Materiały źródłowe

• #1 Primary hyperparathyroidism: predictors of sporadic multi-gland disease in: Endocrine Connections Volume 13 Issue 5 (2024)

  https://ec.bioscientifica.com/view/journals/ec/13/5/EC-23-0492.xml

  In this review, we discuss the definition, prevalence, and etiology of sporadic multiglandular disease (MGD), with an emphasis on its preoperative and intraoperative predictors. Primary hyperparathyroidism (PHPT) is the third-most common endocrine disorder, and multiglandular parathyroid disease (MGD) is a cause of PHPT. […] Therefore, it is crucial to be able to predict the presence of sporadic MGD in a timely manner, either preoperatively or intraoperatively. Various predictive methods cannot accurately identify all cases of sporadic MGD, but they can greatly optimize the management of MGD diagnosis and treatment and optimize the cure rate. Future research will urge us to investigate more integrative predictive models as well as increase our understanding of MGD pathogenesis. […] To maximize and optimize cure rates, precise prediction of MGD would be helpful in planning for the least invasive operation and guiding patients through the risks and advantages of PHPT surgery.

• #2 Survival after the diagnosis of hyperparathyroidism: a population-based study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9528728/

  Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. […] Overall survival in the patients with primary hyperthyroidism was better than expected (P=0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR=1.3 per mg/dL; 95% CI: 1.1-1.6; P 0.02). […] Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death.

• #3 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  If you have hyperparathyroidism and don’t have surgery, you’ll need to monitor your symptoms. […] For people with primary hyperparathyroidism, parathyroidectomy is very effective at bringing calcium levels back to normal, and at improving bone density and symptoms. […] Kidney transplant improves secondary hyperparathyroidism in about 40% of people within a year. […] Many people live with primary hyperparathyroidism for years without it affecting their health. […] Studies suggest that, of people who don’t have symptoms of primary hyperparathyroidism at the time of their diagnosis, about 25% (1 out of 4) will eventually need surgery.

• #4

  https://link.springer.com/article/10.1007/s44231-022-00025-0

  Secondary hyperparathyroidism (SHPT) is one of the most common complications of chronic kidney disease and has a high rate of morbidity and mortality. […] Current studies on prognostic factors in SHPT are inadequate. […] The causes of death among the 46 patients with severe SHPT were cardiogenic death (malignant arrhythmia, cardiac arrest) in 11 cases (47.8%), sepsis in 9 cases (39.2%), and neurogenic death (intracranial hemorrhage) in 3 cases (13.0%). […] Patients were divided into a good prognosis group and a poor prognosis group according to their status at the time of leaving the ICU. […] The age, PTH, PCT, WBC, APACHE II, and neutrophil ratio of the poor prognosis group were higher than those of the good prognosis group, and the ALB level was lower than that of the good prognosis group, with a statistically significant difference of P<0.05.

• #5

  https://link.springer.com/article/10.1007/s44231-022-00025-0

  Binary logistic regression analysis showed that age (OR=1.076, 95% CI (1.011, 1.145)), PTH (OR=1.004, 95% CI (1.000, 1.007)), WBC (OR=1.295, 95% CI (1.026, 1.634)) were indicators for poor prognosis in patients with severe SHPT, and ALB (OR=0.803, 95% CI (0.645, 0.998)) was a protective factor for poor prognosis. […] Age, PTH, and WBC are independent risk factors for poor prognosis of severe SHPT, and ALB is an independent protective factor for poor prognosis. […] The main causes of poor prognosis in this study were cardiovascular events (47.8%) and sepsis (39.2%), which may be associated with higher PTH levels and poor nutritional status in severe SHPT. […] PTH was an independent risk factor for adverse prognosis in severe SHPT. […] The prognosis of SHPT patients with low albumin levels was observed to be relatively poor in this study. […] The results of this study showed that leukocytes were an independent risk factor for severe SHPT. […] Age is also an independent risk factor for poor prognosis in severe SHPT. […] In conclusion, cardiovascular events and sepsis are the main causes of poor prognosis in severe SHPT.

• #6 Frontiers | Prediction of multiglandular parathyroid disease in primary hyperparathyroidism using ultrasound and clinical features

  https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1088045/full

  Background: Identification of multigland disease (MGD) in primary hyperparathyroidism (PHPT) patients is essential for minimally invasive surgical decision-making. […] Conclusion: US provided useful features for evaluating MGD. Combining the US and clinical features in a nomogram showed good diagnostic performance for predicting MGD. […] Our study developed a nomogram based on the clinical and US variables, which demonstrated good efficacy in discrimination of MGD with an AUC of 0.773 (0.68-0.85). When taking 65 points as a diagnostic standard, it achieved a good distinguish capability with a specificity of 0.939 and sensitivity of 0.500. Good consistency was observed in the calibration curve, and the DCA curve also showed an efficient clinical applicability. Thus, the nomogram can effectively predict MGD and aid in treatment strategies.

• #7 Frontiers | Prediction of multiglandular parathyroid disease in primary hyperparathyroidism using ultrasound and clinical features

  https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1088045/full

  In summary, our study indicated that US findings, including US size and texture of the dominant lesion, can serve as risk factors for MGD. And constructed a novel nomogram combing clinical and US characteristics to predict MGD in PHPT patients preoperatively. It could be helpful to assist treatment regimens for PHPT patients with multigland disease.

• #8

  https://apcz.umk.pl/JEHS/article/view/JEHS.2020.10.11.007

  Secondary hyperparathyroidism is a complication of chronic kidney disease in both the non-dialysis and dialysis stages. […] Persistence or recurrence of the disease occurs in 5-30% of cases. […] A decrease in PTH levels on the second day after surgery less than 76% comparatively to the preoperative level should be considered as a predictor of the development of disease persistence. […] A reduction in PTH of more than 90.9% may be an indication of sustained remission.

• #9 Predictive value of characteristics of resected parathyroid glands for persistent secondary hyperparathyroidism during parathyroidectomy | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-023-01936-5

  Parathyroidectomy (PTX), an effective treatment for refractory secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, still has a high persistent rate. This study aimed to analyze the predictive value of characteristics of resected parathyroid glands for postoperative persistent SHPT. […] Major reason for the persistent SHPT is the existence of supernumerary parathyroid glands or resection of less than 4 glands. When 4 glands were resected, a minimum total parathyroid gland weight heavier than 0.535 g implied the potential presence of a missed supernumerary parathyroid gland, which also contributed to the persistent SHPT. […] In summary, our study reveals that major reason for the persistent SHPT is the existence of supernumerary parathyroid glands or resection of less than 4 glands. When 4 glands were resected, a minimum total parathyroid gland weight heavier than 0.535 g implied the potential presence of a missed supernumerary parathyroid gland, which also contributed to the persistent SHPT. In this event, more careful examination of the surgical site for supernumerary or ectopic parathyroid was required to avoid persistent SHPT.

• #10 Surgical outcomes in primary hyperparathyroidism: addressing factors predicting persistent or recurrent hyperparathyroidism | ECE2024 | 26th European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0099/ea0099p391

  Surgical outcomes in primary hyperparathyroidism: addressing factors predicting persistent or recurrent hyperparathyroidism […] This study aims to assess the efficacy of surgery as a definitive treatment for hyperparathyroidism by determining the prevalence of persistent and recurrent hyperparathyroidism as well as predisposing factors. […] Our study reveals that surgery is a definitive and effective treatment for hyperparathyroidism. Nevertheless, surgical failure is not an uncommon occurrence, highlighting the need for continued vigilance in managing patients operated for primary hyperparathyroidism. Adenomas size measurements and anatomopathology results are critical in identifying patients at higher risk of persistent or recurrent hyperparathyroidism. This study provides valuable insights for clinicians to refine their approach in managing those patients ultimately improving long-term prognosis.

• #11

  https://link.springer.com/article/10.1007/s00423-016-1447-7

  The aim of this study was to evaluate the outcomes of surgery for patients with secondary renal hyperparathyroidism (rHPT). […] Subtotal parathyroidectomy is a safe and efficacious treatment for patients with rHPT. Utilization of intraoperative iPTH assay can guide surgical exploration and improve the cure rate. […] Persistent hyperparathyroidism was noted in 12/268 (4.5 %) patients after subtotal resection of the glands and in 5/29 (17.2 %) patients in the second analyzed group. The values were statistically significant (p=0.005). Intraoperative iPTH monitoring allowed for achieving a higher percentage of permanent cures in late follow-up in the group of patients with vs. without intraoperative iPTH monitoring (IOPTH group 201/20797.1 % versus without iPTH group 79/9087.8 %) (p=0.001). The values were statistically significant.

• #12

  https://link.springer.com/article/10.1007/s00423-016-1447-7

  The introduction of modern scintigraphic imaging methods (123I/99mTc-Sestamibi SPECT/single photon emission computed tomography/) and the use of magnetic resonance imaging (MRI) is of a great assistance in identification of supernumerary or ectopic parathyroid tissue. […] The analysis of the literature describing the results of all types of surgical treatment employed in secondary hyperparathyroidism does not provide us with unambiguous criteria of the selection and supremacy of a single given method. The ultimate goal is always resolution of hyperparathyroidism symptoms at the same time providing the patients with end-stage renal disease with a guarantee of normal calcium and phosphorus metabolism.

• #13 Machine learning-based prediction models for parathyroid carcinoma using pre-surgery cognitive function and clinical features | Scientific Reports

  https://www.nature.com/articles/s41598-023-46294-7

  Patients with parathyroid carcinoma (PC) are often diagnosed postoperatively, due to incomplete resection during the initial surgery, resulting in poor outcomes. […] The predicted probability of PC by machine learning was similar to the observed probability in the test set, whereas the logistic model tended to overpredict the possibility of PC. […] Preoperative cognitive function may be a probable predictor for PC. […] The cognitive function-based prediction model based on the XGBoost algorithm outperformed LASSO and logistic regression, providing valuable preoperative assistance to surgeons in clinical decision-making for patients suspected PC. […] The presurgical prediction for PC is still challenging. […] In our study, we proposed the pre-surgery cognitive function as a potential indicator for PC and both MMSE and MOCA could be used as robust tools for assessing the cognition of patients with PC. […] The XGBoost model, which had a better performance than the LASSO and logistic model, could predict PC based on pre-surgery cognitive function and clinical features.

• #14 Unveiling potential drug targets for hyperparathyroidism through genetic insights via Mendelian randomization and colocalization analyses | Scientific Reports

  https://www.nature.com/articles/s41598-024-57100-3

  Hyperparathyroidism significantly impacts the quality of life and survival time of patients. Currently, conventional drugs and surgical methods fall short of fully meeting clinical treatment needs. The development of effective and minimally invasive treatment methods is extremely necessary. Thus far, this study represents the first application of MR leveraging eQTL data to systematically identify potentially molecular targets that could potentially provide protection against hyperparathyroidism. […] This work identified two drug targets for hyperparathyroidism: PIK3C3 and SLC40A1 employing a variety of MR methods (MR-Egger, Wald ratio/IVW, weighted median method, Cochrans Q heterogeneity test, horizontal multiplicity test, bidirectional MR analysis, Steiger test, colocalization analysis and multivariable MR analysis). Moreover, the association between PIK3C3 and SLC40A1 with hyperparathyroidism was corroborated using a parallel analysis in the GTEx database, reinforcing the credibility of the potential drug targets identified in this investigation.

• #15 Unveiling potential drug targets for hyperparathyroidism through genetic insights via Mendelian randomization and colocalization analyses | Scientific Reports

  https://www.nature.com/articles/s41598-024-57100-3

  Ultimately, the study also showed the druggable value of these target genes by predicting compounds matching to these targets. […] These results suggest that the PIK3C3 inhibition as a promising hyperparathyroidism therapeutic strategy worthy of future investigation. […] This study has several strengths, including an extensive collection of eQTL, a substantial number of hyperparathyroidism cases, mutual validation in two independent exposure datasets, supportive colocalization analysis, and the exclusion of horizontal pleiotropy through PheWAS and multivariate MR analyses. […] In summary, this cis-eQTL-wide Mendelian randomization and colocalization analysis identified PIK3C3 inhibitors and SLC40A1 antagonists as promising therapeutic targets for hyperparathyroidism. Nevertheless, randomized controlled trials are imperative to conclusively assess the efficacy and safety of these potential drug targets.

• #16 Primary hyperparathyroidism: predictors of sporadic multi-gland disease in: Endocrine Connections Volume 13 Issue 5 (2024)

  https://ec.bioscientifica.com/view/journals/ec/13/5/EC-23-0492.xml

  The definition, pathogenesis, etiology, and epidemiology of MGD are the main topics of this review, with a focus on the preoperative and intraoperative predictors of sporadic MGD. […] The true prevalence of MGD in SPHPT is difficult to determine. Previous studies have reported a wide variation in the prevalence of sporadic MGD, ranging from 2.4% to 34.3%. […] Current research indicates that the IOPTH is a more reliable predictor of MGD, but there is controversy about which IOPTH interpretation criteria are most reliable. […] Overall, intraoperative real-time assessment of PTH is more sensitive than localization tests, but more research is still needed to explore the behavioral differences (or kinetic differences) in IOPTH between the two groups of patients with SGD and MGD and perhaps to develop better criteria for identifying patients with MGD. […] Looking forward, more integrated predictive models need to be explored to help clinicians develop optimal MGD treatment plans and reduce the incidence of postoperative PHPT persistence or recurrence.

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