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PubMed1977

Metabolic effects of diphosphonate in primary hyperparathyroidism.

Six patients with primary hyperparathyroidism (PHPT) and one with squamous cell carcinoma of the esophagus with parathyroid hormone excess received disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP) at a daily dose of 20 mg/kg orally. During treatment, the decrease in urinary calcium, total urinary hydroxyproline, and fasting urinary calcium suggested an inhibition of bone resorption. Serum calcium intestinal absorption of calcium and urinary cyclic adenosine monophosphate (cAMP) did not change significantly. This preliminary study indicates a possible role of diphosphonates in the management of inoperable cases of primary hyperparathyroidism or pseudohyperparathyroidism.

Adult↗

PubMed1978

Primary hyperparathyroidism and peptic ulcer disease.

To determine whether primary hyperparathyroidism is related to peptic ulcer disease, we evaluated 46 cases of concomitant primary hyperparathyroidism and peptic ulcer disease. Among these patients, there was no sex preponderance. The pathologic findings at parathyroid surgery, as well as the features of peptic ulcer disease, were the same as in patients with primary hyperparathyroidism or with peptic ulcer disease alone. The ulcer symptoms of 58% of the patients with adequate follow up improved after parathyroidectomy. Sixty-six percent of the patients who had active peptic ulcer disease at surgery improved as compared with only 44% of the patients who had complicated peptic ulcer disease. None of the factors studied (age, sex, serum calcium and serum parathyroid hormone levels, location, and duration of ulcer) had any effect on the peptic ulcer symptoms after parathyroidectomy. Our results and a critical review of the experimental and clinical literature suggest that the association between primary hyperparathyroidism and peptic ulcer disease is no more than coincidental.

Follow-Up Studies↗

PubMed2026

10-year cardiovascular disease risk and its contributing factors in primary hyperparathyroidism.

OBJECTIVE: Surgery indications for primary hyperparathyroidism (PHPT) mostly concern kidney and bone outcome, but not cardiovascular disease (CVD). Age less than 50 and eGFR less than 60 ml/min/1.73m2 are two surgery indications. This study aims to evaluate factors influencing the 10-year CVD risk in PHPT patients. METHOD: 159 PHPT patients diagnosed between January 2024 - March 2025 were enrolled. The relationships between biochemical and echocardiographic parameters with 10-year CVD risk score calculated by PREVENT™ were analyzed. Univariate, multivariate, logistic regression and receive operation curve (ROC) analysis were employed. RESULTS: 10-year CVD risk score was positively corelated with age (R2adjusted = 0.604, β = 0.541), systolic blood pressure (R2adjusted =0.149, β = 0.185), eGFR (R2adjusted =0.452, β=-0.252), triglyceride (R2adjusted =0.134, β = 3.629) with P < 0.001.These parameters together with smoking, diabetes and left ventricular end-diastolic diameter were responsible for 10-year CVD risk (R2adjusted =0.849, P < 0.001). Age and eGFR were the two strongest factors to discriminate moderate-to-high risk and low risk, with area under the curve 0.935 (95%CI 0.896–0.974) and 0.827 (95%CI 0.763–0.891), respectively. The optimal cutoffs to identify moderate-to-high CVD risk were age at 56.5 and eGFR at 98.5 ml/min/1.73m2, PHPT patients older or lower than these two thresholds had significantly higher CVD risk than their counterparts (P < 0.001). CONCLUSION: Age and eGFR were significant contributors to CVD risk in PHPT. Patients should be closely monitored and managed for dysregulated gluco-lipid metabolism. Less restrictive surgery indication for PHPT, such as age < 56, irrespective of renal function might be considered.

Humans↗

PubMed1979

Pre- and postoperative studies of plasma calcitonin in primary hyperparathyroidism.

The importance of calcitonin in the homeostatic response to the chronic hypercalcemia of primary hyperparathyroidism is uncertain. To clarify this issue, we have used a new, sensitive radioimmunoassay for human calcitonin to measure basal plasma calcitonin concentrations in 50 patients with primary hyperparathyroidism (32 female, 18 male). We assayed calcium-stimulated calcitonin concentrations preoperatively in 22 of the patients (16 female, 6 male) and postoperatively in 6. Finally, we assayed pentagastrin-stimulated calcitonin concentrations preoperatively in eight of the patients (three female, five male). Plasma calcitonin values after an overnight fast were indistinguishable from those in normal subjects (mean+/-SE, males, 48+/-3 normal and 46+/-5 pg/ml hyperparathyroid, females, 31+/-2 normal and 37+/-3 pg/ml hyperparathyroid.) Among hyperparathyroid patients of both sexes, increases of calcitonin during Ca infusion (15 mg Ca/kg in 4 h) were within normal limits. However, the mean maximal increase of calcitonin was significantly lower in hyperparathyroid than in normal subjects (P < 0.05). In six patients normocalcemic 5-15 mo after parathyroid surgery, fasting plasma calcitonin values were not significantly different, but responses to Ca infusion were greater than preoperatively (Delta calcitonin +/-SE: 13+/-4 preoperatively and 53+/-35 pg/ml postoperatively). The mean maximal increase of calcitonin after pentagastrin (0.5 mug/kg i.v.) was slightly lower than normal in the patients (mean+/-SE, males, 45+/-8 normal and 38+/-10 pg/ml hyperparathyroid, females, 6+/-2 normal and 0 pg/ml hyperparathyroid). Thus, primary hyperparathyroidism is accompanied by normal steady-state concentrations of circulating calcitonin, and normal-to-blunted C-cell responses to pentagastrin or induced hypercalcemia, the response to calcium generally increasing after successful parathyroid surgery. These results clearly show that primary hyperparathyroidism is not characterized by hypercalcitoninemia. The seemingly paradoxical absence of elevated steady-state calcitonin concentrations may be accounted for partly by decreased secretory reserve. However, primary hyperparathyroidism may also be accompanied by an increase in the threshold of sensitivity for calcium stimulation of calcitonin secretion.

Adolescent↗

PubMed1978

Experience with the radioimmunoassay for parathyroid hormone in the diagnosis of primary hyperparathyroidism.

Our results with radioimmunoassay studies for parathyroid hormone performed during the last 6 years are compared retrospectively to results of the laboratory tests customarily secured when hyperparathyroidism is suspected. The results obtained in patients with known primary hyperparathyroidism and in patients with unconfirmed but presumptive hyperparathyroidism are compared to the results obtained from a group of normal controls. Despite the fact that certain discrepant results were noted in the earlier assay techniques the over-all results and, in particular, those of more recent years have been highly sensitive and reproducible corroboratives of the existence of primary hyperparathyroidism. About two-thirds of the patients with primary hyperparathyroidism will present to the urologist. All patients with calcium-containing stones should have at least 3 determinations of the serum calcium in screening for primary hyperparathyroidism. The radioimmunoassay for parathyroid hormone provides the most reliable confirmation. The patient with calculous disease, elevation of the immunoreactive parathyroid hormone level and hypercalcemia is virtually certain to have primary hyperparathyroidism.

Animals↗

PubMed1977

Experience with the radioimmunoassay for parathyroid hormone in the diagnosis of primary hyperparathyroidism.

Calcium↗

PubMed1979

Value of selective parathormone radioimmunoassay in primary hyperparathyroidism.

Nine cases of primary hyperparathyroidism (PHP) in patients with urinary calculi are reported and discussed. Selective venous catheterization and parathormone (PTH) radioimmunoassay confirmed the diagnosis in all cases, preoperatively discriminated between adenoma and diffuse parathyroid hyperplasia, and permitted exact preoperative localization of 5 of 7 adenomas. The interest of the urologist in PHP and the usefulness of selective PTH radioimmunoassay are discussed and emphasized.

Adenoma↗

PubMed1977

Primary hyperparathyroidism exacerbated by pregnancy.

Primary hyperparathyroidism may remain subclinical as long as there is adequate calcium in the diet. If the demand for calcium increases, as in pregnancy, the symptoms become evident. Any giant cell growths should alert the oral surgeon to the possibility of hyperparathyroidism. Untreated, hyperparathyroidism ultimately leads to fractures, irreversible kidney damage, and death by renal failure. Tetany must be guarded against after parathyroid surgery. Finally, the brown tumors of hyperparathyroidism need not be removed surgically since bone will regenerate if the disease is correctly treated by removal of the parathyroid adenoma.

Adenoma↗

PubMed1979

Calcitonin secretion in primary hyperparathyroidism.

Plasma calcitonin (CT) was studied by RIA in 55 patients with surgically proven primary hyperparathyroidism. Basal hormone measurements were performed in all patients and provocative tests of CT secretion were performed in 7. Biochemical measurements were also made before and after parathyroidectomy in 34 patients. Plasma CT was significantly increased above normal in the male but not the female group of patients with primary hyperparathyroidism. A similar sex difference in plasma CT was also seen during provocative testing. In contrast to normal subjects, plasma CT was also significantly correlated to serum calcium concentration in the males but not the females. Hormone concentrations returned to normal after parathyroidectomy in the males and did not significantly change in the females. These studies demonstrate that some patients with primary hyperparathyroidism, especially males, may have an increase, perhaps compensatory, in plasma CT. As with normal females, females with primary hyperparathyroidism seem to have decreased CT reserve.

Adenoma↗

PubMed1978

Primary hyperparathyroidism and stone formation in medullary sponge kidneys.

The etiological role of primary hyperparathyroidism in stone formation in medullary sponge kidney was studied. The necessity of carrying out special biochemical tests for primary hyperparathyroidism has been shown. The combination of two diseases in cases of stones and nephrocalcinosis is explained by the genetic nature of sponge kidney and primary hyperparathyroidism. 4 patients have been under observation; all underwent successful parathyroidectomy.

Adult↗

PubMed1979

[Peptic ulcer disease and primary hyperparathyroidism (author's transl)].

The causal relationship of primary hyperparathyroidism and ulcer disease is reviewed. In contrast to earlier ideas careful clinical and clinico-chemical investigations have shown that in patients with manifest primary hyperparathyroidism neither is the incidence of ulcer disease raised nor are deviations from the normal behavior of acid secretion or the serum gastrin level to be observed in comparison with the average population.

Calcium↗

PubMed1978

Primary hyperparathyroidism with multiple parathyroid gland enlargement: review of 53 cases.

Of 53 patients who had hyperparathyroidism assocated with multiple parathyroid gland enlargement, 39 (74%) had primary hyperparathyroidism without clinical or laboratory evidence of associated endocrine gland dysfunction, 2 had documented familial primary hyperparathyroidism, and 12 had hyperparathyroidism as part of the multiple endocrine neoplasia syndrome. When last studied, 31 of the 39 patients with nonfamilial hyperparathyroidism had normal serum calcium levels, 3 had permanent hypoparathyroidism, 2 had recurrent hyperparathyroidism, and 3 were lost to follow-up. The two patients with familial hyperparathyroidism were treated by removal only of enlarged parathyroid glands, and in each, hyperparathyroidism recurred. Five patients with multiple endocrine neoplasia, type 1, were treated by removal only of enlarged parathyroid glands, and hyperparathyroidism recurred in four. Four patients with multiple endocrine neoplasia, type 1, were treated by removal of three or more parathyroid glands, and there were no instances of recurrent hyperparathyroidism. In one patient, permanent hypoparathyroidism developed. Three patients with multiple endocrine neoplasia syndrome, type 2, had total parathyroidectomies as a part of thyroidectomy for medullary thyroid carcinoma. In each patient, permanent hypoparathyroidism developed. When primary hyperparathyroidism occurs in the absence of a definite history of polyendocrine or familial disease, only the glands that are definitely enlarged should be removed, and normal-appearing glands should be tagged rather than risk the possibility of permanent hypoparathyroidism that may attend routine subtotal parathyroid gland excision.

Adolescent↗

PubMed1975

Back pain and vertebral crush fractures: an unemphasized mode of presentation for primary hyperparathyroidism.

During a 3-year period, 14 of 319 patients (4.4%) with surgically proved primary hyperparathyroidism had spinal rarefaction with vertebral crush fractures but no unequivocal roentgenographic evidence of osteitis fibrosa generalisata. All complained of back pain, and this was the presenting complaint in 9 of the 14 patients. This incidence was significantly higher (P less than 0.001 for women; P less than than 0.01 for men) than the incidence of similar roentgenographic findings among patients of the same age undergoing operation for protruded intervertebral disks during this same time period. Although tradition equates roentgenographically evident bone disease in primary hyperparathyroidism with the classis findings of osteitis fibrosa generalisata, our observations emphasize that patients with primary hyperparathyroidism occasionally may present in a manner that is indistinguishable symptomatically and roentgenographically from that of postmenopausal or senile osteoporosis.

Age Factors↗

PubMed1977

1alpha-hydroxyvitamin D3 in primary hyperparathyroidism.

The surgical management of primary hyperparathyroidism with severe bone disease (and tertiary hyperparathyroidism) has frequently been complicated by severe and prolonged post-operative hypocalcaemia. In seven such cases a short-pre-operative course of 1alpha-hydroxyvitamin D3 has been found to abolish these adverse features virtually completely and even to diminish pre-operative symptoms where present. Exacerbation of hypercalcaemia has not occurred and this regimen is thus recommended as a routine measure.

Adult↗

PubMed1977

Tetracycline fluorescence in uremic and primary hyperparathyroid bone.

Twenty-five patients with end-stage renal disease, nine of whom were receiving pharmacologic doses of vitamin D, and seventeen patients with primary hyperparathyroidism underwent bone biopsy following a three-day course of tetracycline administration. The mean width of the fluorescent tetracycline bands were significantly greater in the bones of patients with uremia than in those with primary hyperparathyroidism. This difference was due to wide labels present in the patients with uremia who had not been treated with vitamin D, as no differences existed in mean label widths of patients with uremia who had received this compound and the patients with primary hyperparathyroidism. Comparison of the maximum label widths distinguished not only primary hyperparathyroid patients from those with uremia, but uremic patients who had recieved vitamin D from those who had not been so treated. Quantitative microscopy of standard, nonfluorescent histologic features failed to make this latter distinction. These data are consistent with the presence of a wide zone of instantaneously fluorescing material in uremic bone following tetracycline administration, which does not relate to bone apposition occurring during antibiotic administration. This phenomenon probably represents a delay in mineral maturation which is normalized by vitamin D. Furthermore, it is apparent that the use of a continuously administered (single) tetracycline label will result in an overestimation of bone formation rates, particularly in osteomalacic states.

Adult↗

PubMed1978

Calcitonin activity of the thyroid gland in primary hyperparathyroidism.

The thyroidal content of calcitonin was investigated in patients with euthyroid goitre, patients undergoing laryngectomies or neck operations and finally patients with primary hyperparathyroidism using method of biological titration. Patients with primary hyperparathyroidism had markedly decreased content of calcitonin in the thyroid gland when compared with the content of calcitonin of both groups of patients without calcium metabolism disturbance. Decreased content of calcitonin in patients with primary hyperparathyroidism can be explained by long lasting hypercalcaemia during which the rate of biosynthesis of calcitonin in the C cells does not keep up with the rate of release of calcitonin into the circulation.

Adult↗

PubMed2025

Approach to the Patient With Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary disorder in which patients develop multiple endocrine tumors simultaneously. Among these, primary hyperparathyroidism is the most common and often the earliest manifestation. All patients with MEN1 and hypercalcemia should have surgery, with most patients requiring surgical treatment before the age of 50 years. The timing of parathyroid surgery mainly depends on hypercalcemia and the presence of renal or skeletal complications. The goals of treatment are to correct hypercalcemia, prevent target organ damage, and minimize the risk of postoperative hypoparathyroidism as much as possible. Currently, the most widely recommended surgical approach is subtotal parathyroidectomy via the cervical approach (removal of 3 or 3.5 glands). With advances in imaging technology, patients with clearly localized lesions-particularly younger patients-may be candidates for individualized unilateral resection (ie, removal of both glands on the affected side). In addition, recurrent hypercalcemia after surgery is relatively common in patients with MEN1. The management of the remaining glands remains challenging, such patients usually need reoperation, calcimimetic therapy, or clinical observation. For patients requiring repeated parathyroid surgeries, in addition to searching for multifocal lesions, the possibility of ectopic parathyroid glands should also be taken into account. Ectopic parathyroid adenoma, caused by abnormal embryonic migration, complicates surgery in both sporadic and MEN1-related primary hyperparathyroidism. However, in MEN1, their higher frequency and multiglandular distribution make localization even more challenging, often leading to incomplete resection and recurrence.

Humans↗

PubMed1977

Delayed fracture healing in primary hyperparathyroidism.

The incidence of fractures in primary hyperparathyroidism is highly variable. The possibility that there might be an increased susceptibility to fracture is discussed. Healing in most is without delay. Three cases of delayed or nonunion following fracture are presented. In all three, healing accelerated dramatically after excision of a parathyroid adenoma. A pathological fracture secondary to the hyperparathyroidism of parathyroid carcinoma healed after excision of the tumor allowed regression of the osseous lesions. The endocrinologic mechanisms which cause nonunion in a small percentage of cases have not been clearly elucidated.

Female↗