BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and ex...BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.展开更多
Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized...Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.展开更多
Accurate identification and viability assessment of the parathyroid glands(PGs)are critical when performing thyroid and parathyroid surgeries.Traditional visual inspection-based intrao-perative methods suffer from sub...Accurate identification and viability assessment of the parathyroid glands(PGs)are critical when performing thyroid and parathyroid surgeries.Traditional visual inspection-based intrao-perative methods suffer from subjectivity and uncertainty.Near-infrared(NIR)imaging meth-ods,including NIR autofluorescence(NIRAF)imaging and indocyanine green fluorescence imaging(ICGFI),have emerged as promising and reliable techniques for intraoperative PG identification and assessment.Here,the principles and clinical performanoe of NIR imaging methods were comprehensively reviewed.展开更多
In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent...In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.展开更多
Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a pa...Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a parathyroid cyst diagnosed and treated at Chongqing University Fuling Hospital in 2020.Clinical presentation,imaging,cytological features,pathological fi ndings,diff erential diagnosis and management strategies were analyzed in conjunction with an updated review of the literature.Conclusion:PCs represent a rare subset of parathyroid lesions and are most often non-functioning.Their imaging and cytological characteristics frequently resemble those of thyroid cysts,which may lead to misdiagnosis.Mea-surement of parathyroid hormone levels in aspirated cyst fl uid is essential when a PC is suspected.Surgical excision remains the defi nitive treatment.This case underscores the diagnostic challenges and highlights the importance of heightened clinical awareness,particularly in primary and rural healthcare settings.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
Osteoporosis and age-related bone loss is associated with changes in bone remodeling characterized by decreased bone formation relative to bone resorption,resulting in bone fragility and increased risk of fractures.St...Osteoporosis and age-related bone loss is associated with changes in bone remodeling characterized by decreased bone formation relative to bone resorption,resulting in bone fragility and increased risk of fractures.Stimulating the function of bone-forming osteoblasts,is the preferred pharmacological intervention for osteoporosis.Recombinant parathyroid hormone(PTH),PTH(1-34),is an anabolic agent with proven benefits to bone strength and has been characterized as a potential therapy for skeletal repair.In spite of PTH’s clinical use,safety is a major consideration for long-term treatment.Studies have demonstrated that intermittent PTH treatment enhances and accelerates the skeletal repair process via a number of mechanisms.Recent research into the molecular mechanism of PTH action on bone tissue has led to the development of PTH analogs to control osteoporotic fractures.This review summarizes a number of advances made in the field of PTH and bone fracture to combat these injuries in humans and in animal models.The ultimate goal of providing an alternative to PTH,currently the sole anabolic therapy in clinical use,to promote bone formation and improve bone strength in the aging population is yet to be achieved.展开更多
Objective:To evaluate the efficacy and safety of rhPTH(1-34) vs.elcatonin.Methods:Sixty palients with primary OP were randomly divided into two groups according to the ratio of 3:1.rhPTH(1-34) group(PTH group) was tre...Objective:To evaluate the efficacy and safety of rhPTH(1-34) vs.elcatonin.Methods:Sixty palients with primary OP were randomly divided into two groups according to the ratio of 3:1.rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34) 20 μg daily for 18 months,and the elcalonin group(CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months.Bone mineral density(BMD) of the lumbar spine 2-4(L_(2-4))and femoral neck,serum calcium and phosphorus,urinary calcium,serum hone specific alkaline phosphatase(BSAP).and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ /Cn were tested at baseline,and 6.12.and 18 months after treatment.Results:In PTH group.HMD of L_(2-4),at 6,12.and 18 months,BDM of Femoral neck at 18 month,BSAP at 6 and 12 months and uCTX- Ⅰ /Cr at 6.12 and 18 months were all significantly raised.In CT group.HMD of L_(2-4) at12 month and that of femoral neck at 12 and 18 months were significantly elevated,while HSAP was significantly decreased at 12 and 18 months,and no significant difference on CTX- Ⅰ /Cr was observed.When BMD growth and growth rate between two groups were compared.PTH group had better improvement in L_(2-4) BMD and growth rate than CT group at 6.12.and 18 months.BMD growth and growth rale of femoral neck al 12 month and its growth at 18 month in CT group were higher than in PTH group,hut there was no significant difference between two groups regarding the growth rates at 18 month.Besides,there were no significant differences regarding the rales ol adverse reactions between two groups.Conclusions:rhPTH(1—34),is safe and effective in the treatment of primary OP.It is superior to elcatonin in improving vertebral HMD at onset time,growth rate and growth range,but inferior to elcatonin at HMD of femoral neck.展开更多
We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially th...We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.展开更多
Assaying parathyroid hormone(PTH) in the washing liquid after fine-needle aspiration biopsy(FNAB) seems to be a valid approach to locate parathyroid tissue.PTH-FNAB was evaluated in 47 patients with a clinical picture...Assaying parathyroid hormone(PTH) in the washing liquid after fine-needle aspiration biopsy(FNAB) seems to be a valid approach to locate parathyroid tissue.PTH-FNAB was evaluated in 47 patients with a clinical picture of primary hyper-parathyroidism(PHP) and ultrasonography(US) suggestive of parathyroid lesion.The patients were subdivided into two groups on the basis of the absence or presence of US thyroid alterations.The result of PTH-FNAB was compared with those of cytology,scintigraphy and,in 24 patients,surgical outcome.PTH-FNAB samples with a value higher than that recorded in the serum and higher than our institutional cut-off were deemed to be probable samples of parathyroid tissue.Cytology proved diagnostic for benign thyroid lesions,non-diagnostic for thyroid lesions,hyperplastic parathyroid tissue,undetermined or malignant thyroid lesions and other lesions in 45%,30%,17%,4%,and 4% of cases,respectively.In 47% of cases,PTH-FNAB indicated that the sample had been taken in parathyroid tissue.In patients without US alterations,the diagnostic accuracy of PTH-FNAB was greater than that of scintigraphy.After surgery,comparison between the results of PTH-FNAB and scintigraphy,in terms of positive predictive value(PPV),revealed the superiority of PTH-FNAB;PPV was 94% for FNAB and 71% for scintigraphy,while sensitivity was 83% and 69%,respectively.PTH-FNAB evaluation after FNAB appears to be more diagnostic than cytology and scintigraphy.Of all the procedures used,PTH-FNAB appears to be the method of choice when the target is US suggestive and reachable.PTH-FNAB appears to be a useful method of guiding surgical intervention.展开更多
Parathyroid hormone(PTH) is well-known as the principal regulator of calcium homeostasis in the human body and controls bone metabolism via actions on the survival and activation of osteoblasts. The intermittent admin...Parathyroid hormone(PTH) is well-known as the principal regulator of calcium homeostasis in the human body and controls bone metabolism via actions on the survival and activation of osteoblasts. The intermittent administration of PTH has been shown to stimulate bone production in mice and men and therefore PTH administration has been recently approved for the treatment of osteoporosis. Besides to its physiological role in bone remodelling PTH has been demonstrated to influence and expand the bone marrow stem cell niche where hematopoietic stem cells, capable of both self-renewal and differentiation, reside. Moreover, intermittent PTH treatment is capable to induce mobilization of progenitor cells from the bone marrow into the bloodstream. This novel function of PTH on modulating the activity of the stem cell niche in the bone marrow as well as on mobilization and regeneration of bone marrow-derived stem cells offers new therapeutic options in bone marrow and stem cell transplantation as well as in the field of ischemic disorders.展开更多
Parathyroid cancer is an uncommon malignant cancer and is associated with a poor prognosis.The staging of parathyroid cancer represents an important issue both at initial diagnosis and after surgery and medical treatm...Parathyroid cancer is an uncommon malignant cancer and is associated with a poor prognosis.The staging of parathyroid cancer represents an important issue both at initial diagnosis and after surgery and medical treatment.The role of positron emission tomography/computed tomography(PET/CT)with 18F-Fluorodeoxyglucose(18F-FDG)as an imaging tool in parathyroid cancer is not clearly reported in the literature,although its impact in other cancers is well-defined.The aim of the following illustrative clinical cases is to highlight the impact of PET/CT in the management of different phases of parathyroid cancer.We describe five patients with parathyroid malignant lesions,who underwent FDG PET/CT at initial staging,restaging and post-surgery evaluation.In each patient we report the value of PET/CT comparing its findings with other common imaging modalities(e.g.,CT,planar scintigraphy with 99mTcsestamibi,magnetic resonance imaging)thus determining the complementary benefit of FDG PET/CT in parathyroid carcinoma.We hope to provide an insight into the potential role of PET/CT in assessing the extent of disease and response to treatment which are the general principles used to correctly evaluate disease status.展开更多
Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most co...Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral ves-tibular parathyroidectomy(RTVP) in four patients with primary hyperparathyroidism. The surgery was perfor-med with the Da Vinci system through three trocars intro-duced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.展开更多
Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female...Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels.Imaging with technetium 99 m sestamibi scintigraphy with dual phase,subtraction thyroid scan(dual isotope scintigraphy),magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites.We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing.We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.展开更多
The current study was designed to determine the safety, tolerability and pharmacokinetic parameters of recombinant human parathyroid hormone [rhPTH （1-84）] used for the treatment of osteoporosis. In the single-dose ...The current study was designed to determine the safety, tolerability and pharmacokinetic parameters of recombinant human parathyroid hormone [rhPTH （1-84）] used for the treatment of osteoporosis. In the single-dose format pharmacokinetic study, thirty-six healthy male volunteers received three dose levels of rhPTH （1-84） subcutaneously： 1, 2, and 4 μg/kg. The blood was timing drawn and the serum concentration of rhPTH （1-84） was determined by enzyme linked immunosorbent assay （ELISA）. Serum concentration-time curves of PTH （1-84） exhibited a double-peak pattern, the first peak appearing about 10 to 30 min after administration and the second peak occurring about 1.5 to2 h after administration. Serum terminal half-time of PTH （1-84） was approximately 2 h. The parameters indicated the serum levels were directly proportional to the administered dose, with the mean Cmax and AUC0_24 ranging from approximately 543.47 to 1845 pg/mL and 2358.6 to 9232.12 pg.h.mL^-1 over the dose range. The drug was well tolerated, the clinical symptoms were generally mild and of short duration.展开更多
Parathyroid hormone （PTH） secretion is characterized by an ultradian rhythm with tonic and pulsatile components. In healthy subjects, the majority of PTH is secreted in tonic fashion, whereas approximately 30% is se...Parathyroid hormone （PTH） secretion is characterized by an ultradian rhythm with tonic and pulsatile components. In healthy subjects, the majority of PTH is secreted in tonic fashion, whereas approximately 30% is secreted in low-amplitude and high-frequency bursts occurring every 10-20 min, superimposed on tonic secretion. Changes in the ultradian PTH secretion were shown to occur in patients with primary and secondary osteoporosis, with skeletal effects depending on the reciprocal modifications of pulsatile and tonic components. Indeed, pathophysiology of spontaneous PTH secretion remains an area potentially suitable to be explored, particularly in those conditions such as secondary forms of osteoporosis, in which conventional biochemical and densitometric parameters may not always give reliable diagnostic and therapeutic indications. This review will highlight the literature data supporting the hypothesis that changes of ultradian PTH secretion may be correlated with skeletal fragility in primary and secondary osteoporosis.展开更多
Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to d...Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.展开更多
Colorectal cancer(CRC)remains one of the leading causes of mortality from malignant diseases worldwide.In general terms,CRC presents high heterogeneity due to the influence of different genetic and environmental facto...Colorectal cancer(CRC)remains one of the leading causes of mortality from malignant diseases worldwide.In general terms,CRC presents high heterogeneity due to the influence of different genetic and environmental factors;also,the neoplastic cells are strongly influenced by the extracellular matrix and several surrounding cells,known together as the tumor microenvironment(TME).Bidirectional communication takes place between the tumor and the TME through the release of autocrine and paracrine factors.Parathyroid hormone-related peptide(PTHrP)is a cytokine secreted by a wide variety of tissues and is able to regulate several cellular functions both in physiological as well as in pathological processes.It exerts its effects as a paracrine/autocrine factor,although its mode of action is mainly paracrine.It has been shown that this peptide is expressed by several tumors and that the tumor secretion of PTHrP is responsible for the malignant humoral hypercalcemia.Eight years ago,when our research group started studying PTHrP effects in the experimental models derived from intestinal tumors,the literature available at the time addressing the effects of PTHrP on colorectal tumors was limited,and no articles had been published regarding to the paracrine action of PTHrP in CRC cells.Based on this and on our previous findings regarding the role of PTH in CRC cells,our purpose in recent years has been to explore the role of PTHrP in CRC.We analyzed the behavior of CRC cells treated with exogenous PTHrP,focalizing in the study of the following events:Survival,cell cycle progression and proliferation,migration,chemoresistance,tumor-associated angiogenesis,epithelial to mesenchymal transition program and other events also associated with invasion,such us the induction of cancer stem cells features.This work summarizes the major findings obtained by our investigation group using in vitro and in vivo CRC models that evidence the participation of PTHrP in the acquisition of an aggressive phenotype of CRC cells and the molecular mechanisms involved in these processes.Recently,we found that this cytokine induces this malignant behavior not only by its direct action on these intestinal cells but also through its influence on cells derived from TME,promoting a communication between CRC cells and surrounding cells that contributes to the molecular and morphological changes observed in CRC cells.These investigations establish the basis for our next studies in order to address the clinical applicability of our findings.Recognizing the factors and mechanisms that promote invasion in CRC cells,evasion to the cytotoxic effects of current CRC therapies and thus metastasis is decisive for the identification of new markers with the potential to improve early diagnosis and/or to predict prognosis,to predetermine drug resistance and to provide treatment guidelines that include targeted therapies for this disease.展开更多
Rapid and sensitive reversed phase high performance liquid chromatography (RP-HPLC) and ultra performance liquid chromatography (RP-UPLC) method with UV detection has been developed and validated for quantification of...Rapid and sensitive reversed phase high performance liquid chromatography (RP-HPLC) and ultra performance liquid chromatography (RP-UPLC) method with UV detection has been developed and validated for quantification of parathyroid hormone (PTH) in presence of meta-cresol as a stabilizer in a pharmaceutical formulation.Chromatography was performed with mobile phase containing 0.1% Trifluoroacetic acid (TFA) in MilliQ water and 0.1% TFA in acetonitrile with gradient program and flow rate at 0.3 mL/min for HPLC and 0.4 mL/min for UPLC.Quantification was accomplished with internal reference standard (qualified against innovator product and National Institute for Biological Standards and Control (NIBSC) standard).The methods were validated for linearity (correlation coefficient 0.99),range,accuracy,precision and robustness.Robustness was confirmed by considering three factors;mobile phase composition,column temperature and flow rate/age of mobile phase.Intermediate precision was confirmed on different equipments,different columns and on different days.The relative standard deviation (RSD) (<2% for RP-HPLC and <1% for UPLC,n=30) indicated a good precision.Retention time was found about 17 min and 2 min by HPLC and UPLC methods,respectively.Both methods are simple,highly sensitive,precise and accurate and have the potential of being useful for routine quality control.展开更多
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
基金Supported by Sichuan Province Science and Technology Program,No.2024YFHZ0214 and No.2023YFS0299Chengdu Science and Technology Program,No.2024-YF05-01820-SN.
文摘BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.
文摘Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism,especially in younger patients and those with a hereditary condition.When parathyroid abnormalities are adequately recognized and addressed,more recurrent attacks of acute pancreatitis are unlikely to occur.
基金supported by Shanghai Jiao Tong University(YG2022ZD005,YG2024QNA06).
文摘Accurate identification and viability assessment of the parathyroid glands(PGs)are critical when performing thyroid and parathyroid surgeries.Traditional visual inspection-based intrao-perative methods suffer from subjectivity and uncertainty.Near-infrared(NIR)imaging meth-ods,including NIR autofluorescence(NIRAF)imaging and indocyanine green fluorescence imaging(ICGFI),have emerged as promising and reliable techniques for intraoperative PG identification and assessment.Here,the principles and clinical performanoe of NIR imaging methods were comprehensively reviewed.
文摘In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.
基金supported by the Fuling District Science and Technology and Health Joint Medical Research Program(Chongqing)(grant number 2024KWLH008)the Fuling District Research Project(Chongqing)(grant number FLKJ,2024AAN3046).
文摘Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a parathyroid cyst diagnosed and treated at Chongqing University Fuling Hospital in 2020.Clinical presentation,imaging,cytological features,pathological fi ndings,diff erential diagnosis and management strategies were analyzed in conjunction with an updated review of the literature.Conclusion:PCs represent a rare subset of parathyroid lesions and are most often non-functioning.Their imaging and cytological characteristics frequently resemble those of thyroid cysts,which may lead to misdiagnosis.Mea-surement of parathyroid hormone levels in aspirated cyst fl uid is essential when a PC is suspected.Surgical excision remains the defi nitive treatment.This case underscores the diagnostic challenges and highlights the importance of heightened clinical awareness,particularly in primary and rural healthcare settings.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
文摘Osteoporosis and age-related bone loss is associated with changes in bone remodeling characterized by decreased bone formation relative to bone resorption,resulting in bone fragility and increased risk of fractures.Stimulating the function of bone-forming osteoblasts,is the preferred pharmacological intervention for osteoporosis.Recombinant parathyroid hormone(PTH),PTH(1-34),is an anabolic agent with proven benefits to bone strength and has been characterized as a potential therapy for skeletal repair.In spite of PTH’s clinical use,safety is a major consideration for long-term treatment.Studies have demonstrated that intermittent PTH treatment enhances and accelerates the skeletal repair process via a number of mechanisms.Recent research into the molecular mechanism of PTH action on bone tissue has led to the development of PTH analogs to control osteoporotic fractures.This review summarizes a number of advances made in the field of PTH and bone fracture to combat these injuries in humans and in animal models.The ultimate goal of providing an alternative to PTH,currently the sole anabolic therapy in clinical use,to promote bone formation and improve bone strength in the aging population is yet to be achieved.
基金supported by Clinical Special Funds of China University Medical Journals(No:11321375)
文摘Objective:To evaluate the efficacy and safety of rhPTH(1-34) vs.elcatonin.Methods:Sixty palients with primary OP were randomly divided into two groups according to the ratio of 3:1.rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34) 20 μg daily for 18 months,and the elcalonin group(CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months.Bone mineral density(BMD) of the lumbar spine 2-4(L_(2-4))and femoral neck,serum calcium and phosphorus,urinary calcium,serum hone specific alkaline phosphatase(BSAP).and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ /Cn were tested at baseline,and 6.12.and 18 months after treatment.Results:In PTH group.HMD of L_(2-4),at 6,12.and 18 months,BDM of Femoral neck at 18 month,BSAP at 6 and 12 months and uCTX- Ⅰ /Cr at 6.12 and 18 months were all significantly raised.In CT group.HMD of L_(2-4) at12 month and that of femoral neck at 12 and 18 months were significantly elevated,while HSAP was significantly decreased at 12 and 18 months,and no significant difference on CTX- Ⅰ /Cr was observed.When BMD growth and growth rate between two groups were compared.PTH group had better improvement in L_(2-4) BMD and growth rate than CT group at 6.12.and 18 months.BMD growth and growth rale of femoral neck al 12 month and its growth at 18 month in CT group were higher than in PTH group,hut there was no significant difference between two groups regarding the growth rates at 18 month.Besides,there were no significant differences regarding the rales ol adverse reactions between two groups.Conclusions:rhPTH(1—34),is safe and effective in the treatment of primary OP.It is superior to elcatonin in improving vertebral HMD at onset time,growth rate and growth range,but inferior to elcatonin at HMD of femoral neck.
文摘We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.
文摘Assaying parathyroid hormone(PTH) in the washing liquid after fine-needle aspiration biopsy(FNAB) seems to be a valid approach to locate parathyroid tissue.PTH-FNAB was evaluated in 47 patients with a clinical picture of primary hyper-parathyroidism(PHP) and ultrasonography(US) suggestive of parathyroid lesion.The patients were subdivided into two groups on the basis of the absence or presence of US thyroid alterations.The result of PTH-FNAB was compared with those of cytology,scintigraphy and,in 24 patients,surgical outcome.PTH-FNAB samples with a value higher than that recorded in the serum and higher than our institutional cut-off were deemed to be probable samples of parathyroid tissue.Cytology proved diagnostic for benign thyroid lesions,non-diagnostic for thyroid lesions,hyperplastic parathyroid tissue,undetermined or malignant thyroid lesions and other lesions in 45%,30%,17%,4%,and 4% of cases,respectively.In 47% of cases,PTH-FNAB indicated that the sample had been taken in parathyroid tissue.In patients without US alterations,the diagnostic accuracy of PTH-FNAB was greater than that of scintigraphy.After surgery,comparison between the results of PTH-FNAB and scintigraphy,in terms of positive predictive value(PPV),revealed the superiority of PTH-FNAB;PPV was 94% for FNAB and 71% for scintigraphy,while sensitivity was 83% and 69%,respectively.PTH-FNAB evaluation after FNAB appears to be more diagnostic than cytology and scintigraphy.Of all the procedures used,PTH-FNAB appears to be the method of choice when the target is US suggestive and reachable.PTH-FNAB appears to be a useful method of guiding surgical intervention.
文摘Parathyroid hormone(PTH) is well-known as the principal regulator of calcium homeostasis in the human body and controls bone metabolism via actions on the survival and activation of osteoblasts. The intermittent administration of PTH has been shown to stimulate bone production in mice and men and therefore PTH administration has been recently approved for the treatment of osteoporosis. Besides to its physiological role in bone remodelling PTH has been demonstrated to influence and expand the bone marrow stem cell niche where hematopoietic stem cells, capable of both self-renewal and differentiation, reside. Moreover, intermittent PTH treatment is capable to induce mobilization of progenitor cells from the bone marrow into the bloodstream. This novel function of PTH on modulating the activity of the stem cell niche in the bone marrow as well as on mobilization and regeneration of bone marrow-derived stem cells offers new therapeutic options in bone marrow and stem cell transplantation as well as in the field of ischemic disorders.
文摘Parathyroid cancer is an uncommon malignant cancer and is associated with a poor prognosis.The staging of parathyroid cancer represents an important issue both at initial diagnosis and after surgery and medical treatment.The role of positron emission tomography/computed tomography(PET/CT)with 18F-Fluorodeoxyglucose(18F-FDG)as an imaging tool in parathyroid cancer is not clearly reported in the literature,although its impact in other cancers is well-defined.The aim of the following illustrative clinical cases is to highlight the impact of PET/CT in the management of different phases of parathyroid cancer.We describe five patients with parathyroid malignant lesions,who underwent FDG PET/CT at initial staging,restaging and post-surgery evaluation.In each patient we report the value of PET/CT comparing its findings with other common imaging modalities(e.g.,CT,planar scintigraphy with 99mTcsestamibi,magnetic resonance imaging)thus determining the complementary benefit of FDG PET/CT in parathyroid carcinoma.We hope to provide an insight into the potential role of PET/CT in assessing the extent of disease and response to treatment which are the general principles used to correctly evaluate disease status.
文摘Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral ves-tibular parathyroidectomy(RTVP) in four patients with primary hyperparathyroidism. The surgery was perfor-med with the Da Vinci system through three trocars intro-duced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.
文摘Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells.We present a case of 86-yearold female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels.Imaging with technetium 99 m sestamibi scintigraphy with dual phase,subtraction thyroid scan(dual isotope scintigraphy),magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites.We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing.We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.
文摘The current study was designed to determine the safety, tolerability and pharmacokinetic parameters of recombinant human parathyroid hormone [rhPTH （1-84）] used for the treatment of osteoporosis. In the single-dose format pharmacokinetic study, thirty-six healthy male volunteers received three dose levels of rhPTH （1-84） subcutaneously： 1, 2, and 4 μg/kg. The blood was timing drawn and the serum concentration of rhPTH （1-84） was determined by enzyme linked immunosorbent assay （ELISA）. Serum concentration-time curves of PTH （1-84） exhibited a double-peak pattern, the first peak appearing about 10 to 30 min after administration and the second peak occurring about 1.5 to2 h after administration. Serum terminal half-time of PTH （1-84） was approximately 2 h. The parameters indicated the serum levels were directly proportional to the administered dose, with the mean Cmax and AUC0_24 ranging from approximately 543.47 to 1845 pg/mL and 2358.6 to 9232.12 pg.h.mL^-1 over the dose range. The drug was well tolerated, the clinical symptoms were generally mild and of short duration.
文摘Parathyroid hormone （PTH） secretion is characterized by an ultradian rhythm with tonic and pulsatile components. In healthy subjects, the majority of PTH is secreted in tonic fashion, whereas approximately 30% is secreted in low-amplitude and high-frequency bursts occurring every 10-20 min, superimposed on tonic secretion. Changes in the ultradian PTH secretion were shown to occur in patients with primary and secondary osteoporosis, with skeletal effects depending on the reciprocal modifications of pulsatile and tonic components. Indeed, pathophysiology of spontaneous PTH secretion remains an area potentially suitable to be explored, particularly in those conditions such as secondary forms of osteoporosis, in which conventional biochemical and densitometric parameters may not always give reliable diagnostic and therapeutic indications. This review will highlight the literature data supporting the hypothesis that changes of ultradian PTH secretion may be correlated with skeletal fragility in primary and secondary osteoporosis.
基金Supported by the Key Project of Scientific and Technological Innovation in Hangzhou,NO.20131813A08the Key Project of Medical Scientific and Technology Program in Hangzhou,NO.2013Z04+1 种基金the Traditional Chinese Medical Science Research Program of Zhejiang Province,NO.2018239534the Applied Research Project of Commonweal Technology in Zhejiang Province,NO.2017C33180
文摘Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.
基金Supported by Agencia Nacional de Promoción Científica y Tecnológica,No. PICT-2013-1441Consejo Nacional de Investigaciones Científicas y Técnicas,No. PIP11220150100350+3 种基金Instituto Nacional del Cáncer,Asistencia financiera Ⅱ,No. 12002-4395-14-1Instituto Nacional del Cáncer,Asistencia Financiera Ⅲ,No. RESOL-2016-1006-E-APN-MSUniversidad Nacional del Sur,Argentina,No. PGI:24/B230PGI:24/B303
文摘Colorectal cancer(CRC)remains one of the leading causes of mortality from malignant diseases worldwide.In general terms,CRC presents high heterogeneity due to the influence of different genetic and environmental factors;also,the neoplastic cells are strongly influenced by the extracellular matrix and several surrounding cells,known together as the tumor microenvironment(TME).Bidirectional communication takes place between the tumor and the TME through the release of autocrine and paracrine factors.Parathyroid hormone-related peptide(PTHrP)is a cytokine secreted by a wide variety of tissues and is able to regulate several cellular functions both in physiological as well as in pathological processes.It exerts its effects as a paracrine/autocrine factor,although its mode of action is mainly paracrine.It has been shown that this peptide is expressed by several tumors and that the tumor secretion of PTHrP is responsible for the malignant humoral hypercalcemia.Eight years ago,when our research group started studying PTHrP effects in the experimental models derived from intestinal tumors,the literature available at the time addressing the effects of PTHrP on colorectal tumors was limited,and no articles had been published regarding to the paracrine action of PTHrP in CRC cells.Based on this and on our previous findings regarding the role of PTH in CRC cells,our purpose in recent years has been to explore the role of PTHrP in CRC.We analyzed the behavior of CRC cells treated with exogenous PTHrP,focalizing in the study of the following events:Survival,cell cycle progression and proliferation,migration,chemoresistance,tumor-associated angiogenesis,epithelial to mesenchymal transition program and other events also associated with invasion,such us the induction of cancer stem cells features.This work summarizes the major findings obtained by our investigation group using in vitro and in vivo CRC models that evidence the participation of PTHrP in the acquisition of an aggressive phenotype of CRC cells and the molecular mechanisms involved in these processes.Recently,we found that this cytokine induces this malignant behavior not only by its direct action on these intestinal cells but also through its influence on cells derived from TME,promoting a communication between CRC cells and surrounding cells that contributes to the molecular and morphological changes observed in CRC cells.These investigations establish the basis for our next studies in order to address the clinical applicability of our findings.Recognizing the factors and mechanisms that promote invasion in CRC cells,evasion to the cytotoxic effects of current CRC therapies and thus metastasis is decisive for the identification of new markers with the potential to improve early diagnosis and/or to predict prognosis,to predetermine drug resistance and to provide treatment guidelines that include targeted therapies for this disease.
文摘Rapid and sensitive reversed phase high performance liquid chromatography (RP-HPLC) and ultra performance liquid chromatography (RP-UPLC) method with UV detection has been developed and validated for quantification of parathyroid hormone (PTH) in presence of meta-cresol as a stabilizer in a pharmaceutical formulation.Chromatography was performed with mobile phase containing 0.1% Trifluoroacetic acid (TFA) in MilliQ water and 0.1% TFA in acetonitrile with gradient program and flow rate at 0.3 mL/min for HPLC and 0.4 mL/min for UPLC.Quantification was accomplished with internal reference standard (qualified against innovator product and National Institute for Biological Standards and Control (NIBSC) standard).The methods were validated for linearity (correlation coefficient 0.99),range,accuracy,precision and robustness.Robustness was confirmed by considering three factors;mobile phase composition,column temperature and flow rate/age of mobile phase.Intermediate precision was confirmed on different equipments,different columns and on different days.The relative standard deviation (RSD) (<2% for RP-HPLC and <1% for UPLC,n=30) indicated a good precision.Retention time was found about 17 min and 2 min by HPLC and UPLC methods,respectively.Both methods are simple,highly sensitive,precise and accurate and have the potential of being useful for routine quality control.
