Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

Shokry, Gina; Morkos, Michael

doi:10.1016/j.eprac.2022.07.009

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Low calcium intake may be associated with SHPT [ 77 ]. Recently, Shokry et al reported a calcium challenge test in 8 women and 1 man with eucalcemic hyperparathyroidism and low calcium intake.…”

Section: Other Causes Of Elevated Pth Levels In Eucalcemic Patientsmentioning

confidence: 99%

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The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Shaker

Wermers

2023

Journal of the Endocrine Society

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Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.

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Section: Other Causes Of Elevated Pth Levels In Eucalcemic Patientsmentioning

confidence: 99%

“…Recently, Shokry et al reported a calcium challenge test in 8 women and 1 man with eucalcemic hyperparathyroidism and low calcium intake. The patients were treated with calcium 600 mg twice daily, and PTH levels normalized in all patients [ 77 ]. They all remained eucalcemic.…”

Section: Other Causes Of Elevated Pth Levels In Eucalcemic Patientsmentioning

confidence: 99%

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Shaker

Wermers

2023

Journal of the Endocrine Society

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“…The parathyroid gland, via the secretion of parathyroid hormone (PTH), tightly controls blood and interstitial calcium concentrations to ensure normal muscle contraction, nerve impulse transmission, coagulation function, and hormone secretion [ 120 ]. Insufficient dietary calcium intake results in decreased blood calcium concentration, which in turn results in increased parathyroid hormone secretion with two important effects.…”

Section: Question Four: What Is Your Preferred Source Of Calcium?mentioning

confidence: 99%

“…Insufficient dietary calcium intake results in decreased blood calcium concentration, which in turn results in increased parathyroid hormone secretion with two important effects. First, vitamin D is hydroxylated into its active form 1,25-dihydroxyvitamin D (calcitriol) [ 120 ]. This results in decreased urinary excretion and increased intestinal absorption of calcium.…”

Section: Question Four: What Is Your Preferred Source Of Calcium?mentioning

confidence: 99%

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Plotnikoff¹,

Dobberstein²,

Raatz

2023

Nutrients

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Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.

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“…Normal alimentary calcium intake since a diet with low calcium content represents a cause of secondary hyperparathyroidism [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism

Vescini,

Borretta,

Chiodini

et al. 2024

EMIDDT

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Aim:: This guideline (GL) is aimed at providing a clinical practice reference for the management of sporadic primary hyperparathyroidism (PHPT) in adults. PHPT management in pregnancy was not considered. Methods:: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) and Società Italiana dell’Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (SIOMMMS) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” were considered in the systematic review of evidence. Those classified as “critical” were considered for the clinical practice recommendations. Results:: The present GL provides recommendations about the roles of pharmacological and surgical treatment for the clinical management of sporadic PHPT. Parathyroidectomy is recommended in comparison to surveillance or pharmacologic treatment in any adult (outside of pregnancy) or elderly subject diagnosed with sporadic PHPT who is symptomatic or meets any of the following criteria: • Serum calcium levels >1 mg/dL above the upper limit of normal range. • Urinary calcium levels >4 mg/kg/day. • Osteoporosis disclosed by DXA examination and/or any fragility fracture. • Renal function impairment (eGFR <60 mL/min). • Clinic or silent nephrolithiasis. • Age ≤50 years. Monitoring and treatment of any comorbidity or complication of PHPT at bone, kidney, or cardiovascular level are suggested for patients who do not meet the criteria for surgery or are not operated on for any reason. Sixteen indications for good clinical practice are provided in addition to the recommendations. Conclusion:: The present GL is directed to endocrinologists and surgeons - working in hospitals, territorial services or private practice - and to general practitioners and patients. The recommendations should also consider the patient’s preferences and the available resources and.

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Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

Cited by 5 publications

References 10 publications

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism

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