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Metabolic abnormalities related to cardiovascular risk in primary hyperparathyroidism : effects of surgical treatment

OBJECTIVES: Untreated primary hyperarathyroidism (pHPT) is accompanied by an excessive morbidity in circulatory disorders, associated with blood pressure and diabetes. The aim of the present study was to further penetrate the impact of pHPT on glucose, urate, lipid and lipoprotein concentrations, known to be interrelated metabolic cardiovascular risk factors.DESIGN: Longitudinal study of patients

Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery

BACKGROUND: The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.METHODS: Intraoperative levels of

Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease

OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption.DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment.SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital.SUBJECTS: Forty cons

Parathyroid function and histology in patients with parathyroid adenoma : correlation of clinical and morphologic findings

Serum levels of parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, creatinine, and vitamin D and the glomerular filtration rate were compared with the histologic properties and expression of PTH and chromogranin A in excised parathyroid adenomas from patients with primary hyperparathyroidism (pHPT). PTH and chromogranin A were detected immunohistochemically, and their mRNA was demonst

Sestamibi versus thallium subtraction scintigraphy in parathyroid localization : a prospective comparative study in patients with predominantly mild primary hyperparathyroidism

BACKGROUND: Technetium 99m sestamibi was recently introduced for the preoperative localization of abnormal parathyroid glands in patients with primary hyperparathyroidism with promising results. However, the sensitivity of sestamibi and thallium to detect abnormal parathyroid glands is partly dependent on the gland size. In this study we compared the sensitivity of sestamibi subtraction scintigrap

Intraoperative secretion of intact parathyroid hormone and amino-terminal parathyroid hormone fragments from normal parathyroid glands associated with solitary parathyroid adenoma

The nonadenomatous parathyroid glands associated with parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) are assumed to exhibit suppressed secretion of parathyroid hormone (PTH). Because the function of these glands is of clinical importance for calcium homeostasis after surgery for pHPT, we studied the decrease of serum levels associated with intact PTH (i-PTH) and amino-term

Nitric Oxide Synthase in Human Parathyroid Glands and Parathyroid Adenomas

Nitric oxide (NO) is a novel gaseous intercellular transmitter thought to play important physiological roles in the regulation of blood flow and hormone secretion in, for example, the pituitary, the thyroid, and the endocrine pancreas. Whether nitric oxide synthase (NOS) is present in the human parathyroid glands has not yet been demonstrated. In the present study, histologically normal, but funct

Persistent elevated serum levels of intact parathyroid hormone after operation for sporadic parathyroid adenoma : evidence of detrimental effects of severe parathyroid disease

BACKGROUND: A significant number of patients with primary hyperparathyroidism (pHPT) who are surgically treated have increased serum levels of intact parathyroid hormone (PTH) during long-term follow-up despite normocalcemia. The cause and significance of this finding remain to be established.METHODS: A total of 82 patients operated on for sporadic parathyroid adenoma were investigated before and

Side localization of parathyroid adenomas by simplified intraoperative venous sampling for parathyroid hormone

Side localization of parathyroid adenomas was performed by venous sampling for intact parathyroid hormone (PTH) in 20 consecutive patients with primary hyperparathyroidism (pHPT) after induction of anesthesia. The results were thus available during surgery. Nineteen of the patients had solitary parathyroid adenoma, and one had hyperplasia. There was no complication to the procedure. A lateralizing

Increased plasma levels of islet amyloid polypeptide in patients with primary hyperparathyroidism

Amylin, also named islet amyloid polypeptide (IAPP), is a protein that is processed and released from pancreatic beta-cells in parallel with insulin. Islet amyloid polypeptide is currently studied with regard to a role for insulin resistance in non-insulin-dependent diabetes. To elucidate a possible function of IAPP for impaired glucose tolerance in primary hyperparathyroidism (pHPT), we studied p

Peptide-containing nerve fibres in normal human parathyroid glands and in human parathyroid adenomas

There are only a few studies on the innervation of the human parathyroid glands and the content of neurotransmitters. We therefore studied the occurrence and distribution of peptide-containing and adrenergic nerve fibres and the coexistence pattern of neuromessengers by immunocytochemistry in normal (unaffected) and adenomatous parathyroid glands from patients undergoing surgery for parathyroid ad

Immunoheterogeneity of parathyroid hormone pre- and postoperatively in primary hyperparathyroidism

In primary hyperparathyroidism (pHPT), a preferential release of intact PTH (i-PTH) versus carboxylterminal PTH fragments is known to occur. We studied whether the release of amino-terminal PTH fragments (N-PTH) is also changed. Serum levels of i-PTH and N-PTH were determined under basal conditions and following oral intake of calcium in six patients with pHPT before and immediately after surgery

Effects of minor increase in serum calcium on the immunoheterogeneity of parathyroid hormone in healthy subjects and in patients with primary hyperparathyroidism

To study possible influences of a mild increase in serum-ionized calcium concentration that is seen during daily life on circulating parathyroid hormone (PTH) immunoheterogeneity, we used sequence-specific PTH assays to determine serum intact PTH, C-terminal PTH and N-terminal PTH following oral calcium (1.5 g) in healthy subjects (n = 7). This was also performed in patients with primary hyperpara

Immunoheterogeneity of parathyroid hormone after surgery for primary hyperparathyroidism

Circulating parathyroid hormone (PTH) immunoheterogeneity is altered in primary hyperparathyroidism (pHPT). It is not known, however, whether the relative secretion of various PTH fragments differs between the adenomatous and the non-adenomatous glands in pHPT. We therefore examined the immunoheterogeneity of PTH in patients operated upon because of parathyroid adenoma pre- and 4 days postoperativ

Functional recovery of the parathyroid glands after surgery for primary hyperparathyroidism

BACKGROUND: The immediate postoperative function of the parathyroid glands after surgery for primary hyperparathyroidism (pHPT) has not been established. We therefore examined the influences of hypercalcemia and hypocalcemia on serum parathyroid hormone (PTH) levels in the immediate postoperative period in patients with pHPT.METHODS: Ethylenediaminetetraacetic acid was infused in patients on the f

Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism

The intraoperative differential diagnosis between adenoma and hyperplasia during surgery for primary hyperparathyroidism (pHPT) is sometimes difficult. Several methods have been proposed to aid the surgeon in deciding on the amount of parathyroid tissue to be resected. We examined the use of intraoperative monitoring of intact PTH in 47 patients operated upon for pHPT. The highly sensitive assay f

Serum levels of thyrotropin are decreased by oral calcium in healthy subjects but not in patients with primary hyperparathyroidism

It has been suggested that calcium changes the set point of the pituitary thyroid feedback. It is not known, however, if small and slow changes of calcium and/or parathyroid hormone (PTH) within the physiological range influence the serum levels of thyrotropin (TSH) and thyroid hormones in healthy subjects or patients with primary hyperparathyroidism (pHPT). Nine healthy subjects and nine patients

Hyperthyroxinemia after surgery for primary hyperparathyroidism

Episodes of transient thyrotoxicosis after surgery for primary hyperparathyroidism have previously been described, and surgical trauma to the thyroid gland has been suggested as an etiologic factor. However, there are several links between the thyroid and parathyroid hormonal systems, and therefore other explanations are possible as well. In this study we investigate pre- and postoperative serum l