Materiały źródłowe

• #1 Surgery versus surveillance for asymptomatic (mild) primary hyperparathyroidism in adults 50 years or older – Ramakant, P – 2012 | Cochrane Library

  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010093/full

  Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder following diabetes and hypothyroidism. It is characterised by hypercalcaemia with an inappropriately elevated serum parathyroid hormone (PTH) level and normal or raised urinary calcium excretion. The incidence of PHPT is 0.03% with a prevalence of 0.1% to 0.5% (Sejean 2005). The prevalence of bone and kidney disease associated with PHPT varies according to geography. In developed countries up to 5% of patients have brown tumours and 15% to 20% of patients have been associated with renal calculi (Gittoes 2010). In contrast, up to 70% of patients in developing countries may have severe bone disease (Pradeep 2008). […] Asymptomatic PHPT is defined as the absence of specific symptoms or signs traditionally associated with hypercalcaemia or high PTH levels in patients with PHPT (Khan 2009). However, this 'absence of signs and symptoms’ is relative and when questioned in detail, patients may report nonspecific symptoms such as fatigue, weakness, poor memory and difficulty in concentration. With the introduction of automated multichannel biochemical analysers started in 1970s the incidence of asymptomatic PHPT has apparently increased (Rao 2004). In one study from the western world, at least 39% of patients with PHPT had untreated mild disease (Yu 2011). With increasing awareness, longer life expectancy and more frequent diagnosis of the condition in young patients previously undiagnosed asymptomatic disease is on the rise.

• #2 Hyperparathyroidism | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p333.html

  Primary hyperparathyroidism is the most frequent cause of hypercalcemia in ambulatory patients. The condition is most common in postmenopausal women, although it can occur in persons of all ages, including pregnant women. […] In the United States, its estimated incidence in persons older than 65 years is one case per 1,000 in men and two to three cases per 1,000 in women. […] Most patients with primary hyperparathyroidism are postmenopausal women. The incidence of the condition increases with age, and the average age at diagnosis is 55 years. […] Asymptomatic primary hyperparathyroidism accounts for 75 to 80 percent of cases. […] Commitment to conscientious, long-term medical monitoring at least semiannually is essential. Recommended surveillance includes biannual measurement of serum calcium levels, annual measurement of serum creatinine levels, and annual bone density testing. […] There are no clinical factors that predict the prognosis of patients with asymptomatic hyperparathyroidism. Studies have demonstrated that up to 25 percent of asymptomatic patients develop indications for surgery during medical observation.

• #3

  https://www.italjmed.org/index.php/ijm/article/view/547

  Primary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. […] Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. […] In case of contraindication for surgery, medical treatment can play a relevant role.

• #4 Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10092691/

  In this narrative review, we present data gathered over four decades (19802020) on the epidemiology, pathophysiology and genetics of primary hyperparathyroidism (PHPT). PHPT is typically a disease of postmenopausal women, but its prevalence and incidence vary globally and depend on a number of factors, the most important being the availability to measure serum calcium and parathyroid hormone levels for screening. […] The prevalence and incidence of PHPT vary around the world and depend on a number of factors, the most important being availability of serum calcium (and parathyroid hormone) measurement for screening, which in the Western world has shifted its presentation to an asymptomatic disorder. […] PHPT is a commonly encountered endocrine disorder in North America. This condition has an equal incidence rate in men and women 45 years of age but is much more common in women after 45 years of age. The incidence rates of PHPT are highest among blacks, followed by whites with lower rates in Asians and Hispanics.

• #5 Hyperparathyroidism epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hyperparathyroidism_epidemiology_and_demographics

  Primary hyperparathyroidism is the 3rd most common endocrine disorder. Highest incidence of primary hyperparathyroidism is in post-menopausal women. The incidence of primary hyperparathyroidism is approximately 0.4 to 21.6 per 100,000 person years. The prevalence of primary hyperparathyroidism is approximately .01 to .07 per 100,000 individuals. The incidence of primary hyperparathyroidism increases with age. Primary hyperparathyroidism usually affects individuals of African-American race. Women are more commonly affected by primary hyperparathyroidism than men. The women to men ratio is approximately 3 to 1. Difference in gender specific incidence of primary hyperparathyroidism becomes more pronounced with advancing age. […] There is insufficient data on epidemiology and demographics of secondary and tertiary hyperparathyroidism.

• #6 Primary Hyperparathyroidism Presenting as Hypercalcemic Crisis | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v1n1/wachtel-hyperparathyroidism/

  Hyperparathyroidism is the most common cause of hypercalcemia in the ambulatory population. The incidence varies widely, from 0.4 to 21.6 cases per 100,000 adults annually. Elderly females are two to three times more likely to be affected. The causative entity of primary hyperparathyroidism (PHPT) is most commonly a single parathyroid adenoma in 80%-85% of patients; multi-gland parathyroid disease constitutes a further 15% of cases, with parathyroid carcinoma contributing approximately 1% of cases. Although PHPT is sporadic in 95% of cases, germline mutations in MEN1, and HRPT2 are associated with the familial PHPT syndromes of multiple endocrine neoplasia types 1 and 2A, and the hyperparathyroidism jaw-tumor syndrome, respectively. In patients with familial syndromes, a higher suspicion for multi-gland disease may exist. Parathyroidectomy remains the only definitive therapy for PHPT, and bilateral exploration should be performed for patients in whom multi-gland disease is suspected.

• #7 Primary Hyperparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441895/

  Primary hyperparathyroidism is the most common, identifiable cause of hypercalcemia diagnosed in postmenopausal women. The female-to-male ratio is approximately 3 to 4 times that of men, and the peak age group is between 50 and 60. Risk factors associated with hyperparathyroidism include specific germline and somatic mutations, chronically low dietary calcium, obesity, prolonged use of furosemide, history of neck radiation therapy, lithium therapy, hypertension, and physical inactivity. […] The primary contributor leading to the diagnosis of primary hyperparathyroidism is the widespread availability of standard laboratory testing, as the majority of cases are diagnosed through asymptomatic hypercalcemia. Before 1970, the diagnosis was made when patients presented with specific symptoms, typically nephrolithiasis or bone pain. Since then, most patients have been diagnosed with hyperparathyroidism when serum calcium is incidentally discovered to be elevated on a routine chemistry profile ordered as a screening test or for an unrelated problem. […] The current incidence of hyperparathyroidism in the United States has been estimated to be at 233 per 100,000 person-years in women and 85 per 100,000 person-years in men. In North America, incidence is higher among Blacks than Whites, with Asians and Hispanics having lower incidence.

• #8 Hyperparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Hyperparathyroidism

  In the developed world, between one and four per thousand people are affected. Primary hyperparathyroidism is the most common type. Certain exposures increase the risk of developing primary hyperparathyroidism such as sex and age. It occurs three times more often in women than men and is often diagnosed between the ages of 50 and 60 but is not uncommon before then. The United States prevalence of primary hyperparathyroidism from 2010 was 233 per 100,000 women and 85 per 100,000 men. Black and white women aged 70-79 have the highest overall prevalence. Secondary hyperparathyroidism is most commonly caused by chronic kidney disease and vitamin D deficiency. The prevalence of vitamin D deficiency is about 50% of the world population and chronic kidney disease prevalence is 15% of the United States population.

• #9 Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

  https://www.mdpi.com/2077-0383/12/19/6321

  Primary hyperparathyroidism is the most common cause of hypercalcemia with a prevalence of approximately 1 per 100 in the elderly. It mostly occurs in elderly females. Multiglandular disease is more frequent in older patients compared to younger ones, with a rate of 20–30% in the former group. […] The prevalence of PHPT has been increasing during the past three decades, with recent evidence showing that about 1.5% of patients over the age of 70 have PHPT. The incidence of PHPT increases with age, ranging from 12–24 per 100,000 in patients aged <50 years, to 95–196 per 100,000 in patients aged 70–79. [...] PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population in terms of improved BMD, fewer fractures, improved psychiatric symptoms, and improved quality of life is now well demonstrated in the literature. [...] Despite the evidence-based positive outcomes, parathyroidectomy is still underused for symptomatic PHPT in older adults.

• #10 Epidemiology of primary hyperparathyroidism in Santander, Spain | ECE2018 | 20th European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0056/ea0056p213

  Epidemiology of primary hyperparathyroidism in Santander, Spain […] The aim of our study is to assess the prevalence and incidence of diagnosed PHPT in adults between 1970 and 2014 in Santander, a population of 290.000 inhabitants, located in the north of Spain. […] We identified 709 patients (82.3% females) diagnosed with PHPT by the end of 2014. […] Prevalence of PHPT was higher in females, and the female preponderance increased with age. […] The incidence in the period from 1995 to 1999 was 2.75/100.000 person-years and doubled in the period from 2010 to 2014, becoming 5.20/100.000 person-years. […] The prevalence of diagnosed PHPT in Santander increased from 0.01 per 1000 population in the period from 1980 to 1984 to 0.38 per 1000 population in the period from 2010 to 2014. […] The incidence of PHPT in Santander continues its remarkable rise. The incidence of diagnosis is greater in females than in males and increases with age.

• #11 Hyperparathyroidism – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hyperparathyroidism/

  Lifetime incidence: 1/80. […] Most cases occur after age 50 years. […] Prevalence: 0.10.5%. […] Parathyroidectomy is curative in 98% of patients and therefore is indicated for most patients with pHPT. […] Management should be guided by a specialist. […] Consider sHPT in patients with hypocalcemia and an associated underlying condition (e.g., CKD, vitamin D deficiency). […] Consider tHPT in patients with long-standing sHPT who develop hypercalcemia.

• #12 Pulsenotes | Primary hyperparathyroidism

  https://app.pulsenotes.com/medicine/endocrinology/notes/primary-hyperparathyroidism

  Primary hyperparathyroidism is the most common cause of hypercalcaemia in the general population. […] The prevalence is estimated to be between 1 and 4 per 1000 of the general population. Its incidence increases with age, in particular affecting post-menopausal women.

• #13 Primary hyperparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Primary_hyperparathyroidism

  Primary hyperparathyroidism affects approximately 1 per 1,000 people (0.1%), while there are 2530 new cases per 100,000 people per year in the United States. […] The prevalence of primary hyperparathyroidism has been estimated to be 3 in 1000 in the general population and as high as 21 in 1000 in postmenopausal women. […] Primary hyperparathyroidism is associated with increased all-cause mortality.

• #14

  https://link.springer.com/article/10.1007/BF01665300

  Primary hyperparathyroidism (HPT) is a common disorder that mainly afflicts elderly women. It can be diagnosed in at least 1% of all postmenopausal females and autopsy studies indicate an even higher frequency. […] Although the widespread use of automated serum calcium analyses has increased the awareness of HPT, only 10% of all cases seem to be identified. […] Various cardiovascular risk factors appear more commonly in patients with HPT and untreated disease is associated with an increased risk of premature death.

• #15 Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10092691/

  Over the past five decades, the epidemiology of PHPT in North America has been highly influenced by changes in medical practice. […] In Western Europe, as in the United States, PHPT is commonly diagnosed in patients with asymptomatic mild hypercalcemia based on multichannel biochemical screening. […] Currently, there are no published studies specifically for the incidence or prevalence of PHPT in the general population of Eastern European countries. […] PHPT is underdiagnosed in the developing world mainly because of a lack of routine serum biochemical screening. […] PHPT epidemiological data within the last two decades have not been reported from Japan or in India, where health policy does not include screening of asymptomatic subjects with serum calcium, but where PHPT remains a severe disease.

• #16 Epidemiology of Primary Hyperparathyroidism

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W3022623290

  After the introduction of automated chemistry panels, including the routine measurement of serum calcium, there was a dramatic rise in the incidence of primary hyperparathyroidism (PHPT) in the early 1970s. […] Postmenopausal women have the highest incidence rate of PHPT and blacks also appear to have a greater risk. […] Although current cost-effectiveness studies of surgery versus observation of asymptomatic PHPT are limited by the lack of long-term randomized data, available information suggests that surgery benefit exceeds cost after 56 years.

• #17

  https://ugeskriftet.dk/dmj/increasing-incidence-primary-hyperparathyroidism-denmark

  Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Over the past years, PHPT has experienced a dramatic change in epidemiology. The disease is often asymptomatic; hence, its incidence was previously often underestimated. With the increasing availability of plasma calcium measurements during the 1970s, the incidence of PHPT has risen significantly. The latest available figures from the US show a continuing downward trend in incidence with an overall incidence rate of 21.6 per 100,000 person-years in the 1993-2001 period. This downward trend was not observed in Denmark; in contrast, the incidence in Denmark was increasing. From 1980 to 1999, the incidence rose significantly among women (from 3.4 to 5.8 per 100,000 per year), while the increase for men was less pronounced. It is worth noting that the large difference in incidence rates between Denmark and the United States probably reflects a large pool of undetected cases in Denmark. The incidence of PHPT in Denmark has not been assessed since 1999. The purpose of the present study was to evaluate incidence rates of PHPT in the 2000-2010 period to determine if the development in Denmark is similar to that seen in the rest of the world. This study reveals a continuing increase in the incidence rates of PHPT in Denmark during the 2000-2010 period. The increase was seen in both men and women, especially above 50 years of age and it was more pronounced for women. The incidence of 21.6 per 100,000 per year seen in the US for the 1993-2001 period is close to but still well above the Danish incidence of 16 per 100,000 per year in 2010 demonstrated in this study. In summary, the increase in incidence observed in Denmark may, in part, be attributed to more measurements being made. In addition, obesity may also play a role. A continuing increase was observed in the incidence of primary hyperparathyroidism in Denmark from 2000 to 2010. Part of the increase can be attributed to increased diagnostic activity.

• #18 US to see growth in diagnosed prevalence of primary hyperparathyroidism – Pharmaceutical Technology

  https://www.pharmaceutical-technology.com/research-reports/researchreportus-to-see-growth-in-diagnosed-prevalence-of-primary-hyperparathyroidism-5746763/

  Improved diagnosis rates may contribute to increase in prevalence. […] GlobalData epidemiologists forecast an increase in diagnosed prevalent cases of primary hyperparathyroidism (PHPT) in the seven major markets (7MM) (US, France, Germany, Italy, Spain, UK, and Japan) from 2015 to 2025. Compared with the other markets, the US is expected to see the most dramatic increase in PHPT cases. […] The number of cases in the 7MM is expected to increase from 2,055,167 in 2015 to 2,373,547 in 2025, at an annual growth rate (AGR) of 1.55%. All countries are expected to see an increase in diagnosed prevalent cases. […] The US is expected to see an even greater increase in PHPT cases, from 385,833 to 513,509, at an AGR of 3.31%. In addition to population growth, this increase is driven by an expected increase in the diagnosed prevalence of PHPT based on analysis of historical data.

• #19

  https://step1.medbullets.com/endocrine/109079/hyperparathyroidism

  occurs in 0.1% of the population and 90% of cases result from a single adenoma […] severe, prolonged calcium or vitamin D deficiency […] menopause […] neck radiation […] lithium use

• #20 Familial hyperparathyroidism — Knowledge Hub

  https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/familial-hyperparathyroidism/

  Familial hyperparathyroidism is a genetic predisposition to parathyroid hormone (PTH)-mediated hypercalcaemia. Primary hyperparathyroidism (PHPT) is a common condition and approximately 1-in-10 cases are caused by a hereditary syndrome. […] The above conditions are inherited in an autosomal dominant manner and are typically associated with a high degree of penetrance (with the exception of activating GCM2 variants). For example, over 95% of individuals with MEN1 will develop PHPT over the course of their lifetime. […] Individuals with autosomal dominant isolated PHPT are generally managed conventionally with parathyroid surgery. Ongoing follow-up is required to monitor calcium and PTH levels.

• #21 Hyperparathyroidism: Background, Anatomy and Embryology, Primary Hyperparathyroidism

  https://emedicine.medscape.com/article/766906-overview

  Primary hyperparathyroidism is more common in women, the incidence being 66 per 100,000 person-years in females, and 25 per 100,000 person-years in males. In a large study of 3.5 million enrollees in Kaiser Permanente of southern California, the incidence fluctuated over time but was not seen to decrease substantially. On the contrary, the prevalence of primary hyperparathyroidism saw a substantial increase in this population. […] However, primary hyperparathyroidism is underdiagnosed, so the incidence and prevalence are likely much higher. Two large studies, both from academic centers, showed that hypercalcemia led to measurement of parathyroid hormone in under one third of patients. […] There is abundant evidence that primary hyperparathyroidism is both underdiagnosed and undertreated. Several studies have documented that patients with primary hyperparathyroidism are treated with surgery in the minority of cases (9-39%) despite clear indications for surgery, and the proportion is decreasing over time.

• #22 Primary hyperparathyroidism in Russian Federation: epidemiology according to the online register | ECE2018 | 20th European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0056/ea0056p236

  Primary hyperparathyroidism in Russian Federation: epidemiology according to the online register […] Primary hyperparathyroidism (PHPT) is one of the most frequently diagnosed endocrine disorders. […] The Russian Registry of PHPT is an on-line web-based database created in 2016 with the aim to estimate the disease prevalence and improve the quality of health care for such patients in Russian Federation. […] According to the Registry the sporadic PHPT was the most frequent form and caused by solitary adenoma. […] The estimated incidence of parathyroid cancer was 2% comparable with other epidemiological studies. […] PHPT as a MEN syndrome component occurred in 9% of cases. […] The majority of patients were symptomatic (74%). […] Conclusion: PHPT considerably influences the Russian healthcare system. We observed a tendency to progressive increase in disease detectability. It should be noted that compared to European countries, the symptomatic PHPT is more likely to be diagnosed, which indicates delayed diagnosis because of no routine screening of serum calcium level.

• #23 Hyperparathyroidism: Background, Anatomy and Embryology, Primary Hyperparathyroidism

  https://emedicine.medscape.com/article/766906-overview

  A survey study by Sharata et al of primary care providers in the United States found that only a minority of respondents showed firm familiarity with management strategies for primary hyperparathyroidism. The investigators found that 31% of the 109 clinicians who responded to the survey were familiar with the whole range of criteria regarding surgical intervention in asymptomatic patients and that 34% were able to accurately identify correct surveillance testing for patients being observed. Among patients under observation, only 16% underwent proper surveillance studies.

• #24 Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10092691/

  The diagnosis of asymptomatic PHPT is largely determined by the measurement of serum calcium and PTH with large variations between regions and healthcare systems. The incidence of PHPT is threefold to fivefold higher in postmenopausal women for unclear reasons, but identification of such factors may provide insight into its etiology. […] There is a need for a prospective study concomitantly carried out in different parts of the world to better define prevalence and incidence of the hypercalcemic and normocalcemic forms of PHPT.

• #25 Epidemiology of primary hyperparathyroidism in Russia (the first results from the database of Federal state institution «Endocrinological Research Centre») | Dedov | Problems of Endocrinology

  https://www.probl-endojournals.ru/jour/article/view/4736?locale=en_US

  To elucidate specific features of epidemiology of various forms of primary hyperparathyroidism (PHPT) in this country using the information about 561 patients accumulated for 19 years in the database of Federal state institution Endocrinological Research Centre. The incidence of PHPT in Moscow estimated from the database of Endocrinological Research Centre for 2007 was 6.8 per 1 000 000 adult population and the prevalence as per 2009 was 3.1/100 000. These values are significantly lower than those reported by foreign authors. […] The above results are the first data on epidemiology of PHPT in this country; however, they are insufficient to comprehensively evaluate the real significance of the problem. Large-scale epidemiological studies are needed to ensure adequate assessment of the situation.

• #26

  https://journals.lww.com/md-journal/fulltext/2015/06020/quality_of_life_after_surgery_or_surveillance_for.19.aspx

  Classic symptoms and signs of primary hyperparathyroidism are uncommon nowadays. With the addition of calcium to routine biochemical screening in the 1970s, the incidence of primary hyperparathyroidism has substantially increased, along with the discovery of many asymptomatic cases. Depending on the length of follow-up, up to 37% of asymptomatic patients who do not undergo surgery showed disease progression. […] Patients with asymptomatic hyperparathyroidism also exhibit neuropsychiatric and cognitive changes, which may have an impact on quality of life. Patient-centered outcomes, including symptoms and quality of life, are as important as clinical outcomes such as mortality and morbidity. […] Our findings are limited by the small number and size of randomized controlled trials. The results need to be interpreted with caution on reliability. In addition, heterogeneity and the test for publication bias may have been underestimated because these tests are underpowered when the number of trials is few. A way to overcome this limitation is to include prospective nonrandomized studies.

• #27 Hyperparathyroidism: Background, Anatomy and Embryology, Primary Hyperparathyroidism

  https://emedicine.medscape.com/article/127351-overview

  Primary hyperparathyroidism is more common in women, the incidence being 66 per 100,000 person-years in females, and 25 per 100,000 person-years in males. […] However, primary hyperparathyroidism is underdiagnosed, so the incidence and prevalence are likely much higher. […] There is abundant evidence that primary hyperparathyroidism is both underdiagnosed and undertreated. […] A survey study by Sharata et al of primary care providers in the United States found that only a minority of respondents showed firm familiarity with management strategies for primary hyperparathyroidism. […] Management of severe hypercalcemia in the acute setting […] Patients who do not undergo surgery require long-term monitoring. […] Recommendations include the following: Annual serum calcium and 25-hydroxyvitamin D concentrations; measurement of parathyroid hormone levels can be performed as clinically indicated.

• #28 Primary hyperparathyroidism and hypertension – Fisher – Gland Surgery

  https://gs.amegroups.org/article/view/32624/html

  Between 40% to 60% of patients with PHPT have concomitant hypertension. […] A matched Scandinavian case-control study of 123 patients with PHPT demonstrated that patients with PHPT were more likely to require antihypertensive medication, and more commonly had a history of congestive heart failure, thromboembolic disease, cerebrovascular accident, or diabetes mellitus than control patients undergoing unrelated surgical procedures. […] A recent Nationwide Inpatient Sample study confirmed these increased rates of comorbidities with an increased prevalence of hypertension (63% vs. 39%, P0.0001), diabetes, hyperlipidemia, obesity, chronic kidney disease, heart failure, and established coronary artery disease in patients with PHPT (n=37,922) as compared to the general population (n=33,094,451).

• #29 Primary hyperparathyroidism and hypertension – Fisher – Gland Surgery

  https://gs.amegroups.org/article/view/32624/html

  The Parathyroid Epidemiology and Audit Research Study is a retrospective population based observational study in Tayside, Scotland that focused on 2,097 adults with untreated mild PHPT over a 9-year time period. […] Patients with PHPT were more likely than the general population to have multiple cardiovascular related comorbidities, including hypertension, even when corrected for pre-existing conditions (standardized incidence ratio for hypertension 3.77; 95% CI: 3.214.41). […] The systemic impact of PHPT is far reaching, and surgical correction of PHPT offers chance for durable cure. […] Population based studies support an association between increasing PTH levels and the incidence of hypertension, independent of the diagnosis of PHPT, although exact mechanism and causality are not clearly understood. […] Few large scale population studies focus on PHPT, but of those, data further support a link between PHPT, PTH levels, and hypertension.

• #30

  https://journals.lww.com/md-journal/fulltext/2015/06020/quality_of_life_after_surgery_or_surveillance_for.19.aspx

  This review is clinically relevant because integrating quality-of-life assessment is helpful in supporting clinical decision making and has potential to enhance patient-centered care. Although the SF-36 is a generic measure of health status that may not be sensitive to clinical changes specific to hyperparathyroidism, significant differences were observed between the surveillance group and surgery group in the present study. It is worth noting that our temporal analysis revealed a trend toward worsening quality of life in the surveillance group and vice versa in the surgery group. This reinforces our conclusion that hyperparathyroidism patients undergoing surgery or surveillance present different alterations in quality of life. A well designed and adequately powered trial would be necessary to establish the magnitude and durability of improvements in quality of life after parathyroidectomy, and whether the relevant changes are related to biochemical abnormalities. Future studies should have longer follow-up to evaluate time trends to determine whether the effect is constant, linear, or prone to plateau over time. […] In summary, pooled data from randomized trials suggest that quality of life significantly differs in patients with asymptomatic primary hyperparathyroidism undergoing surgery or surveillance, particularly in the domain of emotional role functioning.

• #31 Hyperparathyroidism: Background, Anatomy and Embryology, Primary Hyperparathyroidism

  https://emedicine.medscape.com/article/127351-overview

  Patients with primary hyperparathyroidism should maintain a moderate daily elemental calcium intake of 800-1000 mg and a vitamin D intake appropriate for their age and sex. […] Surgical treatment should be offered to most patients with primary hyperparathyroidism. […] The historical criterion-standard operative approach is complete neck exploration with identification of all parathyroid glands and removal of all abnormal glands. […] Cure rates after surgery for primary hyperparathyroidism are very high in expert hands, approximately 97-98%. […] Quality of life has been shown repeatedly to be improved after parathyroidectomy. […] A literature review by Eli et al indicated that in pregnant persons with primary hyperparathyroidism, the risk of neonatal complications from the disease are lower in patients who undergo operative treatment than in those who are managed conservatively.

• #32 The effect of parathyroidectomy compared to non-surgical surveillance on kidney function in primary hyperparathyroidism: a nationwide historic cohort study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-021-00918-z

  Patients with primary hyperparathyroidism (pHPT) and impaired kidney function (estimated glomerular filtration rate (eGFR) 60mL/min) are offered parathyroidectomy (PTX) to protect them from further complications. […] Compared to non-surgical surveillance, PTX is associated with a small but significant decrease in kidney function in pHPT patients with an initial normal kidney function. […] Results from our historic cohort study showed that after 915months follow-up, surgical cure of pHPT is associated with a decline in kidney function compared to surveillance without surgical intervention. […] Our findings do not exclude the possibility that long term kidney outcomes could be more favourable with PTX than with conservative treatment, but we did not find it to be the case in the short term.

• #33 Parathyroid Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0815/p249.html

  Parathyroid disorders most commonly present with abnormalities of serum calcium. Patients with primary hyperparathyroidism, the most common cause of hypercalcemia in outpatients, are often asymptomatic or may have bone disease, nephrolithiasis, or neuromuscular symptoms. […] The estimated incidence of primary hyperparathyroidism is approximately 25 cases per 100,000 persons per year in outpatients of Western countries, with a prevalence of one to four per 1,000 persons. […] Overall, 85% of patients with primary hyperparathyroidism have a single adenoma. Risk factors for primary hyperparathyroidism include a history of neck radiation, age older than 50 years, and female sex; women are twice as likely as men to develop primary hyperparathyroidism. […] The management of secondary hyperparathyroidism in chronic kidney disease usually involves consultation with a nephrologist. […] If patients with primary hyperparathyroidism do not undergo parathyroidectomy, they should be closely monitored for the development of symptoms or other indications for surgery.

• #34 US to see growth in diagnosed prevalence of primary hyperparathyroidism – Pharmaceutical Technology

  https://www.pharmaceutical-technology.com/research-reports/researchreportus-to-see-growth-in-diagnosed-prevalence-of-primary-hyperparathyroidism-5746763/

  From 2015 to 2025, the diagnosed prevalence in men and women in the US ages 20 years and older is expected to grow from 0.16% to 0.19%. This increase may be a result of improved diagnosis rates through more frequent blood screens. […] Previous studies have suggested that growth in PHPT prevalence may be caused in part by improved diagnosis rates and an increase in blood calcium testing. […] This means the number of diagnosed PHPT cases will continue to grow if biochemical testing continues to become more widely available.

Zobacz więcej