Distal Renal Tubular Acidosis Due to Primary Hyperparathyroidism

Muthukrishnan, J; Kumar, K. V. S. Hari; Jha, Ratan; Jha, Sangeeta; Modi, Kirtikumar D

doi:10.4158/ep.14.9.1133

Cited by 20 publications

(14 citation statements)

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“…We retrospectively studied 110 consecutive patients with symptomatic PHPT presenting to a tertiary care center in South India during the period January 1994–January 2015 and comparatively studied the characteristics of these cases divided into two groups presenting from January 1994 to May 2007 (161 months), presented in our earlier publication on the subject and later from June 2007 to January 2015 (92 months). [ 3 4 5 6 ] We aimed to see the trends developing in the last two decades in disease profile of PHPT.…”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism: Achanging scenario in India

Jha¹,

Muthukrishnan²,

Jha³

et al. 2016

Indian J Endocr Metab

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Introduction:Primary hyperparathyroidism (PHPT) is largely a symptomatic disease with varied systemic manifestations, complicated by coexisting Vitamin D (Vit D) deficiency. Increasing awareness, developments in diagnostics, and Vit D supplementation may have an impact on the disease profile of PHPT.Methods:Clinical, biochemical, and pathological profile of PHPT presenting to a tertiary care center in South India were compared in two groups separated as per the period of presentation (Group A: January 1994–May 2007 - 51 cases and Group B: June 2007–January 2015 - 59 cases).Results:PHPT has remained a disease of female preponderance with similar age of presentation. It is being diagnosed earlier (mean duration of symptoms prior to diagnosis was 38.7 months in Group A, significantly longer than 26 months in Group B). Bone pain and metabolic myopathy were the most common presentations (60%) followed by pathological fracture (16%), renal calculi (13%), and pancreatitis (7%). Pathological fractures have become less frequent. Vit D deficiency is still a widespread co-morbidity. Radionuclide scintigraphy is an effective localizing tool, but ultrasound can be an inexpensive and widely available screening modality.Conclusion:PHPT still remains asymptomatic disease of bones and stones, although it is being diagnosed early. Greater awareness, Vit D supplementation, and better diagnostic tools have made it a disease with lesser morbidity and effective cure.

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Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism: Achanging scenario in India

Jha¹,

Muthukrishnan²,

Jha³

et al. 2016

Indian J Endocr Metab

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“…Hypercalciuria by itself does not fully explain the increased risk, and only limited data is currently available on the potential impact of other biochemical abnormalities, such as renal acidification abnormalities on the risk of stones in PHPT [10, 34]. There is no reliable data available on the feasibility of performing metabolic evaluation of stone formers with PHPT, but due to a persistent increased risk after surgical cure of PHPT, it is reasonable to consider screening for other common causes for kidney stones.…”

Section: Presentationmentioning

confidence: 99%

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

et al. 2016

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The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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“…Parathyroidectomy may also result in complete resolution of the distal RTA as shown by the case series by Muthukrishnan et al 4. Complete reversal after parathyroidectomy established primary hyperparathyroidism as the cause of tubular abnormality leading to concomitant electrolyte imbalances.…”

Section: Discussionmentioning

confidence: 91%

Distal renal tubular acidosis in primary hyperparathyroidism

Isip-Tan

2015

BMJ Case Reports

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Primary hyperparathyroidism manifests biochemically as a disturbance in serum calcium homeostasis. The kidney appears to be the central organ that sets the serum calcium level. Hyperchloraemia, defective urinary acidification and renal tubular acidosis have been reported to be associated with primary hyperparathyroidism. Distal renal tubular acidosis due to primary hyperparathyroidism is rarely reported. Renal tubular dysfunction due to significant hypercalciuria appears to be one of the proposed mechanisms. This case report will highlight a case of primary hyperparathyroidism in a 26-year old Filipino man due to a solitary functioning parathyroid adenoma presenting with recurrent nephrolithiasis leading to distal renal tubular acidosis manifesting with hypokalaemia and hypomagnesaemia. The patient underwent a minimally invasive selective parathyroidectomy that resulted in full reversal of hypercalcaemia and hyperparathyroidism together with the features of distal renal tubular acidosis. He is currently on frequent follow-up for monitoring of electrolyte abnormalities and gradual resolution of nephrocalcinosis.

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Distal Renal Tubular Acidosis Due to Primary Hyperparathyroidism

Cited by 20 publications

References 5 publications

Primary hyperparathyroidism: Achanging scenario in India

Primary hyperparathyroidism: Achanging scenario in India

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Distal renal tubular acidosis in primary hyperparathyroidism

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