Document Detail


Development and treatment of tertiary hyperparathyroidism in patients with pseudohypoparathyroidism type 1B.
MedLine Citation:
PMID:  22736772     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Pseudohypoparathyroidism type 1B (PHP1B) patients have PTH resistance at the renal proximal tubule and develop hypocalcemia and secondary hyperparathyroidism. Hyperparathyroid bone disease also develops in some patients. PHP1B patients are at theoretical risk of developing tertiary hyperparathyroidism.
SETTING: Patients were studied in a clinical research center.
PATIENTS: Five female PHP1B patients presented with hypercalcemia and elevated PTH.
INTERVENTION: Patients either underwent parathyroidectomy (n = 4) or received cinacalcet (n = 1).
MAIN OUTCOME MEASURES: Serum calcium and PTH were serially measured before and after intervention.
RESULTS: Five PHP1B patients developed concomitantly elevated serum calcium and PTH levels (range, 235-864 ng/liter) requiring termination of calcium and vitamin D therapy (time after diagnosis, 21-42 yr; median, 34 yr), consistent with tertiary hyperparathyroidism. Four patients underwent parathyroidectomy with removal of one (n = 2) or two (n = 2) enlarged parathyroid glands. Calcium and vitamin D therapy was reinstituted postoperatively, and at 93-month median follow-up, PTH levels ranged between 56 and 182 (normal, <87) ng/liter. One patient was treated with cinacalcet, resulting in resolution of hypercalcemia.
CONCLUSIONS: PHP1B patients are at risk of developing tertiary hyperparathyroidism and/or hyperparathyroid bone disease and should therefore be treated with sufficient doses of calcium and vitamin D to achieve serum calcium and PTH levels within or as close to the normal range as possible. Surgery is the treatment of choice in this setting. Cinacalcet may be a useful alternative in those who do not undergo surgery.
Authors:
Nicola M Neary; Diala El-Maouche; Rachel Hopkins; Steven K Libutti; Arnold M Moses; Lee S Weinstein
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Intramural     Date:  2012-06-26
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  97     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-10     Completed Date:  2012-11-26     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3025-30     Citation Subset:  AIM; IM    
Affiliation:
Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-1752, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age of Onset
Calcitriol / therapeutic use
Calcium / therapeutic use
Child, Preschool
Disease Progression
Ergocalciferols / therapeutic use
Female
Humans
Hyperparathyroidism, Secondary / complications*,  genetics
Hypocalcemia / etiology
Male
Middle Aged
Muscular Diseases / etiology
Osteitis Fibrosa Cystica / etiology
Parathyroid Glands / surgery
Parathyroid Hormone / blood
Parathyroidectomy
Pseudohypoparathyroidism / etiology*,  genetics
Seizures / etiology
Syntaxin 16 / genetics
Young Adult
Chemical
Reg. No./Substance:
0/Ergocalciferols; 0/Parathyroid Hormone; 0/STX16 protein, human; 0/Syntaxin 16; 32222-06-3/Calcitriol; 7440-70-2/Calcium
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