Evaluation of blood supply to the parathyroid glands in secondary hyperparathyroidism compared with histopathology

Onoda, Noritaka; Kurihara, Satoshi; Sakurai, Yusei; Owada, Kazuhiro; Osono, Eiichi; Adachi, Hideki; Suga, Masaru; Yoneshima, Hideo

doi:10.1093/ndt/gfg1009

Cited by 27 publications

(27 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, the VI may reliably estimate the serum i-PTH level. Our results are in agreement with the finding of Onoda et al [21] that the strength of the power Doppler signal determines the nodularity of the parathyroid gland. With the same adenoma volumes, a greater number of injections may be needed to achieve a better outcome in a patient with a higher VI compared to those with a lower VI.…”

Section: Discussionsupporting

confidence: 94%

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Chen

Lu²,

Lin³

et al. 2010

Nephron Clin Pract

View full text Add to dashboard Cite

Aims: To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT). Methods: A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT. Results: Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively). Conclusion: A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.

show abstract

Section: Discussionsupporting

confidence: 94%

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Chen

Lu²,

Lin³

et al. 2010

Nephron Clin Pract

View full text Add to dashboard Cite

show abstract

“…High blood flow signals evaluated by power Doppler ultrasonography are associated with pathological features of nodular hyperplasia [27]. To date, however, there have been no reports showing a reduction in the parathyroid gland vasculature in CKD patients, except for rare cases associated with spontaneous infarction of the glands [6,7].…”

mentioning

confidence: 99%

Regression of parathyroid hyperplasia by calcimimetics--fact or illusion?

Komaba

Fukagawa

2008

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

Secondary hyperparathyroidism is one of the most common and serious complications of chronic kidney disease (CKD). The main factors responsible for excessive synthesis and secretion of parathyroid hormone (PTH) include phosphate retention, hypocalcaemia and calcitriol deficiency resulting from decreased kidney function [1,2]. Sustained hypersecretion of PTH is associated with an increase in the parathyroid gland size, initially leading to diffuse parathyroid hyperplasia. Subsequently, some cells in the parathyroid glands proliferate in a monoclonal growth pattern, and the enlarged glands exhibit an advanced type of nodular hyperplasia [3]. In the course of parathyroid hyperplasia, both calcium-sensing receptors (CaSR) and vitamin D receptors (VDR) are progressively down-regulated [4,5], which results in diminished responsiveness of parathyroid glands with nodular hyperplasia to active vitamin D treatment.Conversely, whether regression of parathyroid hyperplasia can occur has remained a matter of discussion. Regression of parathyroid hyperplasia has been reported in rare cases of spontaneous infarction of the glands [6,7]. In addition, enhanced apoptosis of parathyroid cells has been observed in diffuse hyperplasia after kidney transplantation, suggesting the possibility of regression in the long term [8].In the past, the capacity of calcitriol therapy to induce regression of parathyroid hyperplasia had been a matter of debate. In a study of oral calcitriol pulse therapy, given to chronic haemodialysis patients, we observed a significant decrease in the mean ± SD volume of parathyroid glands (from 0.87 ± 0.32 to 0.51 ± 0.23 cm 3 ) after 12 weeks of treatment, with a concomitant significant reduction in intact PTH levels [9]. In contrast, Quarles et al. failed to observe a decrease in the parathyroid gland size after 36 weeks of intermittent intravenous or oral calcitriol treatments [10]; the mean ± SD gland volume was 1.9 ± 0.6 and 2.1 ± Correspondence and offprint requests to:

show abstract

“…Patients with at least one gland greater than 0.5 cm 3 or 1 cm in diameter are usually refractory to medical therapy [18,19]. Patients selected by sonography benefit from surgical parathyroidectomy or parathyroid intervention [2,4,[18][19][20][21]. Unlike the primary hyperparathyroidism, the glandular enlargement in ESRD tends to involve more than one gland and the gland size is directly related to increased iPTH secretion [17,22].…”

Section: Discussionmentioning

confidence: 99%

“…This is important since most glands progress to nodular hyperplasia as they grow larger [4]. Onoda et al stated that power Doppler US imaging could be used to determine the type of hyperplasia in patients with secondary hyperparathyroidism [2]. The parenchymal color Doppler pattern of parathyroid lesions is also useful to differentiate them from other cervical masses [14].…”

Section: Discussionmentioning

confidence: 99%

“…The failure of normal phosphate and calcium mechanisms is the main cause of secondary hyperparathyroidism in end-stage renal disease (ESRD). Chronic overstimulation triggers parathyroid gland enlargement which causes secondary hyperparathyroidism (sHPT) and disturbed calcium (Ca), phosphate (P), and vitamin D metabolisms increase serum intact parathyroid hormone (iPTH) levels [1,2]. The control of this serious complication is one of the major objectives in planning the management strategy [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography

Özcan

Oktay²

2009

Eur Radiol

View full text Add to dashboard Cite

The aim of this study was to assess the role of color and spectral Doppler ultrasound (CDU) in the evaluation of enlarged parathyroid glands in hemodialysis patients with secondary hyperparathyroidism. Fourteen hemodialysis patients with elevated intact parathyroid hormone (iPTH) levels were evaluated prospectively with CDU. The volume of each observed parathyroid gland and the spectral CDU data (velocities, resistance and pulsatility indices, systolic to diastolic ratio, and flow volume output (FVO)) were noted. The biochemical data (iPTH, calcium, phosphate levels), and CDU results were analyzed with the Spearman correlation test. Two patients were excluded, and 27 enlarged parathyroid glands were observed in 12 patients. The mean total volume of enlarged parathyroid glands per patient was 1.95 cm(3) (0.06-5.5 cm(3)). Arterial supply was demonstrated in 78% (21/27) of enlarged parathyroid glands. Mean total FVO of enlarged glands per patient was 238.5 ml/min (620-0 ml/min) and mean iPTH level was 1,477 pg/ml (643-3,132 pg/ml). The positive correlations of total volume (p = 0.022), iPTH (p = 0.024), and FVO (p = 0.022) were statistically significant. In secondary hyperparathyroidism, total volume of the visualized enlarged parathyroid glands and the total of FVOs per patient are positively correlated with iPTH levels which may help clinical management and follow-up of end-stage renal disease patients.

show abstract

Evaluation of blood supply to the parathyroid glands in secondary hyperparathyroidism compared with histopathology

Cited by 27 publications

References 10 publications

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Regression of parathyroid hyperplasia by calcimimetics--fact or illusion?

Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography

Contact Info

Product

Resources

About