Asymptomatic Primary Hyperparathyroidism

Silverberg, Shonni J.; Walker, Marcella D.; Bilezikian, John P.

doi:10.1016/j.jocd.2012.11.005

Cited by 97 publications

(82 citation statements)

References 75 publications

(70 reference statements)

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“…Asymptomatic normocalcemic subjects are likely to be discovered only through non-selected epidemiological cohorts in which there is no selection bias (8-9). Among those individuals described so far, nevertheless, progression to hypercalcemia has been described (1,(5)(6). Recently, even a case of parathyroid carcinoma presenting as normocalcemic PHPT was reported (14).…”

Section: Discussionmentioning

confidence: 99%

“…In countries that began to utilize the multichannel biochemical screening test in the 1970s, the presentation of primary hyperparathyroidism (PHPT) changed from a disease that was classically symptomatic with "stones, bones, moans and groans" to a contemporary asymptomatic disorder ( 1). While this clinical evolution was apparent in the United States and other Western countries, in Asian countries, such as India and China, PHPT continued to be seen as a symptomatic disorder with severe biochemical and target organ manifestations (2).…”

Section: Introductionmentioning

confidence: 99%

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Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

et al. 2013

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In the 1970s, with the advent of biochemical multichannel screening in the United States and other western countries, the clinical presentation of primary hyperparathyroidism (PHPT) changed from a symptomatic to an asymptomatic disorder. However, in Asian countries, like China, PHPT did not show this evolution, but rather continued to be a symptomatic disease with target organ involvement. In this paper, we revisit the clinical features of PHPT in New York and Shanghai, representative United States and Chinese cites, over the past decade. The questions we address are whether the disease evolved in China to a more asymptomatic one and, whether in the United States further changes are evident. The results indicate that while PHPT continues to present primarily as an asymptomatic disease in the United States, a new phenotype characterized by normal serum calcium and high parathyroid hormone levels, normocalcemic PHPT, has emerged. Data from Shanghai demonstrates a trend for PHPT to present more commonly as an asymptomatic disorder in China. However, most patients with PHPT in China still manifest classical symptoms, i.e. nephrolithiasis and fractures. A comparison of the two cohorts shows that Chinese patients with PHPT are younger, with higher serum calcium and PTH levels, and lower 25-hydroxyvitamin D levels than patients in New York. Normocalcemic PHPT has not yet been recognized in Shanghai. In summary, although the phenotypes of PHPT in both cities are evolving towards less evident disease, sharp clinical and biochemical differences are still apparent in PHPT as expressed in China and the United States. Keywords: normocalcemic primay hyperparathyroidism; asymptomatic; symptomatic Bone Research (2013) 2: 162-169. doi: 10.4248/BR201302005 IntroductionIn countries that began to utilize the multichannel biochemical screening test in the 1970s, the presentation of primary hyperparathyroidism (PHPT) changed from a disease that was classically symptomatic with "stones, bones, moans and groans" to a contemporary asymptomatic disorder ( 1). While this clinical evolution was apparent in the United States and other Western countries, in Asian countries, such as India and China, In this paper, we review the more recent experience in two cities, Shanghai and New York, with the central question: has the clinical expression of PHPT changed in these countries over the past 10 years? MethodsThe cohort from Shanghai has recently been reported (4). These subjects form the basis for the description of the more recent experience in China. In the United States, an ongoing new cohort of subjects since 2010 form the basis of the New York experience, along with a published experience of subjects who present with normocalcemic PHPT (5-6). As opposed to asymptomatic cases, symptomatic PHPT refers to symptoms related with hypercalcemia, such as skeletal and renal diseases, neuromuscular, gastrointestinal, articular, hematologic, cardiovascular and central nervous system manifestations. Statistical analysesAll statistical analyses were pe...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

et al. 2013

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“…Profile-This area has given rise to the most significant controversies in the description of asymptomatic PHPT and is covered in greater detail in another report in this issue (30). Mental status changes, obtundation, and frank psychosis were reported in patients with severe hypercalcemia of classical PHPT.…”

Section: Psychiatric and Cognitivementioning

confidence: 99%

Asymptomatic Primary Hyperparathyroidism

Silverberg

Bilezikian

2015

The Parathyroids

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“…[3] Moreover, psychiatric, neurological, cardiovascular and gastrointestinal signs and symptoms can be also present. [4] The most common causes of PHTP include single parathyroid adenoma that accounts for the 85% of the cases, multiglandular hyperplasia in 10%-15% of cases, and lastly carcinoma in 1% or less of the cases. In addition uncommon familiar causes do exist, such as MEN-1 and MEN-2A.…”

Section: Introductionmentioning

confidence: 99%

Resolution of primary hyperparathyroidism following surgical removal of cervical thymus

Cannarella

Scilletta

et al. 2017

CRIM

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Recent research has emphasized the capacity of thymus cells of producing parathyroid hormone (PTH) if adequately stimulated, and have investigated the role of the so-called "thymic PTH", produced by the medullary thymic epithelial cells (m-TECs). To the best of our knowledge, only a single case of well-documented PTH secretion from a thymoma causing primary hyperparathyroidism (PHTP) has been reported in the literature so far. We report here the case of a female patient with PHTP who underwent neck exploration for a suspected parathyroid adenoma. After surgery, a normalization of serum PTH concentration was observed, but the histological examination of the surgically excised mass revealed exclusively normal thymus tissue. The present case provides additional evidence of PHTP caused by an ectopic thymus.

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Asymptomatic Primary Hyperparathyroidism

Cited by 97 publications

References 75 publications

Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai

Asymptomatic Primary Hyperparathyroidism

Resolution of primary hyperparathyroidism following surgical removal of cervical thymus

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