Normocalcemic hyperparathyroidism: A Collaborative Endocrine Surgery Quality Improvement Program analysis

Pandian, T.K.; Lubitz, Carrie C.; Bird, Sarah; Kuo, Lindsay E.; Stephen, Antonia E.

doi:10.1016/j.surg.2019.06.043

Cited by 33 publications

(38 citation statements)

References 19 publications

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Section: Surgical and Medical Outcomesmentioning

confidence: 99%

“…Few data about the effects of parathyroidectomy or medical management on NHPT have been published to date. In the largest study, Pandian and colleagues ( 53 ) confirmed that NHPT is characterized by a higher prevalence of multigland disease, which has been associated with lower cure rates. ( 54 ) Smaller gland size may also be more common in NHPT as compared with PHPT.…”

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

“…( 55 ) These findings have implications for the preoperative and surgical localization of the pathological glands. To address this issue, Pandian and colleagues ( 53 ) concluded that routine bilateral neck exploration was necessary, in addition to using intraoperative PTH monitoring (ioPTH) in all patients affected by NHPT. Alternatively, another study suggested ( 55 ) proceeding with bilateral neck exploration (BNE) if ioPTH did not drop by 50% within 10 min of removal of the suspected overactive parathyroid gland(s).…”

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

“…A single case of parathyroid carcinoma was reported to present with NHPT. ( 62 ) A large surgical series ( 53 ) compared outcomes in NHPT ( n = 733) versus PHPT ( n = 6836) patients. Among those with parathyroid cancer or atypical adenoma ( n = 212), 26.8% ( n = 57) were categorized as having NHPT.…”

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

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Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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Normocalcemic primary hyperparathyroidism (NHPT) was first described over 10 years ago, but uncertainties still remain about its definition, prevalence, and rates of complications. As a result, consensus management guidelines for this condition have not yet been published. Several hypotheses have been proposed for the pathophysiology of NHPT, but it may be a heterogeneous disorder with multiple causes, rather than a single etiology that explains this biochemical phenotype. A common clinical concern is whether NHPT should be treated surgically when complications are already present at first recognition of the disorder, rather than following patients clinically over time. The literature on NHPT is based mostly on larger studies of population‐based cohorts and smaller studies from referral centers. Lack of rigorous diagnostic criteria and selection bias inherent in populations seen at tertiary referral centers may explain the heterogeneity of reported rates of bone and renal complications in relation to consistently mild laboratory alterations. Unresolved questions remain about the significance of NHPT when it is diagnosed biochemically without evident bone or kidney complications. Moreover, its natural history remains to be elucidated because a proportion of what is classified as NHPT may revert to normal spontaneously, thus revealing previously unrecognized secondary hyperparathyroidism. These issues indicate that caution should be used in recommending surgery for NHPT. This review will focus on recent issues regarding the pathophysiology, evaluation, and management of NHPT. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Surgical and Medical Outcomesmentioning

confidence: 99%

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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“…A multi-institutional, retrospective study of 7634 patients by Pandian et al showed comparable rates of 'clinical concern for persistent hyperparathyroidism' (p = 0.09) between nPHPT and hPHPT patients. 31 However, the authors of the study acknowledged that this data was not recorded for 25% of study participants and this may have prevented possible differences being identified.…”

Section: Localisation Studiesmentioning

confidence: 99%

Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

Aojula

Khan

Gittoes

et al. 2021

Therapeutic Advances in Endocrinology

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Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration.

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Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

Bilezikian

Khan

Silverberg

et al. 2020

Journal of Bone and Mineral Research

118

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The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non‐surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence‐based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in‐depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Normocalcemic hyperparathyroidism: A Collaborative Endocrine Surgery Quality Improvement Program analysis

Cited by 33 publications

References 19 publications

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

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