Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002

Ohe, Monique Nakayama; Santos, Rodrigo de Paula; Barros, Elizabete Ribeiro; Lage, Andrea; Kunii, Ilda S.; Abrahão, Márcio; Cervantes, Onivaldo; Hauache, Omar M.; Lazaretti-Castro, Marise; Vieira, José Gilberto H.

doi:10.1590/s0100-879x2005000900013

Cited by 30 publications

(26 citation statements)

References 11 publications

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“…The high prevalence of parathyroid carcinoma seen in our study could also be related to this selection bias, since it is much higher than the values reported in the Western literature (16), although similar prevalences have been found in other studies from developing countries (6,17). Nevertheless, we emphasize that this presentation profile is gradually changing, as stated by Ohe et al (11), who studied most of these patients and observed that the diagnostic incidence of PHP as well as the proportion of asymptomatic patients slowly increased in the last few years.…”

Section: Discussionsupporting

confidence: 78%

“…Late diagnosis, related to limited access to routine measurement of calcium levels and/or poor recognition of PHP, as well as the possible high prevalence of vitamin D deficiency in these countries, may lead to a more symptomatic clinical profile (10). However, as we have demonstrated in a recent study, the proportion of symptomatic cases is gradually but still slowly decreasing in our public service (11).…”

Section: Introductionmentioning

confidence: 67%

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Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Oliveira

Ohe

Santos

et al. 2007

Braz J Med Biol Res

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Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 67%

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Oliveira

Ohe

Santos

et al. 2007

Braz J Med Biol Res

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“…As occurs for other syndromes, such as sporadic HPT, for which specific screening programs are not performed in Brazil, 40 it is likely that most patients with MEN1 present as symptomatic, late-diagnosed cases. To our knowledge, no public hospital other than Hospital das Clínicas in Brazil is routinely offering genetic testing for MEN1 gene mutations.…”

Section: State Of Art Of Men1 In Brazilmentioning

confidence: 99%

The Impact of Clinical and Genetic Screenings on the Management of the Multiple Endocrine Neoplasia Type 1

Lourenço-Jr

Toledo

Coutinho

et al. 2007

Clinics

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METHODS:The clinical diagnosis of MEN1 was made in accordance with the Consensus on multiple endocrine neoplasias. Mutation analysis of the entire MEN1 tumor suppressor gene and genetic screening of at-risk family members were performed by direct sequencing. To analyze the implementation of genetic diagnosis, the studied patients were separated into 3 groups: MEN1 index cases (group I), clinically diagnosed MEN1 cases (group II), and genetically diagnosed MEN1 cases (group III). RESULTS: In total, 154 individuals were clinically and genetically studied. We identified 12 different MEN1 mutations. Fifty-two MEN1 cases were identified: 13 in group I, 28 in group II, and 11 in group III. The mean age in group III (27.0 years) was significantly lower than in groups I (39.5 years) and II (42.4 years; P = 0.03 and P = 0.01, respectively). Patients in groups I and II mostly presented 2 or 3 MEN1-related tumors, while 81.8% of those in group III presented 1 or no MEN1-related tumor. Additionally, in group III, 45.4% of cases were asymptomatic, and no metastasis or death was verified. Surveillance for MEN1 mutations allowed the exclusion of 102 noncarriers, including a case of MEN1 phenocopy. CONCLUSION: Our data supports the benefits of clinical and genetic screening for multiple endocrine neoplasia type 1 in the management of this syndrome.

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“…Em nosso estudo, 43% dos pacientes mostraram normocalcemia, que sugere a apresentação mais precoce da doença 19 , um momento oportuno para intervenção médica, a fim de evitar o aparecimento de intercorrências. Um trabalho da Columbia University chamou atenção para esses casos ao demonstrar que pacientes normocalcêmicos apresentaram maior comprometimento ósseo no diagnóstico e complicações em longo prazo 20 .…”

Section: Discussionunclassified

Hiperparatireoidismo Primário - Diferentes Modalidades De Tratamentos

Costa¹,

Moura²,

Vaucher³

et al. 2015

Rev. Med. UFPR

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RESUMOIntrodução: Objetivo: Avaliar a resposta clínica dos portadores de hiperparatireoidismo primário (HPTP), submetidos ou não à cirurgia, comparando a evolução de cada grupo. Métodos: Avaliação através dos prontuários dos pacientes com HPTP atendidos no Hospital de Clínicas da UFPR no período de 1992 a 2014. Os pacientes foram divididos de acordo com o tratamento em grupo cirúrgico (GC) e clínico (GCL). Dados de exames laboratoriais e densitométricos pré e pós-tratamento foram coletados e comparados. Resultados: Cinquenta e um dos 99 prontuários selecionados compuseram a amostra final, sendo 27 no GC, com idade média de 73±9,8 anos e 24 no GCL, com idade média de 58±12,8 anos, (p=0,0001). Todos os parâmetros avaliados se mantiveram semelhantes no GCL, com exceção da DMO de coluna lombar (L1-L4), que aumentou em média 7,5 %. Já o GC apresentou aumento médio na DMO de 22,2% em L1-L4, 14,5% em colo de fêmur e de 11,3% em fêmur total. Neste grupo, cálcio sérico, urinário e PTH diminuíram (p<0,05), embora seis pacientes não apresentaram cura cirúrgica. O GCL apresentou maior comorbidade cardiovascular (p=0,038) que o GC. Os demais parâmetros foram semelhantes entre os grupos. Conclusão: Foi observada melhora nos parâmetros laboratoriais e densitométricos dos pacientes do GC. O tratamento cirúrgico consistiu na melhor opção em pacientes mais jovens.Palavras--Chaves: Hiperparatireoidismo. Hormônio Paratireóideo. Hipercalcemia. Densidade Mineral Óssea. Paratireoidectomia. ABSTRACTBackground: To evaluate the clinical response of patients with primary hyperparathyroidism (PHPT), submitted or not to surgery, comparing the evolution of each group. Methods: Evaluation through the medical records of patients with PHPT treated at the Hospital de Clínicas da UFPR from 1992 to 2014. Patients were divided according to the treatment in surgical group (GC) and clinical group (GCL). Laboratory tests and BMD (bone mineral density) previous and after treatment were collected and subsequently compared between them. Results: Fifty-one of the 99 selected records made up the final sample, 27 in the GC, with a mean age of 73 ± 9.8 years and 24 in the GCL, mean age 58 ± 12.8 years (p = 0.0001). All parameters remained similar in GCL except lumbar spine BMD (L1-L4), which increased 7.5%. The CG showed an increase in BMD of 22.2% in L1-L4, 14.5% in femoral neck and 11.3% in total femur. In this group, serum calcium, urinary and PTH decreased (p <0.05), although six patients have not cured with the surgery. The GCL showed greater cardiovascular comorbidity (p = 0.038) than the CG. The other parameters were similar between groups.Conclusion: We found an improvement in laboratory and densitometry parameters of GC patients. Surgical treatment was the best option in younger patients.

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Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002

Cited by 30 publications

References 11 publications

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

The Impact of Clinical and Genetic Screenings on the Management of the Multiple Endocrine Neoplasia Type 1

Hiperparatireoidismo Primário - Diferentes Modalidades De Tratamentos

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