Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency

Agarwal, Amit; Gupta, Sushil K.; Sukumar, R

doi:10.1007/s00268-009-0044-0

Cited by 23 publications

(16 citation statements)

References 135 publications

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“…Unlike the developed western nations, the serum calcium, serum parathyroid hormone, and serum alkaline phosphate levels in patients from India have been found to be high (Table 2). A majority of Indian patients also have Vit D deficiency [38], which is similar to reports from countries like Pakistan [27] and Jordan [28]. Overall PHPT has advanced clinical and biochemical features in Indian subjects.…”

Section: Biochemical Parameters and Localization Strategiessupporting

confidence: 70%

Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

Pradeep

Jayashree

Mishra

et al. 2011

International Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.

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Section: Biochemical Parameters and Localization Strategiessupporting

confidence: 70%

Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

Pradeep

Jayashree

Mishra

et al. 2011

International Journal of Endocrinology

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“…Unlike the Western world, the classic presentation of PHPT in the form of OFC and nephrolithiasis is still commonly seen in developing countries and one of the reasons for this has been severe vitamin D deficiency in these regions. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…The PHPT in developing countries is also associated with large and heavy adenomas with a higher mean weight. [ 7 14 ]…”

Section: Discussionmentioning

confidence: 99%

PHPT masquerading as rickets in children and presenting with rare skeletal manifestations: Report of three cases and review of literature

Pradhan

Agarwal

Gupta

2018

Indian J Endocr Metab

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Primary hyperparathyroidism (PHPT) is an uncommon condition in children and adolescents. However, rapid growth spurt during puberty may result in unmasking and development of certain skeletal manifestations of PHPT. We present three cases of PHPT associated with rare skeletal manifestations of rickets. All three patients had radiological evidence of rickets with primary hyperparathyroidism. All the three patients had single gland adenoma. Literature is sparse regarding reversal of features of rickets following parathyroidectomy. In all three patients of our series, there was a complete resolution of bone/joint pain. However, in two children only the genu valgum persisted but their growth was normal and they had no proximal muscle weakness. In another child multiple corrective surgeries were done to correct the deformities.

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“…Patients are younger with poor general health indices and have high incidences of Vitamin D deficiency. [ 5 6 7 ] Parathyroid lesions are larger and heavier compared to those of asymptomatic patients. The spectrum of parathyroid pathologies in PHPT include single-gland adenomas (80–85%), multi-gland hyperplasia (10–15%), and carcinomas (1%).…”

Section: Discussionmentioning

confidence: 99%

Is intraoperative parathyroid hormone monitoring necessary in symptomatic primary hyperparathyroidism with concordant imaging?

Nair

Babu

Jacob

et al. 2016

Indian J Endocr Metab

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Introduction:Symptomatic primary hyperparathyroidism (PHPT) is still seen frequently in referral centers all over India. These patients require parathyroidectomy and this study aimed to assess the roll of intraoperative parathyroid hormone (PTH) assay when concordant results of two localization studies were available.Study Design:We analyzed the case records of patients who underwent parathyroidectomy for PHPT from January 2005 to June 2015.Results:Of 143 patients included in the study, technetium 99m methoxyisobutylisonitrate dual phase scintigraphy showed true positive images in 93.7% and high definition ultrasonography in 84.6% of patients. Concordance in localization studies was observed in 121 (84.6%) patients, successful parathyroidectomy was done in 117 (96.7%) patients with concordant localization studies. Intraoperative PTH monitoring showed 97.84% sensitivity and 75% specificity and predicted failure in 2 patients with concordant imaging. However, re-exploration was not successful in these patients.Conclusion:When concordant result is available between parathyroid scintigraphy and anatomical imaging surgical cure rate is high in trained hands. Re-exploration is unlikely to be successful since these patients require higher imaging.

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Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency

Abstract: In the developing countries, which have severe vitamin D and calcium deficient population, PHPT patients present with advanced disease and particularly severe bone symptoms. There is presently only level IV evidence of vitamin D status affecting the clinical severity of PHPT.

Cited by 23 publications

References 135 publications

Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

PHPT masquerading as rickets in children and presenting with rare skeletal manifestations: Report of three cases and review of literature

Is intraoperative parathyroid hormone monitoring necessary in symptomatic primary hyperparathyroidism with concordant imaging?

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