An overview of normocalcemic primary hyperparathyroidism

Pawłowska, Monika; Cusano, Natalie E.

doi:10.1097/med.0000000000000198

Cited by 51 publications

(41 citation statements)

References 36 publications

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“…Accordingly, both serum Ca and ionized Ca alone fails to recognize some cases of PHPT with normal (or fluctuating around the upper normal limit) serum Ca, (29,30) the diagnosis of NCPHPT requiring the demonstration of elevated serum PTH. (7) Serum P alone was unreliable in the diagnosis of PHPT, in accordance with all previous studies that evaluated this parameter alone and never in combination with Ca. (11,12,15,18) Thus, Ca/P is more accurate than either serum P or Ca alone, avoiding false-negative diagnoses, as suggested by the 25 of 35 (71%) patients recognized as having NCPHPT in this study.…”

Section: Discussionsupporting

confidence: 90%

“…This study proves that Ca/P is a highly reliable tool, especially in NCPHPT patients, who are not clearly identified as having PHPT by the measurement of serum Ca (or corrected Ca) alone . In these patients Ca/P had the best diagnostic value in terms of sensitivity and accuracy compared to other diagnostic tools such as serum Ca and corrected Ca.…”

Section: Discussionmentioning

confidence: 58%

“…(27) This study proves that Ca/P is a highly reliable tool, especially in NCPHPT patients, who are not clearly identified as having PHPT by the measurement of serum Ca (or corrected Ca) alone. (7,29) In these patients Ca/P had the best diagnostic value in terms of sensitivity and accuracy compared to other diagnostic tools such as serum Ca and corrected Ca. Accordingly, both serum Ca and ionized Ca alone fails to recognize some cases of PHPT with normal (or fluctuating around the upper normal limit) serum Ca, (29,30) the diagnosis of NCPHPT requiring the demonstration of elevated serum PTH.…”

Section: Discussionmentioning

confidence: 91%

“…Normohormonal PHPT (NHPHPT) and normocalcemic PHPT (NCPHPT) are characterized by serum PTH close to the upper limit, but still within the normal range and by normal serum Ca (often in the highest quartile of the normal range), respectively. Even though they are in the normal range in NHPHPT and NCPHPT, serum Ca and phosphorous (P) levels are very close to the highest and lowest limit of the normal range, respectively . To complicate the picture, clinical signs and symptoms are not always present, as in asymptomatic PHPT .…”

Section: Introductionmentioning

confidence: 99%

“…Even though they are in the normal range in NHPHPT and NCPHPT, serum Ca and phosphorous (P) levels are very close to the highest and lowest limit of the normal range, respectively. (5)(6)(7) To complicate the picture, clinical signs and symptoms are not always present, as in asymptomatic PHPT. (8) Hence, the diagnosis of PHPT is challenging (1,3) and often delayed (2) because of this wide spectrum of clinical and biochemical manifestations, especially in asymptomatic and NCPHPT patients.…”

Section: Introductionmentioning

confidence: 99%

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Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

Fuleihan

Chakhtoura

Cipriani

et al. 2020

Journal of Bone and Mineral Research

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This narrative review summarizes data on classical and nonclassical manifestations of primary hyperparathyroidism (PHPT). It is based on a rigorous literature search, inclusive of a Medline search for systematic reviews from 1940 to December 2020, coupled with a targeted search for original publications, covering four databases, from January 2013-December 2020, and relevant articles from authors' libraries. We present the most recent information, identify knowledge gaps, and suggest a research agenda. The shift in the presentation of PHPT from a predominantly symptomatic to an asymptomatic disease, with its varied manifestations, has presented several challenges. Subclinical nephrolithiasis and vertebral fractures are common in patients with asymptomatic disease. The natural history of asymptomatic PHPT with no end organ damage at diagnosis is unclear. Some observational and cross-sectional studies continue to show associations between PHPT and cardiovascular and neuropsychological abnormalities, among the different disease phenotypes. Their causal relationship is uncertain. Limited new data are available on the natural history of skeletal, renal, cardiovascular, neuropsychological, and neuromuscular manifestations and quality of life. Normocalcemic PHPT (NPHPT) is often diagnosed without the fulfillment of rigorous criteria. Randomized clinical trials have not demonstrated a consistent long-term benefit of parathyroidectomy (PTX) versus observation on nonclassical manifestations. We propose further refining the definition of asymptomatic disease, into two phenotypes: one without and one with evidence of target organ involvement, upon the standard evaluation detailed in our recommendations. Each of these phenotypes can present with or without non-classical manifestations. We propose multiple albumin-adjusted serum calcium determinations (albumin-adjusted and ionized) and exclusion of all secondary causes of high parathyroid hormone (PTH) when establishing the diagnosis of NPHPT. Refining the definition of asymptomatic disease into the phenotypes proposed will afford insights into their natural history and response to interventions. This would also pave the

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Evaluation of efficacy of ultrasound‐guided microwave ablation in primary hyperparathyroidism

Zhang

Gao

Xiao-juan

et al. 2022

J of Clinical Ultrasound

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Purpose: We aimed to evaluate the clinical efficacy and safety of ultrasonographically (US)-guided percutaneous microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT). Methods: A total of 35 patients who received MWA treatment in our hospital between August, 2019 and January, 2021 were retrospectively analyzed. Serum parathyroid hormone (PTH), calcium, phosphorus levels, and improvement in clinical symptoms were recorded before and after MWA. All patients were followed up for 6 months. Paired-sample t-tests and paired sample Wilcoxon signed-rank tests were used to indicate PTH, calcium, and P levels before and after ablation. Postoperative complications were statistically analyzed to evaluate the therapeutic effect of MWA on PHPT patients. Results: A total of 38 parathyroid nodules in 35 PHPT patients were completely ablated at one time. These results indicated that MWA could effectively destroy parathyroid tissue and decrease the concentrations of PTH, calcium, and phosphorus compared with those before MWA, and the effect was sustained. Moreover, MWA improved clinical symptoms, and improved quality of life of patients. None of patients developed tracheal and esophageal injuries, peripheral hematoma, infection, or other serious complications. Conclusion: US-guided MWA has shown to be an effective and safe approach to treat PHPT patients.

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An overview of normocalcemic primary hyperparathyroidism

Cited by 51 publications

References 36 publications

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

Evaluation of efficacy of ultrasound‐guided microwave ablation in primary hyperparathyroidism

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