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)

The clinical value of measuring serum immunoreactive parathyroid hormone (iPTH) for the diagnosis of primary hyperparathyroidism is sometimes debated, and the clinical significance of an elevated postoperative serum iPTH level is unknown. Therefore we studied 141 consecutive patients with primary hyperparathyroidism before and after parathyroidectomy to determine the clinical value of measuring serum iPTH by a mid-region-specific radioimmunoassay. Eighty-eight percent of the patients with primary hyperparathyroidism had an absolute increase in the level of serum iPTH (greater than 40 microliter Eq/ml) before surgery, and the remaining patients had an inappropriately increased level of serum iPTH for the simultaneous serum calcium level. Preoperative serum iPTH level correlated positively with serum calcium level and parathyroid tumor size. Postoperative elevation of serum iPTH level was common (as high as 40%) and was associated with higher preoperative levels of blood urea nitrogen, serum creatinine, and alkaline phosphatase and larger tumors. An elevated postoperative serum iPTH level without hypercalcemia did not indicate a failed parathyroidectomy, whereas negative parathyroid exploration and postoperative hypercalcemia were the best predictors of persistent hyperparathyroidism. We conclude that preoperative serum iPTH measurement is a very sensitive diagnostic test for primary hyperparathyroidism, but postoperative serum iPTH measurement is not a good predictor for persistent or recurrent hyperparathyroidism.
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PMID:Parathyroid hormone: before and after parathyroidectomy. 378 59

The effects of norethindrone (5 mg daily) on biochemical variables and forearm mineral density were assessed in 20 postmenopausal women with mild primary hyperparathyroidism. Norethindrone produced a significant fall in plasma calcium levels and the fasting urinary calcium-creatinine and hydroxyproline-creatinine ratios after three months of treatment. There was no change in the plasma parathyroid hormone concentrations. The forearm mineral density before treatment was low in 16 of the 20 patients and there was a significant increase in forearm mineral density after norethindrone treatment. No side effects were reported. We conclude that norethindrone is an effective treatment for mild hyperparathyroidism in postmenopausal women.
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PMID:Treatment of postmenopausal hyperparathyroidism with norethindrone. Effects on biochemistry and forearm mineral density. 382 57

In 89 patients with disorders in calcium regulation either C-terminal or N-terminal PTH or both, were elevated. In haemodialysis patients the results of C-terminal and N-terminal PTH measurements showed the same trend in 10 patients; in 30 patients only C-terminal and in four patients only N-terminal PTH was elevated. In patients with renal failure, creatinine clearance less than 30 ml/min, both C-terminal and N-terminal PTH were elevated in five patients, C-terminal PTH in 12 patients and N-terminal PTH in none of the patients studied. Fourteen patients with primary hyperparathyroidism were studied; in ten both C-terminal and N-terminal PTH were elevated, in two only C-terminal PTH and in another two only N-terminal PTH was elevated. The results show that there seems to be a better clinical correlation for hyperparathyroidism, in haemodialysis patients and patients with renal failure, using N-terminal PTH determinations rather than C-terminal PTH determinations, because in haemodialysis patients and patients with renal failure split products of the C-terminal region of PTH give unrealistically high PTH results.
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PMID:Comparison of C-terminal and N-terminal PTH in secondary hyperparathyroidism in renal failure. 386 28

Controversy has arisen regarding the indications for elective surgical intervention in asymptomatic primary hyperparathyroidism (HPT). The present study was designed to answer two questions: Is untreated primary HPT a progressive disease over time? If not, are the risks attendant on long-term conservative management comparable to those obtained from surgery? Forty-seven patients with primary HPT, established by a persistently elevated serum calcium level and an inappropriately elevated parathormone value, who were managed conservatively and followed for a minimum of 5 years were identified. Serial data collection included calcium, phosphorus, albumin, creatinine, alkaline phosphatase, parathormone levels, skeletal x-ray films, and complications known to result from primary HPT. For each patient the collected data were divided into three equal periods of time (minimum of 20 months per period). In addition, the patients were classified into three groups based on their average serum calcium levels during the first observation period. No patient in any of the three groups experienced a significant progressive increase in serum calcium levels during the periods of observation. Sixteen of the 47 untreated patients (34%) experienced a complication usually associated with primary HPT: peptic ulcer disease (eight patients), decrease in renal function (five patients), renal calculus (one patient), hypercalcemic crisis (one patient), and ventricular conduction defect (one patient). Four deaths were attributed to these complications. In conclusion, the course of primary HPT and attendant complicating features are not accompanied by worsening of the hypercalcemia initially observed. None of the parameters studied offered an accurate prediction of likelihood, progression, or severity of complications. The risks associated with long-term nonoperative management of asymptomatic primary HPT are nevertheless considerable and exceed the morbidity and mortality rates resulting from neck exploration.
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PMID:Observations on the course of untreated primary hyperparathyroidism. 387 2

Bone gamma-carboxyglutamic acid-containing (Gla) protein (BGP, osteocalcin) is a noncollagenous protein of bone present in plasma and removed by the kidney. Plasma BGP has been shown to be elevated in patients with certain bone diseases. The present study evaluates serum BGP (S-BGP), serum alkaline phosphatase (S-AP), and urinary hydroxyproline excretion (U-OHP) in diseases with differing bone turnover rates, and compares the accuracy of these measurements for estimating bone mineralization (m) and resorption (r) rates. S-BGP, S-AP, U-OHP, and creatinine clearance (Clcr) were measured in patients with primary hyperparathyroidism (n = 13), hyperthyroidism (n = 6), and hypothyroidism (n = 6). Bone mineralization and resorption rates were calculated from a 7-d combined calcium balance and 47Ca turnover study. A highly significant correlation (r = 0.69, P less than 0.001) was found between S-BGP and m. Multiple regression analysis disclosed a partial correlation between S-BGP and m when Clcr was taken into account (r = 0.82, P less than 0.001), and between S-BGP and Clcr when m was taken into account (r = -0.62, P less than 0.005). In accordance with this, a stronger correlation (r = 0.89, P less than 0.0001) was found between S-BGP X Clcr and m than between S-BGP and m. A less significant correlation was found between S-AP and m (r = 0.45, P less than 0.05). Furthermore, U-OHP showed a highly significant positive correlation to r (r = 0.78, P less than 0.001). Thus, in the studied disorders of calcium metabolism, individual serum levels of BGP depend on both mineralization rate and renal function. Serum levels of BGP corrected for alterations in renal function are superior to uncorrected S-BGP and to S-AP levels in the estimation of bone mineralization rates.
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PMID:Estimation of bone turnover evaluated by 47Ca-kinetics. Efficiency of serum bone gamma-carboxyglutamic acid-containing protein, serum alkaline phosphatase, and urinary hydroxyproline excretion. 387 67

Two hundred and eighty-nine patients operated on for primary hyperparathyroidism (PHPT) in the years 1956-79 have been followed up for a mean period of 5 years. The aim of the study was to investigate the symptomatology of PHPT and the disappearance of the symptoms after operative treatment. Of the presenting symptoms hypercalcaemic crisis and cystic bone changes were cured, and none of the patients with pancreatitis as presenting symptom had a recurrence. In the renal stone group, 10% of the patients had recurring stones during the follow-up period. The presenting symptom disappeared in 84% of the patients. Thirty-five% of the patients had no presenting symptom and were classified as "asymptomatic", though, on questioning, most of them had various symptoms which disappeared postoperatively. Malaise, fatigue and muscular weakness disappeared in 79% of the patients, upper abdominal pains in 66%, constipation in 63%, pains in the extremities in 51% depression in 65%. Hypertension increased by 28% during the follow-up period; only three of the 90 patients with hypertension has discontinued antihypertensive treatment postoperatively. During the follow-up study, 6% of the patients were hypercalcaemic, though the serum calcium was only slightly elevated in almost all of these patients (mean +/- SD 2.75 +/- 0.09 mmol/l) and most of them had the multiglandular form of PHPT. The renal function did not deteriorate as much as was expected on the basis of earlier reports; only two patients had a serum creatinine over 500 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism. 407 2

The causes for the hypercalciuria and diagnostic criteria for the various forms of hypercalciuria were sought in 56 patients with hypercalcemia or nephrolithiasis (Ca stones), by a careful assessment of parathyroid function and calcium metabolism. A study protocol for the evaluation of hypercalciuria, based on a constant liquid synthetic diet, was developed. In 26 cases of primary hyperparathyroidism, characteristic features were: hypercalcemia, high urinary cyclic AMP (cAMP, 8.58+/-3.63 SD mumol/g creatinine; normal, 4.02+/-0.70 mumol/g creatinine), high immunoreactive serum parathyroid hormone (PTH), hypercalciuria, the urinary Ca exceeding absorbed Ca from intestinal tract (Ca(A)), high fasting urinary Ca (0.2 mg/mg creatinine or greater), and low bone density by (125)I photon absorption. The results suggest that hypercalciuria is partly secondary to an excessive skeletal resorption (resorptive hypercalciuria). The 22 cases with renal stones had normocalcemia, hypercalciuria, intestinal hyperabsorption of calcium, normal or low serum PTH and urinary cAMP, normal fasting urinary Ca, and normal bone density. Since their Ca(A) exceeded urinary Ca, the hypercalciuria probably resulted from an intestinal hyperabsorption of Ca (absorptive hypercalciuria). The primacy of intestinal Ca hyperabsorption was confirmed by responses to Ca load and deprivation under a metabolic dietary regimen. During a Ca load of 1,700 mg/day, there was an exaggerated increase in the renal excretion of Ca and a suppression of cAMP excretion. The urinary Ca of 453+/-154 SD mg/day was significantly higher than the control group's 211+/-42 mg/day. The urinary cAMP of 2.26+/-0.56 mumol/g creatinine was significantly lower than in the control group. In contrast, when the intestinal absorption of calcium was limited by cellulose phosphate, the hypercalciuria was corrected and the suppressed renal excretion of cAMP returned towards normal. Two cases with renal stones had normocalcemia, hypercalciuria, and high urinary cAMP or serum PTH. Since Ca(A) was less than urinary Ca, the hypercalciuria may have been secondary to an impaired renal tubular reabsorption of Ca (renal hypercalciuria). Six cases with renal stones had normal values of serum Ca, urinary Ca, urinary cAMP, and serum PTH (normocalciuric nephrolithiasis). Their Ca(A) exceeded urinary Ca, and fasting urinary Ca and bone density were normal. The results support the proposed mechanisms for the hypercalciuria and provide reliable diagnostic criteria for the various forms of hypercalciuria.
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PMID:The hypercalciurias. Causes, parathyroid functions, and diagnostic criteria. 436 91

The effects of parathyroid hormone (PTH) on plasma and urinary adenosine 3',5'-monophosphate (cyclic AMP) levels were studied in normal subjects. Under basal conditions normal adults have plasma concentrations of cyclic AMP ranging from 10 to 25 nmoles/liter and excrete from 1.5 to 5 mumoles of cyclic AMP per g of urinary creatinine. About one-half to two-thirds of the cyclic AMP excreted in the urine is derived from the plasma by glomerular filtration, and the remainder is produced by the kidney. Renal production of cyclic AMP is partly under the control of PTH. It can be suppressed by infusions of calcium and stimulated by infusions of the calcium chelating agent, EDTA. Infusions of PTH in doses up to 10 mU/kg per min were associated with dose-related increases both in urinary cyclic AMP and phosphate. Infusions of PTH in doses ranging from 20 to 80 mU/kg per min did not lead to any further increase in phosphaturia but did lead to further marked increases in urinary cyclic AMP. A modest increase in plasma cyclic AMP was noted when PTH was infused at 40 mU/kg per min. Anephric patients failed to show appreciable increases in plasma cyclic AMP in response to large doses of PTH but did show expected increases in response to glucagon. Surgical removal of parathyroid adenomas from nine patients with primary hyperparathyroidism was invariably followed by a decrease in urinary cyclic AMP, PTH, in large doses, and calcium infusion produced up to 2-fold increases in the other known naturally occurring cyclic nucleotide, guanosine 3',5'-monophosphate (cyclic GMP).
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PMID:Effects of parathyroid hormone on plasma and urinary adenosine 3',5'-monophosphate in man. 548 Aug 62

Urine specimens were collected from 26 normal subjects, 10 patients with proven primary hyperparathyroidism, and eight patients with hypercalcaemia due to other causes. After overnight urine concentration, an oral water load was given to induce a diuresis and provide urine specimens with a relatively wide range of creatinine concentration for each subject. In normal subjects the urinary calcium/creatinine ratio was found to be independent of urine concentration. In eight out of 10 patients with primary hyperparathyroidism and in two out of eight patients with hyper-calcaemia due to other causes, the urinary calcium/creatinine ratio was found to be high when the creatinine concentration was low, but usually normal when the creatinine concentration was high. The results suggest that if the urinary calcium/creatinine ratio of random urine specimens is used as a ;screening' procedure to detect hypercalciuria the latter cannot be excluded if the urinary creatinine concentration is more than 40 mg per 100 ml.
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PMID:The urinary calcium-creatinine ratio as a measure of urinary calcium excretion. 578 80

One hundred patients with biochemically proved primary hyperparathyroidism had serum amylase estimations before and after cervical or mediastinal exploration. After operation the patients were monitored for the development of abdominal symptoms suggestive of pancreatitis. Although hyperamylasemia occurred in four patients after operation, clinical acute pancreatitis did not arise. Amylase fractionation confirmed the presence of excessive salivary isoamylase in all four patients. Operation on patients with marginally elevated serum creatinine concentrations, those receiving furosemide, and those undergoing concomitant thyroid operation appeared to increase the likelihood of salivary-based hyperamylasemia; this finding suggested an altered renal handling of amylase in the immediate postoperative period. The results of this prospective study and reviewed reports of additional patients undergoing parathyroidectomy indicate that this operation is unlikely to be complicated by postoperative pancreatitis. The probable risk of both pancreatitis and hyperamylasemia would appear to be no more than that with other nonabdominal surgical procedures.
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PMID:Postoperative hyperamylasemia, pancreatitis, and primary hyperparathyroidism. 620 17


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