Short-term medical treatment of hypercalcaemia in primary hyperparathyroidism predicts symptomatic response after parathyroidectomy

Abstract

Background Primary hyperparathyroidism is often associated with non‐disease‐specific symptoms. The aim of this study was to evaluate whether normalization of hypercalcaemia with short‐term medical treatment can be used to predict the effects of parathyroidectomy and guide in surgical decision‐making. Methods This observational study included patients who received calcimimetic treatment for 4 weeks before parathyroidectomy (30–60 mg daily). A panel of tests was used to assess various aspects of quality of life (European Organisation and Treatment of Cancer QLQ‐C30 core questionnaire, Hospital Anxiety and Depression Scale and Positive State of Mind questionnaire), cognitive function (Montreal Cognitive Assessment) and muscle strength (timed‐stands test). The tests were carried out at baseline, after 4 weeks of calcimimetic treatment, and at 6 weeks and 6 months after parathyroidectomy. The predictive values of changes during calcimimetic treatment were determined for each test. Results The study included 110 patients of median age 62 years (91 women). Calcimimetic treatment resulted in normalization of calcium levels and improvements in quality‐of‐life parameters. The time spent on the timed‐stands test was significantly shortened. Eleven of 38 participants with a baseline Montreal Cognitive Assessment score below 26, indicating mild cognitive impairment, reached scores of at least 26 during treatment with calcimimetic. Improvements during treatment with calcimimetic correlated well with postoperative outcomes (positive predictive values 74–96 per cent). Conclusion The method described in this study may be used to aid surgical decision‐making for patients with primary hyperparathyroidism and non‐disease‐specific symptoms by predicting the effects of normalization of hypercalcaemia.

Cinacalcet and primary hyperparathyroidism: systematic review and meta regression

“…The majority of indications for cinacalcet treatment are either for contraindication or refusal for surgery ( 19 , 21 , 22 , 24 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 35 , 36 , 39 , 43 ), reduction in serum Ca levels prior to surgery ( 18 , 20 , 26 , 27 , 31 , 40 , 41 ) or to treat refractory hypercalcemia despite parathyroidectomy ( 16 , 19 , 22 , 27 , 28 , 29 , 31 , 32 , 35 , 36 , 38 , 41 , 43 ).…”

“…Literature review A total of 1301 articles were identified after duplicates removal, and eventually 28 articles were included in the review (16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43), of which 8 were conference proceedings (20,24,25,30,31,32,41,42) (Fig. 1).…”

“…Other adverse reactions include muscle spasm/cramps (3.318.2%) (22,31) and headache (23%) (37). Most patients were able to continue treatment despite the adverse reactions, and only a minority withdrew treatment (17,18,24,25,37).…”

Lipoadenoma of the Parathyroid Gland: Characterization of an Institutional Series Spanning 28 Years

“…Detailed inclusion and exclusion criteria are available through ClinicalTrials.gov (NCT 02227264). The cohort has been previously published and derives from a registry with comprehensive and biochemical workup, of which we extracted information regarding patient gender, age at surgery, tumor weight, and body mass index (BMI) as well as information regarding persistent or recurrent hyperparathyroidism following surgery [53].…”

Biochemistry in Symptomatic and Asymptomatic Primary Hyperparathyroidism: A Cross-Sectional Study

“…Thyroid disease is diagnosed in coincidence of PHPT in an increasing number of middle-aged people, in approximately 17-84% of PHPT patients in the form of nodules, thyroid cancer, or impaired thyroid hormone secretion 22 . Nonetheless, the relationship of PHPT biochemical parameters with the presence of non-classic symptoms has not been well established 23,24 . In relation to the above, the aim of this study is to characterize the clinical and biochemical profiles in symptomatic and asymptomatic Mexican patients with PHPT in a private hospital.…”