Is parathyroidectomy safe and effective in patients with normocalcemic primary hyperparathyroidism?

Traini, Emanuela; Bellantone, Rocco Domenico Alfonso; Tempera, Serena Elisa; Russo, Salvatore; Crea, Carmela De; Lombardi, Celestino Pio; Raffaelli, Marco

doi:10.1007/s00423-018-1659-0

Cited by 41 publications

(39 citation statements)

References 28 publications

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“…24 Lastly, in terms of the clinical presentation of normocalcaemic patients, the sensitivity of the imaging tests (mainly Tc-sestamibi scintigraphy and ultrasonography) was lower and was probably heavily influenced by the higher incidence of multiglandular disease and the presence of small adenomas, a finding shared by practically all series. 17,18,25,26 The main limitation of the present study is that there might be a selection bias, given that all patients were referred to surgery by the endocrinologist. However, in our centre the indications to send a normocalcaemic patient to surgery are similar to those of hypercalcaemic patients.…”

Section: Discussionmentioning

confidence: 96%

Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form?

Gómez-Ramírez

Gómez-Valdazo

Luengo

et al. 2020

The American Journal of Surgery

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Section: Discussionmentioning

confidence: 96%

Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form?

Gómez-Ramírez

Gómez-Valdazo

Luengo

et al. 2020

The American Journal of Surgery

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“…( 45 ) A large surgical single‐center retrospective study found that after parathyroidectomy, as many as 41.7% and 40.0% of patients showed improvements in BMD and kidney stones, respectively. ( 59 ) However, this study did not provide T ‐scores or BMD percentage changes.…”

Section: Surgical and Medical Outcomesmentioning

confidence: 89%

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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Normocalcemic primary hyperparathyroidism (NHPT) was first described over 10 years ago, but uncertainties still remain about its definition, prevalence, and rates of complications. As a result, consensus management guidelines for this condition have not yet been published. Several hypotheses have been proposed for the pathophysiology of NHPT, but it may be a heterogeneous disorder with multiple causes, rather than a single etiology that explains this biochemical phenotype. A common clinical concern is whether NHPT should be treated surgically when complications are already present at first recognition of the disorder, rather than following patients clinically over time. The literature on NHPT is based mostly on larger studies of population‐based cohorts and smaller studies from referral centers. Lack of rigorous diagnostic criteria and selection bias inherent in populations seen at tertiary referral centers may explain the heterogeneity of reported rates of bone and renal complications in relation to consistently mild laboratory alterations. Unresolved questions remain about the significance of NHPT when it is diagnosed biochemically without evident bone or kidney complications. Moreover, its natural history remains to be elucidated because a proportion of what is classified as NHPT may revert to normal spontaneously, thus revealing previously unrecognized secondary hyperparathyroidism. These issues indicate that caution should be used in recommending surgery for NHPT. This review will focus on recent issues regarding the pathophysiology, evaluation, and management of NHPT. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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“…Whether parathyroidectomy improves renal outcomes in patients with normocalcaemic primary hyperparathyroidism remains much less understood. Traini et al followed a small cohort of patients (n = 10) and found that 40% of patients with pre‐existing nephrolithiasis no longer had stones after parathyroid surgery 59 . Another study of 48 patients with normocalcaemic primary hyperparathyroidism demonstrated an 80% cure rate in nephrolithiasis following removal of parathyroid adenomas and hyperplastic glands 61…”

Section: Managementmentioning

confidence: 99%

Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

Dawood

Yan

Shieh

et al. 2020

Clinical Endocrinology

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Normocalcaemic primary hyperparathyroidism is a condition that can present with intermittent hypercalcemia or may evolve into hypercalcemic primary hyperparathyroidism. This milder biochemical entity remains incompletely understood because of a lack of long-term health outcomes regarding both medical and surgical approaches to its management. Medical therapies have shown some efficacy. A limited number of studies have found that bisphosphonates increase bone mineral density, and cal

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Is parathyroidectomy safe and effective in patients with normocalcemic primary hyperparathyroidism?

Abstract: In normocalcemic patients, parathyroidectomy is as safe and effective as in hypercalcemic patients. In the presence of symptoms and/or target organ disease, parathyroidectomy may have a positive effect on the outcome of NHPT patients.

Cited by 41 publications

References 28 publications

Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form?

Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form?

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

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