scholarly journals Multiglandular Parathyroid Disease: the Results of Surgical Treatment

2020 ◽  
Vol 5 (4) ◽  
pp. 90-97
Author(s):  
E. A. Ilyicheva ◽  
G. A. Bersenev ◽  
A. V. Zharkaya ◽  
D. A. Bulgatov ◽  
V. N. Makhutov
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Intraoperative Monitoring ◽  
Parathyroid Glands ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Multiple Lesions ◽  
Multiple Gland Disease

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

scholarly journals Relationship between parathyroid calcium-sensing receptor expression and potency of the calcimimetic, cinacalcet, in suppressing parathyroid hormone secretion in an in vivo murine model of primary hyperparathyroidism

2005 ◽  
Vol 153 (4) ◽  
pp. 587-594 ◽  
Author(s):  
Takehisa Kawata ◽  
Yasuo Imanishi ◽  
Keisuke Kobayashi ◽  
Takao Kenko ◽  
Michihito Wada ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Murine Model ◽  
Hormone Secretion ◽  
Suppressive Effect ◽  
Receptor Expression ◽  
Parathyroid Glands ◽  
Calcium Sensing Receptor ◽  
Calcium Sensing

Cinacalcet HCl, an allosteric modulator of the calcium-sensing receptor (CaR), has recently been approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis, due to its suppressive effect on parathyroid hormone (PTH) secretion. Although cinacalcet’s effects in patients with primary and secondary hyperparathyroidism have been reported, the crucial relationship between the effect of calcimimetics and CaR expression on the parathyroid glands requires better understanding. To investigate its suppressive effect on PTH secretion in primary hyperparathyroidism, in which hypercalcemia may already have stimulated considerable CaR activity, we investigated the effect of cinacalcet HCl on PTH-cyclin D1 transgenic mice (PC2 mice), a model of primary hyperparathyroidism with hypo-expression of CaR on their parathyroid glands. A single administration of 30 mg/kg body weight (BW) of cinacalcet HCl significantly suppressed serum calcium (Ca) levels 2 h after administration in 65- to 85-week-old PC2 mice with chronic biochemical hyperparathyroidism. The percentage reduction in serum PTH was significantly correlated with CaR hypo-expression in the parathyroid glands. In older PC2 mice (93–99 weeks old) with advanced hyperparathyroidism, serum Ca and PTH levels were not suppressed by 30 mg cinacalcet HCl/kg. However, serum Ca and PTH levels were significantly suppressed by 100 mg/kg of cinacalcet HCl, suggesting that higher doses of this compound could overcome severe hyperparathyroidism. To conclude, cinacalcet HCl demonstrated potency in a murine model of primary hyperparathyroidism in spite of any presumed endogenous CaR activation by hypercalcemia and hypo-expression of CaR in the parathyroid glands.

scholarly journals Primary Hyperparathyroidism - Case Report of a Female Patient with Hypercalcemic Crisis

2021 ◽  
Vol 5 (6) ◽  
pp. 01-02
Author(s):  
Rizwan Khalid ◽  
Sidra Rizwan
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Parathyroid Glands ◽  
Daily Activities ◽  
Common Cause ◽  
Hypercalcemic Crisis

Primary hyperparathyroidism is a result of increased and uncontrolled function of the parathyroid hormone caused by hyperfunction of one or more parathyroid glands. The cause of hyperfunction of the parathyroid glands could be adenoma, hyperplasia, and carcinoma. Primary Hyper parathyroidism is the most common cause of Hypercalcemia in outpatient population. The paper presents the case report of a 60years old female treated in our Hospital in March 2013. She presented in outpatient department with complaints of joints pain, Hypertension and renal failure for last 8years. After clinical, laboratory and radiological examination she was diagnosed as a case of PHPT due to a Giant Parathyroid Adenoma. After supportive, symptomatic and surgical treatment, the patient was back to normal daily activities without any signs of disease.

The Parathyroids

2017 ◽  
Author(s):  
Courtney J. Balentine ◽  
C Taylor Geraldson
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Calcium Homeostasis ◽  
Multiple Endocrine Neoplasia ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
Tertiary Hyperparathyroidism ◽  
Endocrine Neoplasia ◽  
And Function

Successful surgery of the parathyroid glands depends on a thorough knowledge of their anatomic and developmental relations. This knowledge is crucial for locating ectopic parathyroids or preventing injury to the recurrent laryngeal nerve. In addition, the surgeon should understand the physiology and function of these glands. Unlike other conditions a surgeon might treat, physiology, and not anatomy alone, often dictates the timing and course of parathyroid procedures. This surgeon-oriented, focused review covers the development, histology, anatomy, physiology, and pathophysiology of the parathyroid. Figures show the location and frequencies of ectopic upper and lower parathyroid glands, and regulation of calcium homeostasis. This review contains 2 highly rendered figures, and 16 references Key words: calcitonin; hypercalcemia; hyperparathyroidism; multiple endocrine neoplasia; parathyroid; parathyroid hormone; primary hyperparathyroidism; secondary hyperparathyroidism; tertiary hyperparathyroidism

scholarly journals Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

2003 ◽  
Vol 49 (6) ◽  
pp. 36-41
Author(s):  
V. N. Smorshchok ◽  
N. S. Kuznetsov ◽  
A. M. Artemova ◽  
L. Ya. Rozhinskaya ◽  
D. G. Beltsevich
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Intraoperative Ultrasound ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Subtotal Parathyroidectomy ◽  
Ultrasound Study ◽  
Made In

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003

2005 ◽  
Vol 132 (3) ◽  
pp. 359-372 ◽  
Author(s):  
James M. Ruda ◽  
Christopher S. Hollenbeak ◽  
Brendan C. Stack
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Intraoperative Pth ◽  
Multiple Gland Disease ◽  
Preoperative Diagnostic ◽  
Diagnostic Modalities ◽  
Surgical Treatments ◽  
Double Adenomas

OBJECTIVE: To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism. STUDY DESIGN: A systematic literature review. RESULTS: Of the 20,225 cases of primary hyperpara-thyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc99m-sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries. CONCLUSION: The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normo-calcemia than is typically quoted. IOPTH was a helpful but not “fool-proof” adjunct in parathyroid exploration surgery. SIGNIFICANCE: These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.

scholarly journals Parathyroidectomia: treatment of secondary hyperparathyroidism. Causes and prophylaxis of disease relapse

2011 ◽  
Vol 18 (4) ◽  
pp. 170-174
Author(s):  
V. BEIŠA ◽  
K. LAGUNAVIČIUS ◽  
A. BEIŠA ◽  
K. STRUPAS
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Ultrasound Examination ◽  
Single Photon ◽  
Photon Emission ◽  
Parathyroid Glands ◽  
Emission Computed Tomography ◽  
Mibi Scintigraphy

Background. The growing number of haemodialysis patients and the increasing their life expectancy within the past few years have resulted in a rise of long-term haemodialysis-associated complications. The aim of the paper is to present a case study of a successful surgical treatment of secondary hyperthyroidism and assess the causes of the disease. Materials and methods. A 63-year-old male patient had been on haemodialysis for 18 years; he had undergone parathyroidectomy for secondary hyperparathyroidism 10 years ago. The relapse of the disease was suspected when the patient developed the onset of pruritus and muscle pain. The following tests were performed: biochemical markers of plasma calcium and parathyroid hormone, thyroid ultrasound examination, parathyroid gland 99 mTc MIBI scintigraphy, single photon emission computed tomography of the neck and mediastinum. Results. Elevated calcium (2.73 mmol/l serum) and parathyroid hormone (1352 pg/ml blood plasma) levels were found. Ultrasound examination, 99 mTc MIBI scintigraphy and SPECT revealed parathyroid adenoma of the left inferior thyroid section. The patient underwent surgery in 2011. Remnants of the previously resected parathyroid gland were removed, and an accessory parathyroid gland was found within the thymus; this gland was removed, and partial autotransplantation was performed. The level of the parathyroid hormone decreased to 24 pg/ml during the day after surgery. The histological examination of the removed tissues was performed. Conclusions. Accessory parathyroid glands are usually found within the thymus; therefore, any type of surgical treatment of secondary hyperparathyroidism should include thymectomy. Keywords: parathyroid glands, secondary hyperparathyroidism, haemodialysis, parathyroidectomy

The Parathyroids

2017 ◽  
Author(s):  
Courtney J. Balentine ◽  
C Taylor Geraldson
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Calcium Homeostasis ◽  
Multiple Endocrine Neoplasia ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
Tertiary Hyperparathyroidism ◽  
Endocrine Neoplasia ◽  
And Function

Successful surgery of the parathyroid glands depends on a thorough knowledge of their anatomic and developmental relations. This knowledge is crucial for locating ectopic parathyroids or preventing injury to the recurrent laryngeal nerve. In addition, the surgeon should understand the physiology and function of these glands. Unlike other conditions a surgeon might treat, physiology, and not anatomy alone, often dictates the timing and course of parathyroid procedures. This surgeon-oriented, focused review covers the development, histology, anatomy, physiology, and pathophysiology of the parathyroid. Figures show the location and frequencies of ectopic upper and lower parathyroid glands, and regulation of calcium homeostasis. This review contains 2 highly rendered figures, and 16 references Key words: calcitonin; hypercalcemia; hyperparathyroidism; multiple endocrine neoplasia; parathyroid; parathyroid hormone; primary hyperparathyroidism; secondary hyperparathyroidism; tertiary hyperparathyroidism

scholarly journals Advances in the diagnosis and the management of primary hyperparathyroidism

2021 ◽  
Vol 12 ◽  
pp. 204062232110159
Author(s):  
Ana Kashfia Islam
Keyword(s):  
Renal Function ◽  
Parathyroid Hormone ◽  
Bone Loss ◽  
Primary Hyperparathyroidism ◽  
Kidney Stones ◽  
Parathyroid Glands ◽  
Definitive Treatment ◽  
Indications For Surgery ◽  
Musculoskeletal Complaints ◽  
Parathyroid Cancer

The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

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