Frequency &amp; predictors of pancreatitis in symptomatic primary hyperparathyroidism

Arya, Ashutosh Kumar; Bhadada, Sanjay Kumar; Mukherjee, Soham; Singh, Priyanka; Rana, Surinder Singh; Dahiya, Divya; Sood, Anil K.; Saikia, Uma Nahar; Prakash, Mahesh; Bhasin, Deepak K.; Behera, Arunanshu; Walia, Rama; Bhansali, Anil

doi:10.4103/ijmr.ijmr_353_16

Cited by 18 publications

(5 citation statements)

References 26 publications

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“…В развивающихся странах, где отсутствует рутинный скрининг на кальций крови, частота панкреатита на фоне ПГПТ достигает 10-20 % случаев [45]. R.A. Misgar и соавт.…”

Section: панкреатитunclassified

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Baranova

Баранов

2023

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. To present data of Russian and foreign studies on the prevalence, pathogenesis and clinical picture of gastrointestinal tract (GIT) pathology in patients with primary hyperparathyroidism (PHPT).Key point. At the beginning of the 20th century PHPT was considered a severe endocrine disease with specific bone and kidney complications, however in 1957 W.T. St Goar proposed a mnemonic triad to recognize this pathology as “diseases of stones, bones and abdominal groans”. A high frequency of gastrointestinal complaints, peptic ulcer, pancreatitis, cholelithiasis in patients with PHPT has been reported. Hyperparathyroidism has been shown to cause smooth muscle atony with specific upper and lower GI symptoms such as nausea, heartburn and constipation. The prevalence of peptic ulcer in patients with PHPT, according to studies of the 50s–60s of the last century, ranged from 10 to 25 %. However, studies linking PHPT to peptic ulcer development were performed before the advent of proton 1). On the other hand, the development of pancreatitis in PHPT is one of the most studied pathologies. In developing countries its frequency can reach 10–20 % due to the absence of routine screening for blood calcium. Some authors report the impact of elevated parathyroid hormone levels on the formation of gallbladder stones by inhibiting of gallbladder emptying, hepatic bile secretion and mobility of the sphincter Oddi, and changing of the bile composition. A number of studies have found an increased risk of developing malignant neoplasms of the intestine, especially the colon, in patients with PHPT.Conclusion. The digestive manifestations of parathyroid dysfunction in patients can often be overlooked, and serum calcium levels should be included in the routine examination in the presence of abdominal symptoms.

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Section: панкреатитunclassified

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Baranova

Баранов

2023

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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“…O tratamento do HPP consiste na ressecção cirúrgica do nódulo secretante. A cura é definida quando há uma redução maior ou igual a 50% no PTH entre o terceiro e sétimo dia de pós-operatório, com normalização dos níveis de cálcio 5,7 .…”

Section: Relato De Casounclassified

“…A PA devido a hipercalcemia, embora rara, pode representar uma dificuldade diagnóstica e, em muitos casos, ser diagnosticada tardiamente 3 . Os mecanismos fisiopatológicos dessa afecção podem estar ligados à deposição de cristais de cálcio nos ductos pancreáticos ou à ativação de enzimas pancreáticas mediada pelo cálcio 4,5 . Sendo assim, para a investigação etiológica recomenda-se além de outros exames a avaliação dos níveis séricos de cálcio do paciente 1 .…”

Section: Introductionunclassified

Hiperparatireoidismo primário: relato de caso sobre uma apresentação rara de pancreatite aguda

Dias

Kuroda

Dib

et al. 2020

ACS

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Introdução: A pancreatite aguda (PA) é uma condição inflamatória comum nos centros médicos com uma incidência anual mundial de 4,9 - 73,4 casos por 100.000 habitantes e tem como principais causas o cálculo biliar (40-70%) e o etilismo (25-35%) seguidas de outras condições incomuns, entre elas a hipertrigliceridemia e a hipercalcemia. A PA devido a hipercalcemia, embora rara, pode representar dificuldade diagnóstica e, em muitos casos, ser diagnosticada tardiamente. Objetivo: Relatar um caso raro de pancreatite aguda causada por hipercalcemia. Relato de Caso: Paciente internado quatro vezes em três anos com queixa de dor abdominal. No momento inicial foi feito o diagnóstico de pancreatite alcoólica reforçado pelo histórico pessoal de etilismo crônico. Na última internação do paciente foram investigados os níveis séricos de cálcio total e paratormônio (PTH), com valores respectivos de 12,2 mmol/L e 178,8 pg/mL, sugerindo possível hiperparatireoidismo primário (HPP). Confirmou-se a hipótese com a cintilografia de paratireoide e o paciente foi submetido à paratireoidectomia esquerda e tireoidectomia parcial homolateral, apresentando melhora dos níveis séricos de PTH no pós-operatório, assim como do seu quadro de PA. Conclusão: A dosagem de cálcio sérico em pacientes com quadro de PA pode ser benéfica para o diagnóstico, instituiçãoprecoce de tratamento e controle de recidivas em pacientes com HPP.

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“…( 137,199 ) Several studies have suggested a greater risk of acute and/or chronic pancreatitis in symptomatic PHPT, with higher serum calcium levels and male sex being identified as risk factors for this complication. ( 151,199,201‐203 ) In contrast, in a community‐based cohort of 684 patients with mild PHPT (mean age of 55.1 years; 74% female; mean serum calcium of 10.8 mg/dL) from the state of Minnesota, USA, subjects with PHPT were not more likely to develop acute pancreatitis than age‐, sex‐ and year of registration‐matched controls. ( 204 ) Some studies have reported a greater prevalence of cholelithiasis in severe PHPT than in general population, particularly among older women.…”

Section: Introductionmentioning

confidence: 98%

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

Fuleihan

Chakhtoura

Cipriani

et al. 2020

Journal of Bone and Mineral Research

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This narrative review summarizes data on classical and nonclassical manifestations of primary hyperparathyroidism (PHPT). It is based on a rigorous literature search, inclusive of a Medline search for systematic reviews from 1940 to December 2020, coupled with a targeted search for original publications, covering four databases, from January 2013-December 2020, and relevant articles from authors' libraries. We present the most recent information, identify knowledge gaps, and suggest a research agenda. The shift in the presentation of PHPT from a predominantly symptomatic to an asymptomatic disease, with its varied manifestations, has presented several challenges. Subclinical nephrolithiasis and vertebral fractures are common in patients with asymptomatic disease. The natural history of asymptomatic PHPT with no end organ damage at diagnosis is unclear. Some observational and cross-sectional studies continue to show associations between PHPT and cardiovascular and neuropsychological abnormalities, among the different disease phenotypes. Their causal relationship is uncertain. Limited new data are available on the natural history of skeletal, renal, cardiovascular, neuropsychological, and neuromuscular manifestations and quality of life. Normocalcemic PHPT (NPHPT) is often diagnosed without the fulfillment of rigorous criteria. Randomized clinical trials have not demonstrated a consistent long-term benefit of parathyroidectomy (PTX) versus observation on nonclassical manifestations. We propose further refining the definition of asymptomatic disease, into two phenotypes: one without and one with evidence of target organ involvement, upon the standard evaluation detailed in our recommendations. Each of these phenotypes can present with or without non-classical manifestations. We propose multiple albumin-adjusted serum calcium determinations (albumin-adjusted and ionized) and exclusion of all secondary causes of high parathyroid hormone (PTH) when establishing the diagnosis of NPHPT. Refining the definition of asymptomatic disease into the phenotypes proposed will afford insights into their natural history and response to interventions. This would also pave the

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Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism

Cited by 18 publications

References 26 publications

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Hiperparatireoidismo primário: relato de caso sobre uma apresentação rara de pancreatite aguda

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

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