Topical corticosteroids were associated with adrenal insufficiency in a minority of patients. Most cases came from uncontrolled observational studies, with widely varying definitions of adrenal insufficiency. Longer follow-up and larger controlled studies are needed to quantify the risk of adrenal insufficiency with maintenance topical corticosteroid therapy in EoE.
Context/Objective
Increased PTH after successful parathyroid surgery represents a clinical conundrum. We aimed to determine the prevalence of persistently elevated PTH (PePTH) postsurgery, along with predisposing factors.
Design
and Setting: Patients ≥ age 18 with parathyroidectomy performed at University of North Carolina Hospitals for primary hyperparathyroidism (PHPT) over a 12-year period were identified from the Carolina Data Warehouse. Clinical and demographic characteristics were collected, transformed, and analyzed.
Results
Five hundred seventy patients met initial criteria for PHPT, and of those 407 had postoperative values. One hundred forty-four had laboratory results within 3 to 18 months post operatively. There was no clinical difference between those with and without long-term laboratory follow-up. Presurgery, patients had average calcium of 11 mg/dL and PTH 125.4 pg/mL. Ninety-seven percent of patients had normalized calcium after surgery, but 30% had PePTH, which can be predicted at 3 months. Patients with PePTH (persistent elevation of PTH) after surgery did not differ from those with normalized PTH in terms of sex, age, body mass index, or excised gland weight; presurgery 25-vitamin D was slightly lower, but not abnormal (26 ± 15 vs 36 ± 11). The presurgical PTH was significantly higher (P < 0.001) in those with PePTH (156.5 pg/mL compared with presurgical level of 102.5 in those whose PTH normalized).
Conclusions
Nearly one-third of PHPT patients have elevated PTH levels postsurgery in a tertiary hospital setting. At presentation, patients with PePTH tend to have higher PTH relative to calcium levels. Whether PePTH after surgical treatment of PHPT has pathological consequences is unknown.
The Na(+)/H(+) exchangers (NHEs) are a family of membrane transporter proteins which catalyze the electroneutral exchange of one Na(+) for one H(+) and thus regulate intracellular pH (pH(i)) and cell volume. It is shown that Na(+)/H(+) exchanger isoform 1 (NHE-1), but not other isoforms, is the important mechanism in extruding H(+) and regulating pH(i) in the immune system. Immune cells, such as monocytes and neutrophils, generate reactive oxygen species (ROS) and cytokines in response to various stimuli and provide the first line of defense in the immune system. NHE-1 is activated during this respiratory burst and required to maintain an optimal pH(i) for the immune cells. In the central nervous system, NHE-1 is important for microglial (macrophage) activation and participates in the inflammatory response under pathological conditions including cerebral ischemia and traumatic brain injury. NHE-1 also affects Ca(2+) homeostasis in microglia and contributes to the increase of [Ca(2+)](i) by coupling to the Na(+)/Ca(2+) exchanger (NCX) stimulation, thus regulating immune cell function and participating in ischemic cell death. A better understanding of the function of NHE-1 in inflammatory responses will provide insight into its role in brain damage under disease conditions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.