Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism

Turken, Sheila A.; Cafferty, Maureen; Silverberg, Shonni J.; Cruz, Luz de la; Cimino, Christopher; Lange, Dale J.; Lovelace, Robert E.; Bilezikian, John P.

doi:10.1016/s0002-9343(89)80613-8

Cited by 112 publications

(25 citation statements)

References 22 publications

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“…300 mg daily calcium excretion) is observed in a significant subset (of up to 30%) of patients. Some patients suffer from easy fatigability, a sense of weakness and mild cognitive impairment (17). Whether these non-specific symptoms are indeed related to hyperparathyroidism remains to be clarified, especially in old age (18).…”

Section: Clinical Presentation Of Primary Hyperparathyroidismmentioning

confidence: 99%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

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As more and more cases of primary hyperparathyroidism are being detected by screening for serum calcium concentration, the majority of patients are older individuals who are asymptomatic or have symptoms which are difficult to ascribe to hyperparathyroidism. Long-term follow-up has provided evidence that most asymptomatic patients who do not undergo parathyroidectomy will not develop symptomatic complications. Some asymptomatic patients, however, have progression of disease over time. These observations and the lack of reliable predictors of the rate of progression in most patients reinforce the need for careful monitoring in elderly individuals who do not undergo surgery. Biannual measurements of serum calcium concentrations and annual measurements of urinary calcium excretion and bone mineral density should be performed in all patients who are managed conservatively. In elderly patients with symptomatic or complicated primary hyperparathyroidism, parathyroidectomy results in biochemical cure and increased bone density, both at the lumbar spine and the femoral neck, and should be considered. Criteria for surgery include significant hypercalcemia (.1 mg/dl above the upper limit of normal), marked hypercalciuria (. 400 mg per day), low bone density, unexplained renal insufficiency and an episode of acute primary hyperparathyroidism. Consideration of parathyroidectomy should also be given to elderly patients with primary hyperparathyroidism who are vitamin D deficient. Radionuclide scanning has become the initial non-invasive study of choice when parathyroid gland localization is necessary before parathyroidectomy; this is generally for fragile patients and reoperative cases. In a subset of older individuals, surgery may not be an option because of coexisting medical problems even though surgical indications are present.European Journal of Endocrinology 151 297-304

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Section: Clinical Presentation Of Primary Hyperparathyroidismmentioning

confidence: 99%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

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“…[16][17][18][19] Several recent studies have established that vitamin D deficiency is common in patients with cirrhosis and is associated with muscle pain. [20][21][22] It would thus be of interest to investigate the relationship between vitamin D levels and muscle cramps in patients with cirrhosis.…”

mentioning

confidence: 99%

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Chatrath¹,

Ghabril²,

Tandra³

et al. 2011

Gastroenterology

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PURPOSE-Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.METHODS-A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.RESULTS-A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL, P = .04) and CLDQ scores (107 ± 37 vs 137 ± 34, P < .0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score > 12). Muscle cramps (P < .001) and hepatic encephalopathy (P = .009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0 ± 8.9 ng/mL vs 19.6 ± 9.5 ng/mL, P = .49).CONCLUSIONS-Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment. KeywordsChronic liver disease questionnaire; Cirrhosis; Muscle crampsThe association of muscle cramps with cirrhosis was first reported by Konikoff and Theodor 1 in 1986 when they made their observation of repeated painful muscle cramps by patients with cirrhosis. They proposed that the strikingly high incidence and uniformity of the phenomenon may justify the inclusion of painful muscle cramps among the recognized symptoms of cirrhosis. 1 Subsequently, several studies have confirmed that muscle cramps are a common symptom of cirrhosis. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript them as sudden, uncomfortable squeezing or contraction of a muscle, lasting seconds to minutes. An electromyogram of a cramping muscle reveals involuntary repetitive firing of motor unit action potentials at high rates (up to 150 per second) producing a sustained muscle contraction. 5,6 These cramps are not associated with any progressive motor neuron disease or chronic neuromuscular disability and are different from muscle contracture, dystonia, and tetany. 5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps thro...

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“…Some patients present with paresthesias and muscle cramps, loss of vibratory sensation with diminished reflexes, and stocking-glove loss-of-pain sensation. [5] This patient had clinically myopathy with normal CPK and EMG evidence of primary muscle disorder. The pathophysiology of neuromuscular manifestations in PHPT is not yet clear.…”

Section: Discussionmentioning

confidence: 91%

Intrathyroidal parathyroid adenoma presenting with neuromuscular manifestation

et al. 2009

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Primary hyperparathyroidism (PHPT) is not an uncommon endocrine disorder. We describe a patient with PHPT who presented with progressive proximal limbs weakness and dystrophic changes of leg muscles. Serum calcium, alkaline phosphatase, and parathyroid hormone were elevated and serum phosphorus was low. Neck computerized tomography scan showed a parenchymatous tumor in the right lobe of the thyroid. The tumor presented as a 'cold nodule' in the dual-phase single-agent Tc-99m MIBI scan. The right lobectomy examination confirmed the diagnosis of an intrathyroidal parathyroid adenoma of the right gland.

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Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism

Cited by 112 publications

References 22 publications

Primary hyperparathyroidism: diagnosis and management in the older individual

Primary hyperparathyroidism: diagnosis and management in the older individual

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Intrathyroidal parathyroid adenoma presenting with neuromuscular manifestation

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