Escalante-Pulido JM, Hermosillo-Sandoval JM, Marmolejo-Orozco G, Fletes-Casillas L

Language: Spanish
References: 18
Page: 7-12
PDF size: 118.03 Kb.

ABSTRACT

The current diagnosis of primary hyperparathyroidism is based on biochemical indices of disease, ie, hypercalcemia, hypophosphatemia, and elevated concentrations of parathyroid hormone. Most patients are usually asymptomatic. In countries where there is no biochemical «multi-channel» determinations, diverse clinical presentations of hyperparathyroidism are described. It is therefore important to analyze the clinical and metabolic characteristics of this entity in a referral hospital in western Mexico. This study describes the clinical and metabolic characteristics of 79 subjects, 59 women (75%) and 20 men (20%) with primary hyperparathyroidism diagnosed during a period of 4 years (2002 – 2006), in a 3rd level care hospital. The mean age was 48.6 ± 13.8 years (range 23 – 91 years), with an evolution of its symptoms of 7.4 &~#177; 6.8 years (range 2 – 38 years) and as the main clinical features at diagnosis include renal stones (65% 51/79) and pathologic fractures (12% 10/79). The lower right parathyroid gland with 39% and the left inferior parathyroid gland (32%) were the most affected parathyroid glands. Histopathology examination shows 83.5% (66/79) as parathyroid adenoma, 9% (7/79) parathyroid hyperplasia and 2.5% (2/79) parathyroid carcinoma. A surgical exploration of the neck found nodular thyroid disease in 35% (28/79), most of them as follicular adenoma in 64% (18/28).

REFERENCES

1. Melton LJ III. The epidemiology of primary hyperparathyroidism in North America. J Bone Miner Res 2002; 17: N12-N17.

2. Heath H III, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980; 302: 189.

3. Silverberg SJ, Shane E, Jacobs TP et al. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341: 1249-1255.

4. Lucas AG, Horne A, Gamble G, Davidson JS, Reid IR. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinolol Metab 2005: 90: 2122-2126.

5. Silverberg SJ. Non-classical target organs for primary hyperparathyroidism. J Bone Miner Res 2002; 17: N117-N125.

6. Silverberg SJ, Bilezikian JP. The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab 2006; 2: 494-503.

7. Silverberg SJ, Bilezikian JP. Clinical presentation of primary hyperparathyroidism in the United States. In: Bilezikian JP, Marcus R, Levine MA, eds. The parathyroid: basic and clinical concepts. 2nd ed. San Diego: Academic Press; 2001: 349-360.

8. Bilezikian JP, Potts JT Jr., Fuleihan GH et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: A prospective for the 21st century. J Bone Mineral Research 2002; 17(Suppl 2): N2-N11.

9. Khan A, Bilezikian JP. Primary hyperparathyroidism: Pathophysiology and impact on bone. CMAJ 2000; 163: 184-187.

10. Resch H, Walliser J, Phillips S, Wehren LE, Sen SS. Physician and patient perceptions on the use of vitamin D and calcium in osteoporosis treatment: an European and Latin American perspective. Curr Med Res Opin 2007; 23: 1227-1237.

11. Rao DS, Agarwal G, Talpos GB, Phillips ER et al. Role of vitamin D and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: a global perspective. 2002; 17: N75-N80.

12. Bilezikian JP, Potts JT Jr. Asymptomatic primary hyperparathyroidism: new issues and new questions –bridging the past with the future. J Bone Miner Res 2002; 17(Suppl 2): N57-N67.

13. Carneiro-Pla DM, Romaguera R, Nadji M, Lew JI, Solorzano CC, Irvin GL. Does histopathology predict parathyroid hypersecretion and influence correctly the extent of parathyroidectomy in patients with sporadic primary hyperparathyroidism? Surgery 2007; 142: 930-935.

14. Russell CF, Dolan SJ, Laird JD. Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg 2006; 93: 418-21.

15. Kaplan EL, Bartlett S, Sugimoto J et al. Relation of postoperative hypocalcemia to operative techniques: deleterious effect of excessive use of parathyroid biopsy. Surgery 1982; 92: 827-834.

16. Demirci H, Suyani E, Karakoc A et al. A longstanding hungry bone syndrome. The Endocrinologist 2007; 17: 10-12.

17. Silverberg SJ, Gartenberg F, Jacobs TP, Shane E et al. Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab 1995; 80: 729-734.

18. ACE/AAES Task Force on primary hyperparathyroidism. The American Association of Clinical Endocrinologist and the American Association of Endocrine Surgeons position Statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract 2005; 11: 49-54.