Primary Hyperparathyroidism, With A Focus On Management Of The Normocalcemic Form: To Treat Or Not To Treat?

Šiprová, Helena; Fryšák, Zdeněk; Souček, Miroslav

doi:10.4158/ep15704.or

Cited by 48 publications

(54 citation statements)

References 29 publications

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“…Imaging methods directed at the parathyroid glands were not performed before surgery. However, these methods were found to be limited in patients with NPHPT [19], and surgical exploration by an experienced surgeon is known to be more sensitive for the identification of altered parathyroid glands. Another limitation was the lack of information about the follow-up of patients with elevated PTH and eGFR 40-60 ml/ min/1.73 m 2 in the absence of altered parathyroid glands during surgery.…”

Section: Discussionmentioning

confidence: 99%

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Rosário

Calsolari

2019

Horm Metab Res

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The prevalence and the diagnostic criterion of “normocalcemic” primary hyperparathyroidism (NPHPT) are still uncertain and there is no consensual definition. This prospective study evaluated the prevalence of NPHPT in 676 adults without a history of fractures or nephrolithiasis and who would be submitted to thyroidectomy, the impact of adopting different cut-off values for 25-hydroxyvitamin D and estimated glomerular filtration rate (eGFR), and the agreement between biochemical diagnosis and the surgical finding of altered parathyroid glands. NPHPT was diagnosed in patients with normal total and ionized calcium and elevated PTH (in 2 measurements) and without a known cause of secondary HPT, including eGFR<40 ml/min/1.73 m2 and 25-hydroxyvitamin D<20 ng/dl. The 4 parathyroid glands were fully explored in these patients. Forty-six patients (6.8%) had a laboratory diagnosis of NPHPT. Altered parathyroid glands were detected in only 4 patients, corresponding to 0.6% of all patients and to 8.7% of those with a biochemical diagnosis of NPHPT. The latter was confirmed in 0/174 men, 1/252 premenopausal women, and 3/250 postmenopausal women. Among the 42 patients with elevated PTH and without altered parathyroid glands, 25 had 25-hydroxyvitamin D between 20 and 30 ng/dl, 7 had eGFR between 40 and 60 ml/min/1.73 m2, and 9 had both. The prevalence of NPHPT was 0.74% in this adult population without a history of nephrolithiasis or fractures. The diagnostic criterion using eGFR>60 ml/min/1.73 m2 and 25-hydroxyvitamin D>30 ng/dl was more appropriate considering the agreement with the surgical finding of altered parathyroid glands.

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Section: Discussionmentioning

confidence: 99%

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Rosário

Calsolari

2019

Horm Metab Res

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“…Despite advances in pathophysiology and a range of medical and surgical treatments for PHPT, little is known about the normocalcaemic variant. Recent studies reported that about 20 per cent of NcPHPT progresses into hypercalcaemic PHPT, the majority within 2–4 years of diagnosis. So far, it seems that hyperparathyroidism affects patients in a similar way, regardless of the blood calcium level.…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by a normal serum calcium level with an inappropriately high parathyroid hormone (PTH) level. The natural history of this disease is still unknown, as it could persist unchanged or evolve at some point towards the more classical hypercalcaemic form. The effects of NcPHPT are debated, with some studies suggesting that it has an impact on the skeletal, renal, metabolic and cardiovascular systems.…”

Section: Introductionmentioning

confidence: 99%

Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism

Bannani

Christou

Guérin

et al. 2018

British Journal of Surgery

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“…Paraneoplastic reactive eosinophilia has been reported in both hematologic and solid malignancies including ovarian [ 5 , 6 ], bronchial [ 3 , 7 ], gastrointestinal [ 2 , 8 ], hepatic [ 9 ], renal [ 10 ] and thyroid [ 11 ] cancers, in addition to sarcoma [ 12 ]. Although pulmonary involvement can be seen in up to 25% of patients with HE and hypereosinophilic syndrome, asthma symptoms are uncommon [ [13] , [14] , [15] , [16] ].…”

Section: Discussionmentioning

confidence: 99%

Marked hypereosinophilia secondary to endometrioid ovarian cancer presenting with asthma symptoms, a case report

Albitar

Egan

Alkhateeb

et al. 2020

Respiratory Medicine Case Reports

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Background Hypereosinophilia (HE) is defined by the presence of >1.5 × 10 9 /L eosinophils in the peripheral blood. Paraneoplastic HE has been reported in a number of solid and hematologic malignancies including ovarian cancer. We present a case with paraneoplastic HE in the setting of underlying endometrioid ovarian carcinoma. Case presentation An 88-year-old woman presented with cough, dyspnea and 20-pound unintentional weight loss of one month duration. Evaluation revealed peripheral hypereosinophilia (HE) with absolute eosinophil count of 15.38 × 10 9 /L (53.8%) and an elevated exhaled nitric oxide at 172 parts per billion (normal < 39 PPB). Given the HE and unintentional weight loss, computed tomography (CT) scan was obtained and showed a pelvic mass. The patient underwent bilateral salpingo-ophorectomy with pathology consistent with endometrioid ovarian carcinoma. The patient experienced complete resolution of her cough, dyspnea, and peripheral eosinophilia following surgical resection. Conclusion This case highlights that solid malignancy should be considered in patients with marked HE.

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Primary Hyperparathyroidism, With A Focus On Management Of The Normocalcemic Form: To Treat Or Not To Treat?

Cited by 48 publications

References 29 publications

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism

Marked hypereosinophilia secondary to endometrioid ovarian cancer presenting with asthma symptoms, a case report

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