A practical approach to normocalcemic primary hyperparathyroidism

Nova, José Luis Muñoz de; Sampedro‐Núñez, Miguel; Huguet-Moreno, Isabel; Azpiroz, Monica Marazuela

doi:10.1007/s12020-021-02845-4

Cited by 9 publications

(4 citation statements)

References 73 publications

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“…Hence, the use of Roche assay in our study might result in underdiagnosis rather than overdiagnosis of nPHPT. Moreover, PTH reference ranges are not adjusted for age ( 16 ), what is important since higher PTH levels were observed in elderly people ( 21 ), who were, however, not included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of nPHPT is established after exclusion of secondary causes of hyperparathyroidism, such as renal disease, vitamin D deficiency, malabsorption and dietary calcium deficiency or use of medications that may increase PTH level (i.e. bisphosphonates, denosumab, loop diuretics, antiepileptic drugs, lithium) ( 16 ), and virtually all of these conditions were excluded in our patients. Other rare causes of elevated PTH like pseudohypoparathyroidism should also be excluded, but none of our patients presented with very high PTH in the setting of hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

“…The reference range for total calcium was 8.41-10.42 mg/dl (2.1-2.6 mmol/l). We have chosen the measurements of total instead of ionized calcium as assessment of ionized calcium is a demanding procedure, sensitive to pH of blood (acidosis increase ionized calcium concentration) and preanalytical errors (fist-clenching or use of venous stasis may increase level of ionized calcium), requiring immediate handling and good quality control ( 16 ). This choice of screening tests was therefore, in our opinion, suitable for screening in primary care settings.…”

Section: Subject and Methodsmentioning

confidence: 99%

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The effects of season (spring versus autumn) on diagnosis of normocalcemic primary hyperparathyroidism

Basińska-Lewandowska¹,

Lewiński

Lewandowski

et al. 2022

Front. Endocrinol.

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BackgroundRaised parathormone (PTH) and normal calcium concentrations can be observed both in normocalcemic primary hyperparathyroidism (nPHPT) and in secondary hyperparathyroidism, e.g. due to vitamin D deficiency. We assessed the impact of season on the validity of diagnosis of nPHPT in terms of screening investigations to be performed in the primary care settings.Material and methodsOn two occasions (March/April & September/October) we measured vitamin D (25OHD), PTH and total calcium in 125 healthy subjects, age range 6-50, not taking any vitamin D supplements.ResultsIn autumn there was an increase in 25OHD concentrations (from 18.1 ± 7.37ng/ml to 24.58 ± 7.72ng/ml, p<0.0001), a decline in PTH from 44.40 ± 17.76pg/ml to 36.63 ± 14.84pg/ml, p<0.001), without change in calcium levels. Only 45 subjects (36%) were vitamin D sufficient (25OHD>20/ml) in spring versus 83 (66.4%) in autumn, p<0.001. Elevated PTH concentrations were noted in 10 subjects in spring (8%) and in six subjects (4.8%) (p<0.05) in autumn. In spring, however, eight out of ten of these subjects (80%) had 25OHD<20 ng/ml, versus one in six (16.7%) in autumn (p<0.01). Normalization of PTH was observed in seven out ten subjects (70%), and all of them had 25-OHD<20 ng/ml in spring.ConclusionsIn spring elevated PTH concentrations in the setting of normocalcemia are more likely to be caused by 25OHD deficiency rather by nPHPT. In contrast, in autumn, increased PTH concentrations are more likely to reflect nPHPT. We postulate that screening for nPHPT should be done in 25OHD replete subjects, i.e. in autumn rather than in spring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Subject and Methodsmentioning

confidence: 99%

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The effects of season (spring versus autumn) on diagnosis of normocalcemic primary hyperparathyroidism

Basińska-Lewandowska¹,

Lewiński

Lewandowski

et al. 2022

Front. Endocrinol.

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“…A widely successful treatment for NC-PHPT has not yet been found ( 84 ). Specific surgical treatments cannot be recommended because of the difficulties posed by negative preoperative imaging studies, high frequency of MGD, small intraoperative parathyroid findings, and uncertainty concerning its clinical benefits.…”

Section: Special Conditionsmentioning

confidence: 99%

Surgery for primary hyperparathyroidism

Neves¹,

Santos²,

Ohe³

2022

Archives of Endocrinology and Metabolism

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Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at risk for multiglandular disease, especially in those who present with familial forms of PHPT that require bilateral neck exploration. This manuscript also explores other conditions that warrant special consideration during surgical treatment for PHPT: normocalcemic primary hyperparathyroidism, pregnancy, reoperation for persistent or recurrent PHPT, parathyroid carcinoma, and familial and genetic forms of hyperparathyroidism.

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Iperparatiroidismo normocalcemico: gestione clinico-terapeutica nel tempo

Amodeo

Corbetta

2023

L'Endocrinologo

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A practical approach to normocalcemic primary hyperparathyroidism

Cited by 9 publications

References 73 publications

The effects of season (spring versus autumn) on diagnosis of normocalcemic primary hyperparathyroidism

The effects of season (spring versus autumn) on diagnosis of normocalcemic primary hyperparathyroidism

Surgery for primary hyperparathyroidism

Iperparatiroidismo normocalcemico: gestione clinico-terapeutica nel tempo

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