Paratireóides: estrutura, funções e patologia

Próspero, José Donato de; Baptista, Pedro Pericles Ribeiro; Amary, Maria Fernanda; Santos, Priscila Pizzo Crêm dos

doi:10.1590/s1413-78522009000200011

Cited by 9 publications

(15 citation statements)

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“…It can be associated with elevated serum calcium levels or within the normal range (22). The PHP has a prevalence of approximately 1% in the adult population, with equal distribution between the genders, doubling after the age of 55, being, in this age group, two to three times more common in women than in men (23).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of parathyroid function and mineral metabolism in psychiatric patients using lithium salts

Oliveira

Neto

Aguiar‐Oliveira

et al. 2014

Arq Bras Endocrinol Metab

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Objective: To evaluate parathyroid function and mineral metabolism in psychiatric patients users of lithium salts. Materials and methods: We measured the serum levels of calcium, ionized calcium, inorganic phosphorus, alkaline phosphatase, albumin, parathyroid hormone (PTH), urea, creatinine, 25-hydroxy-vitamin D and lithium of 35 patients diagnosed with bipolar disorder in use of lithium carbonate (LC) for at least one year (Lithium Group -LG) and 35 healthy subjects (Control Group -CG). Results: The LG and CG were matched by sex and age. There was only statistic difference in relation to the levels of PTH and ionized calcium, with p < 0.004 and p < 0.03, respectively. Secondary form of hyperparathyroidism (HPT) was found in eight (22.8%) LG patients and in none of the CG. There was no correlation between lithemia, usage time and dosage of LC. Conclusion: Our data demonstrate that lithium may create an imbalance in the parathyroid axis, characterized by elevated levels of PTH. Arq Bras Endocrinol Metab. 2014;58(6):619-24Keywords Lithium; parathyroid; mineral metabolism; hyperparathyroidism RESUMO Objetivo: Avaliar a função paratireoidiana e o metabolismo mineral em pacientes psiquiátricos usuários de sais de lítio. Materiais e métodos: Foram avaliados os níveis séricos de cálcio total, cálcio iônico, fósforo inorgânico, fosfatase alcalina, albumina, paratormônio (PTH), ureia, creatinina, 25-hidroxivitamina D e lítio de 35 pacientes diagnosticados com transtorno afetivo bipolar usuários de carbonato de lítio (CL) há pelo menos um ano (Grupo Lítio -GL) e 35 indivíduos saudáveis (Grupo Controle -GC). Resultados: O GL e o GC foram pareados por sexo e idade. Somente se observou diferença estatística em relação aos níveis de PTH e cálcio iônico, com p < 0,004 e p < 0,03, respectivamente. Hiperparatireoidismo secundário foi encontrado em oito (22.8%) pacientes do GL e em nenhum do GC. No GL, não houve correlação entre litemia, tempo de uso e posologia do CL. Conclusão: Nossos dados demonstram que o lítio pode suscitar um desequilíbrio no eixo paratireoideano, caracterizado por níveis elevados de PTH. Arq Bras Endocrinol Metab. 2014;58(6):619-24 Descritores Lítio; paratireoide; metabolismo mineral; hiperparatireoidismo

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Section: Discussionmentioning

confidence: 99%

Evaluation of parathyroid function and mineral metabolism in psychiatric patients using lithium salts

Oliveira

Neto

Aguiar‐Oliveira

et al. 2014

Arq Bras Endocrinol Metab

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“…A small number of patients can have three, five or, occasionally, a greater amount of glands. Anatomical variations in location are frequent, and they can be found even in the mediastinum near the thymus 7 …”

Section: Anatomy Of the Parathyroidsmentioning

confidence: 99%

The history of the parathyroid surgery

Toneto

Prill

Debon

et al. 2016

Rev. Col. Bras. Cir.

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Rev. Col. Bras. Cir. 2016; 43(3): INTRODUCTION Hyperparathyroidism is a condition in whichthere is an abnormal increase in the levels of parathyroid hormone (PTH), responsible for regulating the level of blood calcium and phosphate. The most common cause of hyperparathyroidism, seen in about 80% of cases, is the primary gland dysfunction due to an adenoma. Multiple adenomas or hyperplasia of the parathyroid glands are diagnosed in the remaining patients. Rarely the cause of hyperparathyroidism is a result of a parathyroid carcinoma. It is a disease for which therapy may be surgical, which involves the removal of the affected gland. When surgery is indicated in patients without prior treatment, the cure rate approaches 95% 1 . In cases where the initial operation is not successful, new surgical explorations become necessary, greatly increasing the number of complications and decreasing success rates to about 80% 2 . Therefore, regardless of the hyperparathyroidism origin, the surgeon who will treat these patients must indisputably have skill, experience and technical knowledge to obtain satisfactory results. Currently, advances in the identification of the glands through preoperatively performed diagnostic tests greatly facilitated parathyroid glands surgery. Frozen section biopsies 3 , intraoperative measurement of PTH levels 4 and less invasive procedures 5 allow great improvement in patients' quality of life 6 .However, the identification of the parathyroid glands, the recognition of their important role and the understanding of diseases that affect them traveled a long journey to the present state of knowledge. Since inception, the history of the parathyroid glands is full of incidental findings, often the case in medical history.The aim of this study is to provide the reader with a historical review of the discoveries fundamental to the understanding of the parathyroid glands and to discuss the current role and future prospects of surgery for the treatment of hyperparathyroidism. ANATOMY OF THE PARATHYROIDSThe parathyroid glands originate from the third and fourth pharyngeal pouches and are usually located 214-222 A B S T R A C TThe authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism.Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment.

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“…Tratamento cirúrgico do HPT secundário INTRODUÇÃO A s glândulas paratireoides são responsáveis pela síntese e secreção do paratormônio (PTH) (1)(2)(3)(4)(5)(6)(7)(8). Há diversas causas de hipersecreção hormonal, caracterizando parte da doença denominada hiperparatireoidismo (HPT) (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

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“…Há diversas causas de hipersecreção hormonal, caracterizando parte da doença denominada hiperparatireoidismo (HPT) (1)(2)(3)(4)(5)(6)(7)(8)(9). O HPT secundário é consequência de alterações metabólicas que geram estímulos extraglandulares compensatórios na homeostase mineral, principalmente do cálcio (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12).…”

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“…Diversas condições nas quais existe menor disponibilidade de cálcio iônico podem levar ao HPT secundário, como má-absorção de cálcio ou vitamina D, osteomalácia, raquitismo, pseudo-hipoparatireoidismo, hipercalciúria idiopática, uso crônico de lítio, resistência tecidual à vitamina D, hipomagnesemia severa ou, como causa bastante comum, doença renal crônica (DRC) em pacientes em diálise (1,2,(4)(5)(6)8,11,. Existiam cerca de 90 mil pacientes em tratamento dialí-tico no Brasil em 2011, com tendência de aumento ao longo dos anos (35).…”

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Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Magnabosco

Tavares

Montenegro

2014

Arq Bras Endocrinol Metab

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RESUMOO hiperparatireoidismo (HPT) secundário tem prevalência elevada em doentes renais crônicos. Decorre de alterações na homeostase mineral, principalmente do cálcio, que estimulam as glându-las paratireoides, com aumento na secreção de paratormônio (PTH). O estímulo prolongado pode levar à autonomia na função paratireóidea. Inicialmente, o tratamento é clínico, mas a paratireoidectomia (PTx) pode ser necessária. A PTx pode ser total, subtotal e total seguida de autoimplante de tecido paratireóideo. Este trabalho compara as indicações e resultados dessas técnicas na literatura. Foi realizada revisão sistematizada dos trabalhos publicados entre janeiro de 2008 e março de 2014 sobre tratamento cirúrgico do hiperparatireoidismo secundário nas bases de dados MedLine e LILACS. Foram utilizados os termos: hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides e paratireoidectomia. Foram restritos a pesquisas apenas em humanos; artigos disponíveis em meio eletrônico; publicados em português, espanhol, inglês ou francês. A amostra final foi constituída de 49 artigos. A PTx subtotal e a total mais autoimplante foram as técnicas mais utilizadas, sem consenso sobre a técnica mais efetiva. Embora haja certa preferência pela última, a escolha depende da experiência do cirurgião. Há consenso sobre a necessidade de identificar todas as paratireoides e sobre a criopreservação de tecido paratireóideo, quando possí-vel, para enxerto em caso de hipoparatireoidismo. Exames de imagem podem ser úteis, especialmente nas recidivas. Tratamentos alternativos do HPT secundário, tanto intervencionistas quanto conservadores, carecem de estudos mais aprofundados. Arq Bras Endocrinol Metab. 2014;58(5):562-71 Descritores Hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides; paratireoidectomia ABSTRACT Secondary hyperparathyroidism (HPT) has a high prevalence in renal patients. Secondary HPT results from disturbances in mineral homeostasis, particularly calcium, which stimulates the parathyroid glands, increasing the secretion of parathyroid hormone (PTH). Prolonged stimulation can lead to autonomy in parathyroid function. Initial treatment is clinical, but parathyroidectomy (PTx) may be required. PTx can be subtotal or total followed or not followed by parathyroid tissue autograft. We compared the indications and results of these strategies as shown in the literature through a systematic literature review on surgical treatment of secondary HPT presented in MedLine and LILACS from January 2008 to March 2014. The search terms were: hyperparathyroidism; secondary hyperparathyroidism; parathyroidectomy and parathyroid glands, restricted to research only in humans, articles available in electronic media, published in Portuguese, Spanish, English or French. We selected 49 articles. Subtotal and total PTx followed by parathyroid tissue autograft were the most used techniques, without consensus on the most effective surgical procedure, although there was a preference for the latter. The choice depend...

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Paratireóides: estrutura, funções e patologia

Cited by 9 publications

References 1 publication

Evaluation of parathyroid function and mineral metabolism in psychiatric patients using lithium salts

Evaluation of parathyroid function and mineral metabolism in psychiatric patients using lithium salts

The history of the parathyroid surgery

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

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