medigraphic.com
Anales de Otorrinolaringología Mexicana

2021, Number 3

<< Back Next >>

Otorrinolaringología 2021; 66 (3)

Primary hyperparathyroidism due to a giant parathyroid gland

Moreno-Galeana S, Guerrero-Espinosa D

Language: Spanish
References: 36
Page: 245-252
PDF size: 217.41 Kb.


ABSTRACT

Background: Primary hyperparathyroidism is diagnosed by hypercalcemia and elevated parathyroid hormone levels. The cause of this is mainly by a parathyroid adenoma in 80% of cases. The differential diagnosis includes familial hypocalciuric hypercalcemia and secondary and tertiary hyperparathyroidism. Many cases are asymptomatic while others have bone, kidney, cardiovascular, neuropsychiatric and gastrointestinal disease.
Clinical case: A 55-year-old female patient who began her condition approximately 20 years ago with the presence of recurrent urinary tract infections. She was diagnosed with bilateral renoureteral lithiasis that merited extracorporeal ureterolithotripsy with placement of a bilateral JJ catheter in 2018, with no other associated symptoms, hypercalcemia due to primary hyperparathyroidism was suspected.
Conclusions: The diagnosis of primary hyperparathyroidism is established with blood and urinary biochemical tests. Imaging studies help mainly to assess bone and kidney complications and surgical planning. Preoperative biopsy is not recommended. The only curative treatment is parathyroidectomy. Surgical advances provide minimally invasive approaches. Medical treatment is not curative, but it is an alternative to surgery.


REFERENCES

  1. Heath H, Hodgson S, Kennedy M. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980; 302: 189-193. doi: 10.1056/NEJM198001243020402.

  2. Bandeira L, Bilezikian J. Primary hyperparathyroidism. F1000Research 2016; 5: 1.

  3. Vaidya A, Curhan G, Paik J, Wang M, Taylor E. Body size and the risk of primary hyperparathyroidism in women: A Cohort Study. J Bone Min Res 2017; 32 (9):1900-1906. doi: 10.1002/jbmr.3168.

  4. Mathew V, Mallikarjuna V, Ayyar V, Bantwal G, Ganesh V, George B, et al. Five-year retrospective study on primary hyperparathyroidism in South India: Emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography- computed tomography scan. Indian J Endocrinol Metab 2018; 22 (3): 355. doi: 10.4103/ijem.IJEM_445_16.

  5. Vaidya A, Curhan G, Paik J, Kronenberg H, Taylor E. Hypertension, antihypertensive medications, and risk of incident primary hyperparathyroidism. J Clin Endocrinol Metab 2015; 100 (6): 2396-2404. doi: 10.1210/jc.2015-1619.

  6. Newey PJ, Nesbit MA, Rimmer AJ, Attar M, et al. Wholeexome sequencing studies of nonhereditary (sporadic) parathyroid adenomas. J Clin Endocrinol Metab 2012; 97: E1995-E2005. doi: 10.1210/jc.2012-2303.

  7. Costa-Guda J, Arnold A. Genetic and epigenetic changes in sporadic endocrine tumors: parathyroid tumors. Mol. Cell. Endocrinol 2014; 386: 46-54. doi: 10.1016/j. mce.2013.09.005.

  8. Pardi E, Marcocci C, Borsari S, Saponaro F, et al. Aryl hydrocarbon receptor interacting protein (AIP) mutations occur rarely in sporadic parathyroid adenomas. J Clin Endocrinol Metab 2013; 98: 2800-2810. doi: 10.1210/jc.2012-4029.

  9. Arnold A, Levine M, Marcocci C, Silverberg S, Potts J. The parathyroids: Basic and clinical concepts. Academic Press. 2015; 279-297.

  10. Li Y, Simonds W. Endocrine neoplasms in familial syndromes of hyperparathyroidism. Endocr Relat Cancer 2016; 23 (6): R229-R247. doi: 10.1530/ERC-16-0059.

  11. Walker M, Silverberg, S. Primary hyperparathyroidism. Nat Rev Endocrinol 2018; 14 (2): 115-125. doi: 10.1038/ nrendo.2017.104.

  12. Khan A, Hanley D, Rizzoli R, Bollerslev J, Young J, Rejnmark L, Thakker R, D'Amour P, Paul T, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporosis Int 2017; 28 (1): 1-19. doi: 10.1007/s00198-016-3716-2.

  13. Yeh R, Tay Y, Tabacco G, Dercle L, Kuo J, Bandeira L, et al. Diagnostic performance of 4D CT and sestamibi SPECT/CT in localizing parathyroid adenomas in primary hyperparathyroidism. Radiology 2019; 291 (2): 469-476. https:// doi.org/10.1148/radiol.2019182122.

  14. Wilhelm S, Wang T, Ruan D, Lee J, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016; 151: 959-968. doi: 10.1001/jamasurg.2016.2310.

  15. Bilezikian J, Brandi ML, Eastell R, Silverberg S, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99: 3561-3569. doi: 10.1210/jc.2014-1413.

  16. Tuna M, Caliskan M, Ünal M, Demirci T, et al. Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism. J Bone Miner Metab 2016; 34: 331-335. doi: 10.1007/ s00774-015-0673-3.

  17. Spivacow F, Martinez C, Polonsky A. Primary hyperparathyroidism: postoperative long-term evolution. Medicina (B Aires) 2010; 70: 408-414.

  18. Aygün N, Uludağ M. Surgical treatment of primary hyperparathyroidism: Which therapy to whom? Sisli Etfal Hastan Tip Bul 2019; 53 (3): 201-214. doi: 10.14744/ SEMB.2019.56873.

  19. Uludağ M. Preoperative localization studies in primary hyperparathyroidism. Med Bull Sisli Etfal Hosp 2019; 53: 7-15.

  20. Lou I, Schneider D, Sippel R, Chen H, Elfenbein D. The changing pattern of diagnosing primary hyperparathyroidism in young patients. Am J Surg 2017; 213 (1): 146-150. doi: 10.1016/j.amjsurg.2016.03.019.

  21. Sethi N. Parathyroid surgery: from inception to the modern day. Br J Hosp Med (Lond) 2017; 78: 333-7. doi: 10.12968/ hmed.2017.78.6.333.

  22. Perrier N, Dickson P, Figueroa AS. Parathyroid exploration for primary hyperparathyroidism. UpToDate.

  23. Haciyanli M, Karaisli S, Gucek Haciyanli S, Atasever A, Arikan Etit D, Gur E, et al. Parathyromatosis: a very rare cause of recurrent primary hyperparathyroidism – case report and review of the literature. Ann R Coll Surg Engl 2019; 101 (8): e178-e183. doi: 10.1308/rcsann.2019.0105.

  24. Majcen M, Hocevar M. Surgical options in treating patients with primary hyperparathyroidism. Radiol Oncol 2020; 54 (1): 22-32. doi: 10.2478/raon-2020-0010.

  25. Carneiro D, Solorzano C, Nader M, Ramirez M, Irvin G. 3rd. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 2003; 134: 973-9. doi: 10.1016/j. surg.2003.06.001.

  26. Bellantone R, Raffaelli M, Crea C, Traini E, Lombardi C. Minimally-invasive parathyroid surgery. Acta Otorhinolaryngol Ital 2011; 31 (4): 207-215.

  27. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002; 236: 543-51. doi: 10.1097/00000658- 200211000-00001.

  28. Hessman O, Westerdahl J, Al-Suliman N, Christiansen P, Hellman P, Bergenfelz A. Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism. Br J Surg 2010; 97: 177-84. doi: 10.1002/bjs.6810.

  29. Rajeev P, Movseysan A, Baharani A. Changes in bone turnover markers in primary hyperparathyroidism and response to surgery. Ann R Coll Surg Engl 2017; 99 (7): 559-562. doi: 10.1308/rcsann.2017.0092.

  30. Belli M, Martin R, Brescia M, Nascimento C, Massoni Neto L, Arap S, et al. Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism. PLoS One 2020; 15 (12): e0244162. doi: 10.1371/journal. pone.0244162.

  31. Heyliger A, Tangpricha V, Weber C, Sharma J. Parathyroidectomy decreases systolic and diastolic blood pressure in hypertensive patients with primary hyperparathyroidism. Surgery 2009; 146 (6): 1042-1047. doi: 10.1016/j. surg.2009.09.024.

  32. Mollerup C, Vestergaard P, Mosekilde L, Christiansen P, et al. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ. 2002; 325 (7368): 807. doi: 10.1136/bmj.325.7368.807.

  33. Nelson J, Alsayed M, Milas M. The role of parathyroidectomy in treating hypertension and other cardiac manifestations of primary hyperparathyroidism. Gland Surg 2020; 9 (1): 136-141. doi: 10.21037/gs.2019.12.12.

  34. Fisher S, Perrier N. Primary hyperparathyroidism and hypertension. Gland Surg 2020; 9 (1): 142-149. doi: 10.21037/ gs.2019.10.21.

  35. Leere J, Karmisholt J, Robaczyk M, Vestergaard P. Contemporary medical management of primary hyperparathyroidism: A systematic review. Front Endocrinol (Lausanne) 2017; 8: 79. doi: 10.3389/fendo.2017.00079.

  36. Bilezikian J. Primary hyperparathyroidism. J Clin Endocrinol Metab 2018; 103 (11): 3993-4004. doi: 10.1210/ jc.2018-01225.




2020     |     www.medigraphic.com