The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Antonino De Lorenzo - One of the best experts on this subject based on the ideXlab platform.
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brown tumour in a patient with secondary Hyperparathyroidism resistant to medical therapy case report on successful treatment after subtotal parathyroidectomy
International Journal of Endocrinology, 2009Co-Authors: Nicola Di Daniele, Stefano Condo, Michele Ferrannini, Marta Bertoli, Valentina Rovella, Laura Di Renzo, Antonino De LorenzoAbstract:Brown tumour represents a serious complication of Hyperparathyroidism. Differential diagnosis, based on histological examination, is only presumptive and clinical, radiological and laboratory data are necessary for definitive diagnosis. Here we describe a case of a brown tumour localised in the maxilla due to secondary Hyperparathyroidism in a young women with chronic renal failure. Hemodialysis and pharmacological treatment were unsuccessful in controlling secondary Hyperparathyroidism making it necessary to proceed with a subtotal parathyroidectomy. The proper timing of the parathyroidectomy and its favourable effect on regression of the brown tumor made it possible to avoid a potentially disfiguring surgical removal of the brown tumor.
Electron Kebebew - One of the best experts on this subject based on the ideXlab platform.
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undertreatment of primary Hyperparathyroidism in a privately insured us population decreasing utilization of parathyroidectomy despite expanding surgical guidelines
Surgery, 2021Co-Authors: Carolyn D Seib, Tong Meng, Insoo Suh, Robin M Cisco, Dana T Lin, Arden M Morris, Amber W Trickey, Electron KebebewAbstract:Abstract Background Primary Hyperparathyroidism is associated with substantial morbidity, including osteoporosis, nephrolithiasis, and chronic kidney disease. Parathyroidectomy can prevent these sequelae but is poorly utilized in many practice settings. Methods We performed a retrospective cohort study using the national Optum de-identified Clinformatics Data Mart Database. We identified patients aged ≥35 with a first observed primary Hyperparathyroidism diagnosis from 2004 to 2016. Multivariable logistic regression was used to determine patient/provider characteristics associated with parathyroidectomy. Results Of 26,522 patients with primary Hyperparathyroidism, 10,101 (38.1%) underwent parathyroidectomy. Of the 14,896 patients with any operative indication, 5,791 (38.9%) underwent parathyroidectomy. Over time, there was a decreasing trend in the rate of parathyroidectomy overall (2004: 54.4% to 2016: 32.4%, P Conclusion The majority of US privately insured patients with primary Hyperparathyroidism are not treated with parathyroidectomy. Having an operative indication only modestly increases the likelihood of parathyroidectomy. Further research is needed to address barriers to treatment and the gap between guidelines and clinical care in primary Hyperparathyroidism.
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high prevalence of chronic kidney disease in patients with multiple endocrine neoplasia type 1 and improved kidney function after parathyroidectomy
Surgery, 2019Co-Authors: Patience Green, Electron Kebebew, Stephen J. Marx, Jonathan Zagzag, Dhaval Patel, Lee S Weinstein, William F Simonds, Jenny E Blau, Nancy D Perrier, Naris NilubolAbstract:Background Because chronic kidney disease is an important comorbidity associated with primary Hyperparathyroidism, we sought to evaluate the prevalence of chronic kidney disease and effects of parathyroidectomy on kidney function in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism. Methods We performed a retrospective analysis of 112 patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism who had at least 1 operation for primary Hyperparathyroidism at 2 tertiary referral centers. The preoperative and postoperative estimated glomerular filtration rates were compared. The prevalence of chronic kidney disease stage 3 or worse (estimated glomerular filtration rates less than 60 mL/min/1.73m2) in this cohort was compared to the rates in the US population reported by the Centers for Disease Control and Prevention. Results The median age at the time of parathyroidectomy was 36.5 years (range: 12–76 years). A total of 99 patients had biochemical remission. The rate of chronic kidney disease stage 3 or worse in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism was greater than that observed in the US population for ages 20–39 and 40–59 (5% [n = 2/44] vs 0.39% [n = 18/4565], P = .015 and 10% [n = 4/40] vs 2.31% (n = 89/3848), P = .015, respectively). We observed improved estimated glomerular filtration rates in those with chronic kidney disease stage 3 or worse postoperatively (48 vs 57 mL/min/1.73m2, P = .047). A successful parathyroidectomy normalized all 24-hour urine calcium excretion. Conclusion An indication for early parathyroidectomy should include estimated glomerular filtration rates less than 60mL/min/1.73m2 in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism.
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parathyroid adenoma hyperplasia and carcinoma localization technical details of primary neck exploration and treatment of hypercalcemic crisis
Surgical Oncology Clinics of North America, 1998Co-Authors: Electron Kebebew, Orlo H ClarkAbstract:The pathologic characteristics and clinical presentation of patients with primary Hyperparathyroidism are discussed including the treatment of hypercalcemic crisis. Surgical issues, including the use of localizing studies, and the surgical treatment of primary Hyperparathyroidism are reviewed.
John P Bilezikian - One of the best experts on this subject based on the ideXlab platform.
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osteitis fibrosa cystica a forgotten radiological feature of primary Hyperparathyroidism
Endocrine, 2017Co-Authors: Waldemar Misiorowski, Izabela Czajkaoraniec, Magdalena Kochman, Wojciech Zgliczynski, John P BilezikianAbstract:Although bone disease and stone disease are the universally accepted classical manifestations of primary Hyperparathyroidism, clinical parathyroid bone disease is rarely seen today in the United States (<5% of patients) and Western Europe. Nevertheless, in a given patient, classical skeletal involvement can be the first sign of primary Hyperparathyroidism, but not recognized because it is not usually included, anymore, in the differential diagnosis of this manifestation of skeletal disease. We describe four cases of primary Hyperparathyroidism in which the first clinical manifestation of the disease was a pathological fracture that masqueraded as a malignancy. The presence of large osteolytic lesions gave rise to the initial diagnosis of a primary or metastatic cancer. In none of the reported cases was primary Hyperparathyroidism with osteitis fibrosa considered as the diagnosis. It would seem to us that this course is best explained by the fact that in many countries such manifestations of primary Hyperparathyroidism have become a rarity. In fact, the incidence of osteitis fibrosa among patients with primary Hyperparathyroidism in the US is estimated as so rare, that in majority of medical centers routine x-ray examinations of the bones in these patients is not recommended. The X-ray or computed tomography scan findings of osteitis fibrosa cystica include lytic or multilobular cystic changes. Multiple bony lesions representing brown tumors may be misdiagnosed on computed tomography scan as metastatic carcinoma, bone cysts, osteosarcoma, and especially giant-cell tumor. Distinguishing between primary Hyperparathyroidism and malignancy is made readily by the concomitant measurement of parathyroid hormone which in primary Hyperparathyroidism, again, will be markedly elevated. In the hypercalcemias of malignancy, such elevations of parathyroid hormone are virtually never seen. When radiographic evidence of a lytic lesion and hypercalcemia are present, primary Hyperparathyroidism should always be considered in the differential diagnosis.
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normocalcemic Hyperparathyroidism and hypoparathyroidism in two community based nonreferral populations
The Journal of Clinical Endocrinology and Metabolism, 2013Co-Authors: Natalie E. Cusano, Patty Y Wang, Elizabeth M Haney, Eric S. Orwoll, Serge Cremers, Naim M. Maalouf, Chiyuan Zhang, Douglas C Bauer, John P BilezikianAbstract:Context Normocalcemic primary Hyperparathyroidism is typically identified after referral to a specialty clinic. At diagnosis, patients demonstrate features seen in hypercalcemic primary Hyperparathyroidism. Normocalcemic hypoparathyroidism has been discovered after hypocalcemia unmasked after bisphosphonate administration. Objective We hypothesized that screening unselected, nonreferral populations, such as The Osteoporotic Fractures in Men (MrOS) study and Dallas Heart Study (DHS), would identify asymptomatic subjects with normocalcemic Hyperparathyroidism and hypoparathyroidism. Methods Normocalcemic Hyperparathyroidism was defined as serum PTH greater than the upper reference range with normal albumin-adjusted serum calcium, excluding common secondary causes (renal failure [estimated glomerular filtration rate Results In 2364 men from MrOS, we identified 9 with normocalcemic Hyperparathyroidism (prevalence 0.4%) and 26 with normocalcemic hypoparathyroidism (1.1%). In 3450 men and women from DHS, we identified 108 with normocalcemic Hyperparathyroidism (3.1%) and 68 with normocalcemic hypoparathyroidism (1.9%). Of the 108 normocalcemic hyperparathyroid subjects, 64 had follow-up data. Hypercalcemic primary Hyperparathyroidism developed in 1 subject whereas 13 (0.6% of the follow-up cohort) showed persistently elevated PTH levels with normocalcemia. Of the 26 normocalcemic hypoparathyroid subjects with follow-up data, none developed overt hypoparathyroidism and 2 (0.09%) had persistent evidence of normocalcemic hypoparathyroidism. Conclusions This study documents normocalcemic primary Hyperparathyroidism and hypoparathyroidism identified among community-dwelling individuals. Larger studies are needed to determine the true prevalence and natural history of these parathyroid disorders.
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normocalcemic primary Hyperparathyroidism
Journal of Clinical Densitometry, 2013Co-Authors: Natalie E. Cusano, Shonni J Silverberg, John P BilezikianAbstract:Primary Hyperparathyroidism, a common endocrine disorder, is traditionally defined by hypercalcemia and elevated levels of parathyroid hormone (PTH). A newer presentation of primary Hyperparathyroidism has been described over the past decade, in which PTH is elevated but serum calcium is consistently normal, in the absence of secondary causes of Hyperparathyroidism, such as renal disease or vitamin D deficiency. Recognition of this phenotype of primary Hyperparathyroidism, normocalcemic primary Hyperparathyroidism, supports a biphasic chronological time course in some individuals in which PTH levels are first elevated but serum calcium is normal, followed by the development of frank hypercalcemia. This review focuses on the available literature regarding this newly described phenotype of primary Hyperparathyroidism.
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incipient primary Hyperparathyroidism a forme fruste of an old disease
The Journal of Clinical Endocrinology and Metabolism, 2003Co-Authors: Shonni J Silverberg, John P BilezikianAbstract:Although primary Hyperparathyroidism today is often a relatively asymptomatic disease, it has distinct biochemical and skeletal features. These features are present at diagnosis and are generally stable over time, leading to the theory of a biphasic disease course in which alterations occur during a preclinical phase. Measurement of calciotropic hormones in individuals undergoing skeletal evaluation has led to the identification of normocalcemic individuals with elevated PTH levels. We hypothesize that these patients represent the earliest manifestations of primary Hyperparathyroidism Twenty-two patients had Hyperparathyroidism (94 ± 29 pg/ml) and normal corrected serum calcium levels (2.40 ± 0.02 mmol/liter). No secondary causes of Hyperparathyroidism were found. PTH levels did not correlate with urinary calcium concentration, renal function, vitamin D concentrations, or bone density. The relationship between PTH and serum calcium (regression slope, +0.004) was identical in normocalcemic and hypercalcemi...
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age as a criterion for surgery in primary Hyperparathyroidism
The American Journal of Medicine, 2002Co-Authors: Shonni J Silverberg, Ijeoma Brown, John P BilezikianAbstract:Only about 20% of patients with primary Hyperparathyroidism in the United States have nephrolithiasis, and osteitis fibrosa cystica is rare (1– 4). The evolution of primary Hyperparathyroidism into a disorder that is asymptomatic in the vast majority of patients has led to considerable controversy concerning appropriate management of these patients (4 – 8). Surgery is the only treatment for primary Hyperparathyroidism, but because most patients do not have symptoms, the need for definitive treatment in all patients has been questioned (4 –7). To address this and other issues, the National Institutes of Health (NIH) held a Consensus Development Conference on the Management of Asymptomatic Primary Hyperparathyroidism that developed clinical criteria for surgical intervention (9). Patients meeting certain guidelines (severe hypercalcemia, nephrolithiasis, and reduced bone mass) benefit from parathyroidectomy (10 –14). However, the recommendation for surgery in those less than 50 years of age was based more on concern about the consequences of nonintervention, along with the notion that “years of disease” per se conferred risk. There was no clear sense that the disease was worse or tended to be more progressive in younger patients. Data from our 15-year prospective study of primary Hyperparathyroidism provide information about the clinical course of patients younger than 50 years who were followed without parathyroidectomy.
Yi Miao - One of the best experts on this subject based on the ideXlab platform.
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endoscopic total parathyroidectomy and partial parathyroid tissue autotransplantation for patients with secondary Hyperparathyroidism a new surgical approach
World Journal of Surgery, 2009Co-Authors: Hanlin Zhao, Yi MiaoAbstract:Background Secondary Hyperparathyroidism (SHPT) (i.e., renal Hyperparathyroidism) is one of the most serious complications in long-term hemodialysis patients. The purpose of this retrospective study was to explore the feasibility of a new surgical approach—endoscopic total parathyroidectomy with autotransplantation (ETP+AT)—and evaluate its practical application for patients with SHPT.
Stephen J. Marx - One of the best experts on this subject based on the ideXlab platform.
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high prevalence of chronic kidney disease in patients with multiple endocrine neoplasia type 1 and improved kidney function after parathyroidectomy
Surgery, 2019Co-Authors: Patience Green, Electron Kebebew, Stephen J. Marx, Jonathan Zagzag, Dhaval Patel, Lee S Weinstein, William F Simonds, Jenny E Blau, Nancy D Perrier, Naris NilubolAbstract:Background Because chronic kidney disease is an important comorbidity associated with primary Hyperparathyroidism, we sought to evaluate the prevalence of chronic kidney disease and effects of parathyroidectomy on kidney function in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism. Methods We performed a retrospective analysis of 112 patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism who had at least 1 operation for primary Hyperparathyroidism at 2 tertiary referral centers. The preoperative and postoperative estimated glomerular filtration rates were compared. The prevalence of chronic kidney disease stage 3 or worse (estimated glomerular filtration rates less than 60 mL/min/1.73m2) in this cohort was compared to the rates in the US population reported by the Centers for Disease Control and Prevention. Results The median age at the time of parathyroidectomy was 36.5 years (range: 12–76 years). A total of 99 patients had biochemical remission. The rate of chronic kidney disease stage 3 or worse in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism was greater than that observed in the US population for ages 20–39 and 40–59 (5% [n = 2/44] vs 0.39% [n = 18/4565], P = .015 and 10% [n = 4/40] vs 2.31% (n = 89/3848), P = .015, respectively). We observed improved estimated glomerular filtration rates in those with chronic kidney disease stage 3 or worse postoperatively (48 vs 57 mL/min/1.73m2, P = .047). A successful parathyroidectomy normalized all 24-hour urine calcium excretion. Conclusion An indication for early parathyroidectomy should include estimated glomerular filtration rates less than 60mL/min/1.73m2 in patients with multiple endocrine neoplasia type 1–associated primary Hyperparathyroidism.
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familial Hyperparathyroidism disorders of growth and secretion in hormone secretory tissue
Hormone and Metabolic Research, 2017Co-Authors: Stephen J. Marx, Delmar M LourencoAbstract:Six syndromes of familial Hyperparathyroidism are compared: 1) Familial hypocalciuric hypercalcemia (FHH) expresses primary Hyperparathyroidism (PHPT) beginning at birth with lifelong hypercalcemia. There is nonsuppressed PTH secretion from outwardly normal parathyroid glands. It reflects germline heterozygous mutation in CASR, GNA11, or AP2S1 . 2) Neonatal severe primary Hyperparathyroidism is severest of the six syndromes. It requires urgent total parathyroidectomy in infancy. It usually reflects biallelic inactivation of the CASR. 3) Multiple endocrine neoplasia type 1 (MEN1) is most frequently expressed as PHPT with asymmetric enlargement of 3–4 parathyroids. Benign or malignant tumors may occur among 30 other tissues. It is predisposed by germline inactivation of MEN1 or rarely by inactivation of a cyclin dependent kinase inhibitor, and then termed MEN4. 4) Multiple endocrine neoplasia type 2A from RET activating mutation rarely presents as familial Hyperparathyroidism, because medullary thyroid cancer and pheochromocytoma are more prominent. 5) Hyperparathyroidism-jaw tumor syndrome (HPT-JT) has frequent PHPT and benign jaw tumors. Twenty percent develop parathyroid cancer. It is predisposed by inactivating mutation in CDC73 . 6) Familial isolated Hyperparathyroidism causes multiple parathyroid tumors. It can be an incomplete expression of FHH, MEN1, HPT-JT or even of relatives without a shared driver mutation. However, in 20% of families it reflects GCM2 activating mutation. Five of the PHPT syndromes reflect overgrowth of parathyroid tissue; in contrast, familial hypocalciuric hypercalcemia reflects dysregulation of PTH secretion with little or no parathyroid overgrowth. These differences underlie major differences in clinical expression.