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Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre

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Abstract

Background

Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom.

Methods

Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT.

Results

The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5).

Conclusions

PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.

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References

  1. J.P. Bilezikian, L. Bandeira, A. Khan, N.E. Cusano, Hyperparathyroidism. Lancet 391(10116), 168–178 (2018)

    Article  CAS  PubMed  Google Scholar 

  2. S.J. Silverberg, B.L. Clarke, M. Peacock, F. Bandeira, S. Boutroy, N.E. Cusano et al., Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J. Clin. Endocrinol. Metab. 99, 3580–3594 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. A.A. Khan, D.A. Hanley, R. Rizzoli, J. Bollerslev, J.E. Young, L. Rejnmark et al., Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos. Int. 28, 1–19 (2017)

    Article  CAS  PubMed  Google Scholar 

  4. G. Kontogeorgos, P. Trimpou, C.M. Laine, G. Oleröd, A. Lindahl, K. Landin-Wilhelmsen, Normocalcaemic, vitamin D-sufficient hyperparathyroidism—high prevalence and low morbidity in the general population: a long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden. Clin. Endocrinol. (Oxf.). 83, 277–284 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. S.M. Wilhelm, T.S. Wang, D.T. Ruan, J.A. Lee, S.L. Asa, Q.Y. Duh et al., The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 151, 959–968 (2016)

    Article  PubMed  Google Scholar 

  6. M.J. Campbell, The definitive management of primary hyperparathyroidism: who needs an operation? JAMA 317, 1167–1168 (2017)

    Article  PubMed  Google Scholar 

  7. P. Rajeev, A. Movseysan, A. Baharani, Changes in bone turnover markers in primary hyperparathyroidism and response to surgery. Ann. R. Coll. Surg. Engl. 99, 559–562 (2017)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. D.M. Scott-Coombes, J. Rees, G. Jones, M.J. Stechman, Is unilateral neck surgery feasible in patients with sporadic primary hyperparathyroidism and double negative localisation? World J. Surg. 41, 1494–1499 (2017)

    Article  CAS  PubMed  Google Scholar 

  9. J. Helbrow, A.E. Owais, A.G. Sidwell, L.M. Frank, M.E. Lucarotti, The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery. Ann. R. Coll. Surg. Engl. 98, 516–519 (2016)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. O.A. Mownah, G. Pafitanis, W.M. Drake, J.N. Crinnion, Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement. Ann. R. Coll. Surg. Engl. 97, 603–607 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. S.C. Paravastu, D.R. Chadwick, Parathyroidectomy in a district general hospital: outcomes and evolution in the era of minimally invasive surgery. Int. J. Surg. 10, 373–377 (2012)

    Article  CAS  PubMed  Google Scholar 

  12. B.L. Langdahl, S.H. Ralston, Diagnosis and management of primary hyperparathyroidism in Europe. QJM 105, 519–525 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. J.M. Pappachan, R. Sodi, A.K. Viswanath, I.M. Lahart, Parathyroidectomy for adults with primary hyperparathyroidism (Protocol). Cochrane Database Syst. Rev. 5, CD013035 (2018). https://doi.org/10.1002/14651858.

  14. R.K. Crowley, N.J. Gittoes, When would I use medical therapies for the treatment of primary hyperparathyroidism? Clin. Endocrinol. (Oxf.) 79, 770–773 (2013)

    Article  Google Scholar 

  15. L.M. Evans, D. Owens, D.M. Scott-Coombes, M.J. Stechman, A decade of change in the uptake of parathyroidectomy in England and Wales. Ann. R. Coll. Surg. Engl. 96, 339–342 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. N. Yu, G.P. Leese, P.T. Donnan, What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS). Clin. Endocrinol. (Oxf.) 79, 27–34 (2013)

    Article  CAS  Google Scholar 

  17. P. Schwarz, J.J. Body, J. Cáp, L.C. Hofbauer, M. Farouk, A. Gessl et al., The PRIMARA study: a prospective, descriptive, observational study to review cinacalcet use in patients with primary hyperparathyroidism in clinical practice. Eur. J. Endocrinol. 171, 727–735 (2014)

    Article  CAS  PubMed  Google Scholar 

  18. C. Cipriani, F. Biamonte, A.G. Costa, C. Zhang, P. Biondi, D. Diacinti et al., Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J. Clin. Endocrinol. Metab. 100, 1309–1315 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. E. Castellano, R. Attanasio, L. Gianotti, F. Cesario, F. Tassone, G. Borretta, Forearm DXA increases the rate of patients with asymptomatic primary hyperparathyroidism meeting surgical criteria. J. Clin. Endocrinol. Metab. 101, 2728–2732 (2016)

    Article  CAS  PubMed  Google Scholar 

  20. S. De Geronimo, E. Romagnoli, D. Diacinti, E. D’Erasmo, S. Minisola, The risk of fractures in postmenopausal women with primary hyperparathyroidism. Eur. J. Endocrinol. 155, 415–420 (2006)

    Article  CAS  PubMed  Google Scholar 

  21. J. Starup-Linde, E. Waldhauer, L. Rolighed, L. Mosekilde, P. Vestergaard, Renal stones and calcifications in patients with primary hyperparathyroidism: associations with biochemical variables. Eur. J. Endocrinol. 166, 1093–1100 (2012)

    Article  CAS  PubMed  Google Scholar 

  22. S. Cassibba, M. Pellegrino, L. Gianotti, C. Baffoni, E. Baralis, R. Attanasio et al., Silent renal stones in primary hyperparathyroidism: prevalence and clinical features. Endocr. Pract. 20, 1137–1142 (2014)

    Article  PubMed  Google Scholar 

  23. J.M. Suh, J.J. Cronan, J.M. Monchik, Primary hyperparathyroidism: is there an increased prevalence of renal stone disease? Am. J. Roentgenol. 191, 908–911 (2008)

    Article  Google Scholar 

  24. C. Thongprayoon, W. Cheungpasitporn, M.A. Mao, A. Sakhuja, S.B. Erickson, Admission calcium levels and risk of acute kidney injury in hospitalised patients. Int. J. Clin. Pract. (2018). https://doi.org/10.1111/ijcp.13057. [Epub ahead of print]

    Article  CAS  PubMed  Google Scholar 

  25. F. Medas, E. Erdas, A. Longheu, L. Gordini, G. Pisano, A. Nicolosi, P.G. Calò, Retrospective evaluation of the pre- and postoperative factors influencing the sensitivity of localization studies in primary hyperparathyroidism. Int. J. Surg. 25, 82–87 (2016)

    Article  PubMed  Google Scholar 

  26. E. Romagnoli, C. Cipriani, I. Nofroni, C. Castro, M. Angelozzi, A. Scarpiello et al., “Trabecular Bone Score” (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 53, 154–159 (2013)

    Article  Google Scholar 

  27. T.L. Chow, C.Y. Choi, S.H. Lam, Focused parathyroidectomy without intra-operative parathyroid hormone monitoring for primary hyperparathyroidism: results in a low-volume hospital. J. Laryngol. Otol. 129, 788–794 (2015)

    Article  PubMed  Google Scholar 

  28. E. Karakas, R. Schneider, M. Rothmund, D.K. Bartsch, K. Schlosser, Initial surgery for benign primary hyperparathyroidism: an analysis of 1,300 patients in a teaching hospital. World J. Surg. 38, 2011–2018 (2014)

    Article  PubMed  Google Scholar 

  29. J.A. Tang, A.M. Salapatas, L.B. Bonzelaar, M. Friedman, Parathyroidectomy for the treatment of hyperparathyroidism: Thirty-day morbidity and mortality. Laryngoscope 128, 528–533 (2018)

    Article  CAS  PubMed  Google Scholar 

  30. N.M. Singh Ospina, R. Rodriguez-Gutierrez, S. Maraka, A.E. Espinosa de Ycaza, S. Jasim, A. Castaneda-Guarderas et al., Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis. World J. Surg. 40, 2359–2377 (2016)

    Article  PubMed  Google Scholar 

  31. B. Niederle, J.L. Wémeau, Is surgery necessary for ‘mild’ or ‘asymptomatic’ hyperparathyroidism? Eur. J. Endocrinol. 173, D13–D20 (2015)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK

    Joseph M Pappachan, Mohamed Nabil Elnaggar, Kahtan Jbeili & Paul R Smith

  2. Internal Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt

    Mohamed Nabil Elnaggar

  3. Department of Biochemistry and Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK

    Ravinder Sodi

  4. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK

    Ian M Lahart

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  1. Joseph M Pappachan
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  2. Mohamed Nabil Elnaggar
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Correspondence to Joseph M Pappachan.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was a retrospective analysis of data of patients managed in the hospital, and therefore informed consent from cases could not be obtained. The study was approved by the audit and research department of the institution (Registration No: 408/2017).

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Pappachan, J.M., Elnaggar, M.N., Sodi, R. et al. Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre. Endocrine 62, 174–181 (2018). https://doi.org/10.1007/s12020-018-1676-3

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  • DOI: https://doi.org/10.1007/s12020-018-1676-3

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