Parathyroid Pathology: Hyperparathyroidism and Parathyroid Tumors

Carlson, Diane L.

doi:10.5858/2009-0578-ccr.1

Cited by 94 publications

(51 citation statements)

References 14 publications

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“…Nevertheless, no studies have shown parathyroid gland weight to be an HBS risk factor in patients with SHPT, partly due to different types of parathyroidectomy being conducted across studies. Parathyroid adenoma is the most common causes of PHPT, accounting for 80-85% of cases [42,43], whereas parathyroid hyperplasia is the primary histological finding in more than 90% in patients with SHPT, as shown in our study and various others [16,[44][45][46]. The state of prolonged stimulation of parathyroid cell growth in ESRD patients due to chronic hyperphosphatemia, hypocalcemia, and 1,25(OH) 2 D deficiency results in diffuse parathyroid hyperplasia.…”

Section: Discussionsupporting

confidence: 75%

Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

et al. 2020

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Background Hungry bone syndrome (HBS) following parathyroidectomy is associated with severe hypocalcemia and increased morbidity. This study aims to determine the incidence and risk factors of post-parathyroidectomy HBS in dialysis patients with secondary hyperparathyroidism (SHPT). Methods A retrospective cohort study was conducted, and medical records of patients with SHPT requiring parathyroidectomy between January 2014 and January 2020 were reviewed. HBS was defined as the requirement of intravenous calcium administration due to hypocalcemia-related symptoms and/or reductions in serum calcium concentration (<8.4 mg/dL) within 72 h after parathyroidectomy. Results A total of 130 dialysis patients were enrolled. The majority of patients (85.4%) received hemodialysis and the remaining patients (14.6%) received peritoneal dialysis. Ectopic parathyroid glands were identified in 6.6% of patients by preoperative parathyroid scintigraphy. Diffuse parathyroid hyperplasia was the most common histopathological characteristic of SHPT (90.8%). HBS occurred in 82.3% of patients following parathyroidectomy. Preoperative serum intact parathyroid hormone (iPTH) concentration was significantly correlated with serum calcium ( r = −0.48, p < 0.01) and alkaline phosphatase (ALP) concentration ( r = 0.71, p < 0.01). Patients with HBS had significantly longer hospital stays than patients without (8 versus 3 days, p < 0.01). Based on multiple logistic regression analysis, young age (≤45 years), high preoperative serum ALP (>420 IU/L) and iPTH (>1,000 pg/mL), and absence of preoperative hypercalcemia (>10.2 mg/dL) were significantly associated with HBS. Conclusions Post-parathyroidectomy HBS is common in dialysis patients with SHPT. Young age, high preoperative serum ALP and iPTH, and low preoperative serum calcium concentrations were important risk factors for HBS.

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Section: Discussionsupporting

confidence: 75%

Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

et al. 2020

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“…Clinically, parathyroid carcinoma can occur at any age, with a peak in the fifth decade of life (1,(8)(9)(10)(29)(30)(31). It occurs with equal frequency in both sexes, in contrast to the female predominance reported in parathyroid adenomas (1,(8)(9)(10)(11)25,29,30,32). although the distinction between benign and malignant parathyroid disease remains challenging at the clinical level, certain clinical features can raise a physician's suspicion for an underlying malignancy (Table I) (1,(8)(9)(10)(11)25,29,30,32).…”

Section: Clinical and Biochemical Featuresmentioning

confidence: 99%

“…In particular, extra-parathyroid imaging, comprising of renal ultrasonography and dualenergy X-ray absorptiometry, is used to assess for PTH- Intraoperative suspicion of local invasion and/or regional metastasis* albumin-corrected calcium levels >3 mmol/L* 3 rd /2 nd generation PTH assay ratio >1* Palpable neck mass (lesion > 3 cm)* Infiltration and/or calcifications on neck ultrasound* Suspicion of metastatic disease on sestamibi and/or CT scan* PTH >3 times the upper limit of normal Significant bone and/or kidney involvement Positive personal or family history (HPT-JT) Concomitant jaw tumor Hoarseness and/or neck pain disease (10,11,21,22,(75)(76)(77). Both parathyroid adenomas and carcinomas present as uniglandular parathyroid proliferations (11,13,14,26,32,44,70,72,73). Thus, at the time of intraoperative consultation, the distinction between parathyroid adenoma and carcinoma is often difficult or even impossible, if the tumor does not show grossly evident invasion into surrounding organs (1,8,11,14,17,19,73).…”

Section: Radiological Findingsmentioning

confidence: 99%

Parathyroid carcinoma: diagnosis and clinical implications

Duan¹,

Mete²

2015

TJPATH

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Parathyroid carcinoma is a rare type of endocrine cancer, with significant morbidity and mortality associated with parathyroid hormone (PTH)-mediated hypercalcemia. Concerning clinical features for parathyroid cancer include severe hypercalcemia (albumin-corrected calcium > 3 mmol/L), a palpable neck mass ( > 3 cm), 3rd/2nd generation PTH assay ratio ( > 1), and intraoperative suspicion of local invasion or regional metastasis. A definite diagnosis of malignancy is rendered when a parathyroid tumor presents one of the following clinicopathological features: (1) vascular invasion, (2) perineural invasion, (3) gross invasion into adjacent anatomical structures, and/or (4) metastasis. In difficult cases, the use of ancillary biomarkers is critical to establish an accurate diagnosis. Recent advances in molecular pathology have uncovered the important role of CDC73/HRPT2, a tumor suppressor gene deregulated in parathyroid carcinomas. Loss of nuclear and/or nucleolar expression of parafibromin (the gene product of CDC73/HRPT2) is now regarded as a diagnostic, prognostic and predictive biomarker for parathyroid carcinoma. Furthermore, over 15-20% of seemingly sporadic parathyroid carcinomas have underlying germline CDC73/HRPT2 mutations. As a result, many centers have integrated the use of ancillary biomarkers, notably parafibromin staining, in their routine practise. Radical surgery with en bloc resection has emerged as a primary treatment modality in parathyroid cancer, achieving cure in some patients. However, in those with inoperable disease, there remains a dire need for new therapies, as current treatments are largely ineffective. This review provides an update on the current knowledge of parathyroid carcinoma and highlights its exciting changes in endocrine practice.

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“…On the other hand, false negative findings could be related to very small parathyroid adenomas, particularly in a close vicinity to the thyroid gland [32], to the ectopic localization of the parathyroid gland, to multiglandular disease [7] or in cases of intrathyroidal atypical parathyroid adenoma, which is a rare entity with borderline pathological characteristics between adenoma and carcinoma [13,54].…”

Section: Pitfallsmentioning

confidence: 99%

Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

et al. 2021

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Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.

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Parathyroid Pathology: Hyperparathyroidism and Parathyroid Tumors

Cited by 94 publications

References 14 publications

Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

Parathyroid carcinoma: diagnosis and clinical implications

Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

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