney Failure, Chronic; Parathyroid Hormone; Polymorphism, Single Nucleotide; Receptors, Calcitriol; Receptors, Calcium-Sensing
PubMed: 29794776
DOI: 10.1097/MD.0000000000010834 -
International Journal of Surgery... Dec 2023
Meta-Analysis
A commentary on 'The role of rapid intraoperative parathyroid hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis'.
Topics: Humans; Parathyroid Hormone; Parathyroidectomy; Hyperparathyroidism, Primary; Monitoring, Intraoperative; Retrospective Studies
PubMed: 37702567
DOI: 10.1097/JS9.0000000000000716 -
Clinical Journal of the American... Jul 2008Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic... (Review)
Review
BACKGROUND AND OBJECTIVES
Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic information is available on calciphylaxis from nonuremic causes. This systematic review was designed to characterize etiologies, clinical features, laboratory abnormalities, and prognosis of nonuremic calciphylaxis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
A systematic review of literature for case reports and case series of nonuremic calciphylaxis was performed. Cases included met the operational definition of nonuremic calciphylaxis-histopathologic diagnosis of calciphylaxis in the absence of end-stage kidney disease, renal transplantation, or acute kidney injury requiring renal replacement therapy.
RESULTS
We found 36 cases (75% women, 63% Caucasian, aged 15 to 82 yr) of nonuremic calciphylaxis. Primary hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue disease were the most common reported causes. Preceding corticosteroid use was reported for 61% patients. Protein C and S deficiencies were seen in 11% of patients. Skin lesions were morphologically similar to calcific uremic arteriolopathy. Mortality rate was 52%, with sepsis being the leading cause of death.
CONCLUSION
Calciphylaxis should be considered while evaluating skin lesions in patients with predisposing conditions even in the absence of end-stage kidney disease and renal transplantation. Nonuremic calciphylaxis is reported most often in white women. Mineral abnormalities that are invoked as potential causes in calcific uremic arteriolopathy are often absent, suggesting that heterogeneous mechanisms may contribute to its pathogenesis. Nonuremic calciphylaxis is associated with high mortality, and there is no known effective treatment.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Biomarkers; Calciphylaxis; Connective Tissue Diseases; Female; Humans; Hyperparathyroidism, Primary; Liver Diseases, Alcoholic; Male; Middle Aged; Neoplasms; Prognosis; Protein C Deficiency; Protein S Deficiency; Risk Factors; Sepsis; Skin; Skin Diseases
PubMed: 18417747
DOI: 10.2215/CJN.00530108 -
Frontiers in Endocrinology 2017[This corrects the article on p. 79 in vol. 8, PMID: 28473803.].
[This corrects the article on p. 79 in vol. 8, PMID: 28473803.].
PubMed: 28740484
DOI: 10.3389/fendo.2017.00172 -
Archives of Endocrinology and Metabolism Apr 2020While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and...
While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.
Topics: Developing Countries; Humans; Hyperparathyroidism, Primary; Severity of Illness Index
PubMed: 32236309
DOI: 10.20945/2359-3997000000211