Cargando…

Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and...

Descripción completa

Detalles Bibliográficos
Autores principales: Aojula, Nivaran, Khan, Shahab, Gittoes, Neil, Hassan-Smith, Zaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923978/
https://www.ncbi.nlm.nih.gov/pubmed/33717430
http://dx.doi.org/10.1177/2042018821995370
_version_ 1783658993497931776
author Aojula, Nivaran
Khan, Shahab
Gittoes, Neil
Hassan-Smith, Zaki
author_facet Aojula, Nivaran
Khan, Shahab
Gittoes, Neil
Hassan-Smith, Zaki
author_sort Aojula, Nivaran
collection PubMed
description Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration.
format Online
Article
Text
id pubmed-7923978
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-79239782021-03-11 Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery? Aojula, Nivaran Khan, Shahab Gittoes, Neil Hassan-Smith, Zaki Ther Adv Endocrinol Metab Review Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration. SAGE Publications 2021-02-27 /pmc/articles/PMC7923978/ /pubmed/33717430 http://dx.doi.org/10.1177/2042018821995370 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Aojula, Nivaran
Khan, Shahab
Gittoes, Neil
Hassan-Smith, Zaki
Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title_full Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title_fullStr Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title_full_unstemmed Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title_short Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
title_sort normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923978/
https://www.ncbi.nlm.nih.gov/pubmed/33717430
http://dx.doi.org/10.1177/2042018821995370
work_keys_str_mv AT aojulanivaran normocalcaemicprimaryhyperparathyroidismwhatistheroleofparathyroidsurgery
AT khanshahab normocalcaemicprimaryhyperparathyroidismwhatistheroleofparathyroidsurgery
AT gittoesneil normocalcaemicprimaryhyperparathyroidismwhatistheroleofparathyroidsurgery
AT hassansmithzaki normocalcaemicprimaryhyperparathyroidismwhatistheroleofparathyroidsurgery