Normohormonal primary hyperparathyroidism is a distinct form of primary hyperparathyroidism

Applewhite, Megan K.; White, Michael G.; Tseng, Jennifer F.; Mohammed, Maryam K.; Mercier, Frédéric; Kaplan, Edwin L.; Angelos, Peter; Vokes, Tamara; Grogan, Raymon H.

doi:10.1016/j.surg.2016.03.038

Cited by 37 publications

(58 citation statements)

References 8 publications

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“…Calva‐Cerqueira et al found that median preoperative PTH levels were higher in patients with correct scans (137 pg/mL) than those found to be incorrect (101 pg/mL, P < .0065) . More recent studies confirm higher localization for both MIBI and US in classic PHPT versus normohormonal PHPT …”

Section: Discussionmentioning

confidence: 94%

“…Due to early detection of hypercalcemia by widespread serum calcium screening as part of routine healthcare, many patients are being diagnosed with early and asymptomatic PHPT with hypercalcemia. Furthermore, low biochemical profile hypercalcemic normohormonal PHPT with parathyroid hormone (PTH) within normal range is a well‐documented variant of PHPT . Normohormonal PHPT accounts for up to 17% to 22% of patients with PHPT …”

Section: Introductionmentioning

confidence: 99%

“…In addition, evolving guidelines and consensus recommendations for surgery in asymptomatic patients has resulted in more surgery in asymptomatic patients . Targeted parathyroidectomy with preoperative localization of abnormal parathyroids and availability of rapid intraoperative PTH (IOPTH) has further increased the appeal for surgical intervention in early asymptomatic disease and in normohormonal disease . However, the sensitivity and accuracy of imaging may decrease with early disease, leading to higher numbers of unsuccessful operations and/or unexpected bilateral explorations.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, low biochemical profile hypercalcemic normohormonal PHPT with parathyroid hormone (PTH) within normal range is a welldocumented variant of PHPT. [2][3][4][5] Normohormonal PHPT accounts for up to 17% to 22% of patients with PHPT. 3,5 The benefit of parathyroidectomy in asymptomatic patients has been demonstrated in a prospective randomized controlled trial resulting in increased bone mineral density and normalization of biochemical values.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] Normohormonal PHPT accounts for up to 17% to 22% of patients with PHPT. 3,5 The benefit of parathyroidectomy in asymptomatic patients has been demonstrated in a prospective randomized controlled trial resulting in increased bone mineral density and normalization of biochemical values. 6 In addition, evolving guidelines and consensus recommendations for surgery in asymptomatic patients has resulted in more surgery in asymptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

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Minimally elevated preoperative parathyroid hormone level influences the management of primary hyperparathyroidism

Sadeghi

Shokri

et al. 2017

The Laryngoscope

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Minimally elevated preoperative parathyroid hormone level influences the management of primary hyperparathyroidism

Sadeghi

Shokri

et al. 2017

The Laryngoscope

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Primary hyperparathyroidism: Disease of diverse genetic, symptomatic, and biochemical phenotypes

et al. 2021

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Genetic, symptomatic, and biochemical heterogeneity of patients with primary hyperparathyroidism (PHPT) has become apparent in recent years. An indepth, evidence-based review of the phenotypes of PHPT was conducted. This review was intended to provide the resulting information to surgeons who operate on patients with hyperparathyroidism. This review revealed that the once relatively clear distinction between familial and sporadic PHPT has This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

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Intraoperative Parathyroid Hormone Monitoring In Normohormonal Primary Hyperparathyroidism: How Low Do You Go?

Law,

Larrabee,

Stefan

et al. 2023

The Laryngoscope

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ObjectiveThe primary goal of this study was to determine in patients with normohormonal primary hyperparathyroidism (NHHPT) what percent reduction in post‐excision intraoperative parathyroid hormone (IOPTH) from baseline would yield a rate of cure comparable to that in patients with classical primary hyperparathyroidism (PHPT).MethodsThis is a retrospective cohort study of patients who underwent parathyroidectomy between July 2013 and February 2020. Demographic data, preoperative, intraoperative, and postoperative metrics were collected. Patients with NHHPT were compared to those with classical PHPT. Subgroup analyses were performed.ResultsOf the 496 patients included in the study, 66 (13.3%) were of the normohormonal variant based on preoperative intact parathyroid hormone (PTH) levels and 28 (5.6%) based on baseline IOPTH levels. The cure rates in the two normohormonal groups were not significantly different from their classical counterparts (98.4% and 100.0% vs. 97.1%, p = 1.000). The median percent decline in post‐excision IOPTH from baseline that achieved cure in the normohormonal groups were 82.6% and 80.4% compared to their respective controls at 87.3%, p = 0.011 and p = 0.001. Although the rate of multiglandular disease was higher in one of the normohormonal variant groups, this difference was due to a higher rate of double adenomas, not four‐gland hyperplasia.ConclusionPatients with NHHPT undergoing parathyroidectomy can expect cure rates similar to that in patients with classical PHPT. The results of this study indicate that achieving an 80% drop or more in IOPTH levels predicts a high likelihood of cure. This is true irrespective of whether the patient is deemed normohormonal based on preoperative or intraoperative testing.Level of EvidenceLevel 3 Laryngoscope, 2023

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Normohormonal primary hyperparathyroidism is a distinct form of primary hyperparathyroidism

Cited by 37 publications

References 8 publications

Minimally elevated preoperative parathyroid hormone level influences the management of primary hyperparathyroidism

Minimally elevated preoperative parathyroid hormone level influences the management of primary hyperparathyroidism

Primary hyperparathyroidism: Disease of diverse genetic, symptomatic, and biochemical phenotypes

Intraoperative Parathyroid Hormone Monitoring In Normohormonal Primary Hyperparathyroidism: How Low Do You Go?

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