Should Symptoms Be Considered an Indication for Parathyroidectomy in Primary Hyperparathyroidism?

McDow, Alexandria D.; Sippel, Rebecca S.

doi:10.1177/1179551418785135

Cited by 22 publications

(16 citation statements)

References 46 publications

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“…PTH acts as on G-protein-coupled receptors to activate phospholipase V on myocytes and protein kinase A on vascular endothelium [8]. The proposed mechanisms of development of cardiovascular dysfunction in PHPT include: 1) Development of hypertension: driven by alteration in vasodilatory properties of endothelium and/or hyperaldosteronism as a result of activation of renin-aldosterone-angiotensin axis (RAAS); 2) Development of LVH: driven by PTH mediated hypertrophy of cardiac myocytes, endothelial dysfunction [19]; 3) Calcification of myocardium and aorta.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, angiotensin II may have an acute and direct effect on PTH synthesis and secretion [20]. In addition, PTH may play a direct effect on the RAAS system, through potentiation of angiotensin II induced aldosterone secretion from the zona glomerulosa cells [19][20][21][22]. It has been suggested that aldosterone may stimulate secretion of PTH by one of two mechanisms: either by virtue of a secondary hyperparathyroidism induced by a chronic aldosterone excess inducing hypercalciuria and hypocalcaemia [23], or by a more direct effect mediated via mineralocorticoid receptors in the parathyroid tissue [24].…”

Section: Discussionmentioning

confidence: 99%

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Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management

Nana

Morgan

Shrikrishnapalasuriyar

et al. 2019

J Endocrinol Metab

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Background: There is emerging evidence suggestive of endothelial and cardiovascular dysfunction in patients with mild or asymptomatic primary hyperparathyroidism (PHPT) although there is a lack of clear consensus regarding potential cardiovascular benefits post elective parathyroidectomy. Methods: We carried out a retrospective observational study on patients with a biochemically confirmed diagnosis of PHPT who were under follow-up at our district general hospital between 1995 and 2016. The primary objective of the study was to compare all-cause mortality in patients who underwent elective parathyroidectomy versus the patients who were managed conservatively. The secondary objective of our study was to compare the rate of development of atherosclerotic cardiovascular disease (ASCVD) in the two groups. Results: Our results showed no statistically significant difference in all-cause mortality rate in the patients managed conservatively as compared to the surgically treated group. However, the rate of AS-CVD events, including coronary artery disease and hypertension, were lower in the latter group. Conclusions: The adverse impact of PHPT on the cardiovascular system remains underrecognized with most of the evidence being derived from observational studies supporting a correlation between parathyroid hormone (PTH) levels and ASCVD events. All patients with PHPT should undergo clinical evaluation for ASCVD risks during initial workup as well as during follow-up visits. As elective parathyroidectomy is a relatively safe procedure and ASCVD risk is known to increase with age, there is a rationale to consider surgery for the majority of asymptomatic PHPT patients aged < 60 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management

Nana

Morgan

Shrikrishnapalasuriyar

et al. 2019

J Endocrinol Metab

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“…Afterward, the patients undergoing asymptomatic primary hyperparathyroidism were selected based on the following criteria: serum calcium levels 1 mg/dl above the upper limit of the normal range (>11.5 mg/dl), below 50 years old, glomerular filtration rate (eGFR) < 60 mL/min, a history of fracture fragility, and T-score <2.5 SD. 16 The exclusion criteria were as follows: being unwilling to continue the study, experiencing unsuccessful PTX, using Estrogen and Progestin, and taking vitamin D supplements. 17 Factors such as serum phosphate, 1,25(OH) 2 D 3 , calcium vitamin D, alkaline phosphatase (ALP), PTH, urea, creatinine (Cr), FGF23, and 24-hour urine for calcium were first checked in the same laboratory.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Serum Level of FGF23 and 1,25(OH)2D3 in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy

Hassani

Afkhamizadeh

Teimouri

et al. 2020

IJGM

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Purpose: Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) play critical roles in phosphate homeostasis. To the best of our knowledge, there are limited data on the impact of FGF23 and PTH on serum calcium, 1,25(OH) 2 D 3 , and phosphate in patients with primary hyperparathyroidism (PHPT). We examined these parameters and their correlations in PHPT patients before and after parathyroidectomy (PTX). Patients and Methods: In this prospective cohort study, 29 PHPT patients who met the inclusion criteria were selected. The patient's blood samples were taken three times: before the operation, 24 h after the operation, and 1 week after the operation. The concentrations of serum calcium, FGF23, 1,25(OH) 2 D 3 , phosphate, PTH, and alkaline phosphatase were measured in a referral laboratory at each of the three steps. Moreover, 25(OH)D was primarily measured just before the surgery. Results: Of 29 patients included in this study with a mean age of 52.37±12.3 years, majority were females (75.8%). Serum FGF23 and 1,25(OH) 2 D 3 levels were high before PTX and decreased after the operation; however, the difference was not statistically significant. FGF23 levels were significantly correlated with 1,25(OH) 2 D 3 at each of the three steps (r=0.964, P <0.01; r=0.985, P <0.0; and r=0.976, P <0.05). The variations in calcium, phosphate, creatinine, and PTH were preoperatively and postoperatively significant. Conclusion: Although 1,25(OH) 2 D 3 and FGF23 levels were preoperatively higher in PHPT, their variations were not meaningful. There was a statistically direct significant relationship between 1,25(OH) 2 D 3 and FGF23 preoperatively and postoperatively; however, the correlations between FGF23 and calcium, phosphate, and PTH were not significant.

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“…However, this is disputed as some claim that a truly asymptomatic PHPT patient is quite rare. 4 Whereas most asymptomatic patients do not exhibit disease progression, as defined by worsening hypercalcemia, hypercalciuria, bone disease, and/or nephrolithiasis, 5 some individuals do progress and would benefit from surgery. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

Sagiv

Delgado

Sadeh

et al. 2021

Laryngoscope Investig Oto

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Background: Patients with primary hyperparathyroidism (PHPT) treated surgically occasionally have normalized calcium, but persistently high parathyroid hormone (PTH). We hypothesized that a possible explanation for this phenomenon is an underlying hyperplasia rather than adenoma.Methods: Retrospective cohort of patients who underwent parathyroidectomy for PHPT with biopsy of a normal-appearing parathyroid gland were included. Cellularity level of each biopsy and of the adenoma's rim was determined.Results: Forty-seven patients were included. Of them, 19 (40%) had postoperative normocalcemia but elevated PTH. There was no correlation between cellularity either in the rim or of the normal-appearing parathyroid gland and postoperative PTH. The postoperative high PTH group had higher preoperative PTH (P = 0.001) and larger adenomas (P = 0.025).Conclusions: High PTH levels after successful parathyroidectomy in patients with primary hyperparathyroidism do not appear to result from underlying hyperplasia. A possible alternative explanation is that these patients have a higher preoperative burden of disease.cellularity, elevated PTH levels, parathyroid adenoma, parathyroid hyperplasia, parathyroidectomy | INTRODUCTIONPrimary hyperparathyroidism (PHPT) is diagnosed by an elevated parathyroid hormone (PTH) concentration in patients with hypercalcemia and hypercalciuria. Its most common clinical presentation is asymptomatic hypercalcemia. 1 It is recommended that patients with symptomatic PHPT (nephrolithiasis, symptomatic hypercalcemia) have parathyroid surgery, which is the only definitive therapy. 2,3 In some patients with asymptomatic disease, surgery is not mandatory. However, this is disputed as some claim that a truly asymptomatic PHPT patient is quite rare. 4 Whereas most asymptomatic patients do not exhibit disease progression, as defined by worsening hypercalcemia,

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Should Symptoms Be Considered an Indication for Parathyroidectomy in Primary Hyperparathyroidism?

Cited by 22 publications

References 46 publications

Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management

Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management

<p>Evaluation of Serum Level of FGF23 and 1,25(OH)<sub>2</sub>D<sub>3</sub> in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy</p>

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

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