COMPLICATIONS BEFORE SURGERY: PRIMARY HYPERPARATHYROIDISM

  • D.N. Păduraru 1General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Cristina Moldovan 3County Clinical Hospital, Cluj-Napoca, Romania
  • Andra Morar 4Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
  • Mara Carsote "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
  • Alexandra Bolocan 1General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • O. Andronic 1General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Alexandra Ene 3County Clinical Hospital, Cluj-Napoca, Romania
  • B. Socea 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 7ClinicalEmergencyHospital “Sf. Pantelimon”, Bucharest, Romania
  • Roxana Turturea 5“C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
  • Ana Valea 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 6“I. Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
Keywords: hyperparathyroidism, hypercalcemia, chronic kidney disease

Abstract

If surgery is not provided in adequate time, nephrolithiasis and nephrocalcinosis, caused by prolonged hypercalciuria, are well-known complications of PHPT (Primary Hyperparathyroidism) and may lead to chronic kidney failure. A 71-year-old female patient with chronic kidney disease KDIGO stage G4 was admitted for diffuse bone and joint pain and high blood pressure. The evaluation of phosphor-calcic metabolism revealed high PTH (Parathyroid Hormone) of 1072.7 pg/mL (normal:12-88 pg/mL), hypercalcemia (ionized calcium of 6.31 mg/dL, normal: 4.4-5.4 mg/dL; total calcium of 11.36 mg/dL, normal:8.8-10.6 mg/dL), increased alkaline phosphatase (of 293 U/L, normal:30-120 U/L) and  25OH D (25OH vitamin D) deficiency of 8.76 ng/mL (normal:30-100 ng/mL). The CT (Computed Tomography) scan of the neck showed two inferior parathyroid adenomas of 1.4 centimeters. Laboratory tests also showed uremia and decreased GFR (glomerular filtration rate) of 21 mL/min/1.73 m2. Parathyroidectomy and vitamin D supplementation were recommended. Parathyroidectomy is indicated in patients with primary hyperparathyroidism and eGFR (estimated glomerular filtration rate) less than 60 mL/min/1.73 m2 because they have an increased risk of morbidity and mortality. After surgery, patients require periodic monitoring of renal function and risk factors.

References

[1] J.P. Bilezikian, L. Bandeira, A. Khan, N.E. Cusano. Hyperparathyroidism. In Lancet, 2018; 391(10116):168–178.
[2] M.D. Walker, T. Nickolas, A. Kepley, J.A. Lee, C. Zhang, D.J. McMahon, S.J. Silverberg. Predictors of Renal Function in Primary Hyperparathyroidism. The Journal of Clinical Endocrinology & Metabolism 2014; 99(5): 1885–1892.
[3] W.D. Fraser. Hyperparathyroidism. In Lancet, 2009; 374: 145-158.
[4] Valea A, Radu O, Morar A, Ghemigian A, Carsote M. Synchronous medullar thyroid cancer and primary hyperparathyroidism on a female within the sixth decade of life with positive family history for type 2A MEN syndrome. Journal of Medical Practice 2016;4(47)-11:346-349.
[5] C. Verdelli, S. Corbetta. Mechanisms in Endocrinology: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects. European Journal of Endocrinology 2017; 176(1): R39–R52.
[6] A. Sharata, T.L. Kelly, Y. Rozenfeld, et al. Management of Primary Hyperparathyroidism: Can We Do Better? The American Surgeon 2017; Jan 1.83 (1):64-70.
[7] A. Baradaran. Primary hyperparathyroidism and kidney; recent findings. Journal of Parathyroid Dissease 2014; 2(1): 7-8.
[8] H. Yamashita, S. Noguchi, S. Uchino, et al. Influence of renal function on clinico-pathological features of primary hyperparathyroidism. European Journal of Endocrinology 2003; 148(6):597–602.
[9] C.D. Hendrickson, D.J. Castro Pereira, R.J. Comi. Renal impairment as a surgical indication in primary hyperparathyroidism: do the data support this recommendation? Journal of Clinical Endocrinology and Metabolism 2014; 99: 2646 –2650.
[10] A. Grey, J. Lucas, A. Horne, G. Gamble, J.S. Davidson, I.R. Reid. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. The Journal of Clinical Endocrinology and Metabolism 2005; Apr, 90 (4):2122-6.
[11] F. Tassone, A. Guarnieri, E. Castellano, C. Baffoni, R. Attanasio, G. Borretta. Parathyroidectomy halts the deterioration of renal function in primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism 2015; 100: 3069-3073.
[12] J.P. Bilezikian, M.L. Brandi, R. Eastell, S.J. Silverberg, R. Udelsman, C. Marcocci, J.T. Potts Jr.. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. The Journal of Clinical Endocrinology and Metabolism 2014; 99(10):3561–3569.
[13] R. Udelsman, G. Åkerström, C. Biagini, Q.Y. Duh, P. Miccoli, B. Niederle, F. Tonelli. The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. The Journal of Clinical Endocrinology and Metabolism 2014; 99(10):3595–3606.
[14] R. Eastell, M.L. Brandi, A.G. Costa, P. D’Amour, D.M. Shoback, R.V. Thakker. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. Journal of Clinical Endocrinology Metabolism 2014; 99: 3570-3579.
[15] C.C. Chow, W.B. Chan, J.K. Li, N.N. Chan, M.H. Chan, G.T. Ko, K.W. Lo, C.S. Cockram. Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism 2003; 88: 581-587.
[16] H. Ejlsmark-Svensson, T. Sikjaer, S.M. Webb, L. Rejnmark, L. Rolighed. Health related quality of life improves one year after parathyroidectomy in primary hyperparathyroidism: A prospective cohort study. Clinical Endocrinology (Oxford). 2018;Sep 29.
[17] Poiană C, Chiriţă C, Carşote M, Hortopan D, Ioachim D, Corneci CM, Stănescu B. Adrenal and pituitary incidentalomas in a case of Cushing's syndrome. Chirurgia (Bucur). 2013 Nov-Dec;108(6):886-91.
[18] Gheorghisan-Galateanu AA, Carsote M, Valea A. Incidentaloma: from general practice to specific endocrine frame.J Pak Med Assoc. 2017 Jun;67(6):917-922.
[19] Carsote M, Paduraru DN, Nica AE, Valea A. Parathyroidectomy: is vitamin D a player for a good outcome? J Med Life. 2016 Oct-Dec;9(4):348-352.
[20] Paduraru DN, Nica A, Carsote M, Valea A. Adrenalectomy for Cushing's syndrome: do's and don'ts.J Med Life. 2016 Oct-Dec;9(4):334-341.
[21] Poiana C, Carsote M, Chirita C, Terzea D, Paun S, Beuran M. Giant adrenal cyst: case study.J Med Life. 2010 Jul-Sep;3(3):308-13.
[22] H.A. Jo , K.H. Han , Y.K. So , H. Jun , S.Y. Han . Effect of Cinacalcet in Kidney Transplant Patients With Hyperparathyroidism. Transplant Proc. 2019 Jun;51(5):1397-1401. doi: 10.1016/j.transproceed.2019.01.141.
[23] P.S. Vetshev , P.L. Yankin , V.A. Zhivotov , E.I. Poddubniy , A.Y. Drozhzhin , V.D. Prokhorov . Risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. Khirurgiia (Mosk). 2019;(4):5-14. doi: 10.17116/hirurgia20190415.
[24] G.A. Block , D.A. Bushinsky , S. Cheng , J. Cunningham, B. Dehmel , T.B. Drueke , M. Ketteler , R. Kewalramani , K.J. Martin , S.M. Moe , U.D. Patel , J. Silver, Y. Sun , H. Wang , G.M. Chertow . Effect of Etelcalcetide vs Cinacalcet on Serum Parathyroid Hormone in Patients Receiving Hemodialysis With Secondary Hyperparathyroidism: A Randomized Clinical Trial. JAMA. 2017 Jan 10;317(2):156-164. doi: 10.1001/jama.2016.19468.
[25] K.E. Eidman , J.B. Wetmore . Treatment of secondary hyperparathyroidism: How do cinacalcet and etelcalcetide differ? Semin Dial. 2018 Sep;31(5):440-444. doi: 10.1111/sdi.12734. Epub 2018 Jul 15.
[26] G.A.E. Mostafa , A.A. Al-Badr . Cinacalcet Hydrochloride. Profiles Drug Subst Excip Relat Methodol. 2017;42:1-90. doi: 10.1016/bs.podrm.2017.02.001. Epub 2017 Apr 3.
Published
2019-12-31
How to Cite
Păduraru, D., Moldovan, C., Morar, A., Carsote, M., Bolocan, A., Andronic, O., Ene, A., Socea, B., Turturea, R., & Valea, A. (2019). COMPLICATIONS BEFORE SURGERY: PRIMARY HYPERPARATHYROIDISM. Romanian Journal of Clinical Research, 2(2). Retrieved from https://rjcronline.com/index.php/rjcr/article/view/36
Section
Articles