553:
hyperparathyroidism. Multiple endocrine neoplasia is more likely to be associated with childhood and adolescent primary hyperparathyroidism. The fundamental skeletal radiologic manifestation include diffuse osteopenia, pathologic fractures and the coexistence of resorption and sclerosis at numerous sites. Skeletal lesions can be specifically bilateral, symmetric and multifocal, exhibiting different types of bone resorption. Pathologic fractures of the femoral neck and spine can potentially initiate serious complications. Because pediatric primary hyperparathyroidism is frequently associated with pathologic fractures it can be misdiagnosed as osteogenesis imperfecta. Pediatric patients with primary hyperparathyroidism are best remedied by parathyroidectomy. Early diagnosis of pediatric primary hyperparathyroidism is all-important to minimize disease complications and start off timely and relevant treatment.
452:
and observational and clinical trial data as to which patients are more likely to have end-organ effects of primary hyperparathyroidism (nephrolithiasis, skeletal involvement), disease progression if surgery is deferred, and the most benefit from surgery. The panel emphasized the need for parathyroidectomy to be performed by surgeons who are highly experienced and skilled in the operation. The Third
International Workshop guidelines concluded that surgery is indicated in asymptomatic patients who meet any one of the following conditions:
402:
sestamibi scan of head, neck and upper thorax is the most commonly used test for localizing parathyroid adenomas having a sensitivity and specificity of 70–80%. Sensitivity falls down to 30% in case of double/multiple parathyroid adenomas or in case of parathyroid hyperplasia. Ultrasonography is also a useful test in localizing suspicious parathyroid lesions.
32:
451:
The 2002 NIH Workshop on
Asymptomatic Primary Hyperparathyroidism developed criteria for surgical intervention . The criteria were revised at the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism . These criteria were chosen on the basis of clinical experience
447:
The surgical removal of one or more of the parathyroid glands is known as a parathyroidectomy; this operation was first performed in 1925. The symptoms of the disease, listed above, are indications for surgery. Surgery reduces all cause mortality as well as resolving symptoms. However, cardiovascular
401:
Biochemical confirmation of primary hyperparathyroidism is following by investigations to localize the culprit lesion. Primary hyperparathyroidism is most commonly due to solitary parathyroid adenoma. Less commonly it may be due to double parathyroid adenomas or parathyroid hyperplasia. Tc99
1301:
Wilhelm, Scott M.; Wang, Tracy S.; Ruan, Daniel T.; Lee, James A.; Asa, Sylvia L.; Duh, Quan-Yang; Doherty, Gerard M.; Herrera, Miguel F.; Pasieka, Janice L.; Perrier, Nancy D.; Silverberg, Shonni J.; SolĂłrzano, Carmen C.; Sturgeon, Cord; Tublin, Mitchell E.; Udelsman, Robert (2016-10-01).
552:
In contrast with primary hyperparathyroidism in adults, primary hyperparathyroidism in children is considered a rare endocrinopathy. Pediatric primary hyperparathyroidism can be distinguished by its more severe manifestations, in contrast to the less intense manifestations in adult primary
469:
Operative intervention can be delayed in patients over 50 years of age who are asymptomatic or minimally symptomatic and who have serum calcium concentrations <1.0 mg/dL (0.2 mmol/L) above the upper limit of normal, and in patients who are medically unfit for surgery
477:
have studied the role of surgery in patients with asymptomatic hyperparathyroidism. The largest study reported that surgery resulted in an increase in bone mass, but no improvement in quality of life after one to two years among patients in the following groups:
916:
Titon, I.; Cailleux-Bounacer, A.; Basuyau, J. P.; Lefebvre, H.; Savoure, A.; Kuhn, J. M. (2007). "Evaluation of a standardized short-time calcium suppression test in healthy subjects: Interest for the diagnosis of primary hyperparathyroidism".
410:
Normocalcemic PHPT was first recognized in 2009 by an international panel of experts. By definition these patients have normal serum calcium (though usually in the upper range) and are typically found to have elevated PTH during workup for
355:
Serum calcium levels are usually elevated, and the parathyroid hormone level is abnormally high compared with an expected low level in response to the high calcium. A relatively elevated parathyroid hormone has been estimated to have a
86:
The diagnosis is initially made on blood tests; an elevated level of calcium together with a raised (or inappropriately high) level of parathyroid hormone are typically found. To identify the source of the excessive hormone secretion,
520:
are used to reduce the amount of parathyroid hormone released by the parathyroid glands and subsequent hypercalcemia. Other medications used for PHPT includes treatments for osteoporosis such as estrogen replacement therapy,
1056:
Weber T, Eberle J, Messelhäuser U, et al. (2013). "Parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism: results of a prospective multicenter study".
1591:
1576:
1276:
367:
A more powerful variant of comparing the balance between calcium and parathyroid hormone is to perform a 3-hour calcium infusion. After infusion, a parathyroid hormone level above a
237:
462:
Bone density at the hip, lumbar spine, or distal radius that is more than 2.5 standard deviations below peak bone mass (T score <-2.5) and/or previous fragility fracture
587:
537:
Primary hyperparathyroidism affects approximately 1 per 1,000 people (0.1%), while there are 25–30 new cases per 100,000 people per year in the United States. The
224:(malignant tumor), and adenomas in more than one gland (together ~0.5%).Primary hyperparathyroidism is also a feature of several familial endocrine disorders:
698:
Bargren AE, Repplinger D, Chen H, Sippel RS (2011). "Can biochemical abnormalities predict symptomatology in patients with primary hyperparathyroidism?".
1500:
985:
541:
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.
1269:
1702:
204:
When subjected to formal research, symptoms of depression, pain, and gastric dysfunction seem to correlate with mild cases of hypercalcemia.
762:
737:
1148:"Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial"
677:
1230:"Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism"
1350:
613:
Barreras, R. F.; Donaldson, R. M. (1967). "Role of
Calcium in Gastric Hypersecretion, Parathyroid Adenoma and Peptic Ulcer".
134:, which results in pain and sometimes pathological fractures. Other bone diseases associated with hyperparathyroidism are
1391:
Bilezikian, John P.; Silverberg, Shonni J. (2002). "Primary hyperparathyroidism: Epidemiology and clinical consequences".
233:
229:
1695:
1469:"Primary hyperparathyroidism in a child: The musculoskeletal manifestations of a late presenting rare endocrinopathy"
1189:"Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial"
961:
1304:"The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism"
999:
Silverberg, Shonni J.; Lewiecki, E. Michael; Mosekilde, Leif; Peacock, Munro; Rubin, Mishaela R. (February 2009).
439:
Treatment is usually surgical removal of the gland(s) containing adenomas, but medication may also be required.
1802:
1732:
387:
1755:
1514:
Mallet E (2008). "Primary hyperparathyroidism in neonates and childhood. The French experience (1984–2004)".
562:
420:
337:
power plant are faced with a substantial risk of primary hyperparathyroidism, possibly caused by radioactive
588:"Hyperparathyroidism or Hypercalcemia: "Stones, Bones, abdominal Groans, thrones and psychiatric overtones""
107:. They are classically summarized by "stones, bones, abdominal groans, thrones and psychiatric overtones".
1760:
1688:
1001:"Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop"
567:
225:
191:
505:
474:
376:
372:
361:
357:
456:
Serum calcium concentration of 1.0 mg/dL (0.25 mmol/L) or more above the upper limit of normal
187:. Symptoms include lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.
1097:"Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism"
1765:
1727:
1606:
368:
131:
1101:
217:
130:"Bones" refers to bone-related complications. The classic bone disease in hyperparathyroidism is
650:"Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up"
877:"Clinical performance of a parathyrin immunoassay with dynamically determined reference values"
428:
330:
184:
95:, the surgical removal of one or more parathyroid glands, may be required to control symptoms.
1657:
1494:
315:
221:
1428:"Association between Primary Hyperparathyroidism and Increased Body Weight: A Meta-Analysis"
785:"Familial isolated hyperparathyroidism is linked to a 1.7 Mb region on chromosome 2p13.3–14"
758:
733:
508:
reported improvements in bone density and some improvement in quality of life with surgery.
424:
1349:
Deshmukh, R. G.; Alsagoff, S. A. L.; Krishnan, S.; Dhillon, K. S.; Khir, A. S. M. (1998).
8:
1742:
1711:
1595:
649:
395:
380:
213:
72:
59:
1719:
1600:
1539:
1408:
1033:
1000:
979:
809:
784:
334:
323:
170:
120:
1123:
1096:
711:
1617:
1531:
1449:
1370:
1362:
1331:
1323:
1251:
1210:
1169:
1128:
1074:
1038:
1020:
967:
957:
934:
898:
875:
Lepage, R.; d'Amour, P.; Boucher, A.; Hamel, L.; Demontigny, C.; Labelle, F. (1988).
872:
855:
814:
715:
669:
630:
92:
75:(PTH). The symptoms of the condition relate to the resulting elevated serum calcium (
68:
44:
1668:
1543:
1412:
516:
Medications are used when surgery is not indicated or for poor surgical candidates.
1523:
1480:
1439:
1400:
1315:
1241:
1200:
1159:
1118:
1110:
1066:
1028:
1012:
926:
888:
845:
804:
796:
707:
661:
622:
198:
116:
893:
876:
1781:
1611:
416:
88:
80:
1485:
1468:
626:
1319:
522:
124:
104:
76:
1622:
1585:
1466:
1070:
971:
544:
Primary hyperparathyroidism is associated with increased all-cause mortality.
1796:
1404:
1327:
1303:
1114:
1024:
166:
112:
49:
800:
1535:
1453:
1335:
1255:
1214:
1173:
1132:
1078:
1042:
938:
859:
818:
719:
665:
517:
412:
212:
The most common cause of primary hyperparathyroidism is a sporadic, single
174:
150:
139:
135:
31:
1366:
902:
673:
634:
485:
Serum calcium between 2.60 and 2.85 mmol/liter (10.4–11.4 mg/dL)
1652:
1444:
1427:
1246:
1229:
1205:
1188:
1164:
1147:
1016:
850:
833:
390:
is occasionally measured; it is generally elevated due to activation of G
154:
1568:
951:
930:
538:
529:
and for treatment hypercalciuria to reduce the risk for kidney stones.
311:
1680:
1527:
1663:
1628:
915:
526:
352:
The diagnosis of primary hyperparathyroidism is made by blood tests.
338:
143:
1351:"Primary hyperparathyroidism presenting with pathological fracture"
162:
103:
The signs and symptoms of primary hyperparathyroidism are those of
998:
1633:
341:
1426:
Bolland, M. J.; Grey, A. B.; Gamble, G. D.; Reid, I. R. (2004).
296:
281:
262:
1580:
1348:
158:
874:
289:
274:
783:
Warner JV, Nyholt DR, Busfield F, et al. (March 2006).
405:
697:
319:
270:
249:
197:
Other signs include proximal muscle weakness, itching, and
1187:
Ambrogini E, Cetani F, Cianferotti L, et al. (2007).
1186:
1146:
Bollerslev J, Jansson S, Mollerup CL, et al. (2007).
831:
500:
Creatinine level < 130 ÎĽmol/liter (<1.47 mg/dL)
216:
resulting from a clonal mutation (~97%). Less common are
149:"Abdominal groans" refers to gastrointestinal symptoms of
1145:
379:
of 93% in detecting primary hyperparathyroidism, with a
123:(polyuria and polydipsia). These can ultimately lead to
71:(or a benign tumor within it) produce excess amounts of
1467:
EL-Sobky TA, Ahmad KA, Samir S, EL Mikkawy DME (2016).
1227:
1055:
952:
Jameson, J. Larry, Ă©diteur intellectuel. (2018-08-13).
419:
levels should be normal, and all secondary causes for
364:
of approximately 90% for primary hyperparathyroidism.
322:
gene in MEN1), or involve gain of function mutations (
1425:
1355:
Journal of the Royal
College of Surgeons of Edinburgh
580:
459:
Creatinine clearance that is reduced to <60 mL/min
1558:
1390:
1094:
1005:
The
Journal of Clinical Endocrinology and Metabolism
782:
751:
726:
648:
Stefenelli T, Abela C, Frank H, et al. (1997).
647:
832:Boehm BO, Rosinger S, Belyi D, Dietrich JW (2011).
482:
Untreated, asymptomatic primary hyperparathyroidism
1432:Journal of Clinical Endocrinology & Metabolism
1300:
1228:Rao DS, Phillips ER, Divine GW, Talpos GB (2004).
1090:
1088:
834:"The parathyroid as a target for radiation damage"
173:. The peptic ulcers can be an effect of increased
16:Excess hormone production by the parathyroid gland
612:
183:"Psychiatric overtones" refers to effects on the
1794:
1393:Clinical Reviews in Bone and Mineral Metabolism
1085:
83:, psychiatric abnormalities, and bone disease.
1696:
491:No medications interfering with Ca metabolism
180:"Thrones" refers to polyuria and constipation
1499:: CS1 maint: multiple names: authors list (
1221:
1180:
1139:
984:: CS1 maint: multiple names: authors list (
314:, but is thought to involve inactivation of
776:
691:
415:. In order to diagnose normocalcemic PHPT,
1703:
1689:
954:Harrison's principles of internal medicine
30:
1484:
1443:
1245:
1204:
1163:
1122:
1032:
892:
849:
808:
406:Normocalcemic Primary Hyperparathyroidism
1513:
825:
448:mortality is not significantly reduced.
1710:
1095:Vestergaard, P.; Mosekilde, L. (2003).
79:), which can cause digestive symptoms,
1795:
1684:
1049:
98:
329:Recently, it was demonstrated that
67:) is a medical condition where the
13:
14:
1814:
1554:
919:European Journal of Endocrinology
712:10.1016/j.jamcollsurg.2011.06.401
497:No previous operation in the neck
1282:from the original on 28 May 2024
494:No hyperparathyroid bone disease
1507:
1460:
1419:
1384:
1342:
1294:
1262:
992:
945:
909:
765:from the original on 2009-03-07
740:from the original on 2009-03-08
680:from the original on 2011-05-16
615:New England Journal of Medicine
532:
1733:Pseudopseudohypoparathyroidism
866:
641:
606:
511:
243:Genetic associations include:
1:
573:
563:Secondary hyperparathyroidism
421:secondary hyperparathyroidism
310:In all cases, the disease is
165:. Hypercalcemia can lead to
568:Tertiary hyperparathyroidism
475:randomized controlled trials
434:
347:
238:familial hyperparathyroidism
226:Multiple endocrine neoplasia
192:Left ventricular hypertrophy
7:
1486:10.1016/j.ejrnm.2016.09.002
894:10.1093/clinchem/34.12.2439
627:10.1056/NEJM196705182762005
556:
547:
177:secretion by hypercalcemia.
25:Primary hyperparathyroidism
10:
1819:
1320:10.1001/jamasurg.2016.2310
1234:J. Clin. Endocrinol. Metab
1193:J. Clin. Endocrinol. Metab
1152:J. Clin. Endocrinol. Metab
654:J. Clin. Endocrinol. Metab
442:
1774:
1741:
1718:
1643:
1562:
1071:10.1001/2013.jamasurg.316
207:
43:
38:
29:
24:
1766:Osteitis fibrosa cystica
1728:Pseudohypoparathyroidism
1270:"SENSIPAR® (cinacalcet)"
1115:10.1136/bmj.327.7414.530
488:Age between 50 and 80 yr
132:osteitis fibrosa cystica
39:Thyroid and parathyroid.
1473:Egypt J Radiol Nucl Med
801:10.1136/jmg.2005.035766
398:binds to its receptor.
218:parathyroid hyperplasia
666:10.1210/jcem.82.1.3666
465:Age less than 50 years
429:chronic kidney disease
371:of 14 ng/L has a
316:tumor suppressor genes
185:central nervous system
1803:Parathyroid disorders
759:"Endocrine Pathology"
734:"Endocrine Pathology"
473:More recently, three
304:unknown at 2p13.3-14
222:parathyroid carcinoma
1445:10.1210/jc.2004-1891
1247:10.1210/jc.2004-0028
1206:10.1210/jc.2007-0219
1165:10.1210/jc.2006-1836
1017:10.1210/jc.2008-1760
851:10.1056/NEJMc1104982
425:vitamin D deficiency
228:type 1 and type 2A (
1743:Hyperparathyroidism
1712:Parathyroid disease
931:10.1530/EJE-07-0132
381:confidence interval
214:parathyroid adenoma
111:"Stones" refers to
73:parathyroid hormone
60:hyperparathyroidism
1720:Hypoparathyroidism
1644:External resources
1405:10.1385/BMM:1:1:25
881:Clinical Chemistry
324:RET proto-oncogene
194:may also be seen.
171:acute pancreatitis
121:diabetes insipidus
99:Signs and symptoms
91:may be performed.
1790:
1789:
1678:
1677:
1528:10.1159/000112592
1109:(7414): 530–534.
887:(12): 2439–2443.
621:(20): 1122–1124.
308:
307:
93:Parathyroidectomy
69:parathyroid gland
55:
54:
19:Medical condition
1810:
1705:
1698:
1691:
1682:
1681:
1560:
1559:
1548:
1547:
1511:
1505:
1504:
1498:
1490:
1488:
1464:
1458:
1457:
1447:
1438:(3): 1525–1530.
1423:
1417:
1416:
1388:
1382:
1381:
1379:
1378:
1369:. Archived from
1346:
1340:
1339:
1298:
1292:
1291:
1289:
1287:
1281:
1274:
1266:
1260:
1259:
1249:
1225:
1219:
1218:
1208:
1184:
1178:
1177:
1167:
1143:
1137:
1136:
1126:
1092:
1083:
1082:
1053:
1047:
1046:
1036:
996:
990:
989:
983:
975:
949:
943:
942:
913:
907:
906:
896:
870:
864:
863:
853:
829:
823:
822:
812:
780:
774:
773:
771:
770:
755:
749:
748:
746:
745:
730:
724:
723:
695:
689:
688:
686:
685:
645:
639:
638:
610:
604:
603:
601:
599:
584:
383:of 80% to 100%.
360:of 60–80% and a
246:
245:
199:band keratopathy
117:nephrocalcinosis
34:
22:
21:
1818:
1817:
1813:
1812:
1811:
1809:
1808:
1807:
1793:
1792:
1791:
1786:
1782:Parathyroiditis
1770:
1737:
1714:
1709:
1679:
1674:
1673:
1639:
1638:
1571:
1557:
1552:
1551:
1512:
1508:
1492:
1491:
1465:
1461:
1424:
1420:
1389:
1385:
1376:
1374:
1347:
1343:
1314:(10): 959–968.
1299:
1295:
1285:
1283:
1279:
1272:
1268:
1267:
1263:
1240:(11): 5415–22.
1226:
1222:
1185:
1181:
1144:
1140:
1093:
1086:
1054:
1050:
997:
993:
977:
976:
964:
950:
946:
914:
910:
871:
867:
838:N. Engl. J. Med
830:
826:
781:
777:
768:
766:
757:
756:
752:
743:
741:
732:
731:
727:
696:
692:
683:
681:
646:
642:
611:
607:
597:
595:
594:. July 12, 2016
586:
585:
581:
576:
559:
550:
535:
523:bisphosphonates
514:
445:
437:
417:ionized calcium
408:
393:
350:
210:
101:
89:medical imaging
20:
17:
12:
11:
5:
1816:
1806:
1805:
1788:
1787:
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1784:
1778:
1776:
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1567:
1566:
1564:
1563:Classification
1556:
1555:External links
1553:
1550:
1549:
1506:
1479:(4): 1613–16.
1459:
1418:
1383:
1361:(6): 424–427.
1341:
1293:
1261:
1220:
1199:(8): 3114–21.
1179:
1158:(5): 1687–92.
1138:
1084:
1065:(2): 109–115.
1048:
1011:(2): 351–365.
991:
962:
944:
925:(3): 351–357.
908:
865:
824:
775:
750:
725:
700:J Am Coll Surg
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407:
404:
394:proteins when
391:
375:of 100% and a
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306:
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293:
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277:
268:
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259:
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125:kidney failure
100:
97:
53:
52:
47:
41:
40:
36:
35:
27:
26:
18:
15:
9:
6:
4:
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592:Time of Care
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533:Epidemiology
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175:gastric acid
151:constipation
140:osteomalacia
136:osteoporosis
102:
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1653:MedlinePlus
598:October 18,
512:Medications
377:specificity
373:sensitivity
362:specificity
358:sensitivity
331:liquidators
234:MEN type 2A
155:indigestion
1618:DiseasesDB
1377:2011-06-18
972:1056749127
795:(3): e12.
769:2009-05-08
744:2009-05-08
684:2007-04-27
574:References
539:prevalence
504:Two other
312:idiopathic
230:MEN type 1
1756:Secondary
1669:radio/355
1664:eMedicine
1629:SNOMED CT
1328:2168-6254
1059:JAMA Surg
1025:0021-972X
980:cite book
527:denosumab
435:Treatment
423:(such as
348:Diagnosis
339:strontium
335:Chernobyl
326:MEN 2a).
220:(~2.5%),
144:arthritis
45:Specialty
1797:Category
1761:Tertiary
1634:36348003
1544:25046706
1536:18219222
1516:Horm Res
1454:15613408
1413:74793206
1336:27532368
1277:Archived
1256:15531491
1215:17535997
1174:17284629
1133:12958111
1079:23560281
1043:19193910
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860:21848480
819:16525030
763:Archived
738:Archived
720:21723154
678:Archived
557:See also
548:Children
386:Urinary
342:isotopes
163:vomiting
58:Primary
1751:Primary
1612:D049950
1367:9990797
1286:12 July
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443:Surgery
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369:cutoff
301:HRPT3
297:610071
286:HRPT2
282:145001
267:HRPT1
263:145000
208:Causes
159:nausea
142:, and
119:, and
1775:Other
1586:E21.0
1540:S2CID
1409:S2CID
1280:(PDF)
1273:(PDF)
320:Menin
290:HRPT2
275:HRPT2
257:Gene
254:Name
1623:6283
1607:MeSH
1596:9-CM
1532:PMID
1501:link
1450:PMID
1363:PMID
1332:PMID
1324:ISSN
1288:2024
1252:PMID
1211:PMID
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1021:ISSN
986:link
968:OCLC
958:ISBN
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670:PMID
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600:2023
427:and
388:cAMP
271:MEN1
250:OMIM
232:and
169:and
161:and
65:PHPT
63:(or
1592:ICD
1577:ICD
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