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C Letizia - One of the best experts on this subject based on the ideXlab platform.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with Primary Hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with Primary Hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h “weighted” Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-Primary Hyperparathyroidism patients, respectively. Normotensive-Primary Hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire Primary Hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively). Systolic blood pressure variability is increased in normotensive patients with Primary Hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Introduction Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk.
Antonio Concistre - One of the best experts on this subject based on the ideXlab platform.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with Primary Hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with Primary Hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h “weighted” Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-Primary Hyperparathyroidism patients, respectively. Normotensive-Primary Hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire Primary Hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively). Systolic blood pressure variability is increased in normotensive patients with Primary Hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Introduction Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk.
John P Bilezikian - One of the best experts on this subject based on the ideXlab platform.
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Primary Hyperparathyroidism hypercalcemic and normocalcemic variants
Current Opinion in Endocrine and Metabolic Research, 2018Co-Authors: John P Bilezikian, Barbara C Silva, Natalie E. CusanoAbstract:Abstract Primary Hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or inappropriately normal PTH concentrations. The normocalcemic variant of the disease presents with persistently elevated PTH concentrations, but normal levels of ionized and albumin-corrected total calcium. In countries where serum calcium is measured as part of a biochemical-screening panel, PHPT presents primarily as an asymptomatic disease. In parts of the world where calcium is not routinely measured, the disease is more likely to be symptomatic, with skeletal and renal complications. Parathyroidectomy is recommended for those with symptomatic disease, and for those with asymptomatic PHPT who meet guidelines or prefer surgery. This article reviews the current state of the hypercalcemic and normocalcemic variants of PHPT, with particular emphasis on recently published literature.
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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 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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the calcimimetic cinacalcet normalizes serum calcium in subjects with Primary Hyperparathyroidism
The Journal of Clinical Endocrinology and Metabolism, 2003Co-Authors: Dolores M Shoback, John P Bilezikian, Matthew Guo, Stewart A Turner, Laura C Mccary, Munro PeacockAbstract:Calcimimetics increase the sensitivity of the calcium-sensing receptor (CaR) to circulating serum calcium, reducing the secretion of PTH and the serum calcium concentration. We evaluated the calcimimetic cinacalcet, a novel therapy for the management of Primary Hyperparathyroidism. In this randomized, double-blind, dose-finding study, patients (n = 22) with Primary Hyperparathyroidism were given cinacalcet (30, 40, or 50 mg) or placebo twice daily for 15 d and observed for an additional 7 d. Serum calcium, plasma PTH, and 24-h and fasting urine calcium were measured. Baseline mean serum calcium was 10.6 mg/dl for the combined cinacalcet-treated patients (normal range, 8.4-10.3 mg/dl), compared with 10.4 mg/dl for the placebo group. Mean PTH at baseline was 102 pg/ml (normal range, 10-65 pg/ml) for the combined cinacalcet-treated patients, compared with 100 pg/ml in the placebo group. Serum calcium normalized after the second dose on d 1 and remained normal through d 15 in all cinacalcet dose groups. Maximum decreases in PTH of over 50% occurred 2-4 h after dosing in all cinacalcet-treated groups. The fasting and 24-h urine calcium to creatinine ratios were similar in the cinacalcet and placebo groups. This study demonstrates that cinacalcet safely normalized serum calcium and lowered PTH concentrations without increasing urinary calcium excretion in the study subjects, indicating the potential benefit of cinacalcet as a medical treatment for 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...
David T Hughes - One of the best experts on this subject based on the ideXlab platform.
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early biochemical response to parathyroidectomy for Primary Hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent Primary Hyperparathyroidism
Surgery, 2021Co-Authors: Charity Yoonhee Ryder, Mark S Cohen, Paul G Gauger, Barbra S Miller, Adrienne Jarocki, Molly M Mcneely, Erin Currey, David T HughesAbstract:Abstract Background The traditional definition of cure after parathyroidectomy (PTX) for Primary Hyperparathyroidism is normocalcemia. Our hypothesis was that early postoperative levels of serum calcium and parathyroid hormone after PTX would have predictive value for later recurrence. Methods We performed a retrospective study of 1,146 patients with Primary Hyperparathyroidism who underwent PTX and had long-term biochemical follow-up. The first postoperative serum level of calcium and parathyroid hormone values were used to categorize patients into the following four early biochemical response groups: (1) complete response (normal calcium and normal parathyroid hormone), (2) partial response with hyperparathormonemia (normal calcium and increased parathyroid hormone), (3) partial response with hypercalcemia (increased calcium and normal parathyroid hormone), and (4) non-response (increases in both calcium and parathyroid hormone). Incidences of recurrent hypercalcemia and recurrent Primary Hyperparathyroidism >6 months after operation were then analyzed. Results The overall rate of any elevated serum levels of calcium and any increase in serum levels of parathyroid hormone during >6-month follow-up was 9.8% (112 of 1146), with 6.6% (57 of 861) for group 1, 27% (35 of 129) for group 2, and 16% (20 of 127) for group 3 (P Conclusion This study demonstrates the importance of measuring parathyroid hormone in the early postoperative period to better predict later recurrent Primary Hyperparathyroidism.
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intraoperative parathyroid hormone levels 40 pg ml are associated with the lowest persistence rates after parathyroidectomy for Primary Hyperparathyroidism
Surgery, 2019Co-Authors: Jake Claflin, Apoorv Dhir, Nicolas M Espinosa, Alexis G Antunez, Mark S Cohen, Paul G Gauger, Barbra S Miller, David T HughesAbstract:Abstract Background Intraoperative parathyroid hormone (IOPTH) monitoring is used to predict biochemical cure during parathyroidectomy for Primary Hyperparathyroidism; however, there is variability in the intraoperative parathyroid hormone criteria used by surgeons to predict normocalcemia after parathyroidectomy. This study sought to determine the intraoperative parathyroid hormone criteria correlated with the lowest rates of persistent Hyperparathyroidism after parathyroidectomy for Primary Hyperparathyroidism. Materials and Methods This is a retrospective cohort study of 2,654 patients with Primary Hyperparathyroidism who underwent parathyroidectomy with intraoperative parathyroid hormone monitoring at a single institution from 1999 to 2014. Multivariate logistic regression analysis was used to measure the association between the lowest intraoperative parathyroid hormone level and the persistence of Primary Hyperparathyroidism after parathyroidectomy. Results A total of 66 patients (2.5%) had persistent Hyperparathyroidism after parathyroidectomy. Using the traditional intraoperative parathyroid hormone criteria of a ≥50% decrease from the baseline level, the rate of persistent Primary Hyperparathyroidism was greater when intraoperative parathyroid hormone did not decrease to ≥50% from the baseline level (17 of 180 patients [9.4%] vs 49 of 2,474 [2.0%], [OR 5.9, 95% CI 3.2–10.5, P Conclusion Patients with a lowest intraoperative parathyroid hormone ≤40 pg/mL compared with the traditional criteria of a ≥50% decrease from baseline and a final parathyroid hormone in the normal range (
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influence of concurrent chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for Primary Hyperparathyroidism
Surgery, 2018Co-Authors: Bipin Sunkara, Mark S Cohen, Paul G Gauger, Barbra S Miller, David T HughesAbstract:Abstract Background The influence of chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for Primary Hyperparathyroidism has not been well-established. We hypothesize that chronic kidney disease influences intraoperative parathyroid hormone degradation kinetics during parathyroidectomy. Methods This is a single institution retrospective cohort study of consecutive patients with Primary Hyperparathyroidism underdoing parathyroidectomy. Patients were stratified according to normal kidney function (glomerular filtration rates ≥60 mL/min/1.73 m2 or presence of chronic kidney disease (glomerular filtration rates 15 − 60 mL/min/1.73 m2). Demographics, laboratory data, operative findings, and intraoperative parathyroid hormone data were compared between groups. Results Of the 964 study patients, 235 had chronic kidney disease (24.4%), while 729 (75.6%) had normal kidney function. The chronic kidney disease population had a greater median preoperative serum parathyroid hormone (PTH) (125 vs 114 pg/mL; P Conclusion Patients with chronic kidney disease undergoing parathyroidectomy for Primary Hyperparathyroidism have similar intraoperative parathyroid hormone degradation kinetics, and the intraoperative parathyroid hormone criteria used to predict cure should be similar to those with normal kidney function.
Francesco Fallo - One of the best experts on this subject based on the ideXlab platform.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with Primary Hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with Primary Hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h “weighted” Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-Primary Hyperparathyroidism patients, respectively. Normotensive-Primary Hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire Primary Hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively). Systolic blood pressure variability is increased in normotensive patients with Primary Hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
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ambulatory blood pressure monitoring derived short term blood pressure variability in Primary Hyperparathyroidism
Endocrine, 2018Co-Authors: Antonio Concistre, Andrea Grillo, G La Torre, Renzo Carretta, Bruno Fabris, Luigi Petramala, Cristiano Marinelli, Andrea Rebellato, Francesco Fallo, C LetiziaAbstract:Introduction Primary Hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk.