Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma

Gülçelik, Neşe Ersöz; Bozkurt, Fani; Tezel, Gaye Güler; Kaynaroğlu, Volkan; Erbaş, Tomris

doi:10.1007/s12020-008-9135-1

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…An elevated intracellular free-calcium concentration via a decrease in normal insulin-stimulated glucose transport increases the requirement for insulin, makes over-produce and over-secrete of insulin, resulting in hyperparathyroidism-mediated insulin resistance [ 58 ]. Serum calcium level should be evaluated in diabetic patients because hyperparathyroidism has been linked to hypertension [ 21 58 ]. For T1DM patients, a high serum calcium level is a risk factor for autoimmune hyperparathyroidism associated with anti-calcium-sensing receptor autoantibodies [ 37 ].…”

Section: Relationship Between Hypercalcemia and Diabetesmentioning

confidence: 99%

Calcium homeostasis in diabetes mellitus

2017

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Diabetes mellitus (DM) is becoming a lifestyle-related pandemic disease. Diabetic patients frequently develop electrolyte disorders, especially diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. Such patients show characteristic potassium, magnesium, phosphate, and calcium depletion. In this review, we discuss a homeostatic mechanism that links calcium and DM. We also provide a synthesis of the evidence in favor or against this linking mechanism by presenting recent clinical indications, mainly from veterinary research. There are consistent results supporting the use of calcium and vitamin D supplementation to reduce the risk of DM. Clinical trials support a marginal reduction in circulating lipids, and some meta-analyses support an increase in insulin sensitivity, following vitamin D supplementation. This review provides an overview of the calcium and vitamin D disturbances occurring in DM and describes the underlying mechanisms. Such elucidation will help indicate potential pathophysiology-based precautionary and therapeutic approaches and contribute to lowering the incidence of DM.

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Section: Relationship Between Hypercalcemia and Diabetesmentioning

confidence: 99%

Calcium homeostasis in diabetes mellitus

2017

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“…It is thought that an elevated intracellular free calcium concentration increases the requirement for insulin, resulting in hyperparathyroidism-mediated insulin resistance 47 . Diabetes patients should be evaluated for hypercalcemia given that untreated hyperparathyroidism is linked to hypertension 47,49 . A decreased bone formation due to metabolic acidosis and an increased bone mineral dissolution and resorption due to severe insulin deficiency and metabolic acidosis may also play a role 50 .…”

Section: Calciummentioning

confidence: 99%

Electrolyte Disturbances in Patients with Diabetes Mellitus

Khanduker

Ahmed²,

Khondker

et al. 2018

Bangladesh J Med Biochem

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Diabetic patients frequently develop a constellation of electrolyte disorders. These derangement results from insulin deficiency, hyperglycemia and hyperketonemia. Hyperglycemia sets the internal environment for osmotic diuresis while causing a dilutional effect on electrolyte concentrations.The osmotic effect of glucose results in decreased circulating blood volume and fluid shift from the intracellular spaces causing cellular dehydration. These disturbances are particularly common in decompensated diabetes, especially in the context of diabetic ketoacidosis or non ketotic hyperglycemic hyperosmolar syndrome.These patients are markedly sodium, magnesium and phosphate depleted. Diabetes mellitus is linked to both hypo and hyperkalemia and also hypo and hypercalcemia reflecting coexistence of hyperglycemia related mechanisms, which tend to change serum potassium and calcium to opposite directions. This article provides an overview of the electrolyte disturbances occurring in Diabetes and mechanisms underlying those disturbances.Bangladesh J Med Biochem 2017; 10(1): 27-35

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“…The diagnosis of PHP is classically based on the finding of hypercalcemia in the presence of high (or non suppressed) PTH levels [6,[8][9][10][11]; additional laboratory hallmark features are hypophosphatemia and elevated urinary cyclic adenosine monophospate [10]. Unfortunately, the diagnosis is not always so simple and a number of other factors must be considered [6].…”

Section: Introductionmentioning

confidence: 99%

“…While normocalcemic hyperparathyroidism is well recognized in PHP, less is known about patients with high calcium but normal iPTH possibly leading to diagnostic difficulties [1,3,9,10,[12][13][14]. The literature on this condition is poor and consists mainly of clinical cases [3,4,[12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative parathyroid hormone (PTH) testing in patients with primary hyperparathyroidism and PTH levels in the normal range

et al. 2019

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Background: Primary hyperparathyroidism is a common endocrine disorder. Hypercalcemia with normal PTH levels is very unusual and can lead to diagnostic difficulties. There are very few very few studies in the literature and all with limited numerical samples. The goal of the present study was to determine the real incidence and characteristics of primary hyperparathyroidism with normal PTH and to evaluate if intraoperative PTH testing is useful in these patients. Methods: We performed a retrospective review of 314 patients who had undergone parathyroidectomy to treat primary hyperparathyroidism between January 2002 and December 2016. Patients were divided in two groups according to biochemical preoperative findings: in Group A were included patients with normal serum PTH, in Group B those with increased serum PTH. Results: Nine patients (3.7%) were included in group A and 235 in group B. Patients in group A were younger (51. 5 ± 12.9 years vs 59.6 ± 12.5); preoperative serum calcium and the incidence of coexisting thyroid disease were similar between the two groups. Symptomatic patients were more frequent in Group A (77.8% vs 39.1%; p = 0.048). There were no significant differences regarding preoperative localization studies and surgical procedure. Intraoperative PTH determination demonstrated sensitivity of 86% in group A and 97% in group B, specificity and positive predictive value of 100% in both the groups, negative predictive value of 67% in group A and 79% in group B. Histopathological examination demonstrated a single gland disease in 8 (88.9%) patients in group A and a multi gland disease in 1 (11.1%), in group B single gland disease was found in 218 (92.8%) patients and multi gland disease in 17 (7.2%). Unsuccessful surgery with persistent or recurrent hyperparathyroidism occurred in 1 (11.1%) patient in group A and 4 (1.7%) in group B. Conclusions: Primary hyperparathyroidism with normal PTH is rare but physicians should be aware of this possibility in patients with hypercalcaemia. Patients with normal PTH levels are younger and more frequently symptomatic. Intraoperative PTH testing plays an important role in the operative management even in such patients.

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Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma

Cited by 9 publications

References 9 publications

Calcium homeostasis in diabetes mellitus

Calcium homeostasis in diabetes mellitus

Electrolyte Disturbances in Patients with Diabetes Mellitus

Intraoperative parathyroid hormone (PTH) testing in patients with primary hyperparathyroidism and PTH levels in the normal range

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