open access

Vol 71, No 3 (2020)
Review paper
Submitted: 2020-03-16
Accepted: 2020-03-17
Published online: 2020-06-30
Get Citation

Primary hyperparathyroidism

Grzegorz J. Kowalski1, Grzegorz Buła1, Dominika Żądło1, Agata Gawrychowska1, Jacek Gawrychowski1
·
Pubmed: 32797471
·
Endokrynol Pol 2020;71(3):260-270.
Affiliations
  1. Department of General and Endocrine Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

open access

Vol 71, No 3 (2020)
Reviews — Postgraduate Education
Submitted: 2020-03-16
Accepted: 2020-03-17
Published online: 2020-06-30

Abstract

Primary hyperparathyroidism is an endocrine disorder that results in overproduction of parathyroid hormone by overactivated parathyroid gland leading to a significant rise in blood serum calcium. It results in hypercalcaemia, which has a significant impact mainly on the kidneys and bones and results in a variety of signs and symptoms. Primary hyperparathyroidism should be treated because, if left without any therapy, it can lead even to death. Surgery is considered as the best and only successful therapy, with very low risk of recurrence and relatively low complication rate. The aim of this review is to present clinical basis, aetiology, diagnostic possibilities, and treatment opportunities.

Abstract

Primary hyperparathyroidism is an endocrine disorder that results in overproduction of parathyroid hormone by overactivated parathyroid gland leading to a significant rise in blood serum calcium. It results in hypercalcaemia, which has a significant impact mainly on the kidneys and bones and results in a variety of signs and symptoms. Primary hyperparathyroidism should be treated because, if left without any therapy, it can lead even to death. Surgery is considered as the best and only successful therapy, with very low risk of recurrence and relatively low complication rate. The aim of this review is to present clinical basis, aetiology, diagnostic possibilities, and treatment opportunities.

Get Citation

Keywords

primary parathyroidism; hypercalcaemia; parathyroidectomy; parathormone

About this article
Title

Primary hyperparathyroidism

Journal

Endokrynologia Polska

Issue

Vol 71, No 3 (2020)

Article type

Review paper

Pages

260-270

Published online

2020-06-30

Page views

4990

Article views/downloads

3907

DOI

10.5603/EP.a2020.0028

Pubmed

32797471

Bibliographic record

Endokrynol Pol 2020;71(3):260-270.

Keywords

primary parathyroidism
hypercalcaemia
parathyroidectomy
parathormone

Authors

Grzegorz J. Kowalski
Grzegorz Buła
Dominika Żądło
Agata Gawrychowska
Jacek Gawrychowski

References (66)
  1. Longo DL, Fauci AS, Kasper DL, Hausser SL, Jameson J, Loscalzo J. (eds). Harrison’s: Principles of Internal Medicine. 18th ed. McGraw-Hill, New York 2012.
  2. Gopinath P, Mihai R. Hyperparathyroidism. Surgery (Oxford). 2011; 29(9): 451–458.
  3. Cordellat IM. Hyperparathyroidism: primary or secondary disease? Reumatol Clin. 2012; 8(5): 287–291.
  4. Colaço SM, Si M, Reiff E, et al. Hyperparathyroidism after radioactive iodine therapy. Am J Surg. 2007; 194(3): 323–327.
  5. Madkhali T, Alhefdhi A, Chen H, et al. Primary hyperparathyroidism. Ulus Cerrahi Derg. 2016; 32(1): 58–66.
  6. Bandeira F, Griz L, Chaves N, et al. Sociedade Brasileira de Endocrinologia e Metabologia. Diagnosis and management of primary hyperparathyroidism — a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism. Arq Bras Endocrinol Metabol. 2013; 57(6): 406–424.
  7. Calvi LM, Sims NA, Hunzelman JL, et al. Activated parathyroid hormone/parathyroid hormone-related protein receptor in osteoblastic cells differentially affects cortical and trabecular bone. J Clin Invest. 2001; 107(3): 277–286.
  8. Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009; 94(2): 340–350.
  9. Reiher AE, Mazeh H, Schaefer S, et al. Symptoms of gastroesophageal reflux disease improve after parathyroidectomy. Surgery. 2012; 152(6): 1232–1237.
  10. Gurrado A, Piccinni G, Lissidini G, et al. Hypercalcaemic crisis due to primary hyperparathyroidism — a systematic literature review and case report. Endokrynol Pol. 2012; 63(6): 494–502.
  11. Jacobs TP, Bilezikian JP. Clinical review: Rare causes of hypercalcemia. J Clin Endocrinol Metab. 2005; 90(11): 6316–6322.
  12. Reiher AE, Mazeh H, Schaefer S, et al. Symptoms of gastroesophageal reflux disease improve after parathyroidectomy. Surgery. 2012; 152(6): 1232–1237.
  13. Hinnie J. The management of primary hyperparathyroidism. Scott Med J. 2013; 58(4): 251–253.
  14. Tordjman KM, Greenman Y, Osher E, et al. Characterization of normocalcemic primary hyperparathyroidism. Am J Med. 2004; 117(11): 861–863.
  15. Segiet OA, Deska M, Michalski M, et al. Molecular profiling in primary hyperparathyroidism. Head Neck. 2015; 37(2): 299–307.
  16. Marini F, Cianferotti L, Giusti F, et al. Molecular genetics in primary hyperparathyroidism: the role of genetic tests in differential diagnosis, disease prevention strategy, and therapeutic planning. A 2017 update. Clin Cases Miner Bone Metab. 2017; 14(1): 60–70.
  17. Zhao L, Sun Lh, Liu Dm, et al. Copy number variation in CCND1 gene is implicated in the pathogenesis of sporadic parathyroid carcinoma. World J Surg. 2014; 38(7): 1730–1737.
  18. Sulaiman L, Nilsson IL, Juhlin CC, et al. Genetic characterization of large parathyroid adenomas. Endocr Relat Cancer. 2012; 19(3): 389–407.
  19. Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol. 2015; 68(10): 771–787.
  20. Cavaco BM, Torrinha F, Mendonça E, et al. Preoperative diagnosis of suspicious parathyroid adenomas by RT-PCR using mRNA extracted from leftover cells in a needle used for ultrasonically guided fine needle aspiration cytology. Acta Cytol. 2003; 47(1): 5–12.
  21. Kutahyalioglu M, Nguyen HaT, Kwatampora L, et al. Genetic profiling as a clinical tool in advanced parathyroid carcinoma. J Cancer Res Clin Oncol. 2019; 145(8): 1977–1986.
  22. Costa-Guda J, Imanishi Y, Palanisamy N, et al. Allelic imbalance in sporadic parathyroid carcinoma and evidence for its de novo origins. Endocrine. 2013; 44(2): 489–495.
  23. Sisson JC, Giordano TJ, Raymond VM, et al. First description of parathyroid disease in multiple endocrine neoplasia 2A syndrome. Endocr Pathol. 2008; 19(4): 289–293.
  24. Deska M, Romuk E, Segiet OA, et al. Expression of TRAIL and Fas in Primary Hyperparathyroidism. J Invest Surg. 2017; 30(4): 242–246.
  25. Gawrychowski J, Kowalski G, Buła G. Parathyroid Carcinoma — Diagnosis and Surgical Treatment a 24-year Experience. Polish Journal of Surgery. 2010; 82(2).
  26. Kelly KJ, Chen H, Sippel RS. Primary hyperparathyroidism. Cancer Treat Res. 2010; 153: 87–103.
  27. Bradley SJ, Knodle KF. Ultrasound based focused neck exploration for primary hyperparathyroidism. Am J Surg. 2017; 213(3): 452–455.
  28. Kushchayeva YS, Tella SH, Kushchayev SV, et al. Comparison of hyperparathyroidism types and utility of dual radiopharmaceutical acquisition with Tc99m sestamibi and I for localization of rapid washout parathyroid adenomas. Osteoporos Int. 2019; 30(5): 1051–1057.
  29. Paillahueque G, Massardo T, Barberán M, et al. [False negative spect parathyroid scintigraphy with sestamibi in patients with primary hyperparathyroidism]. Rev Med Chil. 2017; 145(8): 1021–1027.
  30. Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007; 188(6): 1706–1715.
  31. Takumi K, Fukukura Y, Hakamada H, et al. CT features of parathyroid carcinomas: comparison with benign parathyroid lesions. Jpn J Radiol. 2019; 37(5): 380–389.
  32. Goroshi M, Lila AR, Jadhav SS, et al. Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism. Clin Endocrinol (Oxf). 2017; 87(6): 791–798.
  33. Schweighofer-Zwink G, Hehenwarter L, Rendl G, et al. [Imaging of parathyroid adenomas with F‑18 choline PET-CT]. Wien Med Wochenschr. 2019; 169(1-2): 15–24.
  34. Keidar Z, Solomonov E, Karry R, et al. Preoperative [Tc]MIBI SPECT/CT Interpretation Criteria for Localization of Parathyroid Adenomas-Correlation with Surgical Findings. Mol Imaging Biol. 2017; 19(2): 265–270.
  35. Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun. 2018; 39(12): 1129–1137.
  36. Gawrychowski J, Buła G. Imaging diagnostics for primary hyperparathyroidism. Endokrynol Pol. 2013; 64(5): 404–408.
  37. Dijkstra B, Healy C, Kelly LM, et al. Parathyroid localisation--current practice. J R Coll Surg Edinb. 2002; 47(4): 599–607.
  38. Bilezikian JP, Khan AA, Potts JT, et al. Third International Workshop on the Management of Asymptomatic Primary Hyperthyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009; 94(2): 335–339.
  39. Díaz-Aguirregoitia FJ, Emparan C, Gaztambide S, et al. Intraoperative monitoring of kinetic total serum calcium levels in primary hyperparathyroidism surgery. J Am Coll Surg. 2004; 198(4): 519–524.
  40. Bergenfelz A, Lindblom P, Tibblin S, et al. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002; 236(5): 543–551.
  41. Inabnet WB, Dakin GF, Haber RS, et al. Targeted parathyroidectomy in the era of intraoperative parathormone monitoring. World J Surg. 2002; 26(8): 921–925.
  42. Ryan JA, Lee FT. Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization tests. Arch Surg. 2004; 139(8): 838–42; discussion 842.
  43. Goldstein RE, Billheimer D, Martin WH, et al. Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement. Ann Surg. 2003; 237(5): 722–30; discussion 730.
  44. Haldar A, Thapar A, Khan S, et al. Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma. Ann R Coll Surg Engl. 2014; 96(5): e21–e23.
  45. Kitada M, Yasuda S, Nana T, et al. Surgical treatment for mediastinal parathyroid adenoma causing primary hyperparathyroidism. J Cardiothorac Surg. 2016; 11: 44.
  46. Daliakopoulos SI, Chatzoulis G, Lampridis S, et al. Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature. J Cardiothorac Surg. 2014; 9: 62.
  47. Nakada T, Akiba T, Inagaki T, et al. A case of a retroesophageal parathyroid adenoma with an aberrant right subclavian artery: a potential surgical pitfall. Ann Thorac Cardiovasc Surg. 2014; 20 Suppl: 786–789.
  48. Sadler GP, Dudley N. Surgery for the parathyroid glands. In: Moriris PJ, Wood WC. ed. Oxford textbook of surgery. 2. Oxford University Press, Oxford 2000: 1129–1141.
  49. Panchani R, Varma T, Goyal A, et al. A challenging case of an ectopic parathyroid adenoma. Indian J Endocrinol Metab. 2012; 16(Suppl 2): S408–S410.
  50. Kim YSu, Kim J, Shin S. Thoracoscopic removal of ectopic mediastinal parathyroid adenoma. Korean J Thorac Cardiovasc Surg. 2014; 47(3): 317–319.
  51. Nagano H, Suda T, Ishizawa H, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: subxiphoid and lateral thoracic approach. J Thorac Dis. 2019; 11(7): 2932–2938.
  52. Isaacs KE, Belete S, Miller BJ, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open. 2019; 3(6): 743–749.
  53. Buderi SI, Saleh HZ, Theologou T, et al. Endobronchial ultrasound-guided biopsy to diagnose large posterior mediastinal parathyroid adenoma prior to video-assisted thoracoscopic resection. BMJ Case Rep. 2014; 2014.
  54. Brasier AR, Nussbaum SR. Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med. 1988; 84(4): 654–660.
  55. Gawrychowski J, Kowalski G, Gawrychowska A. Parathyroid Cancer — Occurrence, Diagnosis, Treatment. Pol J Surg. 2008; 80(9).
  56. Gopinath P, Sadler GP, Mihai R. Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism. Langenbecks Arch Surg. 2010; 395(7): 941–946.
  57. Schneider DF, Mazeh H, Sippel RS, et al. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012; 152(6): 1008–1015.
  58. Hughes DT, Miller BS, Park PB, et al. Factors in conversion from minimally invasive parathyroidectomy to bilateral parathyroid exploration for primary hyperparathyroidism. Surgery. 2013; 154(6): 1428–34; discussion 1434.
  59. Gupta M, Singhal L, Kumar A. Hyperparathyroidism Mimicking Metastatic Bone Disease: A Case Report and Review of Literature. J Adolesc Young Adult Oncol. 2018; 7(3): 400–403.
  60. Allen E, Fingeret A. Anatomy. Head and Neck, Thyroid. StatPearls Publishing, Treasure Island (FL) 2019.
  61. Zhu R, Wang Z, Hu Ya. Prognostic role of parafibromin staining and CDC73 mutation in patients with parathyroid carcinoma: A systematic review and meta-analysis based on individual patient data. Clin Endocrinol (Oxf). 2020; 92(4): 295–302.
  62. Erickson LA, Mete O. Immunohistochemistry in Diagnostic Parathyroid Pathology. Endocr Pathol. 2018; 29(2): 113–129.
  63. Broos WAM, van der Zant FM, Knol RJJ, et al. Choline PET/CT in parathyroid imaging: a systematic review. Nucl Med Commun. 2019; 40(2): 96–105.
  64. Buła G, Truchanowski W, Koziołek H, et al. A follow-up study of patients with MEN syndromes - five case reports. Endokrynol Pol. 2018; 69(2): 163–167.
  65. Schweighofer-Zwink G, Hehenwarter L, Rendl G, et al. [Imaging of parathyroid adenomas with F‑18 choline PET-CT]. Wien Med Wochenschr. 2019; 169(1-2): 15–24.
  66. Tariq M, Alhefdhi A, Chen H, et al. Primary Hyperparathyrodoism. Ulus Cerrahi Derg. 2016; 32(1): 60.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaWydawcą jest  VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl