Primary Hyperparathyroidism with a Low-Normal, Atypical Serum Parathyroid Hormone as Shown by Discordant Immunoassay Curves

Lafferty, Fred W.; Hamlin, Clive R.; Corrado, Kristin; Arnold, Andrew; Shuck, Jerry M.

doi:10.1210/jc.2006-0273

Cited by 27 publications

(18 citation statements)

References 10 publications

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“…Others have cited fluctuating or pulsatile PTH secretion, target tissue resistance to PTH, PTH-related peptide, variability in sample storage and measurement, circulating inhibitors to PTH, and post-translational modification of the PTH molecule as explanations for this phenomenon (11, 24, 27, 36). Potential explanations for normocalcemic hyperparathyroidism include low serum binding protein concentrations, target tissue resistance to PTH, and vitamin D deficiency (19, 37, 38).…”

Section: Discussionmentioning

confidence: 99%

“…To date, studies of mild primary hyperparathyroidism in the U.S. have included relatively few patients and have not consistently reported outcomes like recurrence (11, 13, 15, 18–27). The purpose of this study was to characterize patterns of disease presentation, intraoperative PTH kinetics, and postoperative outcomes in patients with mild hyperparathyroidism.…”

Section: Introductionmentioning

confidence: 99%

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Multigland Disease and Slower Decline in Intraoperative PTH Characterize Mild Primary Hyperparathyroidism

et al. 2013

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BACKGROUND Many patients with primary hyperparathyroidism (PHPT) present with less severe biochemical parameters. The purpose of this study was to compare the presentation, operative findings, and outcomes of these patients with “mild” PHPT to patients with “overt” disease. METHODS A retrospective review of a prospectively collected parathyroid database was performed to identify cases of PHPT undergoing an initial neck operation. Patients were classified as mild when either the preoperative calcium or PTH was within the normal limits. Comparisons were made with the student’s t-test, Chi-squared test, or Wilcox on rank-sum test where appropriate. Kaplan-Meier estimates were plotted for disease-free survival and compared by the log-rank test. RESULTS Of the 1,429 patients who met inclusion criteria, 1,049 were classified as overt and 388 (27.1%) were mild. Within the mild group, 122 (31.4%) presented with normocalcemic PHPT and 266 (68.6%) had a normal PTH. The two groups had similar demographics and renal function. Interestingly, the mild group had more than double the rate of kidney stones (3.1% vs. 1.3%, p = 0.02). The mild group was less likely to localize on sestamibi scan (62.4% vs. 78.7%, p<0.01). Intraoperatively, more mild patients exhibited multigland disease (34.3% vs. 14.1%, p<0.01). When examining intraoperative PTH (IoPTH) kinetics where single adenomas were excised, the IoPTH fell at a rate of 6.9 pg/min in mild patients compared to 11.5 pg/min in the overt group (p<0.01). Accordingly, 62.2% of patients in the overt group and 53.3% in the mild group were cured at five minutes post-excision (p<0.01). There was no difference in the rates of persistence or recurrence between the groups, and disease-free survival estimates were identical (p = 0.27). CONCLUSIONS Patients with mild PHPT were more likely to have multigland disease and a slower decline in IoPTH, but these patients can be successfully treated with surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multigland Disease and Slower Decline in Intraoperative PTH Characterize Mild Primary Hyperparathyroidism

et al. 2013

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“…Hence, the diagnosis of PHPT is challenging and often delayed because of this wide spectrum of clinical and biochemical manifestations, especially in asymptomatic and NCPHPT patients . For all these reasons, physicians cannot completely rule out the diagnosis of PHPT even in presence of normal PTH or normal serum calcium …”

Section: Introductionmentioning

confidence: 99%

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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“…The sensitivity of the intact PTH assay was reported to be 73-86%, whereas bio-intact PTH assays are suggested to exhibit a higher sensitivity (96%) [9,10]. However, intact and bio-intact assays may not completely detect PTH if a posttranslational alteration has occurred within an adenoma [11]. We could measure neither bio-intact PTH nor PTHrP because of our lack of facilities.…”

Section: Discussionmentioning

confidence: 97%

Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma

Gülçelik

Bozkurt

Tezel

et al. 2008

Endocr

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Primary Hyperparathyroidism with a Low-Normal, Atypical Serum Parathyroid Hormone as Shown by Discordant Immunoassay Curves

Cited by 27 publications

References 10 publications

Multigland Disease and Slower Decline in Intraoperative PTH Characterize Mild Primary Hyperparathyroidism

Multigland Disease and Slower Decline in Intraoperative PTH Characterize Mild Primary Hyperparathyroidism

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma

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