Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary hyperparathyroidism (PHPT) may result in greater cortical than trabecular bone loss. Ultrasound is able to predict osteoporotic fracture risk independent of densitometric measurements, but little is known about the changes in ultrasound variables with PHPT. The aim of our study was to examine the effect of PHPT on ultrasound variables and bone density measurements at cortical (hand) and trabecular (lumbar spine and heel) sites, and to evaluate their reversibility following surgical treatment. We recruited 25 postmenopausal women diagnosed with PHPT ages 51-76 years (mean 62 years) and 95 postmenopausal controls ages 57-80 years (mean 67 years). Measurements were made at baseline and 1 year. Speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the heel were measured using the Lunar Achilles (LA+) and McCue CUBA Clinical (CC). Amplitude-dependent speed of sound (AD-SoS) and ultrasound bone profile index (UBPI) of the fingers were measured using the IGEA DBM Sonic. Bone mineral density (BMD) of the hand and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). At baseline, hand BMD, LS BMD and heel BUA were significantly lower and finger UBPI significantly higher in the PHPT patients compared with controls ( p<0.001). There were no differences in Stiffness Index, heel SOS or finger AD-SoS between control and PHPT subjects. At 1 year postoperatively, there was a mean (+/-SD) increase in LS and hand BMD of 3+/-1% ( p<0.01). BUA at the heel increased (11+/-5%, p<0.001), and UBPI of the fingers decreased (17+/-7%, p<0.001) probably reflecting different modes of attenuation in trabecular (scattering) and cortical (absorption) bone. Stiffness Index, SOS of the heel and AD-SoS of the fingers did not change. BUA, UBPI and BMD returned towards normal postmenopausal values following surgery. There were no changes in BMD or QUS variables at 1 year in the control group. Quantitative ultrasound (QUS) measurements provide different information about bone structure than densitometric measurements and cannot be regarded as simply reflecting bone density. With further research the combined use of BMD and QUS could improve the assessment of skeletal status in patients with PHPT before and after surgery.
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PMID:Differential effects of primary hyperparathyroidism on ultrasound properties of bone. 1211 Oct 18

Primary hyperparathyroidism (PHPT) is a disease whose form of presentation, diagnosis and treatment recommendations have been substantially modified in the last few years. With the development of autoanalyzers and routine calcemia determination, classical forms of presentation with bone and renal involvement have disappeared and the disease is more frequently detected in patients undergoing investigation for osteoporosis or kidney stones. Moreover, there is a difficult-to-quantify relationship between PHPT and cardiovascular and neurocognitive diseases. Therefore, although surgical treatment is clearly recommended in symptomatic patients, several consensus meetings have been required in the last 18 years to establish the recommendations for surgery in asymptomatic patients (age less than 50 years, calcemia 1 mg/dl above the normal limit, glomerular filtrate less than 60 ml/min, osteoporotic fracture or osteoporosis detected by densitometry in the hip, spinal column or forearm or impossibility of follow-up). If medical follow-up is chosen, annual evaluation of calcemia, glomerular filtrate and bone mass measurement is recommended and the possibility of medical treatment with bisphosphonates, raloxifene or cinacalcet is considered. If surgery is indicated, parathyroid scintigraphy and other localization techniques help to identify patients with a single adenoma who can undergo a minimally invasive approach under local anesthesia, as well as those with parathyroid tissue remnants undergoing reintervention due to persistent or recurrent PHPT. Intraoperative parathyroid hormone determination seems to be valid in these situations.
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PMID:[Consensus and clinical practice guidelines in primary hyperparathyroidism]. 1962 60