Evaluation de la qualité de vie dans l'hyperparathyroïdie primaire (étude prospective, comparative, avant et après chirurgie)

Introduction : L'hyperparathyroïdie primaire (HPT) est une pathologie fréquente, dont les symptômes classiques sont bien connus. De nos jours, la plupart des patients sont asymptomatiques ou présentent des symptômes non spécifiques, qui ne sont pas pris en compte dans les indications chirurgicales. L'objectif de cette étude était de rechercher ces symptômes non spécifiques et d'évaluer leur évolution, ainsi que celle de la qualité de vie, après chirurgie. Patients et méthodes : L'étude multicentrique et prospective a répertorié les patients opérés pour HPT primaire. Deux questionnaires ont été évalués chez ces patients avant chirurgie et au troisième mois postopératoire : un questionnaire de qualité de vie (SF-36) et un questionnaire de symptômes non spécifiques. Résultats : Soixante-cinq patients on été inclus de mai 2003 à juillet 2004. Les signes cliniques le plus souvent retrouvés par l'interrogatoire étaient l'asthénie, les douleurs articulaires, osseuses et musculaires, la fatigabilité musculaire et l'irritabilité. Tous ces signes, sauf la perte de poids, les troubles de mémoire et les troubles du rythme, ont été améliorés par la chirurgie : cette amélioration était significative pour l'asthénie, l'irritabilité et les calculs rénaux. Tous les paramètres du score SF-36 étaient améliorés après chirurgie : cette amélioration étaient significative pour 6 paramètres sur 8. Cette amélioration n'était pas dépendante du taux de parathormone à 3 mois. D'après le questionnaire, les symptômes les plus souvent retrouvés en préopératoire étaient l'anxiété, le météorisme abdominal, les douleurs musculaires, les troubles de mémoire, l'humeur labile, la constipation, les douleurs abdominales et l'amyotrophie. Il existait en postopératoire une amélioration significative de 3 symptômes sur 21 (polydipsie, météorisme abdominal et constipation). Conclusion : La parathyroïdectomie dans l'HPT primaire permet une amélioration de la qualité de vie à 3 mois. L'amélioration des symptômes non spécifiques est plus difficile à mettre en évidence. Cette étude doit aider à mieux préciser les indications chirurgicales.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Long-term shedding of viable SARS-CoV-2 in kidney transplant recipients with COVID-19

The exact duration of viable SARS-CoV-2 shedding in kidney transplant recipients (KTRs) remains unclear. Here, we retrospectively investigated this issue using cell cultures of SARS-CoV-2 RT-PCR-positive nasopharyngeal samples (n = 40) obtained from 16 KTRs with symptomatic COVID-19 up to 39 days from symptom onset. A length of viable SARS-CoV-2 shedding >3 weeks from the onset of symptoms was identified in four KTRs (25%). These results suggest that a significant proportion of KTRs can shed viable SARS-CoV-2 for at least 3 weeks, which may favor the emergence of new variants. Based on these data, we recommend prolonging the isolation of KTRs with COVID-19 until negative SARS-CoV-2 RT-PCR testing

[Acute pancreatitis and primary hyperparathyroidism: a multicentric study by the Francophone Association of Endocrine Surgeons] : Pancréatite aiguë et hyperparathyroïdie primaire : étude multicentrique de l'Association francophone de chirurgie endocrinienne

International audienceBACKGROUND: Primary hyperparathyroidism is an unusual cause of acute pancreatitis. The aim of this study was to analyse data from multiple centers concerning patients with primary hyperparathyroidism and associated acute pancreatitis and to analyze potential predictive factors. METHODS: In this retrospective multicentric study, 19 patients were identified (Group A) with the associated diagnoses of acute pancreatitis and primary hyperparathyroidism. Their clinical data was compared to that of a control group of 65 patients (group B) with primary hyperparathyroidism without acute pancreatitis. RESULTS: Age, parathormone levels and pathology (uni/multiglandular disease) were similar between the two groups. The mean plasma calcium level was significantly higher in group A (12.64 mg/100ml) than in group B patients without pancreatitis (11.28 mg/100ml) (p<0.0001). CONCLUSION: This study confirms the causal relationship between primary hyperparathyroidism and acute pancreatitis. The degree of hypercalcemia may play an important role in this association. Calcium levels should be measured in all patients with acute pancreatitis

Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism

International audienceBACKGROUND: Normocalcaemic primary hyperparathyroidism (NcPHPT) is a new clinical entity being diagnosed increasingly among patients with mild primary hyperparathyroidism (PHPT). The aim of this study was to evaluate quality of life and non-specific symptoms before and after parathyroidectomy in patients with NcPHPT compared with those with hypercalcaemic mild PHPT (Hc-m-PHPT).METHODS: This was a prospective multicentre study of patients with mild PHPT from four university hospitals. Patients were evaluated before operation, and 3, 6 and 12 months after surgery for quality of life using the SF-36-v2® questionnaire, as well as for 25 non-specific symptoms.RESULTS: Before operation, the only statistically significant difference between the NcPHPT and Hc-m-PHPT groups was in the mean(s.d.) blood calcium level (2·54 versus 2·73 mmol; P &lt; 0·001). At 1 year after surgery, the blood calcium level had improved significantly in both groups, with no significant difference between them. Quality of life improved significantly in each group compared with its preoperative score, with regard to the physical component summary (P = 0·040 and P = 0·016 respectively), whereas the mental component summary improved significantly in the Hc-m-PHPT group only (P = 0·043). Only two non-specific symptoms improved significantly in the NcPHPT group compared with nine in the Hc-m-PHPT group.CONCLUSION: Parathyroidectomy mildly improves quality of life and some non-specific symptoms in patients with NcPHPT.</p

Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

International audienceBACKGROUND:Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate.METHODS:We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland.RESULTS:We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%. The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1-96.2%).CONCLUSIONS:MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus

Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism

International audienceBackground: The benefits of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism (PHPT) are controversial. This monocentric, observational, prospective study aimed to assess the effects of parathyroidectomy on glucose and lipid metabolism in classic or mild PHPT.Methods: Patients who underwent parathyroidectomy for classic (calcemia &gt;2.85 mmol/L) or mild PHPT (calcemia ≤2.85 mmol/L) between 2016 and 2019 were included. A metabolic assessment was performed before and 1 year after parathyroidectomy. Patients with a history of diabetes were excluded.Results: Nineteen patients had classic and 120 had mild PHPT. Ninety-five percent were normocalcemic 6 months after surgery. Fasting plasma glucose and insulin levels decreased after parathyroidectomy in patients with mild PHPT (p &lt; 0.001). HOMA-IR decreased after surgery in the overall population (p &lt; 0.001), while plasma adiponectin concentrations increased in patients with both classic (p = 0.005) and mild PHPT (p &lt; 0.001). Plasma triglyceride levels decreased significantly only in patients with classic PHPT (p = 0.021). Plasma PCSK9 levels decreased in patients with mild PHPT (p &lt; 0.001).Conclusions: Parathyroidectomy for PHPT improves insulin resistance and decreases plasma triglyceride levels in classic PHPT and plasma PCSK9 levels in mild PHPT. Further studies are needed to better characterize the consequences of such metabolic risk factors' improvements on cardiovascular events

Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study

International audienceBACKGROUND: The objectives of this study were to evaluate, in mild primary hyperparathyroidism (pHPT) patients, the quality of life (QoL) using the SF-36 questionnaire before and after parathyroidectomy and to detect preoperatively patients who benefit the most from surgery. Most pHPT patients present a mild pHPT defined by calcemia ≤11.4&nbsp;mg/dL. For these patients, there is debate about whether they should be managed with surveillance, medical therapy, or surgery.METHODS: A prospective multicenter study investigated QoL (SF-36) in patients with mild pHPT before and after parathyroidectomy in four university hospitals. Laboratory results and SF-36 scores were obtained preoperatively and postoperatively (3, 6, and 12&nbsp;months).RESULTS: One hundred sixteen patients were included. After surgery, the biochemical cure rate was 98%. Preoperatively, the mental component summary and the physical component summary (PCS) were 38.69 of 100 and 39.53 of 100, respectively. At 1&nbsp;year, the MCS and the PCS were 41.29 of 100 and 42.03 of 100. The subgroup analysis showed a more significant improvement in patients&nbsp;&lt;&nbsp;70&nbsp;years and with calcemia ≥10.4&nbsp;mg/dL. Postoperative PCS was correlated with age and preoperative PCS: variation&nbsp;=&nbsp;32.11&nbsp;-&nbsp;0.21&nbsp;×&nbsp;age&nbsp;-&nbsp;0.4&nbsp;×&nbsp;preoperative PCS. Men did not improve their MCS postoperatively. Only women with a preoperative MCS &lt;43.6 of 100 showed postoperative improvement.CONCLUSIONS: This study showed, in patients with mild pHPT, an improvement of QoL 1&nbsp;year after parathyroidectomy. Patients &lt;70&nbsp;years and with calcemia ≥10.4&nbsp;mg/dL had a more significant improvement.</p

TRANSPLANT RENAL ARTERY STENOSIS : A CASE SERIES

International audience53rd ERA-EDTA Congres