Primary Hyperparathyroidism

Heath, Hunter; Hodgson, Stephen F.; Kennedy, Margaret

doi:10.1056/nejm198001243020402

Cited by 859 publications

(133 citation statements)

References 30 publications

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“…In our patients an increased prevalence of parathyroid adenomas, thyroid carcinomas, and adrenal adenomas was observed that was 10 times higher compared with the corresponding European population (2,18,19,20,21,22,23,24,25,26,27,28,29). However, this finding should be interpreted with caution, as it may be attributed to the extensive investigations and periodical assessment performed and to the mixed populations living in different European countries.…”

Section: Discussioncontrasting

confidence: 56%

Long-term follow-up of a large series of patients with type 1 gastric carcinoid tumors: data from a multicenter study

Thomas¹,

Tsolakis²,

Grozinsky‐Glasberg³

et al. 2013

European Journal of Endocrinology

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Objective: To study the clinical presentation, diagnostic approach, response to treatment, and the presence of other pathologies in patients with gastric carcinoid type 1 (GC 1) tumors. Design and methods: Retrospective analysis of 111 patients from four institutions and a mean follow-up of 76 months. Results: The main indications for gastroscopy were upper gastrointestinal tract symptoms. The mean number of lesions, maximum tumoral diameter, and percentage of cells expressing Ki-67 labeling index were 3.6G3.8, 8G12.1 mm and 1.9G2.4% respectively. Serum gastrin and chromogranin A (CgA) levels were elevated in 100/101 and 85/90 patients respectively. Conventional imaging studies demonstrated pathology in 9/111 patients. Scintigraphy with radiolabeled octreotide was positive in 6/60 without revealing any additional lesions. From the 59 patients who had been followed-up without any intervention, five developed tumor progression. Thirty-two patients were treated with long-acting somatostatin analogs (SSAs), leading to a significant reduction of gastrin and CgA levels, number of visible tumors, and CgA immune-reactive tumor cells in 28, 19, 27, and 23 treated patients respectively. Antrectomy and/or gastrectomy were initially performed in 20 patients and a complete response was achieved in 13 patients. The most common comorbidities were vitamin B12 deficiency, thyroiditis, and parathyroid adenomas. Conclusions: Most GCs1 are grade 1 (82.7%) tumors presenting with stage I (73.9%) disease with no mortality after prolonged follow-up. Ocreoscan did not provide further information compared with conventional imaging techniques. Treatment with SSAs proved to be effective for the duration of administration.

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Section: Discussioncontrasting

confidence: 56%

Long-term follow-up of a large series of patients with type 1 gastric carcinoid tumors: data from a multicenter study

Thomas¹,

Tsolakis²,

Grozinsky‐Glasberg³

et al. 2013

European Journal of Endocrinology

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“…The cut-off value was adopted because most of the recommended levels of serum calcium, as an indication for surgery, range between 11.5 and 12.0 mg/dl [13,14,22], and even "conservative" physicians indicate pa rathyroidectomy when the level exceeds 12 mg/dl [12,15].…”

Section: Study Selectionmentioning

confidence: 99%

Psychiatric Symptoms, Bone Density and Non-Specific Symptoms in Patients with Mild Hypercalcemia due to Primary Hyperparathyroidism: A Systematic Overview of the Literature.

1997

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Abstract.To determine (1) the relationship between primary hyperparathyroidism with mild hypercalcemia and psychiatric disturbances, bone density, or non-specific symptoms, and (2) the effect of parathyroidectomy on these outcomes, a systematic and critical review of the literature was conducted. Relevant citations were identified using MEDLINE (1966( to August, 1995 and PsycINFO (1967 to August, 1995. Studies were included for the overview if they described patients with mild hypercalcemia (< 12 mg/dl), and if they dealt with at least one of the following outcomes: psychiatric disturbances, bone density, joint pain, constipation, polyuria/nocturia or weight loss. Either a calculated effect size or Z score was used to estimate the effect of the disease or parathyroidectomy on these outcomes. Seven studies met the inclusion criteria for this overview. Two out of three case-control studies on psychiatric symptoms found a significant association between primary hyperparathyroidism with mild hypercalcemia and psychiatric disturbances (effect sizes; 0.17, 1.2 and 1.6). One of the three studies also examined the effect of parathyroidectomy on psychiatric symptoms, and found an effect size of 1.5. All four cross-sectional studies that measured bone mass showed significantly reduced bone density in the forearm and the lumbar spine. The bone loss ranged from 0.9 to 1.4 standard deviation below the age-and sex-adjusted mean value in the forearm, and was 0.5 in the spine. There was no relevant study regarding non-specific symptoms. Among the seven studies, five did not explicitly indicate whether the patients had classical symptoms of either osteitis fibrosa cystica or renal stones. Primary hyperparathyroidism with mild hypercalcemia is associated with psychiatric disturbances and reduced bone density. Nevertheless, further research is needed to determine the symptoms, particularly for a group of patients without either classical bone disease or renal stones.The effects of parathyroidectomy on these outcomes also remain to be determined.

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“…Primary hyperparathyroidism is a metabolic disorder resulting from excessive production of parathyroid hormone (PTH) and probably is the most common cause of hypercalcaemia in the general population [1]. Primary hyperparathyroidism is presented in a patient with impending renal failure due to systemic lupus erythematosus with antiphospholipid syndrome (SLE-aPLS).…”

Section: Introductionmentioning

confidence: 99%

“…Primary hyperparathyroidism is the most frequent cause of hypercalcemia as described in population-based epidemiologic studies [1]. Description of endocrine abnormalities in SLE has been limited in the literature.…”

Section: Introductionmentioning

confidence: 99%