Normal PTH Levels in Primary Hyperparathyroidism: Still the Same Disease?

Amin, Amanda L.; Wang, Tracy; Wade, Thomas J.

doi:10.1245/s10434-011-1744-x

Cited by 35 publications

(52 citation statements)

References 14 publications

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“…On the other hand, decreased 1.25(OH) 2 D 3 despite normal 25(OH)D indicating non-enhanced 25-hydroxyvitamin D 3 1-alpha-hydroxylase, and normal bone alkaline phosphatase pointing to absence of increased bone turnover, were not indicative of PHPT. Moreover, the serum concentration of intact PTH fluctuated spontaneously above and below the upper limit of the reference range in this patient, which was also observed in 13% (108/861) of patients with sporadic PHPT [4] in a previous study. Although a rare adult case of mild hypercalcaemia with a mutation in CaSR has been reported [5] , there was no inactivating mutation of CaSR in this patient.…”

supporting

confidence: 81%

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

Nakasone

Uchino

Sato

et al. 2015

European Journal of Case Reports in Internal Medicine

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A 68-year-old man was admitted because of tonic-clonic convulsion. He had been receiving 200 mg itraconazole for 10 days. He had hypokalaemia (2.2 mEq/l), hypercalcaemia (Ca corr 11.0 mg/dl) and elevated serum parathyroid hormone (PTH, 95 pg/ml). Ultrasound examination of the neck revealed a low echoic tumour. Cessation of itraconazole and fluid supplementation eradicated clinical symptoms and profound hypokalaemia, but serum potassium remained low normal (3.4 mEq/l) and the mild hypercalcaemia and elevated PTH were unchanged. To conclude, a small amount of itraconazole (200 mg) precipitated profound hypokalaemia and seizure in a patient with mild hyperparathyroidism and low normal serum potassium. LEARNING POINTS• The clinical presentation of hyperparathyroidism is very diverse.• Determination of corrected calcium is mandatory in critical care units.• A few minor things occurring together can have major clinical consequences.

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supporting

confidence: 81%

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

Nakasone

Uchino

Sato

et al. 2015

European Journal of Case Reports in Internal Medicine

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“…The true incidence of normohormonal PHP is very difficult to ascertain [14]. The reported incidence in the literature is 3-10.5% [6,13,14,18,23,24]. To our knowledge, the cohort of Amin [18] of 58 sporadic PHP patients with normal PTH levels is the largest reported in the literature to date.…”

Section: Discussionmentioning

confidence: 95%

“…In 1987, parathyroid-hormone-related peptide (PTHrp) has been isolated as a causative factor of malignant hypercalcemia [10]. Previous studies have suggested that this condition is a less symptomatic, lighter and weaker form of PHP [18].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative parathyroid hormone (PTH) testing in patients with primary hyperparathyroidism and PTH levels in the normal range

et al. 2019

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Background: Primary hyperparathyroidism is a common endocrine disorder. Hypercalcemia with normal PTH levels is very unusual and can lead to diagnostic difficulties. There are very few very few studies in the literature and all with limited numerical samples. The goal of the present study was to determine the real incidence and characteristics of primary hyperparathyroidism with normal PTH and to evaluate if intraoperative PTH testing is useful in these patients. Methods: We performed a retrospective review of 314 patients who had undergone parathyroidectomy to treat primary hyperparathyroidism between January 2002 and December 2016. Patients were divided in two groups according to biochemical preoperative findings: in Group A were included patients with normal serum PTH, in Group B those with increased serum PTH. Results: Nine patients (3.7%) were included in group A and 235 in group B. Patients in group A were younger (51. 5 ± 12.9 years vs 59.6 ± 12.5); preoperative serum calcium and the incidence of coexisting thyroid disease were similar between the two groups. Symptomatic patients were more frequent in Group A (77.8% vs 39.1%; p = 0.048). There were no significant differences regarding preoperative localization studies and surgical procedure. Intraoperative PTH determination demonstrated sensitivity of 86% in group A and 97% in group B, specificity and positive predictive value of 100% in both the groups, negative predictive value of 67% in group A and 79% in group B. Histopathological examination demonstrated a single gland disease in 8 (88.9%) patients in group A and a multi gland disease in 1 (11.1%), in group B single gland disease was found in 218 (92.8%) patients and multi gland disease in 17 (7.2%). Unsuccessful surgery with persistent or recurrent hyperparathyroidism occurred in 1 (11.1%) patient in group A and 4 (1.7%) in group B. Conclusions: Primary hyperparathyroidism with normal PTH is rare but physicians should be aware of this possibility in patients with hypercalcaemia. Patients with normal PTH levels are younger and more frequently symptomatic. Intraoperative PTH testing plays an important role in the operative management even in such patients.

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“…Generally, PTH levels are frankly elevated in cases with PHP, but in our case it was mildly elevated despite marked calcium elevation. This was unexpected, but in a study that compared patients with PHP having normal PTH levels with those having elevated PTH levels, the mean serum calcium levels and subjective symptoms were similar (32). Although mild-moderate hypercalcemia is frequent in (PHP), it should be noted that it can be severe and refractory to maximum medical treatment requiring emergency surgical intervention.…”

Section: Discussionmentioning

confidence: 96%

Parathyroid Adenoma Complicated with Severe Hypercalcemia, Encephalopathy and Pancreatitis

Okaygün¹,

Sav²,

Mousa³

et al. 2015

tjem

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Abs tract ÖzetPrimary hyperparathyroidism is the most frequent cause of hypercalcemia in adults. Primary hyperparathyroidism generally leads to mildmoderate hypercalcemia. Severe hypercalcemia in these cases is rare. Coexistence of severe hypercalcemia and hypercalcemic encephalopathy is very unusual with very limited number of reported cases. Our case is a 50-year-old female who presented to the emergency department with the complaints of nausea and severe abdominal pain. Her serum calcium level was 19.7 mg/dL (8.8-10.2 mg/dL) and her PTH level was 73.5 ng/ dL (15-65) on presentation. After her hospitalization, she was treated with saline infusions and furosemide, however, her calcium level increased to 22.4 mg/dL. Her calcium levels were also refractory to subcutaneous calcitonin 200 mg twice a day and zoledronic acid 4 mg. Ultrasonography of the neck revealed a 3.2x2.7x4.6 cm mass suspicious for a left parathyroid adenoma hardly being distinguished from a left thyroid nodule. Considering her general situation getting worse despite maximum medical treatment, she underwent an emergency parathyroidectomy and total thyroidectomy. Early postoperatively, the patient's general condition deteriorated reaching a precoma state. Cranial computed tomography (CT) at this point revealed periventricular ischemia compatible with metabolic encephalopathy. During the follow-up postoperatively, the patient's serum calcium levels normalized eventually requiring active vitamin D and calcium pills and she no longer had symptoms of encephalopathy. The pathology specimen was reported as a parathyroid neoplasm compatible with atypical parathyroid adenoma. Although mild-moderate hypercalcemia is frequent in primary hyperparathyroidism, it should be noted that it can be severe and refractory to maximum medical treatment requiring emergency surgical intervention. In addition, not being one of the most frequent reasons, severe hypercalcemia due to primary hyperparathyroidism should be considered as an important cause of metabolic encephalopathy. Turk Jem 2015; 19: 105-108Erişkinlerde hiperkalseminin en sık görülen sebebi primer hiperparatiroididir. Primer hiperparatiroidinin yol açtığı kalsiyum yüksekliği genellikle ılımlıdır. Bu olgularda ciddi hiperkalsemi seyrektir. Bu olgularda ciddi hiperkalsemi ile birlikte hiperkalsemik ensefalopati birlikteliği seyrek görülmekte olup sınırlı sayıda olgu sunumu literatürde bildirilmiştir. Elli yaşındaki kadın olgumuz bulantı ve ciddi karın ağrısı şikayeti ile acil servise başvurusunda serum kalsiyum düzeyi 19,7 mg/dL (8,8-10,2 mg/dL) ve serum PTH düzeyi 73,5 (13-65) ng/dL olarak saptandı. Hastaneye yatışının ardından serum fizyolojik infüzyonu ve furosemid tedavisine rağmen kalsiyum düzeyi 22,4 mg/dL'ye kadar yükseldi. Kalsitonin günde 2 kez 200 mg subkutan ve zoledronik asit 4 mg intravenöz verilmesi sonrası da yanıt alınamadı. Boyun ultrasonografisinde sol lob inferiorunda tiroid nodülünden zor ayrılabilen ve paratiroid ile uyumlu olabilecek 3,2x2,7x4,6 cm kitle izlendi. Genel durumunun tedaviye ...

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Normal PTH Levels in Primary Hyperparathyroidism: Still the Same Disease?

Cited by 35 publications

References 14 publications

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

Intraoperative parathyroid hormone (PTH) testing in patients with primary hyperparathyroidism and PTH levels in the normal range

Parathyroid Adenoma Complicated with Severe Hypercalcemia, Encephalopathy and Pancreatitis

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