| The phenotype of primary hyperparathyroidism with normal parathyroid hormone levels: How low can parathyroid hormone go? | |
| | |
MedLine Citation:
|
PMID: 22136828 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
BACKGROUND: While normocalcemic hyperparathyroidism is well recognized in primary hyperparathyroidism (PHP), less is known about patients with high calcium but normal intact parathyroid hormone (iPTH). We aimed to describe this entity and designated it normohormonal primary hyperparathyroidism (NHPHP). METHODS: From a prospectively maintained database of patients undergoing bilateral parathyroid exploration for PHP, we identified and compared those with preoperative iPTH levels below (NHPHP) and above (typical PHP) normal reference peak (60 pg/mL). RESULTS: NHPHP occurred in 46 of 843 patients (5.5%) undergoing initial parathyroidectomy for PHP. All had hypercalcemia (11.1 mg/dL). Regarding preoperative iPTH, 7 patients (15%) had values <40 pg/mL, 19 (41%) had values <60 pg/mL; and 20 (44%) had intermittent values >60 pg/mL. Unlike patients with elevated iPTH, nearly all NHPHP patients had additional testing delaying the operation. Imaging correctly localized NHPHP parathyroid disease in 80%. At the time of operation, 74% of NHPHP patients had single adenomas. Intraoperatively postmobilization, using the same assay that was used preoperatively, 82% had PTH levels >60 pg/mL (mean, 279 pg/mL). During the follow-up period, iPTH levels remained lower among NHPHP patients (21 pg/mL) compared to 41 pg/mL for patients with preoperative iPTH 60 to 100 pg/mL and 56 pg/mL for patients with preoperative iPTH 100 to 200 pg/mL (P < .0001). CONCLUSION: Lower PTH set points may exist in some patients with otherwise typical PHP features. Although high normal iPTH is inappropriate for hypercalcemia and should suggest PHP, this disorder may occur with iPTH levels as low as 5 pg/mL. Awareness of the unusual phenotype of NHPHP may facilitate earlier diagnosis and surgery. |
| | |
Authors:
|
Lucy B Wallace; Rikesh T Parikh; Louis V Ross; Peter J Mazzaglia; Christina Foley; Joyce J Shin; Jamie C Mitchell; Eren Berber; Allan E Siperstein; Mira Milas |
Related Documents
:
|
14656618 - Is airway remodeling clinically relevant in asthma? 1854108 - Aminophylline therapy for acute bronchospastic disease in the emergency room. 18421428 - Budesonide/formoterol decreases expression of vascular endothelial growth factor (vegf)... 1244288 - The spirographic "kink". a sign of emphysema. 3987678 - Microbial colonization of the oropharynx, esophagus and stomach in patients with gastri... 21288648 - Severity in phenotypic expression of homozygous sickle cell disease (hb.ss) - does hype... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Surgery Volume: 150 ISSN: 1532-7361 ISO Abbreviation: Surgery Publication Date: 2011 Dec |
Date Detail:
|
Created Date: 2011-12-05 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0417347 Medline TA: Surgery Country: United States |
Other Details:
|
Languages: eng Pagination: 1102-12 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2011 Mosby, Inc. All rights reserved. |
Affiliation:
|
Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Elevated parathyroid hormone predicts mortality in dialysis patients undergoing valve surgery.
Next Document: Population-level predictors of persistent hyperparathyroidism.