... From the period 2007 to 2016, a total of 55 parathyroidtumors (51 adenomas and 4 hyperplasias) with prominent inflammatory infiltrates were identified from more than 2000 parathyroidtumors in the pathology archives, and investigated by immunohistochemistry for CD4 ... 0.037) AbstractText: No evidence of virus-like sequences in the parathyroidtumors could be found by transcriptome sequencing, suggesting that other factors may contribute to attract the immune system to the parathyroidtumor tissue ...
Immune System Diseases (1) Neoplasms (8), Hyperparathyroidism (2), Adenoma (2), more mentions
DescriptorName: ParathyroidNeoplasms... AbstractText: Parathyroidcarcinoma is a rare endocrine malignancy. Acute pancreatitis as an initial manifestation of parathyroidcarcinoma has been rarely reported AbstractText: A 22-year-old woman ... the diagnosis of primary hyperparathyroidism (PHPT) due to a left parathyroidtumor AbstractText: The patient was given a complete tumor excision.
Pancreatitis (6), Parathyroid Carcinoma (5), Hyperparathyroidism (3), more mentions
Inversion polymorphisms between low-copy repeats (LCRs) might predispose chromosomes to meiotic non-allelic homologous recombination (NAHR) events and thus lead to genomic disorders. However, for the 22q11.2 deletion syndrome (22q11.2DS), the most common genomic disorder, no such inversions have been uncovered as of yet. Using fiber-FISH, we demonstrate that parents transmitting the de novo 3 Mb LCR22A-D 22q11.2 deletion, the reciprocal duplication, and the smaller 1.5 Mb LCR22A-B 22q11.2 deletion carry inversions of LCR22B-D or LCR22C-D. Hence, the inversions predispose chromosome 22q11.2 to meiotic rearrangements and increase the individual risk for transmitting rearrangements. Interestingly, the inversions are nested or flanking rather than coinciding with the deletion or duplication sizes. This finding raises the possibility that inversions are a prerequisite not only for 22q11.2 rearrangements but also for all NAHR-mediated genomic disorders.
INTRODUCTION: Nodular hyperplasia of parathyroid glands (PG) is the most probable cause of medical treatment failure in secondary hyperparathyroidism (sHPT). This prospective cohort study is located at the interface of medical and surgical consideration of sHPT treatment options and identifies risk-factors for nodular hyperplasia of PG.
MATERIAL AND METHODS: One-hundred-eight resected PG of 27 patients with a broad spectrum of sHPT severity were classified according to the degree of hyperplasia by histopathology. Twenty routinely gathered parameters from medical history, ultrasound findings of PG and laboratory results were analyzed for their influence on nodular hyperplasia of PG by risk-adjusted multivariable binary regression. A prognostic model for non-invasive assessment of PG was developed and used to weight the individual impact of identified risk-factors on the probability of nodular hyperplasia of single PG.
RESULTS: Independent risk-factors for nodular hyperplasia of single PG were duration of dialysis in years, PG volume in mm3 determined by ultrasound and serum level of parathyroid hormone in pg/mL. Multivariable analyses computed a model with an Area Under the Receiver Operative Curve of 0.857 (95%-CI:0.773-0.941) when predicting nodular hyperplasia of PG. Theoretical assessment of risk-factor interaction revealed that the duration of dialysis had the strongest influence on the probability of nodular hyperplasia of single PG.
CONCLUSIONS: The three identified risk-factors (duration of dialysis, PG volume determined by ultrasound and serum level of parathyroid hormone) can be easily gathered in daily routine and could be used to non-invasively assess the probability of nodular hyperplasia of PG. This assessment would benefit from periodically collected data sets of PG changes during the course of sHPT, so that the choice of medical or surgical sHPT treatment could be adjusted more to the naturally changing type of histological PG lesion on an individually adopted basis in the future.
Pathologically proven parathyroidadenomas and lesions in patients with imaging or laboratory findings consistent ... SD] age, 72 ± 7 years) with pathologically or laboratory-proven parathyroidadenomas were identified... Three additional patients with possible parathyroidadenomas at (11)C-choline PET/CT were ultimately found to ... In our patient population, (11)C-choline PET/CT identified parathyroidadenomas with high specificity.
... fluorocholine PET/CT detected 52 of 54 patients and 52 of 56 lesions with histopathologically proven parathyroidadenomas on patient-based and lesion-based analysis, respectively... the 3 imaging techniques tested simultaneously, FCH PET/CT was superior for accurate preoperative localization of parathyroidadenomas, especially for ectopic or small parathyroid lesions.
Our aim was to investigate the accuracy of available imaging modalities for parathyroidcarcinoma (PC) in our institution and to identify which imaging modality, or combination thereof, is optimal in preoperative determination of precise tumor location.All operated PC patients in our institution between 2000 and 2015 that had at ...
The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders.We analyzed the data acquired from Taiwan's Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR).A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80).The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.
We assessed the clinical significance and risk factors of incidental parathyroidectomy during total thyroidectomy with or without central neck dissection or subtotal thyroidectomy.Retrospective analysis of clinical and pathological features of 548 consecutive thyroidectomy cases was compared by grouping into inadvertent resection (IR, n = 86) with IR of parathyroid glands, non-IR (n = 462) without, and then into postoperative hypoparathyroidism (PH, n = 140) with PH and non-PH (n = 408) without.Two hundred ninety-eight patients had total thyroidectomy and 250 had subtotal thyroidectomy. IR had higher malignant disease (P < .001), total thyroidectomy (P = .016), T3 and T4 classification (P = .005), central neck dissection (P < .001), recurrent laryngeal nerve palsy (P = .003), postoperative transient hypoparathyroidism (P < .001), duration of disease prior to thyroidectomy (P < .001), and weight of excised thyroid tissue (P < .001) than non-IR.Preoperative diagnosis of malignant disease, duration of disease prior to thyroidectomy, and central neck dissection were independent risk factors for incidental parathyroidectomy. Preoperative diagnosis of malignant disease, central neck dissection, duration of disease prior to thyroidectomy, weight of excised thyroid tissue, and incidental parathyroidectomy were correlated with PH.
The risk factors of hypoparathyroidism after total thyroidectomy (TT) with central lymph node dissection (CND) have not been completely defined. The aim of the study was to evaluate the risk factors of hypoparathyroidism after the surgery.We retrospectively reviewed our patients who underwent TT and CND (including lateral lymph node dissection) for thyroid carcinoma between January 2013 and June 2016. According to the postoperative serum levels of parathyroid hormone within 6 months, the patients were divided into normal, transient hypoparathyroidism, and permanent hypoparathyroidism groups. The clinicopathologic characteristics and surgical details were compared among the 3 groups. The risk factors of hypoparathyroidism were investigated by univariate and multivariate analyses.Of the 903 patients, 399 (44.2%) were found to have transient hypoparathyroidism and 10 (1.1%) had permanent hypoparathyroidism. On multivariate analysis, female gender (P < .001), nonuse of carbon nanoparticles (P = .038), parathyroid autotransplantation (P < .001), accidental parathyroid resection (P = .004), and bilateral CND (BCND, P = .003) were the independent risk factors of transient hypoparathyroidism; nonuse of carbon nanoparticles (P = .041) and a tumor in the upper pole of thyroid gland (P = .031) were the independent risk factors of permanent hypoparathyroidism. Patients with transient hypoparathyroidism were more likely to develop permanent hypoparathyroidism when they had hypertension (P = .026) and a tumor in the upper pole of thyroid gland (P = .010).Precise surgical techniques and carbon nanoparticles suspension should be applied for in situ preservation of parathyroid glands (PGs) in thyroid carcinoma patients, especially in females with hypertension and a tumor in the upper pole of thyroid gland. Autotransplantation is only performed when a PG is resected inadvertently or devascularized. TT with BCND should be better performed by an experienced surgeon to reduce the incidence of hypoparathyroidism.
The aim of the study is to systematically review the evidence on post parathyroidectomy (PTX) changes as measured by echocardiogram (ECHO) in patients with primary hyperparathyroidism (PHPT).PHPT may increase risk of cardiovascular morbidity/mortality. Conclusions of studies assessing ECHO changes, pre versus post PTX, are inconsistent.A systematic literature search was conducted to locate published and unpublished studies. Randomized control trials, nonrandomized control trials, and observational studies were included. Variables were reported as means and standard deviations. An inverse variance statistical method, with random-effects analysis model, was applied to continuous data. The effect measure was standardized mean difference, confidence interval of 95%. Primary outcome measure was left ventricular ejection fraction (LVEF). Secondary outcome measures were left ventricular mass index (LVMI), peak early over peak late diastolic velocity ratio (E/A ratio), isovolumetric relaxation time (IVRT), intraventricular septal thickness (IVST), and posterior wall thickness (PWT).Fourteen studies were included. Follow-up time ranged 3 to 67 months. No significant differences (P > .05) in primary outcome measure LVEF (SMD = -0.03, CI = -0.24, 0.19), or secondary outcome measures E/A Ratio (SMD = -0.05, CI = -0.24, 0.14), IVST (SMD = 0, CI = 0.31, 0.32), PWT (SMD = 0.01, CI = -0.38, 0.39), LVMI (SMD = -0.18, CI = -0.74, 0.38), and IVRT (SMD = -0.84, CI = -1.83, 0.14) were observed.There was no significant difference in LVEF pre to post PTX. Due to heterogeneity of current literature, we were unable to determine if other outcome measures of cardiac function are affected after PTX in patients with PHPT. We recommend a randomized control trial be conducted to make concrete conclusions.
The goal of the pharmacological therapy in secondary hyperparathyroidism (SHPT) is to reduce serum levels of parathyroid hormone and phosphorus, to correct those of calcium and vitamin D, to arrest or reverse the parathyroid hyperplasia. However, when nodular hyperplasia or an autonomous adenoma develops, surgery may be indicated. We reviewed the literature with the aim of defining if the echographic criteria predictive of unresponsiveness of SHPT to calcitriol therapy are valid also in the cinacalcet era and if drug therapy may reverse nodular hyperplasia of parathyroid gland (PTG). The responsiveness to therapy and regression of the nodular hyperplasia of PTG remains an open question in the calcimimetic era as well as the cutoff between medical and surgical therapy. Prospective studies are needed in order to clarify if an earlier use of cinacalcet in moderate SHPT might arrest the progression of parathyroid growth and stabilize SHPT.
Hyperplasia (5), Hyperparathyroidism (2), Adenoma (1), more mentions
BACKGROUND: Bariatric surgery is an effective therapy for morbid obesity but may reduce calcium absorption and significantly decrease the bone mineral density. This study examined the prevalence of secondary hyperparathyroidism (SHPT) in obese subjects during follow-up after different bariatric surgeries. We investigated predictors of SHPT.
METHODS: We enrolled 1470 obese subjects undergoing bariatric/metabolic surgery with at least 1-year follow-up, including 322 patients undergoing Roux-en-Y gastric bypass (RYGB), 695 undergoing single anastomosis (mini-) gastric bypass (SAGB), 93 undergoing laparoscopic adjustable gastric banding (LAGB), and 360 undergoing sleeve gastrectomy (SG). Five years of data were available for 215 patients. Patients were instructed to supplement their diet according to the guideline. Calcium, parathyroid hormone (PTH), and vitamin D levels were measured before surgery and at 1 and 5 years after surgery. SHPT was defined as PTH > 69 pg/mL.
RESULTS: The overall prevalence of SHPT was high, 21.0% before surgery and was not different between patients with different bariatric procedures. Pre-operative PTH correlated with age, BMI, and vitamin D levels. Multi-variate analysis confirmed that vitamin D level was the only independent predictor of SHPT before surgery. The prevalence of SHPT increased to 35.4% at 1 year after surgery and 63.3% at 5 years after surgery. SAGB had the highest prevalence of SHPT (50.6%) followed by RYGB (33.2%), LAGB (25.8%), and SG (17.8%) at 1 year after surgery. At 5 years after surgery, SAGB still had the highest prevalence of SHPT (73.6%), followed by RYGB (56.6%), LAGB (38.5%), and SG (41.7%). Serum PTH at 1 year after surgery correlated with decreased BMI and weight loss. Multi-variate analysis confirmed that age, sex, calcium level, and bypass procedure were independent predictor of SHPT after surgery.
CONCLUSIONS: The prevalence of SHPT is high in morbidly obese patients before bariatric surgery which is related to vitamin D deficiency. The prevalence of SHPT increased continually along with the time after bariatric surgery, especially in patients receiving SAGB, followed by RYGB. The supplementation of vitamin D and calcium have to be higher in bypass procedure, especially in malabsorptive procedure.
Anti-Obesity and Weight Loss (5), Muscular and Skeletal Diseases (1) Hyperparathyroidism (2), Vitamin D Deficiency (1), Morbid Obesity (1), more mentions
OBJECTIVE: Little is known about the natural changes in parathyroid function after successful parathyroid surgery for primary hyperparathyroidism. The association of intact parathyroid hormone (iPTH) and calcium (Ca) with "temporary hypoparathyroidism" and "hungry bone syndrome" (HBS) was evaluated.
DESIGN: Potential risk factors for temporary hypoparathyroidism and HBS were evaluated by taking blood samples before surgery, intraoperatively, at post-operative day (POD) 1, at POD 5 to 7, in postoperative week (POW) 8 and in postoperative month (POM) 6.
PATIENTS: Of 425 patients, 43 (10.1%) had temporary hypoparathyroidism and 36 (8.5%) had HBS.
MEASUREMENTS: The discriminative ability of iPTH and Ca on POD 1 for temporary hypoparathyroidism and HBS.
RESULTS: IPTH on POD 1 showed the highest discriminative ability for temporary hypoparathyroidism (C-index=0.952), but not for HBS. IPTH was helpful in diagnosing HBS between POD 5 and 7 (C-index=0.708). Extending the model by including Ca resulted in little improvement of the discriminative ability for temporary hypoparathyroidism (C-index=0.964) and a decreased discriminative ability for HBS (C-index=0.705). Normal parathyroid metabolism was documented in 139 (32.7%) patients on POD 1 and in 423 (99.5%) six months post-operatively, while 2 (0.5%) patients had persistent hyperparathyroidism, one diagnosed between POD 5 and 7 and another at POW 8. No patients suffered from permanent hypoparathyroidism.
CONCLUSIONS: The necessity for Ca and vitamin D3 substitution cannot be predicted with certainty before POD 5 to 7 without serial laboratory measurements. Based on the results, a routine 8-week course of Ca and vitamin D3 treatment seems reasonable and its necessity should be evaluated in a follow-up study. This article is protected by copyright. All rights reserved.
Additionally, partial subclinical post-operative hypoparathyroidism was clearly more common in the HSST group (p <0.001) Conclusion SBT demonstrated more impairment in the harmonic scalpel group, parathyroid function was altered after thyroidectomy AbstractText: PTH = Parathormone; SBIT = Sodium Bicarbonate Infusion Test; HSTT = Harmonic Scalpel Total Thyroidectomy Keyword: Hypoparathyroidism. Keyword: Parathormone. Keyword: Parathyroiddisease. Keyword: Parathyroid function. Keyword: Sodium bicarbonate infusion test.
Hypoparathyroidism (2), Parathyroid Diseases (1), Thyroid Diseases (1), more mentions
BACKGROUND: Induction of general anesthesia and endotracheal intubation may precipitate parathyroid hormone (PTH) elevation in patients with primary hyperparathyroidism (HPT). The purposes of this study were to revisit this observation and to study its impact in healthy patients.
METHODS: Patients with primary HPT who underwent parathyroidectomy were retrospectively studied. The PTH was sampled and compared: before, immediately after general anesthesia and endotracheal intubation, and 15 minutes after parathyroidectomy. Healthy adults who underwent elective operations were prospectively studied. The PTH was sampled before general anesthesia and endotracheal intubation, immediately after, and 15 minutes later.
RESULTS: Thirty-one patients, aged 28-89 years (mean 60.1 ± 13 years), were retrospectively studied. The PTH was significantly elevated after general anesthesia and endotracheal intubation (P = .014). Fifty patients, aged 21-86 years (mean 54 ± 15 years), were prospectively studied. The PTH elevation after general anesthesia and endotracheal intubation was not significant.
CONCLUSION: General anesthesia and endotracheal intubation causes an immediate, steep, and significant PTH elevation in patients with primary HPT but only a minor change in healthy adults. The difference may be attributed to an impaired adrenergic response in patients with primary HPT.
Non-surgical hypoparathyroidism (Ns-HypoPT) and pseudohypoparathyroidism (PHP) are both rare diseases, characterized by hypocalcemia. In Ns-HypoPT, PTH levels are low, whereas patients with PHP often have very high levels due to receptor-insensitivity to PTH (PTH-resistance). Accordingly, we hypothesized that indices of bone turnover and bone mineralization/architecture are similar in Ns-HypoPT and PHP despite marked differences in PTH levels. We studied 62 patients with Ns-HypoPT and 31 with PHP as well as a group of age- and sex matched healthy controls. We found a significantly higher areal BMD by DXA among patients with Ns-HypoPT, both compared with PHP and the background population. Compared with Ns-HypoPT, PHP patients had significantly lower total and trabecular volumetric BMD assessed by QCT scans at the spine and hip. HRpQCT-scans, showed a lower trabecular area and volumetric BMD as well as a lower trabecular number at the tibia in PHP compared to Ns-HypoPT and matched controls. In PHP, PTH levels correlated with levels of markers of bone formation (osteocalcin, bone-specific alkaline phosphatase, P1NP), and bone resorption (CTx). In adult males, levels of bone markers were significantly higher in PHP compared with Ns-HypoPT. Levels of procalcitonin and calcitonin were significantly higher in PHP compared with Ns-HypoPT. In conclusion, indices of bone turnover, density, and microarchitecture differ between patients with Ns-HypoPT and PHP. Our data suggest that patients with PHP do not have a complete skeletal resistance to PTH and that the effects of chronically high PTH levels in PHP are mostly confined to the trabecular tissue. This article is protected by copyright. All rights reserved.
Muscular and Skeletal Diseases (3), Orphan Diseases (1) Pseudohypoparathyroidism (3), Hypoparathyroidism (3), Hypocalcemia (1), more mentions
BACKGROUND: 20%-25% of patients with primary hyperparathyroidism will have multigland disease (MGD). Preoperatative imaging can be inaccurate or unnecessary in MGD. Identification of MGD could direct the need for imaging and inform operative approach. The purpose of this study is to use machine learning (ML) methods to predict MGD.
METHODS: Retrospective review of a prospective database. The ML platform, Waikato Environment for Knowledge Analysis, was used, and we selected models for (1) overall accuracy and (2) preferential identification of MGD. A review of imaging studies was performed on a cohort predicted to have MGD.
RESULTS: 2010 patients met inclusion criteria: 1532 patients had single adenoma (SA) (76%) and 478 had MGD (24%). After testing many algorithms, we selected two different models for potential integration as clinical decision-support tools. The best overall accuracy was achieved using a boosted tree classifier, RandomTree: 94.1% accuracy; 94.1% sensitivity, 83.8% specificity, 94.1% positive predictive value, and 0.984 area under the receiver operating characteristics curve. To maximize positive predictive value of MGD prediction, a rule-based classifier, JRip, with cost-sensitive learning was used and achieved 100% positive predictive value for MGD. Imaging reviewed from the cohort of 34 patients predicted to have MGD by the cost-sensitive model revealed 39 total studies performed: 28 sestamibi scans and 11 ultrasounds. Only 8 (29%) sestamibi scans and 4 (36%) ultrasounds were correct.
CONCLUSIONS: ML methods can help distinguish MGD early in the clinical evaluation of primary hyperparathyroidism, guiding further workup and surgical planning.