The influence of surgery on the risk of death in patients with primary hyperparathyroidism

Hedbäck, Gunilla; Odén, Anders; Tisell, Lars‐Erik

doi:10.1007/bf01658740

Cited by 140 publications

(91 citation statements)

References 21 publications

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“…In a recent population-based study, there was no evidence that primary hyperparathyroidism with mild hypercalcemia has any adverse effect on survival (58). Nevertheless, some authors recommend parathyroidectomy in all patients, in part because the operative mortality is extremely low (62), and in part because of reports suggesting that surgery may prevent fractures even in mildly hypercalcemic patients (43) and data suggesting surgical reduction of increased long-term mortality risk (63). We support the view that although parathyroidectomy remains the only definitive therapy for primary hyperparathyroidism, surgical intervention is not necessary in all patients (21,64).…”

Section: Management Of Primary Hyperparathyroidism -Medical Treatmentsupporting

confidence: 61%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

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As more and more cases of primary hyperparathyroidism are being detected by screening for serum calcium concentration, the majority of patients are older individuals who are asymptomatic or have symptoms which are difficult to ascribe to hyperparathyroidism. Long-term follow-up has provided evidence that most asymptomatic patients who do not undergo parathyroidectomy will not develop symptomatic complications. Some asymptomatic patients, however, have progression of disease over time. These observations and the lack of reliable predictors of the rate of progression in most patients reinforce the need for careful monitoring in elderly individuals who do not undergo surgery. Biannual measurements of serum calcium concentrations and annual measurements of urinary calcium excretion and bone mineral density should be performed in all patients who are managed conservatively. In elderly patients with symptomatic or complicated primary hyperparathyroidism, parathyroidectomy results in biochemical cure and increased bone density, both at the lumbar spine and the femoral neck, and should be considered. Criteria for surgery include significant hypercalcemia (.1 mg/dl above the upper limit of normal), marked hypercalciuria (. 400 mg per day), low bone density, unexplained renal insufficiency and an episode of acute primary hyperparathyroidism. Consideration of parathyroidectomy should also be given to elderly patients with primary hyperparathyroidism who are vitamin D deficient. Radionuclide scanning has become the initial non-invasive study of choice when parathyroid gland localization is necessary before parathyroidectomy; this is generally for fragile patients and reoperative cases. In a subset of older individuals, surgery may not be an option because of coexisting medical problems even though surgical indications are present.European Journal of Endocrinology 151 297-304

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Section: Management Of Primary Hyperparathyroidism -Medical Treatmentsupporting

confidence: 61%

Primary hyperparathyroidism: diagnosis and management in the older individual

Boonen

Vanderschueren²,

Pelemans³

et al. 2004

European Journal of Endocrinology

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“…47 Mortality benefits are not limited to patients with primary hyperparathyroidism, however. Parathyroidectomy also was associated with lower long-term mortality rates in patients receiving long-term dialysis, estimated at 10 to 15% lower than nonsurgical matched control subjects.…”

Section: Vitamin D Deficiency and Cardiovascular Disease Cardiovasculmentioning

confidence: 99%

The “Sunshine Deficit” and Cardiovascular Disease

2008

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I n past decades, the primary focus on vitamin D was the recognition and treatment of deficiency as it related to metabolic bone disease (rickets, osteomalacia, and secondary hyperparathyroidism). In the last 10 years, however, with the discovery of vitamin D receptors in multiple tissue types has come the recognition that the role of vitamin D extends beyond the musculoskeletal system. 1 The presence of abundant vitamin D receptors in myocardial tissue and vasculature and the observation that hypertension may be ameliorated with vitamin D suggest a greater role for vitamin D in the cardiovascular system. 2 Presently, large numbers of people are found to have hypovitaminosis D (a term chosen for this review to indicate any concentration below normal under substrate-saturated conditions) resulting in part from more indoor activities and the purposeful avoidance of sunshine. This review first describes why vitamin D, parathyroid hormone (PTH), and the skeleton are important to the heart and vasculature, then outlines why the epidemic of hypovitaminosis D deserves further scrutiny by the cardiovascular community, and finally suggests why treatment options for reducing hypovitaminosis D may favorably affect the morbidity and mortality of common cardiovascular disorders. Vitamin D and PTH: Basic Biochemistry and PhysiologyVitamin D is both a nutrient and a hormone. It is an essential precursor of calcitriol, 1,25-hydroxyvitamin D3 [1,25(OH) 2 D], which is necessary for bone development, growth, and mineralization and the maintenance of skeletal integrity. A cascade of steps is needed to cause progression of lesser active nutritionally ingested or synthesized vitamin D to more biologically active forms as depicted in Figure 1. 1 The cascade starts with the photolysis of 7 dehydrocholesterol in the epidermis by solar ultraviolet B (UVB) radiation to previtamin D3, which then undergoes thermal isomerization to vitamin D3. Vitamin D3 undergoes primary hydroxylation in the liver to 25-hydroxyvitamin D [25(OH)D] and then undergoes a second hydroxylation, primarily in the kidney, to the highly biologically active 1,25(OH) 2 D. Calcitriol increases bone resorption, gastrointestinal calcium absorption, renal tubular calcium reabsorption, and renal excretion of calcium. In concert with PTH, it is required for the efficient use of dietary calcium and the maintenance of calcium-phosphorus homeostasis, and it helps to maintain normal ionized calcium and phosphorus concentrations. PTH secretion is inversely related to ionized calcium concentration; thus, if the ionized calcium concentration drops, PTH secretion increases and restores normal calcium concentration. This is accomplished as the hormone stimulates renal production of calcitriol, increases osteoclastic bone resorption, increases gastrointestinal calcium absorption, and increases renal tubular resorption of calcium. PTH secretion is affected not only by vitamin D but also by disorders of magnesium and phosphorus metabolism, which may occur in conditions of malnutrition,...

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“…Symptoms of less than two years' duration usually regress after surgery [6] and the risk of higher mortality seems to disappear after 5 Á15 years [7].…”

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confidence: 99%