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Hoong CWS, Broski SM, Sfeir JG, Clarke BL. Natural history and complications of normocalcemic hyperparathyroidism: a retrospective cohort study. JBMR Plus 2024; 8:ziae074. [PMID: 39290342 PMCID: PMC11406159 DOI: 10.1093/jbmrpl/ziae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/22/2024] [Indexed: 09/19/2024] Open
Abstract
Normocalcemic hyperparathyroidism (NHPT) is variably defined, and information regarding complications and natural history are scarce. We aimed to describe the phenotype of NHPT in relation to hypercalcemic hyperparathyroidism (PHPT) and controls, to determine risk of progression, and to develop a predictive model for progression to PHPT. This is a retrospective chart review of 232 patients at a tertiary medical center, comparing 75 controls, 73 patients with NHPT, and 84 with PHPT. NHPT was intermediate in biochemical profile between controls and PHPT with respect to cCa, iPTH, intraindividual coefficient of variant of cCa, phosphorus, and 25(OH)D. NHPT patients had an increased adjusted risk of urolithiasis (OR 5.34, 95%CI, 2.41-12.71, P < .001) and fragility fractures (OR 4.53, 95%CI, 1.63-14.84, P = .006) versus controls, after adjustment for age, sex, and BMI. Fewer NHPT compared with PHPTH patients achieved cure with parathyroidectomy (P = .001). NHPT more often had nonlocalizing imaging or polyglandular disease (P = .005). Parathyroidectomy improved biochemical but not BMD parameters in NHPT. Over a median follow-up of 4.23 (IQR 1.76-5.31) years, NHPT patients managed expectantly experienced no change in iPTH, and progression to PHPT occurred in 9%. An XGBoost model combining 6 factors for progression (mean index 2 iPTH, mean index 2 cCa, 24-h urinary calcium, age, 25(OH)D, and presence of urolithiasis) had an area under the curve 1.00 (95%CI, 1.00-1.00, P < .001) for predicting combined progression. NHPT is a mild variant of PHPT at intermediate risk of urolithiasis and fragility fractures. Cure was less often achieved with parathyroidectomy, which did not improve BMD parameters. Progression was infrequent with conservative management. Because only a minority progressed to PHPT, in addition to lower surgical success rates, we suggest conservative management for the majority of NHPT unless risk factors for progression are identified.
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Affiliation(s)
- Caroline Wei Shan Hoong
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic Rochester, Rochester, MN 55905, United States
- Department of Endocrinology, Woodlands Health, National Healthcare Group, 737628, Singapore
| | - Stephen M Broski
- Department of Radiology, Mayo Clinic Rochester, MN 55905, United States
| | - Jad G Sfeir
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic Rochester, Rochester, MN 55905, United States
- Robert and Arlene Kogod Center on Aging, Mayo Clinic Rochester, MN 55905, United States
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic Rochester, MN 55905, United States
| | - Bart Lyman Clarke
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic Rochester, Rochester, MN 55905, United States
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Zabolotniuk T, Guo M, Kwon M, Watanabe A, Teichman JMH, Wiseman SM. Screening for asymptomatic nephrolithiasis in primary hyperparathyroidism patients is warranted. Am J Surg 2024; 231:91-95. [PMID: 38480062 DOI: 10.1016/j.amjsurg.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND We aimed to investigate the prevalence, characteristics, and management of nephrolithiasis in primary hyperparathyroidism (PHPT) patients. METHODS Medical records of patients who underwent parathyroidectomy at a tertiary care hospital in British Columbia from January 2016 to April 2023 were retrospectively reviewed. Demographic data, laboratory results, imaging reports, and urologic consultations were examined. Descriptive statistics and relevant statistical tests, including logistic regressions, were utilized for data analysis. RESULT Of the 413 PHPT patients included in the study population, 41.9% harbored renal stones, and nearly half (48.6%) required urological interventions. Male sex, elevated preoperative serum ionized calcium (iCa) and 24-h urinary calcium (24 h urine Ca) levels were independent risk factors for stone formation. Additionally, male sex, younger age, and lower preoperative serum 25-hydroxyvitamin D (25(OH)D) level were associated with higher odds of requiring urological intervention for stones. CONCLUSIONS This study identified significant prevalence of asymptomatic renal calcifications in PHPT patients, with a substantial proportion necessitating urological intervention. These findings emphasize the importance of incorporating screening and treatment of renal stones into the management of PHPT patients.
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Affiliation(s)
- Taryn Zabolotniuk
- Department of Surgery, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Michael Guo
- Department of Surgery, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Michelle Kwon
- Department of Surgery, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Akie Watanabe
- Department of Surgery, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Joel M H Teichman
- Department of Urologic Sciences, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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Wang X, Shi G, Li G, Tang G. Systematic review of the risk of urolithiasis following parathyroidectomy in patients with primary hyperparathyroidism. Int Urol Nephrol 2024; 56:1217-1225. [PMID: 38038823 DOI: 10.1007/s11255-023-03882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Parathyroidectomy (PTX) is the conclusive therapy for primary hyperparathyroidism (PHPT), but its effect on the risk of urolithiasis is inconclusive. We comprehensively reviewed the currently available research to investigate the impact of PTX on the likelihood of urolithiasis among individuals suffering PHPT. METHODS Internet-based articles in English language released on Cochrane, PubMed, Scopus, Web of knowledge, and Embase up to September, 2023 were comprehensively reviewed. Each publication in contrast to the incidence, occurrence, or recurrence of urolithiasis after PTX versus medical treatment in PHPT patients was included. The outcome with pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) was examined employing DerSimonian and Laird's model of random effects. To determine the range of the real effect size of a future study in 95% of all populations, a prediction interval (PI) was also established. RESULTS Finally, ten studies involving 74,190 patients were included. Results from randomized-controlled trials (RCTs) and observational studies (OSs) both revealed that PTX did not substantially lessen the vulnerability of urolithiasis among individuals with PHPT (RCTs: pooled relative risk [RR] 0.42, 95%CI 0.13-1.41, p = 0.163; OSs: pooled RR 1.37, 95%CI 0.96 to 1.97, p = 0.084). The PI (RCT: 0.03 to 5.96; OSs: 0.44-4.20) containing 1.0 suggested the possibility of consistent results in future studies. Subgroup and sensitivity analyses supported the above findings, and no evidence showed publication bias. CONCLUSION Our analysis from the available RCTs or OSs did not give adequate or exact proof that the average effect of PTX lowers the incidence of urolithiasis among PHPT persons based on the random-effects model. Future research shall take into account the common effect of PTX as well as the prerequisites of preventive stone procedures, which will further help us assess the effectiveness of PTX in reducing kidney calculus comorbidity and develop techniques to avoid stone sequelae in these individuals.
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Affiliation(s)
- Xingmu Wang
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Ge Shi
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Gangfeng Li
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Guiliang Tang
- Department of Urology, Shaoxing People's Hospital, No. 568, Zhongxing North Road, Yuecheng District, Shaoxing, 312000, Zhejiang, People's Republic of China.
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Bartz-Kurycki MA, Dream S, Yen TW, Doffek K, Shaker J, Evans DB, Wang TS. Older Patients With Asymptomatic Primary Hyperparathyroidism: Should Criteria for Surgery Be Expanded? J Endocr Soc 2023; 7:bvad098. [PMID: 37873505 PMCID: PMC10590644 DOI: 10.1210/jendso/bvad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 10/25/2023] Open
Abstract
Context Patients with primary hyperparathyroidism (PHPT) can present with variable signs, symptoms, and end-organ effects. Clinical practice guidelines influence referral for consideration of parathyroidectomy. Objective This study compared the demographic, biochemical, and symptom profile and examine indications for surgery in patients older than 50 years who underwent parathyroidectomy to determine how changes to current guidelines may affect recommendations for parathyroidectomy. Methods A retrospective review was conducted of patients age 50 years or older who underwent initial parathyroidectomy for sporadic PHPT from 2012 to 2020. Patients were classified by indications for surgery per guideline criteria (classic, asymptomatic, and no criteria met) and age group (AG): 50 to 59 years; 60 to 69 years; 70 years or older. Patients were treated at a high-volume tertiary medical center by endocrine surgeons. Results Of 1182 patients, 367 (31%) classic and 660 (56%) asymptomatic patients met the criteria for surgery. The most common indications for surgery were extent of hypercalcemia (51%), osteoporosis (28%), and nephrolithiasis (27%). Of the 155 (13%) patients who did not meet the criteria, neurocognitive symptoms (AG1: 88% vs AG2: 81% vs AG3: 70%; P = .14) and osteopenia (AG1: 53% vs AG2: 68% vs AG3: 68%; P = .43) were frequently observed regardless of patient age. If the age threshold of younger than 50 years was expanded to 60, 65, or 70 years, an additional 61 (5%), 99 (8%), and 124 (10%) patients in the entire cohort would have met the guideline criteria for surgery, respectively. Conclusion Expanding current guidelines for PHPT to include a broader age range, osteopenia, and neurocognitive symptoms may allow for earlier surgical referral and evaluation for definitive treatment.
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Affiliation(s)
| | - Sophie Dream
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tina W Yen
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kara Doffek
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Joseph Shaker
- Division of Endocrinology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Douglas B Evans
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tracy S Wang
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Karachentsev YI, Dubovyk VM, Gopkalova IV, Khaziev VV, Sazonov ME, Gerasimenko LV. LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH PRIMARY HYPERPARATHYROIDISM. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2023. [DOI: 10.29254/2077-4214-2022-4-167-160-166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Y. I. Karachentsev
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
| | - V. M. Dubovyk
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
| | - I. V. Gopkalova
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
| | - V. V. Khaziev
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
| | - M. E. Sazonov
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
| | - L. V. Gerasimenko
- SI "V. Danilevsky Institute for Endocrine Pathology Problems of the NAMS of Ukraine"
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Seib CD, Ganesan C, Arnow KD, Pao AC, Leppert JT, Barreto NB, Kebebew E, Kurella Tamura M. Kidney Stone Events Following Parathyroidectomy vs Nonoperative Management for Primary Hyperparathyroidism. J Clin Endocrinol Metab 2022; 107:e2801-e2811. [PMID: 35363858 PMCID: PMC9202696 DOI: 10.1210/clinem/dgac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. OBJECTIVE Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. DESIGN Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. SETTING Veterans Health Administration integrated health care system. PATIENTS A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. MAIN OUTCOMES MEASURE Clinically significant kidney stone event. RESULTS The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a history of kidney stone events. Among patients with baseline history of kidney stones, the unadjusted incidence of ≥ 1 kidney stone event was 30.5% in patients managed with parathyroidectomy (mean follow-up, 5.6 years) compared with 18.0% in those managed nonoperatively (mean follow-up, 5.0 years). Patients treated with parathyroidectomy had a higher adjusted hazard of recurrent kidney stone events (hazard ratio [HR], 1.98; 95% CI, 1.56-2.51); however, this association declined over time (parathyroidectomy × time: HR, 0.80; 95% CI, 0.73-0.87). CONCLUSION In this predominantly male cohort with PHPT, patients treated with parathyroidectomy continued to be at higher risk of kidney stone events in the immediate years after treatment than patients managed nonoperatively, although the adjusted risk of stone events declined with time, suggesting a benefit to surgical treatment.
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Affiliation(s)
- Carolyn D Seib
- Correspondence: Carolyn Dacey Seib, MD, MAS, Stanford University, 300 Pasteur Dr, H3680, Stanford, CA 94305, USA.
| | - Calyani Ganesan
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Katherine D Arnow
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Alan C Pao
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - John T Leppert
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Nicolas B Barreto
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Manjula Kurella Tamura
- Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, CA 94304, USA
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
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Zhou Y, Chu X, Jiang D, Wu X, Xu J, Qi H, Tang Y, Dai Y. Development and validation of a nomogram for risk prediction of nephrolithiasis recurrence in patients with primary hyperparathyroidism. Front Endocrinol (Lausanne) 2022; 13:947497. [PMID: 36120445 PMCID: PMC9470877 DOI: 10.3389/fendo.2022.947497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis is a common complication of primary hyperparathyroidism (PHPT), and the recurrence of nephrolithiasis in patients with PHPT is also an urgent concern. What is worse, there is a scarcity of recommended evaluation to predict the risk of nephrolithiasis recurrence in patients with PHPT. This study was aimed to develop and validate a nomogram to facilitate risk assessment in patients with PHPT. METHODS A total of 197 patients with PHPT were retrospectively included in this study from September 2016 to August 2021. Patients' demographic data, blood test parameters, urinalysis, stone parameters, and surgical intervention were collected. Extracted variables were submitted to a least absolute shrinkage and selection operator (LASSO) regression model. A nomogram was built and validated according to the area under the curve (AUC) value, calibration curve, and decision curve analysis. RESULTS According to the LASSO regression and logistic regression analyses, five predictors were derived from 22 variables: creatinine, uric acid, bilateral stone, multiplicity, and surgery. The AUC and concordance index of the training cohort and validation cohort were 0.829 and 0.856, and 0.827 and 0.877, respectively. The calibration curve analysis and the decision curve analysis showed that the nomogram had an adequate prediction accuracy. CONCLUSION We built a useful nomogram model to predict the risk of nephrolithiasis recurrence in patients with PHPT. This would assist clinicians to provide appropriate advices and managements for these patients.
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Affiliation(s)
- Yihong Zhou
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xi Chu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Dong Jiang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang Wu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jiarong Xu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hao Qi
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuxin Tang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
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