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JAMA Network Open Jun 2022Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results...
IMPORTANCE
Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results from previous studies have been inconsistent. Evidence of the association of parathyroidectomy (PTX) with these outcomes is also limited because of the lack of large well-controlled trials.
OBJECTIVE
To investigate whether untreated pHPT was associated with an increased risk of incident fractures and cardiovascular events (CVEs) and whether PTX was associated with a reduced risk of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included all patients who were diagnosed with pHPT at hospitals in Sweden between July 1, 2006, and December 31, 2017. Each patient was matched with 10 control individuals from the general population by sex, birth year, and county of residence. The patients were followed up until December 31, 2017. Data analyses were performed from October 2021 to April 2022.
MAIN OUTCOMES AND MEASURES
The primary outcomes were fractures, CVEs, and death. Cumulative incidence of events was estimated using the 1-minus Kaplan-Meier estimator of corresponding survival function. Cox proportional hazards regression models were used to calculate hazard ratios (HRs).
RESULTS
A total of 16 374 patients with pHPT were identified (mean [SD] age, 67.5 [12.9] years; 12 806 women [78.2%]), with 163 740 control individuals. The follow-up time was 42 310 person-years for the pHPT group and 803 522 person-years for the control group. Compared with the control group, the pHPT group had a higher risk of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), CVEs (unadjusted HR, 1.45; 95% CI, 1.34-1.57), and death (unadjusted HR, 1.72; 95% CI, 1.65-1.80). In a time-dependent Poisson regression model, PTX was associated with a reduced risk of any fracture (HR, 0.83; 95% CI, 0.75-0.93), hip fracture (HR, 0.78; 95% CI, 0.61-0.98), CVEs (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65).
CONCLUSIONS AND RELEVANCE
Results of this study suggest that pHPT is associated with increased risk of fractures, CVEs, and death, highlighting the importance of identifying patients with this condition to prevent serious unfavorable outcomes. The reduced risk of these outcomes associated with PTX suggests a clinical benefit of surgery.
Topics: Adult; Aged; Cohort Studies; Female; Hip Fractures; Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Proportional Hazards Models
PubMed: 35657624
DOI: 10.1001/jamanetworkopen.2022.15396 -
International Journal of Hyperthermia :... 2022This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism...
INTRODUCTION
This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX).
SUBJECTS AND METHODS
A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA.
RESULTS
After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements.
CONCLUSIONS
RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.
Topics: Calcium; Humans; Hyperparathyroidism, Secondary; Parathyroid Hormone; Parathyroidectomy; Radiofrequency Ablation; Retrospective Studies
PubMed: 35848429
DOI: 10.1080/02656736.2022.2097324 -
The Journal of Clinical Endocrinology... Jul 2022
Topics: Calcimimetic Agents; Cinacalcet; Humans; Parathyroidectomy; Renal Dialysis
PubMed: 35427422
DOI: 10.1210/clinem/dgac211 -
The Indian Journal of Medical Research Jan 2022Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the...
BACKGROUND & OBJECTIVES
Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the haematological manifestations of PHPT in patients with normal renal functions who were treated surgically for parathyroid adenomas.
METHODS
In this retrospective cross-sectional study, 134 patients with normal renal functions who underwent parathyroidectomies for PHPT were included. The haematological manifestations were evaluated in the total study cohort and in the two groups of different calcium (Ca) levels (Group 1 ≤11.2 mg/dl and Group 2 >11.2 mg/dl).
RESULTS
The overall prevalence of anaemia, leucopenia and thrombocytopenia was 20.1, 6.7 and 6.0 per cent, respectively. Normocytic anaemia was present in 19 (14.2%) patients. There were no significant differences in the prevalence of anaemia, leucopenia and thrombocytopenia between the two groups. There were no correlations between the PTH levels and the leukocyte, haemoglobin or platelet values. Six to 12 months after the parathyroidectomy (PTX), 35.7 per cent of the patients with anaemia, 85.7 per cent of the patients with leucopenia and 100 per cent of the patients with thrombocytopenia had recovered.
INTERPRETATION & CONCLUSIONS
In the present study, anaemia was seen with a variable frequency in PHPT, but there was no relationship between anaemia and high PTH or Ca levels. The development of anaemia can be seen regardless of the PTH levels in PHPT patients with normal renal functions. High-resolution rates after PTX indicate a possible association between PHPT and thrombocytopenia or leucopenia, although their prevalence is low in PHPT.
Topics: Anemia; Calcium; Cross-Sectional Studies; Humans; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies; Thrombocytopenia
PubMed: 35859427
DOI: 10.4103/ijmr.IJMR_1200_19 -
Annals of Surgery Nov 2005To provide a rigorous and critical review of studies in which formal neuropsychological (NP) testing and measurement of health-related quality of life (HRQL) were... (Review)
Review
OBJECTIVE
To provide a rigorous and critical review of studies in which formal neuropsychological (NP) testing and measurement of health-related quality of life (HRQL) were conducted pre- and post-parathyroidectomy for primary hyperparathyroidism (PHPT). These data contribute to the discussion on the utility of surgical intervention for nonclassic PHPT.
SUMMARY BACKGROUND DATA
PHPT is a complex endocrinopathy involving calcium metabolism and a potent hormone made by the parathyroid glands. Approximately 1.5% of Americans age 65 years and older, representing more than 3.9 million people, have PHPT, and the prevalence in postmenopausal women is estimated at 3.4%. Current National Institutes of Health guidelines for curative, surgical intervention of PHPT exclude 80% of patients with hyperparathyroid disease who have subjective neurobehavioral and physical symptoms that affect the quality of their lives.
METHODS
An electronic search was conducted of prospective studies in which cognitive functioning was measured with formal NP tests and HRQL was measured with valid and reliable instruments before and following parathyroidectomy for PHPT.
RESULTS
: In studies conducted pre- and post-parathyroidectomy for PHPT, 6 small studies of cognitive functioning report inconsistent findings; however, 7 well-designed studies of HRQL report improvement across multiple domains following surgery.
CONCLUSIONS
Surgical treatment of PHPT is a viable option for patients with laboratory diagnosed, "nonclassic" PHPT. Formal NP testing and evaluation of HRQL are useful tools that may assist physicians in choosing whom to refer for parathyroidectomy. Further longitudinal study of NP functioning and HRQL in patients with laboratory diagnosed PHPT is warranted.
Topics: Adaptation, Psychological; Adolescent; Adult; Age Factors; Aged; Cognition Disorders; Comorbidity; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Neuropsychological Tests; Parathyroidectomy; Postoperative Period; Preoperative Care; Prognosis; Quality of Life; Risk Assessment; Severity of Illness Index; Sex Factors
PubMed: 16244536
DOI: 10.1097/01.sla.0000186337.83407.ec -
Frontiers in Endocrinology 2023The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal... (Review)
Review
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
Topics: Humans; Parathyroid Glands; Optical Imaging; Parathyroidectomy; Hypoparathyroidism; Indocyanine Green; Monitoring, Intraoperative
PubMed: 37284221
DOI: 10.3389/fendo.2023.1160902 -
Annals of Surgery Dec 2020With the recent approval of 2 NIRAF-based devices for label-free identification of PG by the Food and Drug Administration, it becomes crucial to educate the surgical... (Review)
Review
OBJECTIVE
With the recent approval of 2 NIRAF-based devices for label-free identification of PG by the Food and Drug Administration, it becomes crucial to educate the surgical community on the realistic scope of this emerging technology. Here, we have compiled a review of studies that utilize NIRAF and present a critical appraisal of this technique for intraoperative PG detection.
BACKGROUND
Failure to visualize PGs could lead to accidental damage/excision of healthy PGs or inability to localize diseased PGs, resulting in postsurgical complications. The discovery that PGs have NIRAF led to new avenues for intraoperatively identifying PGs with high accuracy in real-time.
METHODS
Using the following key terms: "parathyroid, near infrared, autofluorescence" in various search engines such as PubMed and Google Scholar, we identified various publications relevant to this review of NIRAF as a technique for PG identification. Articles were excluded if they focused solely on contrast agents, served as commentaries/overviews on NIRAF or were not written in English.
RESULTS
To date, studies have investigated the potential of NIRAF detection for (i) identifying PG tissues intraoperatively, (ii) locating PGs before or after dissection, (iii) distinguishing healthy from diseased PGs, and (iv) minimizing postoperative hypocalcemia after total thyroidectomy.
CONCLUSIONS
Because NIRAF-based identification of PG is noninvasive and label-free, the popularity of this approach has considerably surged. As the present limitations of various technologies capable of NIRAF detection are identified, we anticipate that newer device iterations will continue to be developed enhancing the current merits of these modalities to aid surgeons in identifying and preserving PGs. However, more concrete and long-term outcome studies with these modalities are essential to determine the impact of this technique on patient outcome and actual cost-benefits.
Topics: Equipment Design; Humans; Intraoperative Care; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Spectroscopy, Near-Infrared
PubMed: 31804401
DOI: 10.1097/SLA.0000000000003700 -
Frontiers in Endocrinology 2021Parathyroid tumor, in particular carcinoma, is fairly rare among neoplasms of the endocrine system, unlike its benign counterpart. However, there is no bibliometric... (Review)
Review
INTRODUCTION
Parathyroid tumor, in particular carcinoma, is fairly rare among neoplasms of the endocrine system, unlike its benign counterpart. However, there is no bibliometric analysis in the field of parathyroid tumors comprehensively summarizing and discussing a large number of publications by a machine learning-based method.
MATERIALS AND METHODS
Parathyroid tumor-related publications in PubMed from January 2001 to December 2020 were searched using the MeSH term "parathyroid neoplasms". Latent Dirichlet allocation was adopted to identify the research topics from the abstract of each publication using Python.
RESULTS
A total of 3,301 parathyroid tumor-associated publications were identified from the past 20 years, and included in further analyses. Research articles and case reports occupied the most proportion of publications, while the number of clinical studies and clinical trials decreased, especially in recent years. Technetium Tc 99m sestamibi was most studied among the diagnosis-related MeSH terms, while parathyroidectomy was among the treatment-related MeSH terms. The Latent Dirichlet allocation analyses showed that the top topics were Tc-MIBI imaging, parathyroidectomy, gene expression in the cluster of diagnosis research, treatment research, and basic research. Notably, scarce connections were shown between the basic research cluster and the other two clusters, indicating the requirements of translational study turning basic biological knowledge into clinical practice.
CONCLUSION
The annual scientific publications on parathyroid tumors have scarcely changed during the last two decades. Tc-MIBI imaging, parathyroidectomy, and gene expression are the most concerned topics in parathyroid tumor research.
Topics: Bibliometrics; Humans; Machine Learning; Parathyroid Neoplasms; Parathyroidectomy; Technetium Tc 99m Sestamibi
PubMed: 35154009
DOI: 10.3389/fendo.2021.811555 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... May 2022The main causes of hypoparathyroidism are unintentional parathyroidectomy and/or impaired blood supply. Therefore, accurate identification and preservation of... (Review)
Review
The main causes of hypoparathyroidism are unintentional parathyroidectomy and/or impaired blood supply. Therefore, accurate identification and preservation of parathyroid glands in situ during thyroid or parathyroid surgery has become one of the problems that plague endocrine surgeons. In recent years, near-infrared autofluorescence imaging technology has gradually attracted more and more attention from surgeons because of its simplicity, safety, accuracy, real-time, no-contrast agent, and non-invasiveness. This article reviews the development history, clinical application, and application prospects of the parathyroid gland autofluorescence imaging technology in recent years.
Topics: Humans; Hypoparathyroidism; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Thyroidectomy
PubMed: 35483695
DOI: 10.13201/j.issn.2096-7993.2022.05.016 -
Clinical Journal of the American... Jul 2016
Topics: Hyperparathyroidism, Secondary; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy
PubMed: 27269301
DOI: 10.2215/CJN.04950516