The Diagnostic Accuracy of High Resolution Ultrasound Imaging for Detection of Secondary Hyperparathyroidism in Patients with Chronic Renal Failure

Ultrasound is one of the preferred modalities for evaluation of the parathyroid glands. This study was undertaken to determine the accuracy of high resolution ultrasound for secondary hyperparathyroidism in patients with chronic renal failure. From March 2008 to March 2009, ninety-one hemodialysis patients were examined by high resolution ultrasound (14 MHz) of the parathyroid glands in comparison to parathyroid hormone level. 43.9% of patients showed enlarged parathyroid glands with an average of 8.7 mm. The mean parathyroid hormone level of patients with enlarged parathyroid glands on sonography was 503 ± 450 pg/ml. We observed a significant correlation between parathyroid hormone level and enlarged parathyroid glands (P<0.0001). Sensitivity and specificity of sonography for detection of secondary hyperparathyroidism were 62.5% and 85.7% respectively. In conclusion, our study showed that high resolution sonography is a useful noninvasive method for the evaluation of secondary hyperparathyroidism in patients on hemodialysis and that sonographically enlarged glands may be a measure of severity of secondary hyperparathyroidism

Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience.

Abstract Introduction Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p = 0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p = 0.387). 2 patients showed persistent hyperparathyroidism (p = 0.816), and in 2 others was found recurrent hyperparathyroidism (p = 0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice

Parathyroid hormone-related peptide stimulates intestinal strontium absorption in Camels (Camelus dromedarius)

The present work was undertaken to evaluate the stimulatory effect of Parathyroid hormone-related peptide (PTHrP) on the intestinal calcium (Ca) absorption using stable strontium (Sr) as a surgoate marker in 10 Camels. The animals were randomly divided into two groups of five animals. Just after an oral Sr load (4.1 mmol of SrCl2), the first and the second (control) groups received either an i.v infusion of synthetic human PTHrP or solvent alone respectively. PTHrP induced a significant rise in levels of plasma Sr (52.8 ± 4.6 [mu]mol/L VS 41.7 ± 4.5 [mu]mol/L, P &lt; 0.05, at the second hour after oral Sr load) and urinay Pi excretion comparatively with animal controls. Plasma Sr levels remained very higher in treated animals than those measured in controls until the fifth hour of experimentation (52 ± 4.7 [mu]mol/L VS 42.1 ± 4.5 [mu]mol/L, P &lt; 0.05). PTHrP did not induce significant variation on Ca or Sr renal excretion. Our results seem to show that PTHrP may play an important role on modulation of intestinal Ca absorption in camels. (Résumé d'auteur

Serum parathyroid hormone levels and renal handling of phosphorus in patients with chronic renal disease

In eight patients with advanced renal insufficiency (inulin clearance 1.4-9.1 ml/min), concentrations of serum calcium (S[Ca]) and phosphorus (S[P]) were maintained normal (S[Ca] > 9.0 mg/100 ml, (S[P] < 3.5 mg/100 ml) for at least 20 consecutive days with phosphate binding antacids and oral calcium carbonate. The initial serum levels of immunoreactive parathyroid hormone (S-PTH) were elevated in three (426-9230 pg/ml), normal in four (one after subtotal parathyroidectomy), and not available in one. The initial fractional excretion of filtered phosphorus was high in all and ranged from 0.45-1.05. Following sustained normo-calcemia and normo-phosphatemia, S-PTH was reduced below control levels in all patients; being normal in six and elevated in two. decreased below control levels in all patients; it remained high in six (of which five had normal S-PTH) and was normal in two (of which one had elevated S-PTH). The observed relationship between S-PTH and could either reflect the inability of the radioimmunoassay for PTH employed to measure a circulating molecular species of PTH which was present in which case the actual levels of S-PTH were higher than those measured, and/or it could be indicative of the presence of additional important factor(s) (other than S-PTH) which inhibit tubular reabsorption of phosphorus in advanced chronic renal failure. © 1972 by The Endocrine Society

Parathyroid localization

Twenty-nine consecutive patients with suspected primary hyperparathyroidism were examined preoperatively using ultrasound, sonographically guided fine needle aspiration, and aspirate immunostaining for PTH. In 25 patients, localization of enlarged parathyroid glands was successful. In 2 patients, the tumors were located retrosternally and, thus, could not be detected by ultrasound. One patient had a multinodular goiter which impeded localization. In 1 patient with renal osteodystrophy, 2 enlarged parathyroid glands in the neck were not visualized preoperatively. Cytology was not diagnostic, although some cytological features were suggestive of parathyroid cells. Immunostaining of the aspirated smears for PTH, however, correctly diagnosed all preoperatively localized lesions. Ultrasound should be the routine procedure of choice for preoperative localization of abnormal parathyroid glands in primary hyperparathyroidism. Fine needle aspiration and immunocytochemistry can supply confirmation, if necessary

The calcium-sensing receptor as a regulator of cellular fate in normal and pathological conditions

The calcium-sensing receptor (CaSR) belongs to the evolutionarily conserved family of plasma membrane G protein-coupled receptors (GPCRs). Early studies identified an essential role for the CaSR in systemic calcium homeostasis through its ability to sense small changes in circulating calcium concentration and to couple this information to intracellular signaling pathways that influence parathyroid hormone secretion. However, the presence of CaSR protein in tissues is not directly involved in regulating mineral ion homeostasis points to a role for the CaSR in other cellular functions including the control of cellular proliferation, differentiation and apoptosis. This position at the crossroads of cellular fate designates the CaSR as an interesting study subject is likely to be involved in a variety of previously unconsidered human pathologies, including cancer, atherosclerosis and Alzheimer's disease. Here, we will review the recent discoveries regarding the relevance of CaSR signaling in development and disease. Furthermore, we will discuss the rational for developing and using CaSR-based therapeutics

About A Rare Cause Of Primary Hyperparathyroidism

Introduction: Primary hyperparathyroïdism is observed in 35 to 44 subjects/ 100000 persons. The increased production of parathyroid hormones is secondary to primary glandular modifications consisting mainly in adenomas. The authors report a clear-cell hyperplasia causing primary hyperparathyroidism. Observation: We report the case of a 25-year-old man who was admitted to explore pathologic fractures of the left arm and a malignant hypercalcaemia. Complementary laboratory tests revealed primary hyperparathyroidism. A multiple endocrine neoplasia was excluded by radiologic examinations. Cervical ultra-sound examination revealed 2 parathyroid adenomas and per-operative exploration showed 3 « adenomas ». Microscopic examination of the 4 parathyroid glands specimen concluded to a clear cell hyperplasia. Conclusion: Clear cell hyperplasia is a benign cause of primary hyperparathyroidism. The diagnosis is based upon histologic findings and examination of the 4 glands