Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira, Francisco; Griz, Luiz; Chaves, N; Carvalho, Nara Crispim; Borges, Lívia Maria; Lazaretti-Castro, Marise; Borba, Victória Zeghbi Cochenski; Castro, Luiz Cláudio de; Borges, João Lindolfo Cunha; Bilezikian, John P.

doi:10.1590/s0004-27302013000600002

Cited by 70 publications

(83 citation statements)

References 144 publications

(98 reference statements)

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“…Over the past decades, the disease has shown a change in presentation at diagnosis, from very symptomatic to oligo-or asymptomatic, even in developing countries (13,18). These patients, who present with mild primary hyperparathyroidism, are less likely to show abnormal laboratory findings at diagnosis, and present serum calcium and PTH measurements not as elevated as patients with overt symptoms of the disease (19).…”

Section: Discussionmentioning

confidence: 99%

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population

Bonansea

Ohe

Brandão

et al. 2016

Arch. Endocrinol. Metab.

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Objective: To evaluate the usefulness of a third-generation PTH assay in the diagnosis of primary hyperparathyroidism (PHPT). Subjects and methods: Forty-one PHPT patients (4 men and 37 women) with 61.2 ± 10.9 (mean ± SD) years, were studied and had PTH levels measured with two different methods using the same immunochemiluminescent assay plataform (Elecsys 2010 System, Roche). We compared a second-generation assay (I-PTH) with a third-generation PTH assay (Bio-PTH). Two populations of 423 and 120 healthy adults with serum 25OHD levels above 25 ng/mL were used to define normal values in the I-PTH and Bio-PTH assays respectively. Results: Normal PTH values based in the healthy adults population were 24.2-78.0 pg/mL for the I-PTH assay and 19.9-58.5 pg/mL for Bio-PTH assay. In PHPT patients, PTH values ranged from 67 to 553 pg/mL (median: 168 pg/mL) using the I-PTH assay and from 55 to 328 pg/mL (median: 111 pg/mL) using the Bio-PTH assay. Results obtained with the Bio-PTH assay were significantly lower (p < 0.0001, Wilcoxon). In general I-PTH and Bio-PTH showed highly significant correlation (r = 0.952, p < 0.0001). Passing-Bablok analysis gave a regression equation of Bio PTH = 13.44 + 0.59 x intact PTH. PHPT patients had 25OHD levels ranging from 4 to 36 ng/mL (mean 16.2 ng/mL); 35 subjects (85.3%) had values bellow 25 ng/mL. Conclusion: Our results demonstrate that both second and third generation PTH methods are strongly correlated in PHPT patients and control subjects. Lower results with Bio-PTH tests are expected in function of the assay specificity determined by the amino-terminal antibody used. Arch Endocrinol Metab. 2016;60(5):420-5

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Section: Discussionmentioning

confidence: 99%

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population

Bonansea

Ohe

Brandão

et al. 2016

Arch. Endocrinol. Metab.

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“…The Tc-99-Sestamibi scan was less sensitive, failing to localize either adenoma. The sensitivity of ultrasound is highly operator-dependent, but its accuracy may be as high as 88% in asymptomatic hypercalcemic patients (10). When it detects intra-thyroid nodules, FNA with measurement of PTH in the aspiration fluid is very useful as thyroid nodules may cause false-positive Sestamibi scan results (11).…”

Section: Discussionmentioning

confidence: 99%

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

Pimentel

Portela

Loureiro

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYNormocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10 th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications. Arq Bras Endocrinol Metab. 2014;58(5):583-6 SUMáRioHiperparatiroidismo primário normocalcêmico (NPHPT) caracteriza-se pela elevação do hormô-nio da paratiroide (PTH), na ausência da elevação dos níveis séricos de cálcio e exclusão de causas secundárias. O caso descrito ilustra o seguimento de uma mulher na pós-menopausa com NPHPT que evoluiu com múltiplos adenomas. Este caso relata uma paciente de 77 anos de idade que tem dor generalizada crônica e osteoporose. O PTH inicial foi elevado com níveis séricos de cálcio, albumina, fósforo e 25OH vitamina D normais. A densitometria óssea (DMO) evidenciou um T-SCORE da coluna lombar: -3.0, colo do fêmur: -2.6 e rádio distal: -4.2. Outras causas de hiperparatireoidismo secundário foram descartadas e a ultrassonografia cervical e varredura com Sestamibi foram negativos. Fez uso de alendronato e três infusões de ácido zoledrônico para o tratamento da osteoporose. No décimo ano de seguimento, depois de sucessivas imagens negativas, a ultrassonografia evidenciou um nódulo sugestivo de adenoma de paratireoide inferior direita. A paciente foi submetida à paratireoidectomia, e um exame histológico confirmou a hipótese. A elevação dos níveis séricos de PTH no pós-operatório se ma...

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“…The most common clinical presentation of PHPT is asymptomatic hypercalcemia with an elevated or high-or normal intact PTH level. Patients with hypercalcemia may present with vague constitutional symptoms, anorexia, lethargy, or polydipsia and polyuria [7][8][9]. Less specific features of PHPT are fatigue, proximal muscle weakness, mild cognitive disturbances, hypertension, left ventricular hypertrophy, valvular calcification, and cardiovascular mortality [2,10].…”

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confidence: 99%

“…If PHPT due to a parathyroid adenoma (or adenomas), parathyroidectomy is the definitive cure. Surgery has a very high long-term success rate and minimal morbidity [7,8]. Medical therapy, such as calcimimetics, may gain popularity for patients with hypercalcemia who can not undergo surgery.…”

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confidence: 99%

Primary hyperparathyroidism presented with peripheral brown tumor in the oral cavity: a case report

Elbüken¹,

Ozan²,

Öztürk³

et al. 2014

EJEA

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Introduction: Parathyroid hormone (PTH) is the chief regulator of calcium homeostasis in the human body. Primary hyperparathyroidism (PHPT) occurs in a setting of excessive PTH secretion with an autonomous parathyroid gland which resulting in hypercalcemia [1]. Most patients with PHPT have a single adenoma (about 80% of cases), but multigland disease can occur in 10%-15% of cases and double adenomas in 4%-5% [2]. Parathyroid carcinoma is a rare cause (usually less than 1% of patients) of hyperparathyroidism [3,4]. There is a great variation in the manifestations of PHPT. The clinical presentation of PHPT is changing from a severe disease with nephrolithiasis and metabolic bone disease to mild asymptomatic disease [5,6]. The most common clinical presentation of PHPT is asymptomatic hypercalcemia with an elevated or high-or normal intact PTH level. Patients with hypercalcemia may present with vague constitutional symptoms, anorexia, lethargy, or polydipsia and polyuria [7][8][9]. Less specific features of PHPT are fatigue, proximal muscle weakness, mild cognitive disturbances, hypertension, left ventricular hypertrophy, valvular calcification, and cardiovascular mortality [2,10]. Classic skeletal lesions, which are bone resorption, bone cysts, brown tumors and generalized osteopenia, occur in less than 5% of cases [11]. PHPT affects compact bone more than trabecular bone with particular sensitivity in the cortices of long bones leading to subperiostal bone resorption (seen as periosteal elevation on plain radiography) [12]. PHPT is prone to cause loss of the lamina dura [13].

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Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Cited by 70 publications

References 144 publications

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

Primary hyperparathyroidism presented with peripheral brown tumor in the oral cavity: a case report

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