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Yankova I, Lilova L, Petrova D, Dimitrova I, Stoynova M, Shinkov A, Kovatcheva R. Biochemical characteristics and clinical manifestation of normocalcemic primary hyperparathyroidism. Endocrine 2024; 85:341-346. [PMID: 38489132 DOI: 10.1007/s12020-024-03768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Normocalcemic primary hyperparathyroidism (nPHPT) is a condition characterized by persistently high levels of parathyroid hormone (PTH) and normal serum calcium levels in the absence of other causes for secondary hyperparathyroidism. The aim of the present study was to assess the clinical presentation and the biochemical characteristics in patients with nPHPT and to compare them with those in patients with hypercalcemic PHPT (hPHPT). MATERIALS AND METHODS The study included 316 patients (277 women and 39 men, average age 58.7 ± 12.1) diagnosed with PHPT. Total serum calcium, inorganic phosphates (PO4), PTH, urinary Ca (uCa), albumin, creatinine, 25(OH)D and bone markers (b-CTX and ALP) were examined in all of them. BMD of the lumbar spine (LS), distal third of the radius (DR), femoral neck (FN) and total proximal femur (TF) were measured by a dual-energy X-ray absorptiometry (DXA). The patients were divided into two groups according to albumin-corrected calcium (Ca) level - with hPHPT (Ca>2.62 mmol/L) and with nPHPT (Ca 2.12-2.62 mmol/l), without other causes for secondary hyperparathyroidism. RESULTS The frequency of nPHPT was 15.2%. Normocalcemic patients had lower levels of PTH, higher PO4 and 25(OH)D, and smaller parathyroid adenomas. No significant difference in the frequency of osteoporosis, low-energy fractures, nephrolithiasis and gastrointestinal disorders was found between nPHPT and hPHPT. There was no difference in BMD between the two groups. CONCLUSION The patients with nPHPT show a more favorable biochemical profile compared to those with hPHPT. Nevertheless, clinical manifestations and complications are similar, without a significant difference in the frequency of osteoporosis, nephrolithiasis, gastrointestinal disorders and low-energy fractures.
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Affiliation(s)
- Inna Yankova
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria.
| | - Lora Lilova
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
| | - Daniela Petrova
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
| | - Inna Dimitrova
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
| | - Mariya Stoynova
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
| | - Alexander Shinkov
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
| | - Roussanka Kovatcheva
- Department of Endocrinology, Medical University Sofia, University Hospital of Endocrinology "Acad. Ivan Penchev", Sofia, Bulgaria
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Chuang F, Ng SK, Khan R, Lam AKY. Relationship between parathyroid adenoma size, weight and histological subtypes with perioperative serum levels. J Clin Pathol 2024:jcp-2023-209340. [PMID: 38821854 DOI: 10.1136/jcp-2023-209340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024]
Abstract
AIMS This study aims to identify associations between parathyroid adenoma (PTA) characteristics (histology, weight and size) with the change in parathyroid hormone (PTH) and calcium levels. METHODS A historical cohort study was conducted on adult patients with solitary PTA removed in the Gold Coast Health Precinct, Australia, between 2017 and 2022. RESULTS PTA weight is correlated with the change in day 1 PTH level (r=0.26, p=0.036), the change in day 1 corrected calcium level (r=0.20, p=0.033), and the change in follow-up corrected calcium level (r=0.47, p<0.001). The largest dimension (size) of PTA is also correlated with the change in day 1 PTH (r=0.30, p=0.011) and the change in follow-up corrected calcium level (r=0.40, p<0.001). Adjusted for age and gender, a statistically significant negative correlation was found between day 1 PTH level and adenoma size, resulting in a 0.5% change in size for every percentage change in PTH level (equating to a 5.0% increase in variance explained, p=0.038). Similarly, a negative correlation was identified in day 1 corrected calcium levels and weight, with a 4.7% change in weight for every percentage of change in day 1 corrected calcium level (an increase of 5.6% variance explained, p=0.010). In addition, a negative correlation was identified, where every 3.1% change in size (an increase of 17.4% variance explained, p<0.001) and 7.6% change in weight (an increase of 22.7% variance explained, p<0.001) was seen with every percentage change in follow-up corrected calcium levels. Clear-cell PTA had the most significant percentage fall in day 1 corrected calcium levels compared with other PTA subtypes (p=0.007). CONCLUSIONS Preoperative calcium and PTH levels correlate with PTA weight and size. The degree of change in postoperative corrected calcium levels behaved differently in the clear-cell subtype.
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Affiliation(s)
- Fred Chuang
- Griffith University Griffith Health, Gold Coast, Queensland, Australia
| | - Shu Kay Ng
- Griffith University Griffith Health, Gold Coast, Queensland, Australia
| | - Roger Khan
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Alfred King-Yin Lam
- Griffith University Griffith Health, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
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Yazgi D, Richa C, Salenave S, Kamenicky P, Bourouina A, Clavier L, Dupeux M, Papon JF, Young J, Chanson P, Maione L. Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100751. [PMID: 37915399 PMCID: PMC10616552 DOI: 10.1016/j.lanepe.2023.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
Background Neck ultrasound (US) is a widely used and accessible operator-dependent technique that helps characterize thyroid nodules and pathologic parathyroid glands (PPGs). However, thyroid nodules may sometimes be confused with PPGs. PARATH-US study aims at identifying US characteristics to differentiate PPGs from thyroid nodules, as there is no study, at present, which directly compares the US features of these two common neoplasms. Methods PARATH-US is a single-center study that was conducted at a tertiary referral center, including consecutive lesions from patients undergoing neck US examination from 2016 to 2022. Findings 176 PPGs (158 patients: serum calcium levels 2.91 [IQR 2.74-3.05] mmol/L, PTH levels 173 [112-296] ng/L) were compared to 232 size- and volume-matched thyroid nodules (204 age- and sex-matched patients). The morphologic patterns, echoic content and vascular status were all different between PPGs and thyroid neoplasms (p < 0.01 for all comparisons). The combined parameters maximally discriminated PPGs from thyroid nodules (OR, 7.6; 95% CI: 3.4, 17.1, p < 0.0001). When applying risk stratification systems developed for thyroid malignancies, 58-63% of PPGs were classified as high-risk lesions. Parathyroid adenomas had larger sizes and volumes than hyperplasias (p = 0.013 and p = 0.029). Serum calcium and PTH levels were significantly correlated with PPG size and volume (p < 0.0001 for all comparisons). Interpretation We demonstrate the presence of distinct US characteristics in PPGs, which help differentiate them from thyroid nodules. When mistaken for thyroid nodules, PPGs bear high-risk US features. When dealing with high-risk cervical lesions detected on US, a PPG should be suspected, and an assessment of calcium levels recommended to avoid unnecessary invasive procedures. Funding CYTO-TRAIN, C2022DOSRH053, funded by the French Regional Health Agency.
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Affiliation(s)
- Dolly Yazgi
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Carine Richa
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Amel Bourouina
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | | | - Margot Dupeux
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre Service d’Anatomie et Cytologie Pathologiques, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie et Chirurgie Cervico-Maxillo Faciale, Le Kremlin-Bicêtre, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
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Silov G, Erdogan Ozbodur S. The Relationship between Planar and SPECT/CT Parameters and Functional Markers in Primary Hyperparathyroidism. Diagnostics (Basel) 2023; 13:3182. [PMID: 37892003 PMCID: PMC10605384 DOI: 10.3390/diagnostics13203182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to investigate the relationship between quantitative and volumetric parameters of technetium-99-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) imaging and hormonal and biochemical markers in primary hyperparathyroidism (PHPT) patients with single adenoma. In this retrospective study, 70 patients with a single adenoma who underwent 99mTc-MIBI imaging for the diagnosis of PHPT were examined. Early and delayed MIBI lesion/background ratios (eLBR and dLBR), early and delayed lesion/thyroid ratio (eLTR and dLTR), and retention index (RI) were calculated as planar dual-phase scintigraphy parameters. Adenoma volume (Svol) and parathormone (PTH)/Svol ratio were measured as SPECT/CT-derived parameters. Calcium levels exhibited a positive correlation with eLBR (r = 0.33, p < 0.001), dLBR (r = 0.29, p = 0.01), dLTR (r = 0.31, p < 0.001), and PTH/Svol (r = 0.38, p < 0.001). PTH did not correlate with planar parameters and Svol. Among the imaging parameters, only the PTH/Svol ratio showed a negative correlation with phosphorus levels (r = -0.29, p = 0.02). For predicting disease severity, the PTH/Svol ratio exhibited similar diagnostic performance to PTH and phosphorus levels but outperformed the eLBR and dLBR. Both planar and SPECT-derived parameters can provide valuable insights into the functional status of the parathyroid adenoma and the associated disease severity. PTH/Svol ratio, combining imaging and laboratory findings to provide a more comprehensive approach to patient care, could be an exciting new indicator.
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Affiliation(s)
- Guler Silov
- Department of Nuclear Medicine, Samsun University Faculty of Medicine, Samsun 55200, Turkey
| | - Serpil Erdogan Ozbodur
- Department of Nuclear Medicine, Gazi State Hospital, Samsun Provincial Health Directorate, Samsun 55070, Turkey;
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Maldar AN, Shah NF, Chauhan PH, Lala M, Kirtane MV, Chadha M. Differences in the Presentation and Outcome between Premenopausal and Postmenopausal Primary Hyperparathyroidism Indian Women: A Single-Center Experience. J Midlife Health 2023; 14:73-80. [PMID: 38029031 PMCID: PMC10664047 DOI: 10.4103/jmh.jmh_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/29/2023] [Accepted: 03/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Primary hyperparathyroidism (PHPT) is an endocrine disorder wherein enlargement of one or more of the parathyroid glands causes autonomous overproduction of the parathyroid hormone (PTH), which leads to high serum calcium levels. Objective The objective of this study was to compare the clinical, laboratory, and operative variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT. Materials and Methods A retrospective analysis of the data of female patients who underwent surgery for PHPT at a single center, from January 2011 to December 2020, was done. Patients with familial PHPT and secondary hyperparathyroidism were not included. Results Of the 130 women with PHPT, 44.6% were pre-M and 55.4% were post-M. A significantly higher number of pre-M females were symptomatic compared to post-M females (pre-M vs. post-M, 84.5% vs. 68.1%, P = 0.031). Renal calculi were more common in pre-M women (34.5% vs. 18.1%, P = 0.032), while the rest of the clinical features were comparable between the two groups. The proportion of women with osteoporosis (6.7% vs. 19.4%, P = 0.071), hypertension (13.8% vs. 34.7%, P = 0.012), and diabetes mellitus (3.5% vs. 16.7%, P = 0.033) was lesser in the pre-M group. Elevated serum alkaline phosphatase levels were significantly more prevalent in the pre-M group (37.9% vs. 20.8%, P = 0.032). The mean serum calcium (12.35 ± 1.28 vs. 11.96 ± 1.22 mg/dL, P = 0.079), median serum PTH (334 vs. 239 pg/mL, P = 0.051), and median weight of the operated adenomas (1.75 vs. 1.45 g, P = 0.075) were also higher in pre-M females. The proportion of ectopic adenomas and multiple adenomas, presurgery adenoma localization rates, and disease cure rates did not differ according to the menopausal status. The occurrence of postoperative hungry bone syndrome was higher in the pre-M women (15.5% vs. 1.4%, P = 0.008). Conclusion The majority of women with PHPT are post-M, but symptomatic presentation is more common in pre-M females. The severity of the disease appears to be more in pre-M women; however, imaging and operative variables generally did not significantly differ between the two groups.
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Affiliation(s)
- Aasim N. Maldar
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nishitkumar F. Shah
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Phulrenu H. Chauhan
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Murad Lala
- Department of Surgical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Milind V. Kirtane
- Department of ENT Surgery, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Manoj Chadha
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Rezkallah E, Elsaify A, Hanna R, Elsaify W. Correlation between preoperative calcium and parathormone levels with parathyroid gland volume. Endocr Regul 2023; 57:12-17. [PMID: 36753663 DOI: 10.2478/enr-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Objective. Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid adenoma. Successful preoperative localization of the parathyroid adenoma could facilitate the decision regarding the extent of surgical exploration. The aim of the current study was to assess the correlation between the preoperative values of parathyroid hormone and ionized calcium with the adenoma weight and volume in patient with primary hyperparathyroidism caused by single-gland adenoma. Patients and Methods. We did this retrospective review for all patients who were diagnosed with primary hyperparathyroidism due to a solitary parathyroid adenoma in our general surgery department over 4 years. SPSS software was used to get the correlation coefficient between the peak preoperative levels of calcium and parathyroid hormone with the parathyroid adenoma weight and volume. Results. Ninety-nine patients were included into the study. The average age at surgery was 62.65±12.00 years. The correlation coefficient between the adenoma volume and weight with the preoperative ionized calcium level was weakly positive (r=0.329, p<0.01) and (r=0.281, p=0.019), respectively, while the correlation with the preoperative parathyroid hormone level was stronger (r=0.708, p<0.01) and (r=0.650, p<0.01), respectively. Conclusions. The strong positive relationship between the preoperative parathyroid hormone and calcium levels with the parathyroid adenoma size and weight can help the surgeon to predict the volume of the involved gland and avoid an unnecessary dissection.
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Affiliation(s)
- Emad Rezkallah
- General Surgery Department, James Cook University Hospital, England
| | | | - Ragai Hanna
- General Surgery Department, Faculty of Medicine Assiut University, Egypt
| | - Wael Elsaify
- General Surgery Department, James Cook University Hospital, England
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Giant parathyroid tumours in primary hyperparathyroidism: a systematic review. Langenbecks Arch Surg 2022; 407:501-516. [PMID: 35039921 DOI: 10.1007/s00423-021-02406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to present the current evidence on surgical management of GPAs in primary hyperparathyroidism. METHODS A systematic review of the literature on GPAs was conducted following the PRISMA guidelines. Data on clinical, biochemical, preoperative diagnostic, and surgical methods were analysed. RESULTS Sixty-one eligible studies were included reporting on 65 GPAs in eutopic, ectopic mediastinal, and intrathyroidal locations (61.5%, 30.8%, and 7.7%, respectively). A palpable neck mass was present in 58% of GPAs. A total of 90% of patients had symptoms including fatigue, skeletal pain, pathological fracture, nausea, and abdominal pain. Ninety percent of patients had significant hypercalcaemia (mean 3.51 mmol/L; range: 2.59-5.74 mmol/L) and hyperparathyroidism with PTH levels on average 14 times above the upper limit of the normal reference. There was no correlation between the reported GPA size and PTH nor between GPA weight and PTH (p = 0.892 and p = 0.363, respectively). Twenty-four percent had a concurrent thyroidectomy for suspicious features, intrathyroidal location of GPA, or large goitre. Immunohistochemistry such as Ki-67, parafibromin, and galectin-3 was used in 18.5% of cases with equivocal histology. Ninety-five percent of GPAs were benign with 5% reported as atypical adenomas. CONCLUSION The reported data on GPAs are sparse and heterogeneous. In GPAs with suspicious features for malignancy, en bloc resection with concurrent thyroidectomy may be considered. In the presence of equivocal histological features, ancillary immunohistochemistry is advocated to differentiate GPAs from atypical adenomas and PCs.
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Ghemigian A, Trandafir AI, Petrova E, Carsote M, Valea A, Filipescu A, Oproiu AM, Sandru F. Primary hyperparathyroidism-related giant parathyroid adenoma (Review). Exp Ther Med 2022; 23:88. [PMID: 34934453 PMCID: PMC8652388 DOI: 10.3892/etm.2021.11011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023] Open
Abstract
Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue.
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Affiliation(s)
- Adina Ghemigian
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C.I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Alexandra Ioana Trandafir
- Department of Endocrinology, ‘C.I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Eugenia Petrova
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C.I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C.I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, ‘I. Hatieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Endocrinology, Clinical County Hospital, 400000 Cluj-Napoca, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Ana-Maria Oproiu
- Department of Plastic and Reconstructive Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Plastic and Reconstructive Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Elias’ Emergency Hospital, 011461 Bucharest, Romania
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Özçınar B, Öner G, Makay Ö, Soyder A, Zafer Cantürk N, Ümit Uğurlu M, Atakan Sezer Y, Görgülü S, Girgin M, Özemir Aİ, Özbaş S, Ünal B, Pandev R, Erel S, Uğur Emre A, İlker Filiz A, Nuran Akçay M, Demircioğlu S, Güler SA, Öztürk E, Yıldız R, Çakmak GK, Kurt Y, Erbil Y, Güllüoğlu BM. Which biochemical and clinical parameters correlate with parathyroid adenoma weight? Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study. Asian J Surg 2021; 45:407-411. [PMID: 34353709 DOI: 10.1016/j.asjsur.2021.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey. METHOD In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions. RESULTS Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p < 0.001). There was a correlation between adenoma weight and serum PTH level (p = 0.05) and Ca level (p = 0.035). CONCLUSION This study has provided a deeper insight into the effect of the regional differences upon clinicopathological changing and biochemical values of pHTP patients with adenoma. Awareness of regional differences will assist in biochemical screening and treatment of this patient group.
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Affiliation(s)
- Beyza Özçınar
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey.
| | - Gizem Öner
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium; Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Özer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Aykut Soyder
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - N Zafer Cantürk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - M Ümit Uğurlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Y Atakan Sezer
- Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - Semih Görgülü
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Girgin
- Department of General Surgery, Fırat University School of Medicine, Elazığ, Turkey
| | - A İbrahim Özemir
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Serdar Özbaş
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Bülent Ünal
- Department of General Surgery, Inönü University School of Medicine, Malatya, Turkey
| | - Rumen Pandev
- Department of General Surgery, Division of Endocrine Surgery, Tsaritsa Yoanna University School of Medicine, Sofia, Bulgaria
| | - Serap Erel
- Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - A Uğur Emre
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - A İlker Filiz
- Department of General Surgery, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - M Nuran Akçay
- Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Salih Demircioğlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - S Ata Güler
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Erkan Öztürk
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ramazan Yıldız
- Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Yavuz Kurt
- Department of General Surgery, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - Yeşim Erbil
- Department of General Surgery, Division of Endocrine Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Bahadır M Güllüoğlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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10
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Filser B, Uslar V, Weyhe D, Tabriz N. Predictors of adenoma size and location in primary hyperparathyroidism. Langenbecks Arch Surg 2021; 406:1607-1614. [PMID: 33928428 PMCID: PMC8370949 DOI: 10.1007/s00423-021-02179-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
Purpose In primary hyperparathyroidism (PHPT), intraoperative localization of the parathyroid adenoma can be challenging, especially in cases of negative preoperative imaging. Since a focused unilateral parathyroidectomy has benefits compared to a conventional bilateral neck exploration, the question arises whether adenoma size prediction can facilitate a targeted approach. We investigated whether single parathyroid adenoma size can be estimated using preoperative parathyroid hormone (PTH), calcium, and phosphate in patients with PHPT. Preoperative imaging accuracy was evaluated. Methods The data of 156 patients who underwent curative parathyroidectomy for single adenoma PHPT were analyzed retrospectively. Information obtained included laboratory data, imaging results, intraoperative data, and final pathology. Imaging accuracy was analyzed descriptively. The association between preoperative biochemical markers and adenoma dimensions was investigated using Spearman’s correlation coefficient and multivariable regression modeling. Results Cervical ultrasound correctly predicted adenoma laterality in 95.5%, sestamibi scintigraphy in 80.6%, both had lower true-positive rates for quadrant prediction. Patients with negative imaging results showed higher thyroid volumes than those with positive results. Adenoma volume was positively correlated with preoperative PTH (p < 0.001) and calcium (p < 0.001) and negatively correlated with preoperative phosphate (p = 0.001). Using these preoperative biochemical markers and patient age and BMI, adenoma volume can be significantly predicted using the multivariable regression algorithm. Conclusion Cervical ultrasound is superior to scintigraphy for predicting adenoma location and should be the first-choice imaging method, but both methods may be limited by increased thyroid volume. Large adenomas are more likely with higher PTH, higher calcium, and lower phosphate levels. In cases of undetermined adenoma location, an estimation of adenoma volume via our algorithm could corroborate sonographic volume measurements of the suspected adenoma.
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Affiliation(s)
- Barbara Filser
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany.
| | - Verena Uslar
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - Dirk Weyhe
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - Navid Tabriz
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
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11
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Wong G, Ghabbour A, Borumandi F. Giant parathyroid adenoma and challenges with preoperative differentiation from malignancy. BMJ Case Rep 2021; 14:14/4/e241554. [PMID: 33837034 PMCID: PMC8043017 DOI: 10.1136/bcr-2021-241554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Giant parathyroid adenomas are rare and underreported benign tumours of parathyroid gland. Preoperative differentiation between giant parathyroid adenoma (GPA) and parathyroid carcinoma can be challenging, as they both may present as a large parathyroid tumour with hyperparathyroidism. Very few GPAs had been described in the literature, with only 60 cases including our present case. We report a case of GPA and the preoperative diagnostic challenges we faced in differential diagnosis of a potential parathyroid malignancy. As a parathyroid malignancy could not be excluded preoperatively the parathyroid tumour was excised en bloc with surrounding thyroid lobe. The histology was contributory to exclude parathyroid malignancy confirming a benign GPA.
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Affiliation(s)
- Grace Wong
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richards Hospital, Chichester, UK
| | - Andrew Ghabbour
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St Richards Hospital, Chichester and Worthing Hospital, Worthing, UK
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12
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Kong SH, Kim JH, Kim SW, Shin CS. Radioactive Parathyroid Adenomas on Sestamibi Scans: Low Parathyroid Hormone Secretory Potential and Large Volume. Endocrinol Metab (Seoul) 2021; 36:351-358. [PMID: 33820395 PMCID: PMC8090467 DOI: 10.3803/enm.2020.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We investigated the clinical characteristics of parathyroid adenomas according to radioactivity on 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) in primary hyperparathyroidism (PHPT) patients. METHODS The study included 217 patients diagnosed with PHPT from 2000 to 2019 at Seoul National University Hospital who underwent 99mTc-MIBI SPECT/CT scans. On SPECT/CT, the radioactivity of parathyroid adenomas was measured as the ratio of the mean radioactivity count of the parathyroid adenoma to that of the contralateral thyroid. RESULTS Tumors were localized by MIBI scans in 190 patients (MIBI [+] group) and by ultrasound or parathyroid four-dimensional CT in 27 patients (MIBI [-] group). The mean age was 55 years, and mean body mass index was 23.4 kg/m2. Patients in the MIBI (+) group had higher parathyroid hormone (iPTH) and lower 25-hydroxy vitamin D levels than those in the MIBI (-) group (168.0 pg/mL [interquartile range, IQR, 111.0 to 250.7] vs. 134.7 pg/mL [IQR, 98.2 to 191.2], P=0.049; 15.4 ng/mL [IQR, 11.1 to 20.8] vs. 21.2 ng/mL [IQR, 13.9 to 24.8], P=0.012, respectively). Patients in the MIBI (+) group had larger tumor volumes, but lower iPTH/volume ratios than those in the MIBI (-) group (1,216.66 [IQR, 513.40 to 2,663.02], 499.82 mm3 [IQR, 167.77 to 1,229.80], P=0.002; 0.18 [IQR, 0.08 to 0.46], 0.40 pg/mL/mm3 [IQR, 0.16 to 1.29], P=0.016, respectively). Adenoma radioactivity was positively correlated with calcium, iPTH, and volume (r=0.180, P=0.020; r=0.208, P=0.006; r=0.288, P<0.001, respectively), but not with iPTH/volume. CONCLUSION Parathyroid adenomas with positive MIBI scans had larger volumes and higher iPTH than adenomas with negative scans, but lower iPTH per unit volume.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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13
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Tumor Volume Can Be Used as a Parameter Indicating the Severity of Disease in Parathyroid Cancer. Endocr Pract 2021; 27:706-709. [PMID: 34144922 DOI: 10.1016/j.eprac.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether tumor volume and tumor size are related to disease severity in parathyroid cancer (PC). METHODS Patients treated for PC at our institution were retrospectively identified. Data were collected about clinical and pathologic characteristics, laboratory parameters, tumor volume, recurrence, metastasis, and mortality. Correlation analysis was applied to laboratory parameters, tumor volume, and tumor size in PC patients. RESULTS The study included 20 patients diagnosed with PC at our center. The median follow-up was 33 months. Serum calcium (median, 12.5 mg/dL), serum parathormone (PTH) (median, 743 pg/mL), and serum alkaline phosphatase (ALP) (median, 298 U/L) levels were found to be increased, and 25-hydroxyvitamin D (25[0H)D) (median, 12.3 ng/mL) and serum phosphorus (median, 2.1 mg/dL) levels were decreased. Magnesium level was within normal limits (median, 1.9 mg/dL). The median tumor volume was 5.7 mL and median tumor size was 2.5 cm. Significant positive correlations were found between tumor volume and calcium, ALP, and PTH levels. A significant negative correlation was found between tumor volume and 25(OH)D level. There were no significant correlations between tumor size and calcium, ALP, PTH, and 25(OH)D. CONCLUSION These results found that the tumor volume affected PTH, calcium, ALP, and 25(OH)D levels. The morbidity and mortality associated with PC were usually associated with PTH secretion and hypercalcemia. Therefore, tumor volume may be a more effective parameter than tumor size when evaluating the severity of disease.
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14
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Papadakis M, Weyerbrock N, Zirngibl H, Dotzenrath C. Correlation of perioperative biochemical variables with single adenoma weight in patients with primary hyperparathyroidism. BMC Surg 2020; 20:303. [PMID: 33256695 PMCID: PMC7708903 DOI: 10.1186/s12893-020-00922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single parathyroid adenoma is the main cause of primary hyperparathyroidism (PHPT), with surgery remaining the gold standard for its treatment. The ability to preoperatively predict the parathyroid adenoma size and could facilitate the decision about the extent of surgical exploration. It is reasonable to hypothesize that the perioperative levels of PHPT-related variables (i.e. calcium, parathormone, phosphate) may predict the adenoma weight or/and demonstrate whether the adenoma is successfully removed or not. Aim of this study is to explore the relationship between perioperative biochemical values and adenoma weight. Secondarily, we investigated the relationship between adenoma weight and uni-/bilateral neck exploration. METHODS Retrospective study of all patients undergone surgery for primary hyperparathyroidism due to single adenoma in a tertiary university hospital in Germany during a 6-year period. Following variables were analyzed: preoperative serum calcium, phosphorus and parathormone, intraoperative parathormone before and after adenoma excision, intraoperative PTH decrease, postoperative serum calcium and parathormone (PTHpostop-pg/ml), calcium and PTH decrease. Bivariate correlations were calculated by the Spearman's correlation test at the 95% significance level. RESULTS A total of 339 patients were included in the study. The median age of the patients was 60 years (range 21-90) and 77% were females. The median adenoma weight was 1 g (range 0.1-11). Adenoma weight correlated strong with maximum adenoma diameter (r = 0.72, p < 0.05), moderate with preoperative parathormone (r = 0.44) and parathormone decrease (r = 0.27), whereas there was no correlation with the intraoperative PTH decrease (r = 0.02). There was also a borderline (moderate to weak) correlation with pre- and postoperative calcium levels (r = 0.21 and r = 0.23 respectively) and a negative borderline correlation with phosphorus (r = - 0.21). Patients who required bilateral neck exploration, had significantly lighter adenomas (median weight 0.8 g vs 1.1 g, p = 0.005). CONCLUSIONS We conclude that preoperative PTH levels may only serve as an approximate guide to adenoma weight, as direct preoperative prediction is not possible. Serum calcium levels, PTH and calcium decrease correlate only weak with adenoma weight. Patients who require bilateral neck exploration, have significantly (20-25%) lighter adenomas.
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Affiliation(s)
- Marios Papadakis
- Chair of Surgery II, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Norbert Weyerbrock
- Department of Endocrine Surgery, Helios University Clinic Wuppertal, Wuppertal, Germany
| | - Hubert Zirngibl
- Chair of Surgery II, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Cornelia Dotzenrath
- Department of Endocrine Surgery, Helios University Clinic Wuppertal, Wuppertal, Germany
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15
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Leong DCW, Lo J, Nguyen H, Ryan S. Can we predict expected adenoma weight preoperatively with reference to the correlation of preoperative biochemical tests with parathyroid adenoma weight? Asian J Surg 2019; 43:759-764. [PMID: 31699571 DOI: 10.1016/j.asjsur.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism is a prevalent disease with proven benefits for appropriately selected patients who undergo parathyroidectomy. The ability to accurately predict expected single adenoma gland weight as the cause based on preoperative biochemical tests could improve cure rates in a minimally invasive approach. OBJECTIVE To assess the correlation between parathyroid weight and preoperative parathyroid hormone and calcium levels in patients with primary hyperparathyroidism with a solitary adenoma and determine if these could be used to predict expected parathyroid weight. METHODS Patients with primary hyperparathyroidism who underwent curative parathyroidectomy from 2013 to 2018 was retrospectively analysed. RESULTS There is a strong positive correlation r = 0.602 between preoperative PTH levels with respect to parathyroid weight (p < 0.001). There was a moderate correlation r = 0.474 between preoperative adjusted Calcium and PTH weight (p < 0.001). An algorithm was developed to calculate predicted weight of a single adenoma but when tested against cases with hyperplasia and double adenomas during the period, the variability of predicted weight meant it was impossible to differentiate between the causes. Hyperplasia was excluded and 95% of double adenomas excluded however, when parathyroid weight exceeded 1200 mg CONCLUSION: There is a strong correlation between preoperative PTH levels and calcium levels with parathyroid weight. The large variability of predicted parathyroid weight however, precludes the use of biochemical tests alone preoperatively in being able to differentiate between a single adenoma, double adenoma or hyperplasia as the cause in primary hyperparathyroidism. At parathyroid predicted weights above 1200 mg however, all cases of hyperplasia, and 95% of double adenomas excluded.
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Affiliation(s)
| | | | | | - Simon Ryan
- Sir Charles Gairdner Hospital, Australia.
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16
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Relationship of parathyroid adenoma volume with preoperative biochemical parameters. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.435391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism: the eplerenone in primary hyperparathyroidism trial. J Hypertens 2017; 34:1778-86. [PMID: 27379537 DOI: 10.1097/hjh.0000000000001004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients. METHODS Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included. RESULTS Full data were available in 136 patients (mean age 67 ± 10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml. CONCLUSION ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.
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18
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Gatu A, Velicescu C, Grigorovici A, Danila R, Muntean V, Mogoş SJ, Mogoş V, Vulpoi C, Preda C, Branisteanu D. THE VOLUME OF SOLITARY PARATHYROID ADENOMA IS RELATED TO PREOPERATIVE PTH AND 25OH-D3, BUT NOT TO CALCIUM LEVELS. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:441-446. [PMID: 31149214 DOI: 10.4183/aeb.2017.441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). Patients and Methods Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. Results We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). Conclusions The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.
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Affiliation(s)
- A Gatu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - C Velicescu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania.,"Gr.T.Popa" University of Medicine and Pharmacy, 4th unit of surgery, Romania
| | - A Grigorovici
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania
| | - R Danila
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of General Surgery, "St. Spiridon" Hospital, Romania
| | - V Muntean
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Dept. of Surgery, Romania
| | - S J Mogoş
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - V Mogoş
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania.,"Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Iasi, Romania
| | - C Vulpoi
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - C Preda
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
| | - D Branisteanu
- "Gr.T.Popa" University of Medicine and Pharmacy, Dept. of Endocrinology, Romania
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