Primary Hyperparathyroidism

@article{Insogna2018PrimaryH,
  title={Primary Hyperparathyroidism},
  author={Karl L Insogna},
  journal={The New England Journal of Medicine},
  year={2018},
  volume={379},
  pages={1050–1059}
}
  • K. Insogna
  • Published 2018
  • Medicine
  • The New England Journal of Medicine
Primary HyperparathyroidismIn primary hyperparathyroidism, serum calcium levels are elevated in the context of nonsuppressed parathyroid hormone levels. It is most often caused by a single parathyroid adenoma.Patients with mild hyperparathyroidism are at increased risk for renal stones, cortical bone loss, and fractures.Evaluation should include measures of serum calcium, intact parathyroid hormone, 25‐hydroxyvitamin D, glomerular filtration rate, 24‐hour urine calcium excretion, and bone… Expand
Parathyroidectomy improves hypercalciuria in patients with primary hyperparathyroidism.
TLDR
Parathyroidectomy reduces 24-hour UCa excretion in the majority of patients with PHPT and restores normocalciuria in 79% of patientsWith hypercalciuria at baseline. Expand
Skeletal abnormalities in Hypoparathyroidism and in Primary Hyperparathyroidism
TLDR
Skeletal involvement in HypoPT and in PHPT is reviewed, as assessed by bone remodeling, DXA, trabecular bone score, and quantitative computed tomography, as well as data on bone strength and fracture risk. Expand
Hiperparatiroidismo primario clásico secundario a un adenoma paratiroideo
TLDR
A 34-year-old woman with a 4-year history with multiple pathological fractures, weight loss, asthenia and gammagram and parathyroid prospect material 25mci 99m MIBI evidencing a pattern suggestive of lower leftParathyroid adenoma is reported. Expand
Familial Hyperparathyroidism
TLDR
The clinical and genetic investigation of familial HPT in kindreds found to lack germline variants in the already known HPT-predisposition genes represents a promising future direction for the discovery of novel genes relevant to parathyroid tumor development. Expand
Management of Primary Hyperparathyroidism With Severe Hypercalcemia During the COVID-19 Pandemic
TLDR
Medical management of PHPT and severe hypercalcemia presents a reasonable alternative for parathyroid surgery during the COVID-19 outbreak and should be instituted until the pandemic ends and surgery can be performed safely. Expand
Reduction in parathyroid adenomas by cinacalcet therapy in patients with primary hyperparathyroidism
TLDR
It is revealed that cinacalcet treatment reduces the size of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT), and the accumulation of more PHPT cases with cinacancet therapy is required to confirm this finding. Expand
Skeletal effects of combined medical and surgical management of primary hyperparathyroidism.
TLDR
Bisphosphonate initiation after PTX may interfere with the beneficial effects of PTX on fracture risk in osteoporotic patients with primary hyperparathyroidism. Expand
Predictors of adenoma size and location in primary hyperparathyroidism
TLDR
It is found that 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. Expand
Stones left unturned: Missed opportunities to diagnose primary hyperparathyroidism in patients with nephrolithiasis.
TLDR
The proportion of patients presenting with nephrolithiasis ultimately diagnosed with primary hyperparathyroidism was significantly lower than others have reported and missed opportunities for diagnosis are critical. Expand
Could there be a role of serum zonulin increase in the development of hypercalcemia in primary hyperparathyroidism
TLDR
Serum zonulin levels show a moderate/strong positive correlation with serum calcium and plasma PTH levels, which suggests that IP increase may play a role in the development of hypercalcemia in patients with PHPT. Expand
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References

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Nephrolithiasis and renal calcifications in primary hyperparathyroidism.
TLDR
All patients with a diagnosis of primary hyperparathyroidism (PHPT) should initially be evaluated for renal calcifications by unenhanced helical computed tomography and if calcifications are present, parathyroidectomy is recommended. Expand
Urinary parameters as predictors of primary hyperparathyroidism in patients with nephrolithiasis.
TLDR
Serum calcium with parathyroid hormone level was the most accurate test for primary hyperparathyroidism and there were no obvious cutoffs for any of the urinary parameters that reliably differentiated cases of hyperparathiroidism. Expand
The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism
TLDR
Surgery was associated with fewer hip fractures and fewer fractures of any type, regardless of whether patients met guideline criteria for surgery, and bisphosphonates were associated with increases in bone mineral density but not with fewer fractures. Expand
Risk factors associated to kidney stones in primary hyperparathyroidism
TLDR
Investigation of clinical and biochemical parameters in kidney stone former (SF) and non-stone former (NSF) patients with PHPT found hypercalciuria, higher oxalate excretion and severe PHPT are associated with kidney stones in PHPT. Expand
The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years.
TLDR
Parathyroidectomy led to normalization of biochemical indices and sustained increases in BMD, which raises questions regarding how long patients with PHPT should be followed up without intervention. Expand
Renal stones and calcifications in patients with primary hyperparathyroidism: associations with biochemical variables.
OBJECTIVE To study the prevalence of renal stones and nephrocalcinosis in patients with primary hyperparathyroidism (PHPT) and to appraise biochemical variables as risk factors for developing renalExpand
The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake
TLDR
Most patients with mild PHPT and a low calcium intake tolerate a moderate calcium supplement, which may have beneficial effects on the bones, but the patients must be followed carefully. Expand
Prevalence of primary hyperparathyroidism among patients with low bone mass.
TLDR
In the large cohort of unselected patients who presented for bone densitometry, a very high prevalence of PHPT was found among subjects with low bone mass (BMD Z-score less than -2.0 SD), which confirms the importance of the BMD measurements in the screening of the disease. Expand
Bone Histomorphometry and Bone Quality in Primary Hyperparathyroidism
TLDR
This chapter reviews the histomorphometric characteristics of bone involvement in PHPT and the effects of the disease on the material properties of bone matrix. Expand
Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism.
TLDR
Calcium and PTH levels were normalized after surgery, and biochemical markers of bone turnover decreased by 35%, followed by a significant increase in BMD in the spine and femoral neck compared with the observation group. Expand
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