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American Journal of Physiology. Renal... May 2006This review considers many new basic and clinical aspects of parathyroid hormone (PTH). We focus especially on the identification of PTH fragments and how they may... (Review)
Review
This review considers many new basic and clinical aspects of parathyroid hormone (PTH). We focus especially on the identification of PTH fragments and how they may relate to renal failure, diagnosis, and treatment of secondary hyperparathyroidism and renal osteodystrophy. The biosynthesis and metabolism of PTH, measurement of circulating forms of PTH, the effects of PTH on receptor activation and turnover, the relationship between PTH levels and bone turnover in renal failure in humans, and the involvement of PTH in experimental models of renal failure are discussed. Despite these developments in understanding the etiology of renal failure and the availability of new assays for bioactive PTH, no adequate surrogate for bone biopsy and quantitative bone histomorphometry has been developed.
Topics: Amino Acid Sequence; Animals; Chronic Kidney Disease-Mineral and Bone Disorder; Disease Models, Animal; Down-Regulation; Humans; Hyperparathyroidism; Models, Theoretical; Molecular Sequence Data; Parathyroid Hormone; Renal Insufficiency
PubMed: 16601298
DOI: 10.1152/ajprenal.00336.2005 -
Arquivos Brasileiros de Endocrinologia... Mar 2010Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or... (Review)
Review
Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or more of the parathyroid glands. The historical view of this disease describes two distinct entities marked by two eras. When primary hyperparathyroidism was first discovered about 80 years ago, it was always symptomatic with kidney stones, bone disease and marked hypercalcemia. With the advent of the multichannel autoanalyzer about 40 years ago, the clinical phenotype changed to a disorder characterized by mild hypercalcemia and the absence of classical other features of the disease. We may now be entering a 3rd era in the history of this disease in which patients are being discovered with normal total and ionized serum calcium concentrations but with parathyroid hormone levels that are consistently elevated. In this article, we describe this new entity, normocalcemic primary hyperparathyroidism, a forme fruste of the disease.
Topics: Calcium; Humans; Hyperparathyroidism, Primary; Parathyroid Hormone
PubMed: 20485897
DOI: 10.1590/s0004-27302010000200004 -
Nutrients Feb 2021Due to the potentially crucial role of vitamin K in calcium metabolism, a deficit can disrupt many mechanisms, resulting in an array of different issues, such as broken... (Review)
Review
BACKGROUND
Due to the potentially crucial role of vitamin K in calcium metabolism, a deficit can disrupt many mechanisms, resulting in an array of different issues, such as broken bones, stiff arteries and poor fertility. Although there has been existing research, the potential of vitamin K as a treatment for conditions including cerebral palsy, parathyroid disease, heart disease and gastrointestinal disease is unknown. This review discusses the biochemistry of vitamin K and the metabolism of calcium, followed by an analysis of the current literature available on vitamin K and its prospects.
METHODS
Using public libraries including PubMed and Wiley, we searched for existing research on the metabolism and use of vitamin K that has been conducted in the preceding two decades.
RESULTS
Data indicated that vitamin K had a positive impact on osteoporosis, cardiovascular disease, parathyroid disorders, cerebral palsy and sperm motility.
CONCLUSION
Due to the existence of confounding variables and limitations in the quality and volume of research conducted, further investigation must be done to see whether the beneficial effects seen are reproducible and must assess the viability of vitamin K as treatment in isolation for these conditions.
Topics: Calcium; Calcium Metabolism Disorders; Cerebral Palsy; Gastrointestinal Diseases; Heart Diseases; Humans; Parathyroid Diseases; Vitamin K 2; Vitamins
PubMed: 33670005
DOI: 10.3390/nu13020691 -
BMJ Case Reports Oct 2020Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally...
Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally occur in the fourth and fifth decades of life and mainly are non-functioning. They commonly present as a neck mass that is found incidentally during surgery or in imaging test. Its importance lies in the difficulty in diagnosis, often confusing itself with thyroid pathology. The diagnosis is usually made intraoperatively, confirmed by histopathological examination.The aim of this paper is to report a case of parathyroid cyst that mimics a thyroid nodule.
Topics: Adult; Biopsy, Fine-Needle; Cysts; Diagnosis, Differential; Humans; Incidental Findings; Male; Parathyroid Diseases; Parathyroid Glands; Parathyroidectomy; Peritonsillar Abscess; Tomography, X-Ray Computed
PubMed: 33040031
DOI: 10.1136/bcr-2019-232017 -
International Journal of Molecular... Sep 2021Tumors of the parathyroid glands are common endocrine diseases almost always characterized by parathyroid hormone hypersecretion that determines the clinical... (Review)
Review
Tumors of the parathyroid glands are common endocrine diseases almost always characterized by parathyroid hormone hypersecretion that determines the clinical manifestations of primary hyperparathyroidism, such as fatigue, kidney problems, weakness, brittle bones, and other symptoms. Most parathyroid neoplasia are benign adenomas, although rare malignant forms have been described. They are heterogeneous in terms of clinical presentation and the associated signs and symptoms overlap with those of disease and aging. Furthermore, most patients with hypercalcemia are discovered during routine blood tests for other reasons. Surgical removal is considered the main therapeutic option to cure these endocrine tumors and, therefore, innovative therapeutic approaches are actively required. Recently, a growing number of studies have suggested that alterations to the epigenetic mechanisms could play a pivotal role in parathyroid tumorigenesis. Most of the attention has been focused on non-coding RNAs (ncRNAs) (i.e., miRNAs, lncRNAs, and circRNAs) whose expression profile has been found to be deregulated in parathyroid tumors. The aim of the present paper is to give an insight into the ncRNAs involved in parathyroid tumorigenesis, which could be used in the future either as innovative diagnostic biomarkers or as therapeutic targets for the treatment of this endocrine neoplasia.
Topics: Biomarkers, Tumor; Epigenesis, Genetic; Gene Expression Regulation, Neoplastic; Humans; MicroRNAs; Parathyroid Neoplasms; RNA, Circular; RNA, Long Noncoding; RNA, Untranslated
PubMed: 34638805
DOI: 10.3390/ijms221910465 -
IUBMB Life Apr 2011Impaired kidney function and subsequent skeletal responses play a critical role in disrupting phosphate balance in chronic kidney disease (CKD) patients with mineral and... (Review)
Review
Impaired kidney function and subsequent skeletal responses play a critical role in disrupting phosphate balance in chronic kidney disease (CKD) patients with mineral and bone disorder (CKD-MBD). In patients with CKD-MBD, the inability of the kidney to maintain normal mineral ion balance affects bone remodeling to induce skeletal fracture and extraskeletal vascular calcification. In physiological conditions, bone-derived fibroblast growth factor 23 (FGF23) acts on the kidney to reduce serum phosphate and 1,25-dihydroxyvitamin D levels. In humans, increased bioactivity of FGF23 leads to increased urinary phosphate excretion, which induces hypophosphatemic diseases (e.g., rickets/osteomalacia). However, reduced FGF23 activity is associated with hyperphosphatemic diseases (e.g., tumoral calcinosis). In patients with CKD, high serum levels of FGF23 fail to reduce serum phosphate levels and lead to numerous complications, including vascular calcification, one of the important determinants of mortality of CKD-MBD patients. Of particular significance, molecular, biochemical and morphological changes in patients with CKD-MBD are mostly due to osteo-renal dysregulation of mineral ion metabolism. Furthermore, hyperphosphatemia can partly contribute to the development of secondary hyperparathyroidism in patients with CKD-MBD. Relatively new pharmacological agents including sevelamer hydrochloride, calcitriol analogs and cinacalcet hydrochloride are used either alone, or in combination, to minimize hyperphosphatemia and hyperparathyroidism associated complications to improve morbidity and mortality of CKD-MBD patients. This article will briefly summarize how osteo-renal miscommunication can induce phosphate toxicity, resulting in extensive tissue injuries.
Topics: Animals; Bone Diseases, Metabolic; Bone and Bones; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Glucuronidase; Humans; Hyperparathyroidism; Hyperphosphatemia; Kidney; Klotho Proteins; Parathyroid Hormone; Phosphates; Renal Insufficiency, Chronic; Vitamin D
PubMed: 21438115
DOI: 10.1002/iub.437 -
Seminars in Nephrology Jul 2018Chronic kidney disease mineral bone disorder (CKD-MBD) is common in end-stage renal disease and is associated with an increased risk of cardiovascular morbidity and... (Review)
Review
Chronic kidney disease mineral bone disorder (CKD-MBD) is common in end-stage renal disease and is associated with an increased risk of cardiovascular morbidity and mortality. Mainstays of treatment include decreasing serum phosphorus level toward the normal range with dietary interventions and phosphate binders and treating increased parathyroid hormone levels with activated vitamin D and/or calcimimetics. There is significant variation in serum levels of mineral metabolism markers, intestinal absorption of phosphorus, and therapeutic response among individual patients and subgroups of patients with end-stage renal disease. This variation may be partly explained by polymorphisms in genes associated with calcium and phosphorus homeostasis such as the calcium-sensing receptor gene, the vitamin D-binding receptor gene, and genes associated with vascular calcification. In this review, we discuss how personalized medicine may be used for the management of CKD-MBD and how it ultimately may lead to improved clinical outcomes. Although genetic variants may seem attractive targets to tailor CKD-MBD therapy, complete understanding of how these polymorphisms function and their clinical utility and applicability to personalized medicine need to be determined.
Topics: Bone Diseases, Metabolic; Calcium; Cardiovascular Diseases; Humans; Hyperparathyroidism, Secondary; Intestinal Absorption; Kidney Failure, Chronic; Parathyroid Hormone; Phosphorus; Polymorphism, Genetic; Precision Medicine; Receptors, Calcium-Sensing; Vascular Calcification; Vitamin D; Vitamin D-Binding Protein
PubMed: 30082059
DOI: 10.1016/j.semnephrol.2018.05.009 -
Clinical and Experimental Nephrology Jul 2022Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disorder that affects multiple organs and systems and increases the risk of morbidity and... (Review)
Review
Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutrition-inflammation complex syndrome (MICS) in patients receiving dialysis.
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disorder that affects multiple organs and systems and increases the risk of morbidity and mortality in patients with CKD, especially those receiving dialysis therapy. CKD-MBD is highly prevalent in CKD patients, and its treatment is gaining attention from healthcare providers who manage these patients. Additional important pathologies often observed in CKD patients are chronic inflammation and malnutrition/protein-energy wasting (PEW). These two pathologies coexist to form a vicious cycle that accelerates the progression of various other pathologies in CKD patients. This concept is integrated into the term "malnutrition-inflammation-atherosclerosis syndrome" or "malnutrition-inflammation complex syndrome (MICS)". Recent basic and clinical studies have shown that CKD-MBD directly induces inflammation as well as malnutrition/PEW. Indeed, higher circulating levels of inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles, as markers for critical components and effectors of CKD-MBD, were shown to directly induce inflammatory responses, thereby leading to malnutrition/PEW, cardiovascular diseases, and clinically relevant complications. In this short review, we discuss the close interplay between CKD-MBD and MICS and emphasize the significance of simultaneous control of these two seemingly distinct pathologies in patients with CKD, especially those receiving dialysis therapy, for better management of the CKD/hemodialysis population.
Topics: Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Inflammation; Malnutrition; Parathyroid Hormone; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 35353283
DOI: 10.1007/s10157-022-02216-x -
Archives of Pathology & Laboratory... Dec 2005Preoperative fine-needle aspiration of thyroid lesions has greatly diminished the need for surgical evaluation. However, because thyroid nodules are common lesions, many... (Review)
Review
CONTEXT
Preoperative fine-needle aspiration of thyroid lesions has greatly diminished the need for surgical evaluation. However, because thyroid nodules are common lesions, many still require surgical intervention and represent a substantial number of cases that the pathologist encounters in the frozen section laboratory.
OBJECTIVE
Comprehensive reviews of frozen section indications, as well as gross, cytologic, and histologic features of the most common and diagnostically important thyroid and parathyroid lesions, are presented to provide a guideline for proper triage and management of these cases in the frozen section laboratory. The most common pitfalls are discussed in an attempt to avoid discordant diagnoses.
DATA SOURCES
Thyroid lobectomy, subtotal or total thyroidectomy, and parathyroid biopsy or parathyroidectomy cases are included in this review.
CONCLUSIONS
The frozen section evaluation of thyroid and parathyroid lesions remains a highly accurate procedure with a low false-positive rate. Gross inspection, complemented by cytologic and histologic review, provides the surgeon with the rapid, reliable, cost-effective information necessary for optimum patient care.
Topics: Diagnosis, Differential; Diagnostic Errors; Frozen Sections; Humans; Parathyroid Diseases; Parathyroid Glands; Pathology, Surgical; Practice Guidelines as Topic; Reproducibility of Results; Thyroid Diseases; Thyroid Gland
PubMed: 16329730
DOI: 10.5858/2005-129-1575-FSOTAP -
British Medical Journal Aug 1968In our first 200 cases of primary hyperparathyroidism confirmed by operation 12 were also shown to have a long history either of a malabsorption syndrome or of chronic...
In our first 200 cases of primary hyperparathyroidism confirmed by operation 12 were also shown to have a long history either of a malabsorption syndrome or of chronic renal-glomerular failure. We consider that they first went through a phase of secondary hyperparathyroidism, during which one or more of the glands became autonomous adenamata. This then produced the biochemical changes of "primary" hyperparathyroidism, necessitating excision of the adenoma. This condition is best described as "tertiary" hyperparathyroidism. The transition from secondary to tertiary hyperparathyroidism occurred in four of the 12 patients while under our observation. We think the same process can be traced retrospectively in the other eight cases. The concept of tertiary hyperparathyroidism may help to explain the high incidence of other diseases in association with primary hyperparathyroidism.The behaviour of the parathyroid glands provides a valuable model for the investigation of tumour formation in man. All states occurred in our patients with primary hyperparathyroidism, from normal through hyperplasia to adenoma formation and finally to parathyroid carcinoma.
Topics: Adenoma; Adult; Aged; Diagnosis, Differential; Female; Humans; Hypercalcemia; Hyperparathyroidism; Hyperplasia; Kidney Failure, Chronic; Malabsorption Syndromes; Male; Middle Aged; Parathyroid Neoplasms; Sex Factors
PubMed: 5691200
DOI: 10.1136/bmj.3.5615.395