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)

Sixty-eight patients with mild primary hyperparathyroidism were studied for a mean period of 4.5 years (median 3.3). Seven of these patients presented with renal colic while the rest had no symptoms. There was no significant deterioration in mean serum creatinine, total calcium or ionized calcium concentrations during this period. No patient had progressive renal stone or parathyroid bone disease. Hypertension was defined as a systolic or diastolic blood pressure greater than one standard deviation from the age-sex mean, or if hypotensive drugs were required. Thirty-nine per cent were hypertensive at presentation and 42 per cent became hypertensive later. Four patients died from causes unrelated to hypercalcaemia and three required parathyroidectomy when serum calcium concentration rose above 3.0 mmol/l. Patients over 55 with mild asymptomatic primary hyperparathyroidism may be managed conservatively for several years without significant renal impairment, progressive stone disease, parathyroid bone disease or worsening hypercalcaemia. We suggest that observation in these patients could be restricted to six-monthly checks of physical state, blood pressure and serum biochemistry, particularly concentration of calcium creatinine and alkaline phosphatase.
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PMID:The conservative management of primary hyperparathyroidism. 345 52

The bone adenylyl cyclase (AC) complex of iliac crest biopsies of normals, uremic patients and subjects with primary hyperparathyroidism (PrHPT) have been investigated. Bone resorption (RS) in uremic patients appears to be related partly to increased serum parathyroid hormone (s-PTH) levels and to netto PTH-stimulated AC (net PTH-AC) and partly to the uremic condition (as estimated by s-Creatinine) per se. Serum PTH is able to completely desensitize the PTH dependent bone AC in normals in vivo, but only partially in uremic patients. In patients with PrHPT, the bone AC appears to be inert to homologous desensitization. Positive aluminum staining is associated with blunted CT-responsive and low basal AC. In the combined group of normals and uremic patients, net PTH-AC is (as predicted from human in vitro data and the rat model) inversely related to serum 24,25-diOH-D3. Net PTH-AC, when corrected for s-24,25-diOH-D3 levels, correlated well with RS. The described action of 24,25-diOH-D3 presents a clearly defined rationale for the use of 24,25-diOH-D3 concurrently with 1,25-diOH-D3 to treat renal osteodystrophy: By administering 1,25-diOH-D3, s-Ca2+ and s-PTH will normalize and consequently net PTH-AC diminish. 24,25-diOH-D3 is then believed to further reduce net PTH-AC and RS. A concomitant alleviation of the uremic condition would eventually ensure the fastest possible restoration of bone structure and function.
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PMID:The effect of parathyroid hormone (PTH) and 24,25-dihydroxy-vitamin D3 on adenylyl cyclase of iliac crest biopsies: diagnostic and prognostic tool for evaluation and treatment of uremic patients. 349 56

Osteocalcin (serum bone-Gla protein, sBGP), serum alkaline phosphatase (sAP) and urinary hydroxyproline/creatinine ratio (uOH-Prol/creatinine) have been measured in 21 patients with primary hyperparathyroidism (PHPT) and in nine patients with hypercalcaemia of malignancy (HM). A positive linear correlation between sBGP and uOH-Prol/creatinine ratio (y = 0.023 + 0.0025x; r = 0.705; p less than 0.01) and between sBGP and sAP (y = 35.6 + 2.14x; r = 0.430, p less than 0.05), have been observed in the PHPT patients. No correlation was found in the HM patients. PHPT patients have been grouped according to their uOH-Prol/creatinine ratio (group A: uOH-Prol/creatinine greater than 0.034; group B: uOH-Prol/creatinine less than or equal to 0.034). Group A presented sBGP higher than the control group (11.06 +/- 5.7 vs. 4.2 +/- 1.2 ng/ml; p less than 0.001) (mean +/- SD). Group B presented sBGP similar to the control group (4.4 +/- 1.96 ng/ml) (mean +/- SD). Group A presented serum calcium (sCa) higher than group B (3.11 +/- 0.28 vs. 2.78 +/- 0.09 mmol/l; p less than 0.01) (mean +/- SD). In HM patients uOH-Prol/creatinine ratio was elevated as compared with the control group (0.074 +/- 0.036 vs. 0.024 +/- 0.004; p less than 0.001) (mean +/- SD), but sBGP was normal or low (range: indetectable-5.1 ng/ml). The simultaneous estimations of sBGP and uOH-Prol/creatinine ratio improve the differential diagnosis between these two forms of hypercalcaemia: high uOH-Prol/creatinine ratio with concomitant high sBGP point to the presence of PHPT. Elevated uOH-Prol/creatinine ratio with normal or low sBGP suggest the existence of HM.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Osteocalcin and urinary hydroxyproline/creatinine ratio in the differential diagnosis of primary hyperparathyroidism and hypercalcaemia of malignancy. 349 57

An asymptomatic 11-year-old boy was found to have primary hyperparathyroid secondary to an isolated parathyroid adenoma. This rare disorder of childhood can have asymptomatic hypercalcemia as its only manifestation. Parathyroid hormone assays and studies of urinary calcium excretion, especially the calcium-creatinine clearance ratio, distinguish parathyroid hormone excess from hypocalciuric forms of hypercalcemia. Real-time ultrasonography and dual-isotope subtraction scanning provide accurate, noninvasive, preoperative localization of abnormal parathyroid tissue. The prognosis of untreated, asymptomatic primary hyperparathyroidism in children is not known, and the indications for surgery are unclear. Diagnostic certainty is, therefore, especially important prior to surgical exploration.
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PMID:Asymptomatic primary hyperparathyroidism in children. Newer methods of preoperative diagnosis. 352 97

From 1965 to 1985, 412 patients were operated on for primary hyperparathyroidism (pHPT). Of these, 35 (8.7%) were without specific symptoms and findings. The follow-up investigations after six months to 14 years (median: 31 months) revealed a normalization of the preoperative pathological parameters of alkaline phosphatase, uric acid, creatinine and hypertension in the majority of patients apart from the improvement of their general condition. All patients were normocalcemic. According to these results, the indication for early surgical therapy of the asymptomatic pHPT is to be advocated in order to avoid long-term complications.
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PMID:[Asymptomatic hyperparathyroidism. An indication for surgery?]. 356 55

Among 12 aged postmenopausal females with primary hyperparathyroidism, 5 had no bone fracture and 7 had fractures. Both serum 1,25 (OH)2D levels and creatinine clearance values in patients with fracture were significantly lower than those without fracture (p less than 0.025). In addition, significant positive correlation was observed between serum 1,25 (OH)2D levels and creatinine clearance values (p less than 0.05). These data suggest that decreased serum 1,25 (OH)2D level due to renal dysfunction may causally correlate to bone fracture in postmenopausal primary hyperparathyroidism.
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PMID:Bone fracture in elderly female with primary hyperparathyroidism: relationship among renal function, vitamin D status and fracture risk. 358 26

Serum and 24-h urinary uric acid were measured in 29 patients with primary hyperparathyroidism pre- and post-operatively. No significant difference was observed. A positive correlation was found between the ratios of urinary calcium/creatinine and urinary uric acid/creatinine pre-operatively but not after surgery. The serum uric acid level showed an increase from the first to the third day post-operatively and returned to normal within a week, but in patients undergoing other urological operations there was no post-operative increase. On a low calcium diet the level of serum uric acid was found to be increased. These findings suggest that primary hyperparathyroidism has some influence on uric acid metabolism.
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PMID:Serum and urinary uric acid in primary hyperparathyroidism. 359 96

We studied circulating 1,25(OH)2D3 and its determinants in 102 patients with primary hyperparathyroidism (PHPT), 33 of them with recurrent renal stones, 60 with non-specific symptoms, and nine with overt bone disease. Means for serum 1,25(OH)2D3 and intestinal absorption of calcium were abnormally high in the renal stone group, slightly elevated in the non-specific group, and low-normal in the bone disease group. In the whole population of patients, we found a positive correlation between circulating 1,25(OH)2D3 and creatinine clearance (taken as an index of the functional renal mass). Negative correlations were observed between 1,25(OH)2D3 and age, and between creatinine clearance and age, the latter being not different from that observed in a normal large population. In the renal stone group, means for the determinants of the renal 1 alpha hydroxylase activity, that is, PTH activity expressed as nephrogenous cyclic AMP (NcAMP), serum phosphate and calcium were identical to those of the group with non-specific symptoms. However means for age were lower and functional renal mass significantly higher in the renal stone group, which may account for the higher value of circulating 1,25(OH)2D3. In the bone disease group, means for age, renal mass and serum calcium were identical to those of the group with non-specific symptoms, and NcAMP was far higher and hypophosphatemia more marked, which may not account for the lower value of circulating 1,25(OH)2D3. However, in the bone disease group, serum 25(OH)D was abnormally low, which may limit the renal production of 1,25(OH)2D3 and explain the low-normal circulating values.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal mass and reserve of vitamin D: determinants in primary hyperparathyroidism. 359 57

The aim of the present study was to determine the diurnal secretion of melatonin, cortisol, prolactin, and calcitonin during chronic parathyroid hormone-dependent hypercalcemia. Eight women, aged 40-76 years, with primary hyperparathyroidism (PHPT) were studied before and after surgical removal of a parathyroid adenoma. The hormone concentrations in blood were determined at 08, 12, 16, 22, 02, 04, and 06 h. Concomitantly, the excretion of melatonin and cortisol in urine between 07-19 h and 19-07 h, and the clearance of calcium and creatinine were measured. Nyctohemeral serum prolactin and calcitonin were unaffected by moderate parathyroid hormone-dependent hypercalcemia. In contrast, serum cortisol and melatonin were significantly higher during active disease than after surgical cure. Mean 24-h variation of serum cortisol was 349 +/- 34 nmol/liter vs. 223 +/- 17 nmol/liter and mean serum melatonin was 0.13 +/- 0.04 nmol/liter vs. 0.06 +/- 0.02 nmol/liter. Endogenous creatinine clearance was similar before and after surgery, while the clearance of melatonin and cortisol significantly increased after surgery, indicating an increased tubular reabsorption of both hormones during active disease. Fasting morning glucose concentrations were also significantly decreased after successful surgery, 6.1 +/- 0.6 vs. 5.2 +/- 0.5 mmol/liter. It is suggested that the relative hypercortisolism may be the cause of the glucose intolerance in primary hyperparathyroidism. Three to 4 months after surgical cure the serum melatonin levels were significantly lower than those seen in age-matched controls, indicating a melatonin insufficiency in patients successfully treated for PHPT. The meaning of this finding is not yet understood but might be of importance in the development of primary hyperparathyroidism.
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PMID:Melatonin, cortisol, prolactin, and calcitonin secretion in primary hyperparathyroidism before and after surgery. 362 59

A retrospective study of 75 patients who were surgically cured of primary hyperparathyroidism from 1976 to 1984 was performed to evaluate the blood pressure and metabolic responses to parathyroid surgery. Published data on the population prevalence of hypertension (HT) in South Africa were used for comparison. The overall prevalence of HT before surgery was 47%, compared with 23% in the general population. Hypertension was most frequent in patients older than 60 years (62% vs 39% expected). Renal insufficiency was found in 13 of 35 hypertensive patients and in two of 40 normotensive patients. However, the prevalence of HT in patients with normal creatinine levels (37%) exceeded that expected. The frequency of urolithiasis and mean levels of serum and urine calcium and phosphate were similar in normotensive and hypertensive patients. Parathyroidectomy resulted in a substantial fall in both mean systolic and mean diastolic blood pressures in 54% of the hypertensive subjects, unrelated to improvement in renal function.
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PMID:Parathyroid hypertension. A reversible disorder. 375 10


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