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Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (15 January 2021) | Viewed by 28166

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Special Issue Editor

Prof. Dr. Aliya Khan

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Guest Editor

Divisions Endocrinology and Geriatrics, McMaster University, Oakville, ON, Canada
Interests: primary hyperparathyroidism; hypoparathyroidism

Special Issue Information

Dear Colleagues,

Advances in our understanding of the pathogenesis and complications of parathyroid disease over the past 5 years have resulted in improved treatment options and management strategies for both primary hyperparathyroidism as well as hypoparathyroidism.

This Issue in the Journal of Clinical Medicine will review global progress in the knowledge and clinical application in this field, and will present advances in the diagnosis, presentation, and management of both primary hyperparathyroidism and hypoparathyroidism.

The diagnosis of primary hyperparathyroidism requires careful evaluation with the exclusion of familial hypocalciuric hypercalcemia as well as other causes of hypercalcemia. The role of genetic testing will be addressed, as well the clinical utility of PTH assays will be reviewed. Both classical and non-classical features of primary hyperparathyroidism will be discussed.

Preoperative imaging is of great value in guiding the surgical approach, and the various modalities of imaging the parathyroid glands will be presented. The benefits of surgery in comparison to medical management will be reviewed.

Hypoparathyroidism is an uncommon condition associated with significant morbidity. Postsurgical hypoparathyroidism occurs in 75% of individuals, with the remaining cases being due to autoimmune, genetic, or other rare causes. Individuals who do not have postsurgical hypoparathyroidism are often not diagnosed until the condition has significantly advanced. An overview of the diagnosis including the role of genetic testing will be addressed in detail in this issue. Evaluation for complications of hypoparathyroidism will be described, as well as the advances in medical intervention. This issue will also include the current standards of care for hypoparathyroidism. I am happy with the physicians being invited to contribute.

Prof. Dr. Aliya Khan
Guest Editor

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Keywords

Primary hyperparathyroidism
Hypoparathyroidism
Diagnosis
Presentation
Management
Imaging
Treatment
Surgery
Bisphosphonates
Calcimimetics
Calcium
Vitamin D

Published Papers (6 papers)

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Research

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12 pages, 1599 KiB

Open AccessArticle

Shear Wave Elastography in Patients with Primary and Secondary Hyperparathyroidism

by Daniela Amzar, Laura Cotoi, Ioan Sporea, Bogdan Timar, Oana Schiller, Adalbert Schiller, Andreea Borlea, Nicusor Gheorghe Pop and Dana Stoian

J. Clin. Med. 2021, 10(4), 697; https://doi.org/10.3390/jcm10040697 - 10 Feb 2021

Cited by 7 | Viewed by 2141

Abstract

Objectives: In this study, we aim to determine the elastographic characteristics of both primary and secondary hyperparathyroidism using shear wave elastography. We also aim to evaluate the elastographic differences between them, as well as the differences between the parathyroid, thyroid, and muscle tissue, in order to better identify a cutoff value for the parathyroid tissue. Methods: In this prospective study, we examined a total of 68 patients with hyperparathyroidism, divided into two groups; one group consisted of 27 patients with primary hyperparathyroidism and the other group consisted of 41 selected patients with confirmed secondary hyperparathyroidism. The elasticity index (EI) was determined in the parathyroid, thyroid, and muscle tissue. The determined values were compared to better identify the parathyroid tissue. Results: The median value of mean SWE values measured for parathyroid adenomas from primary hyperparathyroidism was 4.86 kPa. For secondary hyperparathyroidism, the median value of mean SWE was 6.96 KPa. The median (range) presurgical values for parathormone (PTH) and calcium were 762.80 pg/mL (190, 1243) and 9.40 mg/dL (8.825, 10.20), respectively. We identified significant elastographic differences between the two groups (p < 0.001), which remained significant after adjusting elastographic measures to the nonparametric parameters, such as the parathormone value and vitamin D (p < 0.001). The cutoff values found for parathyroid adenoma were 5.96 kPa and for parathyroid tissue 9.58 kPa. Conclusions: Shear wave elastography is a helpful tool for identifying the parathyroid tissue, in both cases of primary and secondary hyperparathyroidism, as there are significant differences between the parathyroid, thyroid, and muscle tissue. We found a global cutoff value for the parathyroid tissue of 9.58 kPa, but we must keep in mind that there are significant elastographic differences between cutoffs for primary and secondary hyperparathyroidism. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

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Review

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11 pages, 580 KiB

Open AccessReview

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

by Dalal S. Ali, Karel Dandurand and Aliya A. Khan

J. Clin. Med. 2021, 10(13), 2956; https://doi.org/10.3390/jcm10132956 - 30 Jun 2021

Cited by 14 | Viewed by 4037

Abstract

Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

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15 pages, 1569 KiB

Open AccessReview

Primary Hyperparathyroidism: A Narrative Review of Diagnosis and Medical Management

by Karel Dandurand, Dalal S. Ali and Aliya A. Khan

J. Clin. Med. 2021, 10(8), 1604; https://doi.org/10.3390/jcm10081604 - 9 Apr 2021

Cited by 22 | Viewed by 6328

Abstract

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the outpatient setting. Symptomatic presentation includes non-specific signs and symptoms of hypercalcemia, skeletal fragility, nephrolithiasis and nephrocalcinosis. The majority of individuals present at an asymptomatic stage following routine biochemical screening, without any signs or symptoms of calcium or parathyroid hormone (PTH) excess or target organ damage. Indications for surgery have recently been revised as published in recent guidelines and consensus statements. Parathyroidectomy is advised in patients younger than 50 years old and in the presence of either significant hypercalcemia, impaired renal function, renal stones or osteoporosis. Surgery is always appropriate in suitable surgical candidates, however, medical management may be considered in those with mild asymptomatic disease, contraindications to surgery or failed previous surgical intervention. We summarized the optimal medical interventions available in the care of PHPT patients not undergoing parathyroidectomy. Calcium and vitamin D intake should be optimized. Antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk. Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels. The effect of medical treatment on the reduction in fracture risk is unknown and should be the focus of future research. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

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14 pages, 976 KiB

Open AccessFeature PaperReview

Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management

by Dalal S. Ali, Karel Dandurand and Aliya A. Khan

J. Clin. Med. 2021, 10(7), 1378; https://doi.org/10.3390/jcm10071378 - 29 Mar 2021

Cited by 11 | Viewed by 3896

Abstract

Background: Hypoparathyroidism is an uncommon endocrine disorder. During pregnancy, multiple changes occur in the calcium-regulating hormones, which may affect the requirements of calcium and active vitamin D during pregnancy in patients with hypoparathyroidism. Close monitoring of serum calcium during pregnancy and lactation is ideal in order to optimize maternal and fetal outcomes. In this review, we describe calcium homeostasis during pregnancy in euparathyroid individuals and also review the diagnosis and management of hypoparathyroidism during pregnancy and lactation. Methods: We searched the MEDLINE, CINAHL, EMBASE, and Google scholar databases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters, and clinical guidelines were included in this review. Conclusions: During pregnancy, rises in 1,25-dihydroxyvitamin D (1,25-(OH)2-D3) and PTH-related peptide result in suppression of PTH and enhanced calcium absorption from the bowel. In individuals with hypoparathyroidism, the requirements for calcium and active vitamin D may decrease. Close monitoring of serum calcium is advised in women with hypoparathyroidism with adjustment of the doses of calcium and active vitamin D to ensure that serum calcium is maintained in the low-normal to mid-normal reference range. Hyper- and hypocalcemia should be avoided in order to reduce the maternal and fetal complications of hypoparathyroidism during pregnancy and lactation. Standard of care therapy consisting of elemental calcium, active vitamin D, and vitamin D is safe during pregnancy. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

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8 pages, 222 KiB

Open AccessReview

Management of Parathyroid Disease during the COVID-19 Pandemic

by Nivaran Aojula, Andrew Ready, Neil Gittoes and Zaki Hassan-Smith

J. Clin. Med. 2021, 10(5), 920; https://doi.org/10.3390/jcm10050920 - 26 Feb 2021

Cited by 5 | Viewed by 3099

Abstract

The coronavirus disease, COVID-19, has caused widespread and sustained disruption to healthcare, not only in the delivery of emergency care, but knock-on consequences have resulted in major delays to the delivery of elective care, including surgery. COVID-19 has accelerated novel pathways for delivering clinical services, many of which have an increased reliance on technology. COVID-19 has impacted care for patients with both hypoparathyroidism and hyperparathyroidism. The role of vitamin D in the prevention of severe COVID-19 infection has also been widely debated. Severe hypocalcemia can be precipitated by infection in patients with hypoparathyroidism. With this in mind, compliance with medical management, including calcium and vitamin D supplementation, is crucial. Technology in the form of text message reminders and smartphone apps may have a key role in ensuring this. Furthermore, clinicians should ensure that patients are educated on the symptoms of hypocalcemia and the steps needing to be taken should these symptoms be experienced. Patients with primary hyperparathyroidism (PHPT) should be educated on the symptoms of hypercalcemia, as well as the importance of remaining adequately hydrated. In addition, patients should be reassured that the postponement of parathyroidectomy is likely to have negligible impact on their condition; for those with symptomatic hypercalcemia, cinacalcet can be considered as an interim measure. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

13 pages, 912 KiB

Open AccessReview

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

by Antonio Sitges-Serra

J. Clin. Med. 2021, 10(3), 543; https://doi.org/10.3390/jcm10030543 - 2 Feb 2021

Cited by 23 | Viewed by 7719

Abstract

Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy. Full article

(This article belongs to the Special Issue Primary Hyperparathyroidism and Hypoparathyroidism: Diagnosis and Management)

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