Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

Dawood, Nardeen B; Yan, Kimberly; Shieh, Albert; Livhits, Masha J.; Yeh, Michael W.; Leung, Angela M.

doi:10.1111/cen.14315

Cited by 18 publications

(18 citation statements)

References 63 publications

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“…These results indicate that chronic PTH over-secretion is implicated in the development of dyshomeostasis on β-cells function, as well as development of insulin resistance in adipose tissue [20]. However, previous clinical human studies have not consistently reported a deterioration of peripheral insulin action [8][9][10]. In this study, no differences in HOMA-IR or HOMA-B indices between groups were evident, probably as a result of the small sample size.…”

Section: Discussioncontrasting

confidence: 50%

“…A total of 32 patients with NPHPT and prediabetes were initially included. NPHPT was defined as elevated serum PTH concentration (>65 pg/mL) and normal corrected serum Ca concentration [1,10]. Corrected Ca and PTH concentrations were measured on at least two occasions during a 3-6-month period, to confirm the persistence of the hyperparathyroid state.…”

Section: Study Populationmentioning

confidence: 99%

“…Three months prior to baseline evaluation, all participants were supplemented with a daily vitamin D regimen (ranging from 1.200 to 4.000 IU) according to their latest available 25-hydroxy-vitamin D (25(OH)D) concentrations. This was in order to achieve 25(OH)D concentrations ≥ 30 ng/mL, according to international criteria [1,9,10], to avoid the effects of vitamin D deficiency on PTH values [18]. All participants underwent methoxy isobutyl isonitrile (MIBI) scintigraphy and parathyroid gland ultrasonography prior to inclusion.…”

Section: Study Populationmentioning

confidence: 99%

“…Normocalcemic primary hyperparathyroidism (NPHPT) is recognized as a new subclinical entity in the field of parathyroid disorders, and is characterized by increased serum PTH concentrations where serum calcium levels are within normal values, after the exclusion of other causes of high PTH [9,10]. In the field of metabolic complications, available results are conflicting regarding the effects of NPHPT as a potential risk factor for the development of cardiovascular and metabolic complications, although it has been associated with increased fasting glucose levels in patients with type 2 diabetes [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

et al. 2020

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We have previously described increased fasting plasma glucose levels in patients with normocalcemic primary hyperparathyroidism (NPHPT) and co-existing prediabetes, compared to prediabetes per se. This study evaluated the effect of parathyroidectomy (PTx) (Group A), versus conservative follow-up (Group B), in a small cohort of patients with co-existing NPHPT and prediabetes. Sixteen patients were categorized in each group. Glycemic parameters (levels of fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), and fasting insulin (fIns)), the homeostasis model assessment for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR), and a 75-g oral glucose tolerance test were evaluated at baseline and after 32 weeks for both groups. Measurements at baseline were not significantly different between Groups A and B, respectively: fGlu (119.4 ± 2.8 vs. 118.2 ± 1.8 mg/dL, p = 0.451), HbA1c (5.84 ± 0.3 %vs. 5.86 ± 0.4%, p = 0.411), HOMA-IR (3.1 ± 1.2 vs. 2.9 ± 0.2, p = 0.213), HOMA-B (112.9 ± 31.8 vs. 116.9 ± 21.0%, p = 0.312), fIns (11.0 ± 2.3 vs. 12.8 ± 1.4 μIU/mL, p = 0.731), and 2-h post-load glucose concentrations (163.2 ± 3.2 vs. 167.2 ± 3.2 mg/dL, p = 0.371). fGlu levels demonstrated a positive correlation with PTH concentrations for both groups (Group A, rho = 0.374, p = 0.005, and Group B, rho = 0.359, p = 0.008). At the end of follow-up, Group A demonstrated significant improvements after PTx compared to the baseline: fGlu ((119.4 ± 2.8 vs. 111.2 ± 1.9 mg/dL, p = 0.021) (−8.2 ± 0.6 mg/dL)), and 2-h post-load glucose concentrations ((163.2 ± 3.2 vs. 144.4 ± 3.2 mg/dL, p = 0.041), (−18.8 ± 0.3 mg/dL)). For Group B, results demonstrated non-significant differences: fGlu ((118.2 ± 1.8 vs. 117.6 ± 2.3 mg/dL, p = 0.031), (−0.6 ± 0.2 mg/dL)), and 2-h post-load glucose concentrations ((167.2 ± 2.7 vs. 176.2 ± 3.2 mg/dL, p = 0.781), (+9.0 ± 0.8 mg/dL)). We conclude that PTx for individuals with NPHPT and prediabetes may improve their glucose homeostasis when compared with conservative follow-up, after 8 months of follow-up.

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Section: Discussioncontrasting

confidence: 50%

Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

et al. 2020

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“…It is defined as elevated concentrations of calcium (total calcium corrected for albumin level or ionized calcium), elevated parathormone concentration (PTH; or normal, but not suppressed by hypercalcemia) and exclusion of secondary causes of hyperparathyroidism. Normocalcemic PHPT is a condition in which calcium concentration is normal, but PTH is elevated (and secondary causes of hyperparathyroidism are excluded) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel Germline c.1267T>A MEN1 Mutation in MEN1 Family—from Phenotype to Gene and Back

Gierlikowski

Skwarek-Szewczyk

Popow

2020

Genes

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Primary hyperparathyroidism is a relatively common endocrine disorder, which may be hereditary. This report describes clinical, biochemical, radiographic, and genetic findings, the latter obtained using next generation sequencing (NGS), in three consanguineous patients. Gene panels in NGS consisted of 5 or 70 genes, including MEN1 and RET. The first patient suffered from recurrent primary hyperparathyroidism. Primary hyperparathyroidism and pituitary microadenomas were afterwards diagnosed in two of her daughters. No clinical nor radiological features of gastroenteropancreatic neuroendocrine tumors were found. All three family members were heterozygous for MEN1 NM_130799: c.1267T>A transversion, which is predicted to result in substitution of tryptophan with arginine in position 423. Additionally, the first patient was also a carrier of RET NM_020975: c.1946C>T missense mutation, which was not present in two other family members. We describe a family with a novel heterozygous mutation (NM_130799: c.1267T>A) in MEN1 gene and postulate that it leads to MEN1 syndrome. The study underlies the importance of genetic testing in primary hyperparathyroidism in personalizing patients’ care.

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Surgical management of MILD hyperparathyroidism

Lecourt

Creff

Coudert

et al. 2021

Eur Arch Otorhinolaryngol

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

Cited by 18 publications

References 63 publications

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

A Novel Germline c.1267T>A MEN1 Mutation in MEN1 Family—from Phenotype to Gene and Back

Surgical management of MILD hyperparathyroidism

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