Primary hyperparathyroidism: A prospective clinical study

Purnell, Don C.; Smith, Lynwood H.; Scholz, D; Elveback, Lila R.; Arnaud, Claude D.

doi:10.1016/0002-9343(71)90122-7

Cited by 202 publications

(34 citation statements)

References 9 publications

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“…The immunoreactive species of parathyroid hormone which this assay measures in 95% of normal adult sera is undetectable in hypoparathyroid sera and is increased over 40 fj. eq/ml [50] in 90% of hyperparathyroid sera [3,27]. GP-1M antiserum reacts with all currently known circulating species of parathyroid hormone [10].…”

Section: Methodsmentioning

confidence: 99%

Serum Parathyroid Hormone and Blood Minerals: Interrelationships in Normal Children

et al. 1973

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Section: Methodsmentioning

confidence: 99%

Serum Parathyroid Hormone and Blood Minerals: Interrelationships in Normal Children

et al. 1973

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“…N MOST SERIES PRIMARY hyperparathyroidism typically presents as an asymptomatic disorder, which has been, for the most part, attributable to the introduction of routine screening started in the mid 1970s (1)(2)(3). In our institution, routine serum calcium measurements have now been used as part of medical examination for 23 years (4).…”

mentioning

confidence: 99%

From mild to severe primary hyperparathyroidism: the Brazilian experience

Bandeira

Griz

Caldas

et al. 2006

Arq Bras Endocrinol Metab

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Primary hyperparathyroidism often presents as an asymptomatic disorder. In our institution, routine serum calcium measurements have now been used as part of medical examination for 23 years. Out of 124 patients consecutively seen at our institution, 47% presented with no symptoms related to the disease, while 25% presented with severe skeletal involvement and osteitis fibrosa cystica, 25% with renal stone disease without overt bone involvement, and 2% with the typical neuropsychiatric syndrome. This same pattern is seen in the city of São Paulo. In severe disease pathological fractures are frequently seen, especially in long bones of the lower extremities, and also loss of lamina dura of the teeth and salt-and-pepper appearance of the skull. Bone mineral density is extremely low in these patients but usually show remarkable recovery following surgical cure. Serum PTH and bone markers are considerable higher in severely affected patients, who also have a high rate of vitamin D deficiency, and the parathyroid lesion is easier located compared with asymptomatic patients. From pathological specimens 87% had histological confirmation of a single adenoma, 6.4% multiple gland hyperplasia and 3.8% carcinoma. Na maioria dos relatos da literatura recente, o hiperparatiroidismo primário apresenta-se, com freqüência, na forma assintomática. Em nossa instituição utilizamos a determinação rotineira do cálcio sérico há 23 anos. Em nossa série de 124 casos consecutivos, 45% não apresentavam sintomas relacionados com a doença, 25% tinham envolvimento esquelético intenso com osteíte fibrosa cística, 25% tinham nefrolitíase sem envolvimento ósseo severo, e 2% apresentavam a síndrome neuro-psiquiátrica típica. Esse mesmo padrão tem sido observado na cidade de São Paulo. Na doença severa são freqüentes as fraturas patológicas, especialmente nos ossos longos dos membros inferiores, como também a reabsorção da lâmi-na dura dos dentes e o aspecto em "sal e pimenta" nas radiografias do crânio. A densidade mineral óssea mostra-se extremamente reduzida nesses pacientes, mas em geral exibe melhora marcante após a cura cirúrgi-ca. O PTH no soro e os marcadores bioquímicos da remodelação óssea estão significativamente mais altos nos pacientes com doença severa, os quais freqüentemente apresentam deficiência de vitamina D e localização mais fácil da lesão paratiroideana, quando comparados aos pacientes assintomáticos. Ao exame anátomo-patológico, 87% tiveram confirmação de adenoma único, 6,4% hiperplasia glandular difusa e 3,8% carcinoma.

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“…This suggests that the secretion of parathyroid hormone is presumably greater in patients with skeletal syndrome than in those with other syndromes. Such presumption is substantially supported by the report of Purnell et al (1971), showing that in patients with primary hyper parathyroidism, both levels of tumor weight and serum parathyroid hormone are significantly higher in the cases with than in those without bone disease as evidenc ed on roentgenograms. Therefore, it may well be justified to conclude that in patients with primary hyperparathyroidism, the degree of parathyroid hormone secretion is related to the incidence and extent of proximal RTA .…”

Section: Discussionmentioning

confidence: 69%