Search

Background: It is unclear whether parathyroidectomy guided by intraoperative parathormone (PTH) monitoring is predictive of operative success in patients with normohormonal hyperparathyroidism (nhHPT), a variant of primary hyperparathyroidism (pHPT) in which patients develop clinical manifestations similar to those of pHPT. This study examined intraoperative PTH monitoring in patients undergoing parathyroidectomy for nhHPT. Methods: We performed a retrospective review of prospectively collected data from adult (age > 18 yr) patients who underwent parathyroidectomy for pHPT at 1 of 2 North American medical centres (in Calgary, Alberta, Canada, or Miami, Florida, United States) between 2007 and 2015. In patients with nhHPT, we used the criterion of an intraoperative decrease of more than 50% in PTH after abnormal gland excision. We defined operative success as continuous eucalcemia more than 6 months after parathyroidectomy. Results: Of 333 patients, 38 (11.4%) had nhHPT, with mean preoperative calcium and PTH levels of 2.7 mmol/L and 53 pg/dL, respectively. An intraoperative decrease of more than 50% in PTH level was seen in 27 patients (71.0%) with nhHPT and 265 patients (89.8%) with classic pHPT at 5 minutes (p < 0.001); the corresponding values at 20 minutes were 35 (92.1%) and 286 (96.9%). Although 5 patients (13.2%) with nhHPT did not reach this criterion until 20 minutes, the rate of operative success was still 97.0% at long-term follow-up (mean 13 mo, range 6-67 mo). Of the 38 patients, 3 (7.9%) did not have an intraoperative decrease of more than 50% in PTH level by 20 minutes. Two of the 3 achieved operative success and remained normocalemic, and 1 developed recurrent disease at 12 months. Conclusion: Parathyroidectomy guided by intraoperative PTH monitoring accurately predicted operative success in patients with nhHPT. Intraoperative PTH monitoring may also help identify multiglandular disease in patients with nhHPT, using criteria similar to those in classic pHPT, with comparable operative success. Contexte : On ne sait pas si la parathyroidectomie guidee par la surveillance peroperatoire de la parathormone (PTH) permet de predire le succes operatoire chez les patients atteints d'hyperparathyroidie normo-hormonale (nhHPT), une variante de l'hyperparathyroidie primaire (pHPT) qui entraine chez les patients des manifestations cliniques similaires a celles de la pHPT. Cette etude a exa mine la surveillance peroperatoire de la PTH chez des patients subissant une parathyroidectomie pour une nhHPT. Methodes : Nous avons effectue une revue retrospective des donnees recueillies prospectivement aupres de patients adultes (> 18 ans) ayant subi une parathyroidectomie pour une pHPT a l'un ou l'autre de 2 centres medicaux nord-americains (a Calgary, en Alberta, au Canada, et a Miami, en Floride, aux Etats-Unis) entre 2007 et 2015. Chez les patients atteints de nhHPT, nous avons utilise le critere d'une diminution peroperatoire de plus de 50 % de la PTH apres l'ablation de la glande anormale. Le critere de succes operatoire consistait en une eucalcemie continue plus de 6 mois apres la parathyroidectomie. Resultats : Sur 333 patients, 38 (11,4 %) avaient une nhHPT, avec des taux moyens de calcium et de PTH preoperatoires de 2,7 mmol/L et 53 pg/dL, respectivement. Une diminution peroperatoire de plus de 50 % du niveau de PTH a ete observee chez 27 patients (71,0 %) avec nhHPT et 265 patients (89.8 %) avec pHPT classique a 5 minutes (p < 0,001); les valeurs correspondantes a 20 minutes etaient 35 (92,1 %) et 286 (96,9 %). Bien que 5 patients (13,2 %) avec nhHPT n'aient pas atteint ce critere avant 20 minutes, le taux de succes operatoire etait encore de 97,0 % lors du suivi a long terme (moyenne 13 mois, intervalle 6-67 mois). Sur les 38 patients, 3 (7,9 %) n'ont pas eu de diminution peroperatoire de plus de 50 % du taux de PTH avant 20 minutes. Pour 2 de ces 3 patients, l'operation a reussi; ils sont demeures normocalcemiques. L'autre patient a developpe une maladie recurrente a 12 mois. Conclusion : La parathyroidectomie guidee par la surveillance peroperatoire de la PTH a permis de predire avec precision le succes operatoire chez les patients atteints de nhHPT. La surveillance peroperatoire de la PTH peut egalement aider a detecter une maladie multiglandulaire chez les patients atteints de nhHPT, par l'utilisation de criteres similaires a ceux de la pHPT classique, avec succes operatoire comparable., Primary hyperparathyroidism (pHPT) affects about 50 per 100 000 people annually, and its clinical manifestations have adverse effects on bone, kidney and cognitive function. (1), (2) With the advent of [...]

Purpose of the study: Besides its known effects on bone metabolism, vitamin D may regulate immune function. We performed a randomized controlled trial (RCT) to test whether cholecalciferol supplementation can improve vitamin D status and modulate immune responses in HIV‐infected children and youth. Methods: Caucasian vertically HIV‐infected patients (aged 8 to 26 years) with vitamin D deficiency and normal parathormone (PTH) levels were randomized into an experimental (n=25) and control (n=25) group to receive 100,000 IU of oral cholecalciferol every 3 months for a total of 4 doses, or placebo. A pre‐randomization period (−3 months) was also taken into account to better model within‐individual variability. Mixed linear regression models were used to evaluate the between‐group changes in the outcomes of interest. The analysis was intention to treat. Summary of results: 47 subjects completed the RCT. Cholecalciferol supplementation produced an early decrease in PTH levels (3 months) and a later concomitant increase in 25(OH)D and 1,25(OH)2D levels (6 months), both persisting up to 12 months. The supplementation had no effect on CD4+T‐cell numbers or percentage while was associated with a decreased loge Th1, an increased loge Th2 (*p Conclusions: In our cohort, supplementation with oral cholecalciferol was effective in increasing serum 25(OH)D and 1–25(OH)[sub.2]D while decreasing serum PTH levels, had no effect on CD4+T‐cell count, but was associated with T‐cell phenotype changes mainly favoring Tregulatory subset., Reference Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009;94:26–34. DOI: [...]