Normocalcemic Primary Hyperparathyroidism: Further Characterization of a New Clinical Phenotype

Lowe, Hyesoo; McMahon, Donald J.; Rubin, Mishaela R.; Bilezikian, John P.; Silverberg, Shonni J.

doi:10.1210/jc.2006-2802

Cited by 308 publications

(223 citation statements)

References 13 publications

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“…While some groups have reported low progression rates and morbidity,13, 14 others have found high progression rates (19–25%) during much shorter follow‐up periods 6, 7. The highest progression rates were seen in studies on referral patients with clinical features of metabolic bone disease 6, 7.…”

Section: Discussionmentioning

confidence: 99%

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Normocalcaemic, vitamin D‐sufficient hyperparathyroidism – high prevalence and low morbidity in the general population: A long‐term follow‐up study, the WHO MONICA project, Gothenburg, Sweden

Kontogeorgos

Trimpou

Lainé

et al. 2015

Clinical Endocrinology

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SummaryObjectiveThere is limited knowledge about the natural history of normocalcaemic, vitamin D‐sufficient hyperparathyroidism (nHPT). The aim was to study the prevalence of nHPT and its relation to morbidity.DesignCross‐sectional and retrospective study at the Sahlgrenska University Hospital, Gothenburg, Sweden.SubjectsA random population of 608 men and women, age 25–64 years, was studied in 1995 as part of the WHO MONICA study and reinvestigated in 2008 (n = 410, of whom 277 were vitamin D sufficient).MeasurementsA serum intact parathyroid hormone (S‐PTH) ≥60 ng/l was considered as HPT, S‐calcium 2·15–2·49 mmol/l as normocalcaemia and S‐25(OH)D ≥ 50 nmol/l as vitamin D sufficiency. Data on fractures, stroke and myocardial infarction were retrieved until 2013, that is a 17‐year follow‐up.ResultsThe prevalence of nHPT was 2·0% in 1995 (age 25–64) and 11·0% in 2008 (age 38–79). S‐PTH was positively correlated with age and BMI. After adjustment for these variables, a high S‐PTH level (≥60 ng/l) at follow‐up was associated with previously low S‐25(OH)D, high osteocalcin, S‐PTH and both past and presently treated hypertension. No relation was seen with creatinine, cystatin C, malabsorption markers, thyroid function, glucose, insulin, lipids, calcaneal quantitative ultrasound, fractures, myocardial infarction, stroke or death at follow‐up.ConclusionsThis small random population study showed that nHPT was common, 11% at follow‐up. Only one individual developed mild hypercalcaemia in 13 years. Previous S‐PTH was predictive of nHPT and hypertension was prevalent, but no increase in hard end‐points was seen over a 17‐year period.

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Section: Discussionmentioning

confidence: 99%

“…Most studies including S‐PTH have been performed on referral groups of patients, mostly to bone and metabolic units 6, 7. In addition, it is uncertain which S‐Ca level could be considered safe in patients with mild pHPT 8.…”

Section: Introductionmentioning

confidence: 99%

Normocalcaemic, vitamin D‐sufficient hyperparathyroidism – high prevalence and low morbidity in the general population: A long‐term follow‐up study, the WHO MONICA project, Gothenburg, Sweden

Kontogeorgos

Trimpou

Lainé

et al. 2015

Clinical Endocrinology

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“…Em nosso estudo, 43% dos pacientes mostraram normocalcemia, que sugere a apresentação mais precoce da doença 19 , um momento oportuno para intervenção médica, a fim de evitar o aparecimento de intercorrências. Um trabalho da Columbia University chamou atenção para esses casos ao demonstrar que pacientes normocalcêmicos apresentaram maior comprometimento ósseo no diagnóstico e complicações em longo prazo 20 .…”

Section: Discussionunclassified

Hiperparatireoidismo Primário - Diferentes Modalidades De Tratamentos

Costa¹,

Moura²,

Vaucher³

et al. 2015

Rev. Med. UFPR

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RESUMOIntrodução: Objetivo: Avaliar a resposta clínica dos portadores de hiperparatireoidismo primário (HPTP), submetidos ou não à cirurgia, comparando a evolução de cada grupo. Métodos: Avaliação através dos prontuários dos pacientes com HPTP atendidos no Hospital de Clínicas da UFPR no período de 1992 a 2014. Os pacientes foram divididos de acordo com o tratamento em grupo cirúrgico (GC) e clínico (GCL). Dados de exames laboratoriais e densitométricos pré e pós-tratamento foram coletados e comparados. Resultados: Cinquenta e um dos 99 prontuários selecionados compuseram a amostra final, sendo 27 no GC, com idade média de 73±9,8 anos e 24 no GCL, com idade média de 58±12,8 anos, (p=0,0001). Todos os parâmetros avaliados se mantiveram semelhantes no GCL, com exceção da DMO de coluna lombar (L1-L4), que aumentou em média 7,5 %. Já o GC apresentou aumento médio na DMO de 22,2% em L1-L4, 14,5% em colo de fêmur e de 11,3% em fêmur total. Neste grupo, cálcio sérico, urinário e PTH diminuíram (p<0,05), embora seis pacientes não apresentaram cura cirúrgica. O GCL apresentou maior comorbidade cardiovascular (p=0,038) que o GC. Os demais parâmetros foram semelhantes entre os grupos. Conclusão: Foi observada melhora nos parâmetros laboratoriais e densitométricos dos pacientes do GC. O tratamento cirúrgico consistiu na melhor opção em pacientes mais jovens.Palavras--Chaves: Hiperparatireoidismo. Hormônio Paratireóideo. Hipercalcemia. Densidade Mineral Óssea. Paratireoidectomia. ABSTRACTBackground: To evaluate the clinical response of patients with primary hyperparathyroidism (PHPT), submitted or not to surgery, comparing the evolution of each group. Methods: Evaluation through the medical records of patients with PHPT treated at the Hospital de Clínicas da UFPR from 1992 to 2014. Patients were divided according to the treatment in surgical group (GC) and clinical group (GCL). Laboratory tests and BMD (bone mineral density) previous and after treatment were collected and subsequently compared between them. Results: Fifty-one of the 99 selected records made up the final sample, 27 in the GC, with a mean age of 73 ± 9.8 years and 24 in the GCL, mean age 58 ± 12.8 years (p = 0.0001). All parameters remained similar in GCL except lumbar spine BMD (L1-L4), which increased 7.5%. The CG showed an increase in BMD of 22.2% in L1-L4, 14.5% in femoral neck and 11.3% in total femur. In this group, serum calcium, urinary and PTH decreased (p <0.05), although six patients have not cured with the surgery. The GCL showed greater cardiovascular comorbidity (p = 0.038) than the CG. The other parameters were similar between groups.Conclusion: We found an improvement in laboratory and densitometry parameters of GC patients. Surgical treatment was the best option in younger patients.

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“…In the follow up analysis, there were 4 fragility fractures, 14% had nephrolithiasis and 57% had osteoporosis at diagnosis. Parathyroidectomy was performed in 10 subjects, in whom the presence of two parathyroid adenomas and hyperplasia was observed in 2 cases, while the others showed a single parathyroid adenoma (6).…”

Section: Case Reportmentioning

confidence: 99%

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

Pimentel

Portela

Loureiro

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYNormocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10 th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications. Arq Bras Endocrinol Metab. 2014;58(5):583-6 SUMáRioHiperparatiroidismo primário normocalcêmico (NPHPT) caracteriza-se pela elevação do hormô-nio da paratiroide (PTH), na ausência da elevação dos níveis séricos de cálcio e exclusão de causas secundárias. O caso descrito ilustra o seguimento de uma mulher na pós-menopausa com NPHPT que evoluiu com múltiplos adenomas. Este caso relata uma paciente de 77 anos de idade que tem dor generalizada crônica e osteoporose. O PTH inicial foi elevado com níveis séricos de cálcio, albumina, fósforo e 25OH vitamina D normais. A densitometria óssea (DMO) evidenciou um T-SCORE da coluna lombar: -3.0, colo do fêmur: -2.6 e rádio distal: -4.2. Outras causas de hiperparatireoidismo secundário foram descartadas e a ultrassonografia cervical e varredura com Sestamibi foram negativos. Fez uso de alendronato e três infusões de ácido zoledrônico para o tratamento da osteoporose. No décimo ano de seguimento, depois de sucessivas imagens negativas, a ultrassonografia evidenciou um nódulo sugestivo de adenoma de paratireoide inferior direita. A paciente foi submetida à paratireoidectomia, e um exame histológico confirmou a hipótese. A elevação dos níveis séricos de PTH no pós-operatório se ma...

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Normocalcemic Primary Hyperparathyroidism: Further Characterization of a New Clinical Phenotype

Abstract: Patients seen in a referral center with normocalcemic hyperparathyroidism have more substantial skeletal involvement than is typical in PHPT and develop more features and complications over time. These patients may represent the earliest form of symptomatic, rather than asymptomatic, PHPT.

Cited by 308 publications

References 13 publications

Normocalcaemic, vitamin D‐sufficient hyperparathyroidism – high prevalence and low morbidity in the general population: A long‐term follow‐up study, the WHO MONICA project, Gothenburg, Sweden

Normocalcaemic, vitamin D‐sufficient hyperparathyroidism – high prevalence and low morbidity in the general population: A long‐term follow‐up study, the WHO MONICA project, Gothenburg, Sweden

Hiperparatireoidismo Primário - Diferentes Modalidades De Tratamentos

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

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