The phenotype of primary hyperparathyroidism with normal parathyroid hormone levels: How low can parathyroid hormone go?

Wallace, Lucy B.; Parikh, Rikesh T.; Ross, Louis; Mazzaglia, Peter J.; Foley, Christina S.; Shin, Joyce; Mitchell, Jamie; Berber, Eren; Siperstein, Allan; Milas, Mira

doi:10.1016/j.surg.2011.09.011

Cited by 52 publications

(69 citation statements)

References 13 publications

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“…They discussed potential mechanisms for its unique biochemical profile and encouraged consideration of pHPT in the differential diagnosis of patients with elevated calcium and normal PTH levels. In a larger study in 2011 of 46 patients with NHHPT, Wallace et al [19] found similar clinical characteristics of abnormal bone density, nephrolithiasis, and neuropsychiatric symptoms when comparing NHHPT patients with those with classic disease and proposed a lower PTH set point in the NHHPT group.…”

Section: Etiologymentioning

confidence: 91%

“…Upon questioning, 70% of these patients had at least one symptom. Further studies suggested pHPT: 50% had abnormal bone densitometry, 37% had suffered neuropsychiatric symptoms, and 17% had a history of nephrolithiasis [19].…”

Section: Presentationmentioning

confidence: 99%

“…Wallace et al [19] recommend a workup for pHPT that consists of two sets of data confirming elevated calcium and intact parathyroid hormone (iPTH) in addition to 25-OH vitamin D, 1,25-OH vitamin D, 24-hour urine calcium. After that, localization studies (ultrasound and sestamibi) are beneficial because they demonstrate pathology 80% of the time, although positive or negative localization studies do not rule in or out disease.…”

Section: Diagnosismentioning

confidence: 99%

“…Wallace et al [19] noted that additional testing led to a delay in diagnosis in nearly all patients with NHHPT. In this study, imaging located parathyroid disease in 80% of the patients, and at median follow-up of this study, 96% remained cured of their disease with normal iPTH and serum calcium after undergoing parathyroidectomy at follow-up (median 8.9 months).…”

Section: Diagnosismentioning

confidence: 99%

“…Of all patients diagnosed with pHPT, 5%-28% have the mild form of the disease [19][20][21][22][23][24][25]. In a large series, the distribution of all patients with mild pHPT was 68.6% NHHPT and 31.4% NCHPT [26].The NIH has had three international workshops on asymptomatic hyperparathyroidism [10,27,28].…”

Section: Introductionmentioning

confidence: 99%

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Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels. These patients often do not fall into the criteria for operation based on the National Institutes of Health consensus guidelines, and they can present a challenge of diagnosis and management. The purpose of this paper is to review the available literature on mild pHPT in an effort to better characterize this patient population and to determine whether patients benefit from parathyroidectomy. Evidence suggests that there are patients with mild pHPTwho have overt symptoms that are found to improve after parathyroidectomy. There is also a group of patients with biochemically mild pHPT who are found to progress to classic pHPT over time; however, it is not predictable which group of patients this will be. Early intervention for this group with mild pHPT may prevent progression of bone, psychiatric, and renal complications, and parathyroidectomy has proven safe in appropriately selected patients at high volume centers. The Oncologist 2014;19:919-929 Implications for Practice: Mild primary hyperparathyroidism (pHPT) is a disease that is being diagnosed with increased frequency; however, recommendations for treatment are not uniform. Current NIH guidelines do not recommend parathyroidectomy for these patients if they are asymptomatic; however, upon focused questioning, many of these patients are found to have subtle symptoms.The biochemically mild nature of the disease has been found to delay diagnosis and treatment, but after it is identified, surgery has shown to provide an improvement in quality of life and bone health. Although the current body of literature suggests that patients with mild pHPT benefit from parathyroidectomy, careful patient and surgeon selection is critical to ensuring safety and efficacy. Universal acceptance of parathyroidectomy in this subset of patients will require more high quality, prospective studies and improved definitions of long-term cure.

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Section: Etiologymentioning

confidence: 91%

Section: Presentationmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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Additional Questions Regarding Wide QRS Tachycardia and Atrial Fibrillation

Chang

Liu

2019

JAMA Intern Med

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Diagnosis and Management of Hyperparathyroidism

Bertocchio

2019

JAMA Intern Med

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tient's normally conducted rhythm. The QRS change between native and wide morphologies can be explained based on the variable AV conduction in atrial fibrillation. When the AV conduction in atrial fibrillation is slower, resulting in longer RR interval, the QRS was narrower, as compared with rapid conduction leading to shorter RR interval and wider QRS because of flecainide-associated toxic effects. More importantly, the width of the wider QRS beats with shorter RR intervals progressively improved in this patient and transitioned to baseline-conducted QRS morphology over a period of a day with therapy. This suggests the arrhythmia was atrial fibrillation with conduction rather than dual tachycardia with atrial fibrillation and irregular ventricular tachycardia with similar QRS axis and progressively changing QRS widths.

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The phenotype of primary hyperparathyroidism with normal parathyroid hormone levels: How low can parathyroid hormone go?

Cited by 52 publications

References 13 publications

Mild Primary Hyperparathyroidism: A Literature Review

Mild Primary Hyperparathyroidism: A Literature Review

Additional Questions Regarding Wide QRS Tachycardia and Atrial Fibrillation

Diagnosis and Management of Hyperparathyroidism

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