Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre

Pappachan, Joseph M; Elnaggar, Mohamed Nabil; Sodi, Ravinder; Jbeili, Kahtan; Smith, Paul; Lahart, Ian

doi:10.1007/s12020-018-1676-3

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…We describe a large series of patients with pHPT and their clinical evolution over time. Consistent with other series [17,26], we have obtained high cure (99%) and low recurrence (4.3%) rates. This study shows recurrences occurred with a median of 6.5 years after parathyroidectomy, whereas other studies have reported recurrence rates between 0 and 5%, but most have shorter follow-up times [26,27].…”

Section: Discussionsupporting

confidence: 92%

“…Classical manifestations of pHPT are related to kidney and skeletal damage, including nephrolithiasis, nephrocalcinosis, decreased renal function, low bone mineral density, bone cysts and brown tumors. In developed countries, however, the clinical presentation of pHPT has changed over the years and is now, in most cases, diagnosed in asymptomatic patients [15][16][17].…”

mentioning

confidence: 99%

“…Besides the classical presentation, pHPT has been linked to neurocognitive changes, cardiovascular dysfunction and malignancy [15,[17][18][19][20]. In fact, an increased risk of cancer-related death in patients with pHPT has been reported [21,22] and pHPT has been associated with a number of malignancies, such as breast, colon, kidney, thyroid and skin cancer [19,20,[23][24][25].…”

mentioning

confidence: 99%

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Primary Hyperparathyroidism: A Retrospective Study Over 18 Years in an Oncology Center

Martins

Simões²,

Leite³

2019

Int. J. Endo. Oncol.

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Aim: To study primary hyperparathyroidism (pHPT) in an oncology center, including its possible association with malignancy and ionizing radiation. Methods: Retrospective analysis of 188 patients with sporadic pHPT treated with parathyroidectomy between 2000 and 2018. We studied the etiology, clinical and biochemical features of pHPT, history of malignancies and exposure to radiotherapy. Results: pHPT was caused by parathyroid adenoma in 90.4%, hyperplasia in 5.3% and carcinoma in 4.3%. Cure and recurrence rates of pHPT were 99 and 4.3%, respectively. Median follow-up time was 19 months. Prevalence of malignancies was 30%, mostly thyroid and breast cancer. Radiotherapy of the head, neck or thorax (8.5%) was not associated with worse hypercalcaemia or recurrence. Males had larger adenomas, higher calcium and parathyroid hormone (p < 0.01). Conclusion: Prevalence of parathyroid carcinoma and other malignancies was higher than reported in other studies. Ionizing radiation exposure was unrelated with pHPT severity. Men had more severe pHPT. High cure and low recurrence rates were achieved.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

mentioning

confidence: 99%

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Primary Hyperparathyroidism: A Retrospective Study Over 18 Years in an Oncology Center

Martins

Simões²,

Leite³

2019

Int. J. Endo. Oncol.

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“…is might be related to older ages and PHPT clinical severity, as hypercalciuria-induced nephrogenic diabetes International Journal of Endocrinology insipidus often results in polyuria leading to volume depletion and a reduction in the glomerular filtration rate, which may lead to a further increase in calcium concentration [12]. Similarly, a retrospective study of 160 PHPT cases managed at a regional centre in the United Kingdom reported that higher peak calcium concentration was an independent predictor of acute kidney injury [13]. erefore, patients experiencing symptomatic hypercalcemia were older, with a reduced kidney function, experiencing higher comorbidity score and treated with a higher number of drugs.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Hypercalcemia in Patients with Primary Hyperparathyroidism Is Associated with Severity of Disease, Polypharmacy, and Comorbidity

Aresta

Passeri

Corbetta

2019

International Journal of Endocrinology

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Current primary hyperparathyroidism (PHPT) clinical presentation is asymptomatic in more than 90% of patients, while symptoms concern osteoporosis and rarely kidney stones. Here, we retrospectively investigated the prevalence of PHPT patients presenting with hypercalcemic-related symptoms (HS-PHPT) as cognitive impairment, changes in sensorium, proximal muscle weakness, nausea and vomiting, constipation, and severe dehydration, in a single center equipped with an emergency department and described their clinical features and outcome in comparison with a series of asymptomatic PHPT out-patients (A-PHPT). From 2006 to 2016, 112 PHPT patients were consecutively diagnosed: 16% (n = 18, 3M/15F) presented with hypercalcemic-related symptoms. Gastrointestinal symptoms occurred in 66% of HS-PHPT patients and cognitive impairment in 44%; one woman experienced hypertensive heart failure. Two-thirds of HS-PHPT patients were hospitalized due to the severity of symptoms. Comparing the clinical features of HS-PHPT patients with A-PHPT patients, no gender differences were detected in the two groups, while HS-PHPT patients were older at diagnosis (71 (61–81) vs. 64 (56–74) years, P=0.04; median (IQR)). HS-PHPT patients presented higher albumin-corrected calcium levels (12.3 (11.3–13.7) vs. 10.6 (10.3–11.3) mg/dl, P<0.001); 4 HS-PHPT presented corrected calcium levels >14 mg/dl. Serum PTH levels and total alkaline phosphatase activity were higher in HS-PHPT. Reduced kidney function (eGFR < 45 ml/min) was prevalent in HS-PHPT patients (42% vs. 5%, P=0.05). No differences in kidney stones and osteoporosis were detected, as well as in the rates of cardiovascular comorbidities and main cardiovascular risk factors. HS-PHPT patients had an age-adjusted Charlson Comorbidity Index higher than that of the A-PHPT patients and were on chronic therapy with a greater number of medications than A-PHPT patients. In conclusion, hypercalcemic-related symptoms occurred in 16% of PHPT patients. Risk factors were severity of the parathyroid tumor function, multimorbidity, and polypharmacy.

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“…Parathyroidectomy (PTX) is the only curative treatment for pHPT [1,2]. If successful, PTH and calcium levels are normalized.…”

Section: Introductionmentioning

confidence: 99%

The effect of parathyroidectomy compared to non-surgical surveillance on kidney function in primary hyperparathyroidism: a nationwide historic cohort study

et al. 2022

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Background Patients with primary hyperparathyroidism (pHPT) and impaired kidney function (estimated glomerular filtration rate (eGFR) < 60 mL/min) are offered parathyroidectomy (PTX) to protect them from further complications. Surprisingly, two recent uncontrolled cohort studies have suggested a further decrease in kidney function following PTX. We aimed to examine the effects of PTX compared to non-surgical surveillance on kidney function in pHPT patients. Methods Historic cohort study. From the Danish National Patient Registry (NPR) and major medical biochemistry laboratories in Denmark, we identified 3585 patients with biochemically confirmed pHPT among whom n = 1977 (55%) were treated with PTX (PTX-group) whereas n = 1608 (45%) were followed without surgery (non-PTX group). Baseline was defined as time of diagnosis and kidney function was re-assessed 9–15 months after PTX (PTX group) or 9–15 months after diagnosis (non-PTX group). Results At follow-up, eGFR had decreased significantly in the PTX- compared to the non-PTX-group (median − 4% vs. − 1%, p < 0.01). Stratification by baseline eGFR showed that the decrease was significant for those with a baseline eGFR value of 80–89 and > 90 mL/min, but not for those with lower eGFR values. Findings did not differ between patients with mild compared to moderate/severe hypercalcemia. However, after mutual adjustments, we identified baseline levels of calcium, PTH, and eGFR as well as age and treatment (PTX vs. no-PTX) as independent predictors for changes in kidney function. Conclusion Compared to non-surgical surveillance, PTX is associated with a small but significant decrease in kidney function in pHPT patients with an initial normal kidney function.

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Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre

Abstract: PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.

Cited by 10 publications

References 31 publications

Primary Hyperparathyroidism: A Retrospective Study Over 18 Years in an Oncology Center

Primary Hyperparathyroidism: A Retrospective Study Over 18 Years in an Oncology Center

Symptomatic Hypercalcemia in Patients with Primary Hyperparathyroidism Is Associated with Severity of Disease, Polypharmacy, and Comorbidity

The effect of parathyroidectomy compared to non-surgical surveillance on kidney function in primary hyperparathyroidism: a nationwide historic cohort study

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