Hyperparathiroidism: Primary or Secondary Disease?

Cordellat, I. Martínez

doi:10.1016/j.reumae.2011.06.002

Cited by 18 publications

(14 citation statements)

References 25 publications

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“…El HPTP es una entidad clínica que se caracteriza por la producción autónoma de parathormona (PTH), que está acompañado con valores normales (en el límite superior) o elevados de calcio sérico, con valores de PTH elevados o inapropiadamente normales; su diagnóstico es bioquímico [1] . El HPTP debe considerarse en aquellos pacientes con historia de litiasis renal, nefrocalcinosis, dolor óseo, fracturas patológicas y resorción subperióstica [1] ; además de hipercalciuria producida por la elevación primaria de PTH y secundaria a una excesiva resorción del hueso [3] . La hipercalciuria es un factor de riesgo para desarrollar urolitiasis [5] y es la causa más frecuente de litiasis en la infancia [6] .…”

Section: Discussionunclassified

“…La causa más frecuente de HPTP es el adenoma paratiroideo (único en el 80-85% de los casos y doble en un 4%, aproximadamente), hiperplasia de las glándulas paratiroides o a un carcinoma paratiroideo [1,2] . Para la localización de las glándulas paratiroideas y valoración de su morfología se utilizan distintas técnicas de imagen como ecografía, tomografía axial computarizada y resonancia magnética pero la gammagrafía con la combinación 99mTc-sestamibi es la que más se recomienda [3] .…”

Section: Discussionunclassified

“…En cuanto a las manifestaciones clínicas del HPTP pueden existir manifestaciones óseas, renales, neuromusculares, cardiovasculares e intestinales [1] . Los síntomas y signos de hipercalcemia son variados y pueden presentarse con calcemias totales >12 mg/dl [2] .…”

Section: Discussionunclassified

“…El hiperparatiroidismo primario (HPTP) es una enfermedad que se caracteriza por la producción excesiva de parathormona (PTH) secretada por una glándula autónoma que trae como consecuencia un estado de normo o hipercalcemia sérica [1] . El HPTP primario suele ocurrir por la presencia de adenomas (80%), hiperplasia (15-20%) o carcinomas (1-3%) [2,3] .…”

Section: Introductionunclassified

“…Hasta el 80% de los casos se asocia a hipercalcemia leve o intermitente y puede haber ausencia de síntomas clásicos [4] . En el cribado del diagnóstico diferencial se suelen evaluar los valores de fósforo sérico (tienden a estar bajos o en limites bajos de la normalidad), cloro (tiende a estar elevado con acidosis metabólica secundaria), 1,25-dihidroxivitamina D (suele estar más baja de lo normal y puede asociarse con enfermedad severa) y calciuria corregida con creatinina en orina de 24 h que se encuentra elevada en un 40% de los pacientes [1] .…”

Section: Introductionunclassified

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Litiasis vesical gigante en un paciente con hiperparatiroidismo primario: reporte de caso

López-Santiesteban

Yanez-Salguero

2017

Acta Med Peru

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Se reporta el caso de un paciente con litiasis vesical gigante e hiperparatiroidismo primario. El hiperparatiroidismo primario se caracteriza por la producción autónoma de parathormonona, presentando hipercalcemia o calcio sérico normal-alto, con valores séricos de hormona paratiroidea elevados. El hiperparatiroidismo primario siempre debe ser tenido en cuenta en pacientes con historia de cálculos renales, nefrocalcinosis, dolor óseo, fracturas patológicas y resorción subperióstica. Se presenta caso de paciente masculino de 16 años de edad con antecedente de lito transuretral que acude a la emergencia por hematuria macroscópica y dolor abdominal suprapúbico. Se le realizó radiografía simple de pelvis, la que confirmó la presencia de litiasis vesical de grandes proporciones. Se reportó nivel de hormona paratiroidea de 335 pg/ml. Los pacientes con historia de cálculos de vías urinarias deben ser estudiados por patologías paratiroideas.

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Section: Discussionunclassified

Section: Introductionunclassified

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Litiasis vesical gigante en un paciente con hiperparatiroidismo primario: reporte de caso

López-Santiesteban

Yanez-Salguero

2017

Acta Med Peru

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Analysis of Time to Diagnosis and Outcomes Among Adults With Primary Hyperparathyroidism

et al. 2022

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ImportanceDespite access to routine laboratory evaluation, primary hyperparathyroidism (PHP) remains underdiagnosed and undertreated.ObjectiveTo determine the consequences associated with missed diagnoses and prolonged time to diagnosis and treatment of PHP.Design, Setting, and ParticipantsThis is a retrospective cohort study of patients older than 40 years with 2 instances of hypercalcemia during 2010 to 2020 and 3 years of follow-up. Patients were recruited from 63 health care organizations in the TriNetX Research Network. Data analysis was performed from January 2010 to September 2020.ExposuresElevated serum calcium.Main Outcomes and MeasuresExisting symptoms and diagnoses associated with PHP (osteoporosis, fractures, urolithiasis, major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, constipation, insomnia, polyuria, weakness, abdominal pain, headache, nausea, amnesia, and gallstones) compared in patients deemed high-risk and without a diagnosis and matched controls, and those who experienced times from documented hypercalcemia to diagnosis and diagnosis to treatment within or beyond 1 year.ResultsThere were 135 034 patients analyzed (96 554 women [72%]; 28 892 Black patients [21%] and 88 010 White patients [65%]; 3608 Hispanic patients [3%] and 98 279 non-Hispanic patients [73%]; mean [SD] age, 63 [10] years). Two groups without a documented diagnosis of PHP were identified as high risk: 20 176 patients (14.9%) with parathyroid hormone greater than or equal to 50 pg/mL and 24 905 patients (18.4%) with no parathyroid hormone level obtained or recorded explanation for hypercalcemia. High-risk patients experienced significantly increased rates of all associated symptoms and diagnoses compared with matched controls. Just 9.7% of those with hypercalcemia (13 136 patients) had a diagnosis of PHP. Compared with individuals who received a diagnosis within 1 year of hypercalcemia, those whose workup exceeded 1 year had significantly increased rates of major depressive disorder, anxiety, hypertension, gastroesophageal reflux disease, malaise or fatigue, joint pain or myalgias, polyuria, weakness, abdominal pain, and headache at 3 years. The rate of osteoporosis increased from 17.1% (628 patients) to 25.4% (935 patients) over the study period in the group with delayed diagnosis. Among those with a diagnosis, 5280 patients (40.2%) underwent parathyroidectomy. Surgery beyond 1 year of diagnosis was associated with significantly increased rates of osteoporosis and hypertension at 3 years after diagnosis compared with those treated within 1 year.Conclusions and RelevanceMany patients were at high risk for PHP without a documented diagnosis. Complications in these patients, as well as those who received a diagnosis after prolonged workup or time to treatment, resulted in patient harm. System-level interventions are necessary to ensure proper diagnosis and prompt treatment of PHP.

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Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience

Rawat

Grover

Kataria

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Hyperparathiroidism: Primary or Secondary Disease?

Cited by 18 publications

References 25 publications

Litiasis vesical gigante en un paciente con hiperparatiroidismo primario: reporte de caso

Litiasis vesical gigante en un paciente con hiperparatiroidismo primario: reporte de caso

Analysis of Time to Diagnosis and Outcomes Among Adults With Primary Hyperparathyroidism

Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience

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