Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy

Agarwal, Gaurav; Mishra, Saroj Kanta; Kar, Dilip K.; Singh, Anil Kumar; Arya, Vivek; Gupta, Sushil K.; Mithal, Ambrish

doi:10.1067/msy.2002.128484

Cited by 76 publications

(72 citation statements)

References 16 publications

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“…Consequently, only 7% of these patients were not scheduled for surgery (8 of 115 patients). These results agree with data obtained in other developing countries which also do not perform routine calcium measurements (6,17). The biochemical parameters of symptomatic patients were more compromised at presentation than those of asymptomatic patients, but BMD was reduced in both groups, with no significant difference between them.…”

Section: Discussionsupporting

confidence: 82%

“…As stated earlier, we observed a high prevalence of parathyroid carcinoma in our series, similar to those found in other series from developing countries (6,17). Our cases were based on surgical findings such as large and poorly circumscribed tumors adherent to the surrounding soft tissues of the neck or Primary hyperparathyroidism www.bjournal.com.br of the thyroid gland and on pathological findings such as capsular and vascular invasion (20).…”

Section: Discussionsupporting

confidence: 69%

“…Perhaps only the more severe cases are referred to this service. The high prevalence of parathyroid carcinoma seen in our study could also be related to this selection bias, since it is much higher than the values reported in the Western literature (16), although similar prevalences have been found in other studies from developing countries (6,17). Nevertheless, we emphasize that this presentation profile is gradually changing, as stated by Ohe et al (11), who studied most of these patients and observed that the diagnostic incidence of PHP as well as the proportion of asymptomatic patients slowly increased in the last few years.…”

Section: Discussioncontrasting

confidence: 53%

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Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Oliveira

Ohe

Santos

et al. 2007

Braz J Med Biol Res

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Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 69%

Section: Discussioncontrasting

confidence: 53%

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Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Oliveira

Ohe

Santos

et al. 2007

Braz J Med Biol Res

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“…Recent case series from Asia reported much higher prevalence rates of 24-87% (31,32,33,34), whereas a case series from Saudi Arabia documented a prevalence rate of only 4% (35).…”

Section: Prevalence Of Hbs After Parathyroidectomymentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature

Witteveen

Thiel

Romijn

et al. 2013

European Journal of Endocrinology

278

220

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Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphataemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. It is a relatively uncommon, but serious adverse effect of parathyroidectomy. We conducted a literature search of all available studies reporting a 'hungry bone syndrome' in patients who had a parathyroidectomy for PHPT, to identify patients at risk and address the pitfalls in their management. The severe hypocalcaemia is believed to be due to increased influx of calcium into bone, due to the sudden removal of the effect of high circulating levels of PTH on osteoclastic resorption, leading to a decrease in the activation frequency of new remodelling sites and to a decrease in remodelling space, although there is no good documentation for this. Various risk factors have been suggested for the development of HBS, including older age, weight/volume of the resected parathyroid glands, radiological evidence of bone disease and vitamin D deficiency. The syndrome is reported in 25-90% of patients with radiological evidence of hyperparathyroid bone disease vs only 0-6% of patients without skeletal involvement. There is insufficient data-based evidence on the best means to treat, minimise or prevent this severe complication of parathyroidectomy. Treatment is aimed at replenishing the severe calcium deficit by using high doses of calcium supplemented by high doses of active metabolites of vitamin D. Adequate correction of magnesium deficiency and normalisation of bone turnover are required for resolution of the hypocalcaemia which may last for a number of months after successful surgery. Preoperative treatment with bisphosphonates has been suggested to reduce post-operative hypocalcaemia, but there are to date no prospective studies addressing this issue. European Journal of Endocrinology 168 R45-R53

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“…8 The treatment of brown tumors requires resolution of hyperparathyroidism and increased oral intake of calcium and vitamin D. This therapeutic strategy is designed to enhance the overall bone mass and to recalcify osteolytic lesions. 9 However, despite this effort to build bone, fracture risk remains high. 10 Our patient's pain was adequately controlled 2 days after admission.…”

Section: Managementmentioning

confidence: 99%

Her Aching Bones: Atypical Parathyroid Adenoma

Rodrigues

Bekerman

Neves

et al. 2016

The American Journal of Medicine

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Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy

Cited by 76 publications

References 16 publications

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature

Her Aching Bones: Atypical Parathyroid Adenoma

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