Secondary and Tertiary Hyperparathyroidism

Messa, Piergiorgio; Alfieri, Carlo

doi:10.1159/000491041

Cited by 40 publications

(31 citation statements)

References 3 publications

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“…For asymptomatic patients, specific guidelines must be consulted. Secondary hyperPT, frequently derived from chronic kidney disease (CKD), and tertiary hyperPT, that follows long-standing secondary hyperPT with hypercalcaemia, are rarer parathyroid gland disorders presenting symptoms of bone, organic and metabolic disorders [10,11]. These forms are primarily pharmacologically treated and may occasionally require parathyroid surgery [10,12].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis

Darbà

Marsà²

2020

PLoS ONE

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Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis originates variable symptoms that affect bone remodelling among other processes. This study aimed to provide data on the epidemiology and characteristics of patients admitted with these disorders in Spain between 2003 and 2017, and to analyse disease management and direct medical costs. Medical records in which a disorder of the parathyroid gland was registered as the admission motive were extracted from a nationwide hospital-discharge database via the Spanish Ministry of Health. Records from 12,903 patients were obtained, with predominance of female patients (74.70%) and of admissions due to hyperparathyroidism (90.23%). The number of patients admitted per year increased over the study period along the incidence of these disorders. The year 2017 incidence of hyperparathyroidism was 2.95 per 10,000, 4.03 per 10,000 in females and 1.37 in males; the same year, the incidence of hypoparathyroidism was 0.17 per 10,000. Length of hospital stay was significantly extended in patients with hypoparathyroidism (7.16 days), admitted mostly due to emergencies. Heart failure was diagnosed in more than 20% of admissions in patients with secondary and tertiary hyperparathyroidism and hypoparathyroidism, while this last group displayed the highest levels of mineral metabolism disruption. Parathyroidectomy was performed in 78.95% of all admissions for primary hyperparathyroidism. The total annual direct medical cost parathyroid gland disorders has increased over the study period, due to the increase of the costs associated to hyperparathyroidism, whereas the cost per patient remained relatively stable, with an average of €3,748, €3,430 and €3,737 for patients with hyperparathyroidism, hypoparathyroidism and other disorders of the parathyroid gland, respectively. This study provides novel data to extend the scarce available knowledge on parathyroid gland disorders' epidemiology and management in Spain.

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Section: Introductionmentioning

confidence: 99%

Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis

Darbà

Marsà²

2020

PLoS ONE

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“…Continuous overproduction of PTH also occurs due to secondary causes such as chronic renal disease and vitamin D deficiency. The skeletal manifestations of secondary hyperparathyroidism are also heterogeneous 8,9 . This condition is modeled in animals by feeding a low calcium diet 10 .…”

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confidence: 99%

PTH induces bone loss via microbial-dependent expansion of intestinal TNF+ T cells and Th17 cells

Tyagi

et al. 2020

Nat Commun

113

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Bone loss is a frequent but not universal complication of hyperparathyroidism. Using antibiotic-treated or germ-free mice, we show that parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched by the Th17 cell-inducing taxa segmented filamentous bacteria (SFB). SFB + microbiota enabled PTH to expand intestinal TNF + T and Th17 cells and increase their S1P-receptor-1 mediated egress from the intestine and recruitment to the bone marrow (BM) that causes bone loss. CXCR3-mediated TNF + T cell homing to the BM upregulated the Th17 chemoattractant CCL20, which recruited Th17 cells to the BM. This study reveals mechanisms for microbiota-mediated gut-bone crosstalk in mice models of hyperparathyroidism that may help predict its clinical course. Targeting the gut microbiota or T cell migration may represent therapeutic strategies for hyperparathyroidism.

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“…According to the investigations performed; vitamin D deficiency was found in 88 (64.2%), PHPT in 38 (27.7%), FHH in 8 (5.8%), and CRF in 3 (2.2%) patients. The mean creatinine values of the patients was found as 0.73±0.16 (0.4-1.5), the mean calcium value as 9.90±0.87 (8)(9)(10)(11)(12), the mean phosphorus value as 3.09±0.60 (1.9-5.1), the mean PTH value as 176.2±72.5 (90-476), and the mean vitamin D level as 15±11.8 (2.4-65). The mean 24-h urine calcium level was found as (n=44) 259±178.9 (22-910) and the mean calcium clearance (n=86) as 0.011±0.009 (0.007-0.431).…”

Section: Resultsmentioning

confidence: 86%

“…In addition, vitamin D related intestinal calcium absorption is also disrupted because 1-alpha-hydroxylase activity will also decrease in this case. As a result, PTH level elevates and SHPT occurs (10). Another cause of SHPT is vitamin D deficiency.…”

Section: Discussionmentioning

confidence: 99%

Examination of the Etiologic Causes in Patients Presenting with Elevated Parathormone

Kırhan¹,

Eren²

2019

Tod

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Parathyroid hormone (PTH) levels are elevated in the blood due to various reasons and named as primary or secondary hyperparathyroidism. There is no any study that investigated the etiology of elevated PTH. Materials and Methods: The study included 137 patients who had elevated PTH, which was detected in blood tests that were performed due to any reason, during 1-year period. Results: Of all patients 118 (86.1%) were female and 19 (13.9%) were male. Vitamin D deficiency was found in 88 (64.2%), primary hyperparathyroidism (PHPT) in 38 (27.7%), familial hypocalciuric hypercalcemia (FHH) in 8 (5.8%), and chronic renal failure (CRF) in 3 (2.2%) patients. Conclusion: Vitamin D deficiency is a common disorder in general population, and occasionally coexisted with increased PTH level. Therefore, vitamin D deficiency should be kept in mind when PTH studied as a first test and is found to be high. The other reason such as PHPT, FHH and CRF must be also investigated.

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Secondary and Tertiary Hyperparathyroidism

Cited by 40 publications

References 3 publications

Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis

Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis

PTH induces bone loss via microbial-dependent expansion of intestinal TNF+ T cells and Th17 cells

Examination of the Etiologic Causes in Patients Presenting with Elevated Parathormone

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