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Objectives: Primary hyperparathyroidism (PHPT) is a disorder marked by chronic parathyroid hormone hypersecretion, which affects bone turnover and remodelling processes. With a loss of bone density and an increase in bone porosity, the cortical compartment is most severely impacted. The study's goal is to assess PHPT's effects on the volumetric bone mineral density (vBMD) of the femur's trabecular compartment as well as the vBMD and thickness of the cortical bone. Methods: This is a retrospective case–control study, valuating age, biochemical doses, anthropometric measurements, and bone measurements. Between 2011 and 2016, 74 Caucasian Italian women and men with PHPT were sought out. Biochemical analyses were added to bone mineral density (BMD) values found in the lumbar spine and femoral neck. Proximal femur parameters such as cortical and trabecular volumetric (v) BMD, cortical thickness (CTh) and surface (s) BMD were analyzed by 3D-DXA software (3D-SHAPER Medical, Spain). Results: The findings showed a negative correlation between PHPT patients and controls, which was equally affecting the cortical and trabecular compartments. This correlation was especially evident in the areal BMD (aBMD) and vBMD measurements. Nonetheless, no appreciable correlation was found between the cortical level and the thickness of the cortical bone. Conclusions: Parathormone (PHT) levels had an adverse effect on the cortical, trabecular volumetric density in this investigation, as was expected. Cortical thickness, however, is unaffected significantly. The literature and these findings are consistent. [ABSTRACT FROM AUTHOR]

Secondary hyperparathyroidism (SHPT) can progress to severe SHPT (sSHPT), which affects the survival rate and quality of life of patients. This retrospective cohort study investigated risk factors for sSHPT and the association between SHPT and mortality (all-cause and infection-related) among 771 clinically stable patients (421 male patients; mean age, 51.2 years; median dialysis vintage, 28.3 months) who underwent >3 months of regular peritoneal dialysis (PD) between January 2013 and March 2021. The sSHPT and non-sSHPT groups comprised 75 (9.7%) (median progression, 35 months) and 696 patients, respectively. sSHPT was defined as a serum intact parathyroid hormone (PTH) level >800 pg/mL observed three times after active vitamin D pulse therapy. The influence of sSHPT on the prognosis of and risk factors for sSHPT progression were evaluated using logistic and Cox regression analyses. After adjusting for confounding factors, higher (each 100-pg/mL increase) baseline PTH levels (95% confidence interval (CI) 1.206–1.649, p <.001), longer (each 1-year increase) dialysis vintages (95% CI 1.013–1.060, p =.002), higher concomitant diabetes rates (95% CI 1.375–10.374, p =.010), and lower (each 1-absolute unit decrease) Kt/V values (95% CI 0.859–0.984, p =.015) were independent risk factors for progression to sSHPT in patients on PD. During follow-up, 211 deaths occurred (sSHPT group, n = 35; non-sSHPT group, n = 176). The sSHPT group had significantly higher infection-related mortality rates than the non-sSHPT group (12.0% vs. 4.3%; p <.05), and sSHPT was associated with increased infection-related mortality. In conclusion, patients with sSHPT are at higher risk for death and infection-related mortality than patients without sSHPT. [ABSTRACT FROM AUTHOR]

Tertiary hyperparathyroidism is a complication of kidney transplantation. This complicated condition carries over from the dialysis period and varies according to the function of the transplanted allograft. Treatments include pharmacotherapy (mainly using calcimimetics) and parathyroidectomy, but calcimimetics are currently not covered by the national insurance system in Japan. Two types of parathyroidectomy can be performed: subtotal parathyroidectomy; and total parathyroidectomy with partial autograft. Both types can be expected to improve hypercalcemia. Concerns about the postoperative deterioration of allograft function are influenced by preoperative allograft function, which is even more likely to be affected by early surgery after kidney transplantation. In general, transient deterioration of allograft function after surgery is not expected to affect graft survival rate in the medium to long term. Tertiary hyperparathyroidism in kidney transplant recipients negatively impacts allograft and patient survival rates, and parathyroidectomy can be expected to improve prognosis in both kidney recipients and dialysis patients. However, studies offering high levels of evidence remain lacking. [ABSTRACT FROM AUTHOR]

Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [18F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [99mTc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy. A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures. The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy. FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease. [ABSTRACT FROM AUTHOR]

Context Contemporary patients with primary hyperparathyroidism are diagnosed with milder disease than previously. Clinical and biochemical factors predictors with an impact on fracture incidence and bone mineral density after surgery have not been firmly established. Objective To investigate predictors of fracture incidence and bone mineral density preoperatively and after surgery for primary hyperparathyroidism (pHPT). Design Prospectively collected surgical cohort with matched population controls. Data were cross-linked with the Swedish National Patient Register, the Prescribed Drug Register, and the Cause of Death Register. Setting Tertiary referral center. Patients or other participants Seven hundred nine patients with successful parathyroidectomy for pHPT and 2112 controls matched on sex, age, and municipality were included in the study. Main outcome measures Fracture incidence, absolute change, and ≥2.77% increase in bone mineral density of femoral neck, L2–L4, and distal third of radius at 1-year follow-up. Results Patients with pHPT had an increased fracture incidence before surgery but not after pHPT surgery. Fracture incidence after surgery was inversely related to preoperative 24-hour urine calcium (incidence rate ratio for the highest tertile 220– mg/d 0.29, 95% confidence interval 0.11-0.73). Serum and 24-hour urine calcium, parathyroid hormone, osteocalcin, and adenoma weight were all associated with bone mineral density recovery after surgery. Conclusion Twenty-four-hour urine calcium is the most important biochemical variable to predict a decreased fracture incidence and improved bone mineral density after surgery for pHPT. [ABSTRACT FROM AUTHOR]

Purposes: Evaluate the changes in quality of life (QoL) in patients affected by tertiary hyperparathyroidism (THPT) after surgical treatment using the Parathyroidectomy Assessment of Symptoms (PAS) and Short Form-36 (SF-36) questionnaires. Methods: Single centre longitudinal retrospective, single-institution analysis of 34 patients with THPT and submitted to parathyroidectomy between 2015 and 2021. The PAS and SF-36 questionnaires were administered before surgery and 24 months after discharge. Results: A significative QoL amelioration was registered in physical SF-36 (42.4 ± 11.7 vs 56.7 ± 9.2; P < 0.001), mental SF-36 (47.3 ± 12.1 vs 61.8 ± 7.9; P < 0.001) and PAS score (582 ± 163 vs 293 ± 141; P < 0.001) with a significative improvement of all the 13 symptoms considered. We found that pre-operative intact parathormone (iPTH) levels, preoperative T-score and time of haemodialysis before RTX were predictors of both PAS and SF-36 mental score modifications. A positive correlation was also fund between pre-operative PAS values and their post operative cutback. Conclusions: Parathyroidectomy for THPT brings to a concrete amelioration of all the disease-related and nonspecific symptoms with significative improvement of QoL. To develop a tailored approach of every patient's needs, from diagnosis to future treatment, we suggest to introduce the symptoms assessment scale as standard stage in periodic evaluations. [ABSTRACT FROM AUTHOR]

Purpose: This study compares the efficacy of two different ranges of parathyroid transplantation weights with the aim of determining a preferable range for transplantation weight. Methods: From May 2018 to June 2023, 79 patients underwent total parathyroidectomy with autotransplantation. Demographic data, symptoms, and pre- or postoperative biochemical indicators were compared between two different ranges of parathyroid transplantation weights. Results: All 79 surgeries were successful, with a total of 316 parathyroid glands reported among the patients. The patients were diagnosed with parathyroid hyperplasia. Postoperatively, itching, bone pain, and muscle weakness disappeared, while serum parathyroid hormone and phosphate levels significantly decreased. With an average follow-up of 12 months, no transplant-dependent recurrence was observed. Conclusion: Parathyroid transplantation with a weight of 30–50 mg is a feasible, safe, and effective surgical approach. [ABSTRACT FROM AUTHOR]

Background: Parathyroid cysts account for a small percentage of parathyroid lesions and are more prevalent in females. Cystic parathyroid hyperplasia is exceptionally rare, with only two cases reported thus far. This case report provides the readers with the first multimodality imaging in cystic parathyroid hyperplasia as well as the authors' first experience in using a 4D computed tomography (CT) scan in our institution while the systematic review will comprehensively search and present similar cases. Main text: The literature search started and ended on August 4, 2024. We searched five academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. The studied population was all patients with cystic parathyroid gland hyperplasia, confirmed by histopathology. A total of 205 articles were initially identified, out of which 29 duplicates were promptly eliminated, leaving 176 unique articles for screening. Following the evaluation of titles and abstracts, ultimately only two studies were included in the systematic review. A 61-year-old male presented with recurrent abdominal pain and weight loss. Ultrasound revealed a left neck mass, cystic. The laryngeal CT scan agreed with the ultrasound while the Technetium-99 sestamibi scan suggested a thyroid lesion. A 4D CT scan confirmed a lobulated cystic lesion in the left parathyroid region. The patient underwent successful surgery, and histopathology confirmed parathyroid hyperplasia with a pseudocyst appearance. Conclusions: This case report presents the first imaging multimodality in cystic parathyroid hyperplasia while highlighting the rarity of this case, with two cases worldwide. In addition, this article describes our institution's first experience with a 4D CT scan. [ABSTRACT FROM AUTHOR]