Hyperparathyroidism Abstracts 3

©

Is estrogen preferable to surgery for postmenopausal women with primary hyperparathyroidism
            (Coe et al., 1986) Download
Is estrogen better for uncomplicated hyperparathyroidism in postmenopausal women than surgery or nothing at all? Perhaps it is; serum and urinary calcium levels and calcium balance return toward normal; indexes of bone turnover improve. Perhaps it is not; urinary calcium levels and serum parathyroid hormone still tend to be high.

Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism.
(Dökmetaş et al., 2001) Download
Dyspeptic symptoms are common in patients with primary hyperparathyroidism (PHPT) and have been attributed to hypercalcemia; however, they may also become permanent after parathyroid surgery. We aimed to evaluate the prevalence of Helicobacter pylori in patients with PHPT and to see whether there is a relationship between dyspeptic complaints and H. pylori infection. Of 21 patients with PHPT, 18 patients had dyspeptic complaints. These 18 female patients with PHPT and dyspeptic symptoms were the study population, and 20 female volunteers with dyspeptic symptoms were the controls. An endoscopic examination was performed in all controls and in patients before parathyroid surgery. H. pylori was assessed by serological and histological evaluation. H. pylori was identified upon histological evaluation in 17 patients (94.4%) and serologically in 17 patients (94.4%). Active macroscopic and microscopic gastritis were found in 15 (83.3%) and in 17 (94.4%) of the patients, respectively. In the control group, H. pylori was identified histologically in 13 subjects (65%) and serologically in 17 subjects (85%). The prevalence of H. pylori assessed by histological examination was significantly (P < 0.05) different between patients and controls. There was a significant association between H. pylori infection identified by histology and/or serology and the presence of microscopic (r = 1; P < 0.001), as well as macroscopic (r = 0.54; P < 0.05), gastritis. In conclusion, this study showed that H. pylori infection was found frequently (85.7%) in patients with PHPT. In the management of PHPT with or without surgery, patients, especially those with dyspeptic symptoms, should be evaluated for H. pylori infection, which can be effectively eradicated by appropriate therapy.


 

The effect of intravenous magnesium sulphate on parathyroid function in primary hyperparathyroidism.
            (Gough et al., 1988) Download
Ten patients with primary hyperparathyroidism caused by enlargement of a single parathyroid gland were studied preoperatively. An intravenous bolus of 4 g magnesium sulphate followed by a continuous infusion of 2 g per hour for 3 hours increased serum magnesium from 0.76 to 2.12 mmol/I (median values, p < 0.005). Serum C-terminal parathyroid hormone (PTH) decreased from 94 to 78 pmol/I (p < 0.005), and serum intact PTH from 7.0 to 4.8 pmol/l (p < 0.008). The PTH changes preceded decreases in serum total calcium from 2.79 to 2.55 mmol/I (p < 0.01), and serum ionized calcium from 1.52 to 1.45 mol/l (p < 0.007). Urinary calcium excretion increased and urinary phosphate excretion decreased. Serum phosphorus, pH, albumin, creatinine, alkaline phosphatase, and urinary cyclic AMP showed no significant changes. The study showed that an intravenous magnesium sulphate infusion which at least doubled the normal serum magnesium concentration significantly suppressed PTH secretion in patients with primary hyperparathyroidism and subsequently reduced the serum calcium concentration.

Low serum reverse T3 levels in patients with primary hyperparathyroidism.
            (Higashi et al., 1987) Download
Although patients with primary hyperparathyroidism (1 degree HPT) were euthyroid, we measured serum thyroid hormone levels in 16 patients with 1 degree HPT together with 17 patients with hypercalcemia due to malignant diseases (HCM). In patients with 1 degree HPT, serum levels of T3, T4 and T3U were within normal range, but serum rT3 (reverse T3) levels (205 +/- 37 pg/ml, mean +/- SD) were significantly decreased as compared with those in normal controls (276 +/- 44 pg/ml, P less than 0.01). A significant inverse correlation was observed between the serum levels of rT3 and parathyroid hormone (PTH) (r = 0.54, P less than 0.05). After parathyroidectomy, serum rT3 levels were significantly elevated (240 +/- 56 pg/ml) compared to preoperative levels (P less than 0.01). Low levels of serum rT3 seemed to be attributed to the high levels of serum PTH. On the other hand, serum levels of T3 and T4 were low and serum rT3 levels were high in patients with HCM. Low serum rT3 allows for the differentiation of patients with 1 degree HPT from those with HCM.


 

Parathyroids and food allergy.
            (Lietze, 1970)  Download
In a recent paper I suggested that there appears to be a correlation between hyperparathyroidism and severity of food allergy. Since it is well-known that increased serum calcium is not always present in hyperparathyroidism the possibility existed that food allergy might be a manifestation of an over-active parathyroid in the presence of normal calcium.

Effects of mild asymptomatic primary hyperparathyroidism on bone mass in women with and without estrogen replacement therapy.
            (McDermott et al., 1994) Download
Primary hyperparathyroidism (HPT) presents most commonly as a mild elevation of the serum calcium concentration in an asymptomatic individual. There are conflicting data regarding the effects of mild primary HPT on bone mass. This cross-sectional study was conducted to examine this question further and to determine whether estrogen replacement therapy (ERT) in postmenopausal women with primary HPT might be beneficial. We measured bone mass in 59 women with mild asymptomatic primary HPT, of whom 43 (HPT) had never taken and 16 (estrogen-replaced HPT) were currently taking ERT. We also studied 84 healthy normocalcemic women who were not on ERT (controls) and 45 who were on ERT (estrogen-replaced controls). After adjustment for age, height, and weight, mean bone mass values in the HPT group were significantly reduced in the midradius (20%), distal radius (20%), lumbar spine (17%), and femoral neck (11%) compared with the controls. The estrogen-replaced HPT group had mean bone mass values greater than those in the HPT group, similar to those in the controls, and lower than those in the estrogen-replaced controls. Mild asymptomatic primary HPT results in bone loss from both the appendicular and axial skeleton, and ERT in postmenopausal women with primary HPT may ameliorate this loss.

Gastric function in primary hyperparathyroidism in man.
            (McGeown and Connell, 1975) Download
1. GASTRIC function was studied pre-operatively in 55 patients with primary hyperparathyroidism. In all patients the diagnosis of hyperparathyroidism was proved by the removal of an enlarged parathyroid gland or glands, following which the serum calcium fell to normal or below. 2. Twenty patients (38 per cent) gave a history of dyspepsia. All patients were given a barium meal and 12 (22 per cent) were found to have a duodenal ulcer. Male patients had dyspepsia and/or an ulcer more frequently than female patients. 3. Kay's augmented histamine test was carried out in all patients. Six patients (11 per cent) had achlorhydria, six had hyperchlorhydria (11 per cent), the remaining patients secreting normal amounts of acid. The acid secretion did not differ significantly from that of a group of euparathyroid patients studied under similar circumstances who did not have duodenal ulcer on barium meal. 4. Antigastric-parietal-cell antibodies and antithyroid antibodies were absent in all 20 patients, including five with achlorhydria, tested. 5. Serum gastrin was slightly elevated in three out of 10 patients preoperatively, and there was no consistent change following parathyroidectomy. 6. Although there is a high incidence of dyspepsia and of duodenal ulcer in patients with primary hyperparathyroidism they do not tend to have increased acid secretion.

The relation of serum parathyroid hormone and serum calcium to serum levels of prostate-specific antigen: a population-based study.
            (Skinner and Schwartz, 2009) Download
Experimental and clinical data implicate calcium and parathyroid hormone (PTH) in the development of prostate cancer. However, epidemiologic data on the role of these variables in prostate health are sparse. We examined the relationship between serum levels of calcium, PTH, and prostate-specific antigen (PSA), an established marker of prostate growth, in a large, population-based study using multivariate linear regression. We studied 1,273 men in National Health and Nutrition Survey 2005 to 2006 who were >or=40 years of age and who were without clinical prostate cancer. Adjusted for age, race, body mass index, and serum levels of 25-hydroxyvitamin D, serum levels of PTH were significantly positively correlated with serum PSA (P = 0.01). Serum levels of PTH and calcium each were correlated significantly with free PSA (P = 0.05 and 0.008, respectively). The percentage of men who had elevated serum levels of PTH (PTH, >or=66 pg/mL) was significantly greater among African American men (19.2 versus 9.6%, P = 0.04). Compared with men whose PTH was at the lower end of the reference range, the predicted PSA for men with a PTH of 66 pg/mL was increased 43%. These findings support the hypothesis that serum calcium and serum PTH stimulate prostate growth in men without clinical prostate cancer and have implications for the use of PSA as a screening tool for prostate cancer.

Parathyroid Hormone Secretion Is Controlled by Both Ionized Calcium and Phosphate During Exercise and Recovery in Men.
            (Townsend et al., 2016) Download
CONTEXT:  The mechanism by which PTH is controlled during and after exercise is poorly understood due to insufficient temporal frequency of measurements. OBJECTIVE:  The objective of the study was to examine the temporal pattern of PTH, PO4, albumin-adjusted calcium, and Ca(2+) during and after exercise. DESIGN AND SETTING:  This was a laboratory-based study with a crossover design, comparing 30 minutes of running at 55%, 65%, and 75% maximal oxygen consumption, followed by 2.5 hours of recovery. Blood was obtained at baseline, after 2.5, 5, 7.5, 10, 15, 20, 25, and 30 minutes of exercise, and after 2.5, 5, 7.5, 10, 15, 20, 25, 30, 60, 90, and 150 minutes of recovery. PARTICIPANTS:  Ten men (aged 23 ± 1 y, height 1.82 ± 0.07 m, body mass 77.0 ± 7.5 kg) participated. MAIN OUTCOME MEASURES:  PTH, PO4, albumin-adjusted calcium, and Ca(2+) were measured. RESULTS:  Independent of intensity, PTH concentrations decreased with the onset of exercise (-21% to -33%; P ≤ .001), increased thereafter, and were higher than baseline by the end of exercise at 75% maximal oxygen consumption (+52%; P ≤ .001). PTH peaked transiently after 5-7.5 minutes of recovery (+73% to +110%; P ≤ .001). PO4 followed a similar temporal pattern to PTH, and Ca(2+) followed a similar but inverse pattern to PTH. PTH was negatively correlated with Ca(2+) across all intensities (r = -0.739 to -0.790; P ≤ .001). When PTH was increasing, the strongest cross-correlation was with Ca(2+) at 0 lags (3.5 min) (r = -0.902 to -0.950); during recovery, the strongest cross-correlation was with PO4 at 0 lags (8 min) (r = 0.987-0.995). CONCLUSIONS:  PTH secretion during exercise and recovery is controlled by a combination of changes in Ca(2+) and PO4 in men.

 


 

References

Coe, FL, MJ Favus, and JH Parks (1986), ‘Is estrogen preferable to surgery for postmenopausal women with primary hyperparathyroidism’, N Engl J Med, 314 (23), 1508-9. PubMed: 3702965
Dökmetaş, HS, et al. (2001), ‘Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism.’, J Bone Miner Metab, 19 (6), 373-77. PubMed: 11685653
Gough, IR, et al. (1988), ‘The effect of intravenous magnesium sulphate on parathyroid function in primary hyperparathyroidism.’, World J Surg, 12 (4), 463-69. PubMed: 3420930
Higashi, K, et al. (1987), ‘Low serum reverse T3 levels in patients with primary hyperparathyroidism.’, Horm Metab Res, 19 (7), 325-27. PubMed: 3623422
Lietze, A (1970), ‘Parathyroids and food allergy.’, Ann Allergy, 28 (6), 282-83. PubMed: 5535838
McDermott, MT, JJ Perloff, and GS Kidd (1994), ‘Effects of mild asymptomatic primary hyperparathyroidism on bone mass in women with and without estrogen replacement therapy.’, J Bone Miner Res, 9 (4), 509-14. PubMed: 8030438
McGeown, MG and AM Connell (1975), ‘Gastric function in primary hyperparathyroidism in man.’, Ir J Med Sci, 144 (1), 217. PubMed: 27518961
Skinner, HG and GG Schwartz (2009), ‘The relation of serum parathyroid hormone and serum calcium to serum levels of prostate-specific antigen: a population-based study.’, Cancer Epidemiol Biomarkers Prev, 18 (11), 2869-73. PubMed: 19861512
Townsend, R, et al. (2016), ‘Parathyroid Hormone Secretion Is Controlled by Both Ionized Calcium and Phosphate During Exercise and Recovery in Men.’, J Clin Endocrinol Metab, 101 (8), 3231-39. PubMed: 27294328