Rapid Improvement of Osteoporosis Following Parathyroidectomy in a Premenopausal Woman With Acute Primary Hyperparathyroidism

Tritos, Nicholas A.; Hartzband, Pamela

doi:10.1001/archinte.159.13.1495

Cited by 19 publications

(2 citation statements)

References 27 publications

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“…[86] reported two patients with osteitis fibrosa cystica who experienced increases in bone density that ranged from 260 to 430% 3–4 years following surgery. More recently, similar observations have been made by Tritos and Hartzband [87] and by DiGregorio [88].…”

Section: Long‐term Results Of Surgery For Hyperparathyroidismsupporting

confidence: 86%

Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features

Bilezikian

Brandi

Rubin³

et al. 2004

Journal of Internal Medicine

186

115

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Primary hyperparathyroidism (PHPT) is characterized most commonly now as an asymptomatic disorder with hypercalcaemia and elevated levels of parathyroid hormone (PTH). The elevation in PTH is detected by both the standard immunoradiometric assays (IRMA) and a more recent IRMA that detects only the 1-84 full-length PTH molecule. The serum calcium concentration is usually <1 mg dL )1 above normal. Recently, another variant of PHPT (normocalcaemic PHPT) has been described in which the serum calcium is normal but the serum PTH is elevated, in the absence of any secondary cause for PTH elevation. Although usually sporadic, PHPT also occurs in inherited syndromes. Skeletal manifestations are appreciated by densitometry showing a typical pattern in which cancellous bone of the lumbar spine is reasonably well preserved whilst the cortical bone of the distal third of the radius is preferentially reduced. Although reduced in incidence, renal stones remain the most common overt complication of PHPT. Other organs are theoretical targets of PHPT such as the neurobehavioural axis and the cardiovascular system. Vitamin D looms as an important determinant of the activity of the PHPT state. The 2002 NIH Workshop on asymptomatic PHPT has led to revised guidelines to help doctors determine who is best advised to have parathyroid surgery and who can be safely followed without surgery. New information about the natural history of PHPT in those who did not undergo surgery has helped to define more precisely who is at-risk for complications. At the NIH workshop, a number of items were highlighted for further investigation such as pharmacological approaches to controlling hypercalcaemia, elevated PTH levels and maintaining bone density.

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Section: Long‐term Results Of Surgery For Hyperparathyroidismsupporting

confidence: 86%

Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features

Bilezikian

Brandi

Rubin³

et al. 2004

Journal of Internal Medicine

186

115

View full text Add to dashboard Cite

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“…The effects of parathyroidectomy on patients with 1°HPT have been well studied using biochemical assays of serum calcium and parathyroid hormone (PTH) and the use of bone mineral density (BMD) determinations as the sole outcome measures of success [7][8][9][10]. Although these physiologic measurements are important for assessing the surgical outcome of hyperparathyroidism, they are seldom sufficient to judge the overall effect of parathyroidectomy on patients with HPT [11,12].…”

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confidence: 99%

Patient‐based Surgical Outcome Tool Demonstrating Alleviation of Symptoms following Parathyroidectomy in Patients with Primary Hyperparathyroidism

et al. 2002

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This study assessed the impact of parathyroidectomy on the preoperative symptoms of patients with primary hyperparathyroidism (1 degrees HPT) using a surgical outcome tool designed specifically for HPT. The multicenter nature of this study allowed us to validate further this disease-specific outcome tool. 1 degrees HPT patients from Canada, the United States, and Australia filled out the questionnaire preoperatively and postoperatively on day 7 and at 3 and 12 months. The symptoms recorded by the patients were expressed as parathyroidectomy assessment of symptoms (PAS) scores: the higher the score, the more symptomatic is the patient. Quality of Life (QOL) and self-rated health uni-scales were included. Altogether, 203 patients with 1 degrees HPT were enrolled; 27 from center A, 54 from center B, and 122 from center C; 58 nontoxic thyroid patients were enrolled for comparison. The comparison group had no significant change in their PAS scores throughout the study (scores 184, 215, 156, 186). All three centers demonstrated a significant reduction in symptoms following surgery. The median preoperative PAS score from center B patients was 282. Following surgery, PAS scores decreased significantly: 136, 58, 0 (p <0.05). Center C patients had a median preoperative PAS score of 344, decreasing postoperatively to 228 (p <0.05) and continuing to decrease to 190, then 180. Center A also demonstrated a significant reduction in symptoms at 3 months, from 510 preoperatively to 209 (p <0.001). Both QOL and self-rated health improved in the HPT patients, whereas no change was found in the comparison group following surgery. PAS scores are a reliable, disease-specific measure of symptoms seen with HPT. Parathyroidectomy significantly reduces these preoperative symptoms, and this change translated into an improved health-related QOL for the patients.

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Abnormal bone scintigraphy and acute-onset severe primary hyperparathyroidism

Dell'Erba

Palermo

Orunesu

et al. 2003

J Endocrinol Invest

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Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

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Rapid Improvement of Osteoporosis Following Parathyroidectomy in a Premenopausal Woman With Acute Primary Hyperparathyroidism

Cited by 19 publications

References 27 publications

Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features

Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features

Patient‐based Surgical Outcome Tool Demonstrating Alleviation of Symptoms following Parathyroidectomy in Patients with Primary Hyperparathyroidism

Abnormal bone scintigraphy and acute-onset severe primary hyperparathyroidism

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