Top

Journal of Endocrinological Investigation

Published in:

01-05-2015 | Consensus Statement

Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism

Authors: C. Marcocci, M. L. Brandi, A. Scillitani, S. Corbetta, A. Faggiano, L. Gianotti, S. Migliaccio, S. Minisola

Published in: Journal of Endocrinological Investigation | Issue 5/2015

Excerpt

Over the last 50 years, the spectrum of clinical presentation of primary hyperparathyroidism (PHPT) has shifted from a symptomatic disorder, characterized by symptoms of hypercalcemia, nephrolithiasis, and overt bone disease, toward a less symptomatic or asymptomatic disorder [1]. The recognition of the asymptomatic variant of PHPT has markedly increased following the inclusion of serum calcium measurement in the multichannel biochemical screening. …

Stone risk profile can be evaluated as indicated by Marangella et al. [46] using an electronic algorithm or may also be obtained by commercial laboratories.

Marcocci C, Cetani F (2011) Clinical practice. Primary hyperparathyroidism. N Engl J Med 365(25):2389–2397. doi:10.1056/NEJMcp1106636 CrossRefPubMed

Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99(10):3561–3569. doi:10.1210/jc.2014-1413 CrossRefPubMed

Swiglo BA, Murad MH, Schunemann HJ, Kunz R, Vigersky RA, Guyatt GH, Montori VM (2008) A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab 93(3):666–673. doi:10.1210/jc.2007-1907 CrossRefPubMed

Dalemo S, Eggertsen R, Hjerpe P, Jansson S, Almqvist EG, Bengtsson Bostrom K (2013) Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care. Scand J Prim Health Care 31(4):248–254. doi:10.3109/02813432.2013.861152 CrossRefPubMedCentralPubMed

Bollerslev J, Rolighed L, Mosekilde L (2011) Mild primary hyperparathyroidism and metabolism of vitamin D. IBMS BoneKEy 8:342–351CrossRef

Grieff M, Bushinsky DA (2011) Diuretics and disorders of calcium homeostasis. Semin Nephrol 31(6):535–541. doi:10.1016/j.semnephrol.2011.09.008 CrossRefPubMed

Lumachi F, Cappelletti P, Tozzoli R, Basso SM, Luisetto G, Camozzi V (2012) Diagnosis of alterations of serum calcium metabolism. Med Chem 8(4):551–555CrossRefPubMed

Wermers RA, Kearns AE, Jenkins GD, Melton LJ 3rd (2007) Incidence and clinical spectrum of thiazide-associated hypercalcemia. Am J Med 120 (10):911 e919–915. doi:10.1016/j.amjmed.2006.07.044

McHenry CR, Lee K (1996) Lithium therapy and disorders of the parathyroid glands. Endocr Pract 2(2):103–109. doi:10.4158/EP.2.2.103 CrossRefPubMed

10.

Haden ST, Stoll AL, McCormick S, Scott J, Ge-H Fuleihan (1997) Alterations in parathyroid dynamics in lithium-treated subjects. J Clin Endocrinol Metab 82(9):2844–2848. doi:10.1210/jcem.82.9.4218 PubMed

11.

Lally J, Lee B, McDonald C (2013) Prevalence of hypercalcaemia in patients on maintenance lithium therapy monitored in primary care. Ir Med J 106(1):15–17PubMed

12.

Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Brixen K, Mosekilde L (2008) Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism: a follow-up study on methods. Clin Endocrinol (Oxf) 69(5):713–720. doi:10.1111/j.1365-2265.2008.03259.x CrossRef

13.

Mackenzie-Feder J, Tsang J, Demyttenaere S (2012) Unsuspected pheochromocytoma: is it time for a registry? Can J Anaesth 59(1):112–113. doi:10.1007/s12630-011-9601-8 CrossRefPubMed

14.

Ong GS, Walsh JP, Stuckey BG, Brown SJ, Rossi E, Ng JL, Nguyen HH, Kent GN, Lim EM (2012) The importance of measuring ionized calcium in characterizing calcium status and diagnosing primary hyperparathyroidism. J Clin Endocrinol Metab 97(9):3138–3145. doi:10.1210/jc.2012-1429 CrossRefPubMed

15.

Tassone F, Gianotti L, Baffoni C, Visconti G, Pellegrino M, Cassibba S, Croce CG, Magro G, Cesario F, Attanasio R, Borretta G (2013) Vitamin D status in primary hyperparathyroidism: a Southern European perspective. Clin Endocrinol (Oxf) 79(6):784–790. doi:10.1111/cen.12210 CrossRef

16.

Carnevale V, Nieddu L, Romagnoli E, Battista C, Mascia ML, Chiodini I, Eller-Vainicher C, Frusciante V, Santini SA, La Porta M, Minisola S, Scillitani A (2010) Regulation of PTH secretion by 25-hydroxyvitamin D and ionized calcium depends on vitamin D status: a study in a large cohort of healthy subjects. Bone 47(3):626–630. doi:10.1016/j.bone.2010.06.013 CrossRefPubMed

17.

Bollerslev J, Marcocci C, Sosa M, Nordenstrom J, Bouillon R, Mosekilde L (2011) Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism. Eur J Endocrinol 165(6):851–864. doi:10.1530/EJE-11-0589 CrossRefPubMed

18.

Silverberg SJ, Brown I, Bilezikian JP (2002) Age as a criterion for surgery in primary hyperparathyroidism. Am J Med 113(8):681–684CrossRefPubMed

19.

Egan AM, Ryan J, Aziz MA, O’Dwyer TP, Byrne MM (2013) Primary hyperparathyroidism in a patient with familial hypocalciuric hypercalcaemia due to a novel mutation in the calcium-sensing receptor gene. J Bone Miner Metab 31(4):477–480. doi:10.1007/s00774-012-0399-4 CrossRefPubMed

20.

Jayasena CN, Mahmud M, Palazzo F, Donaldson M, Meeran K, Dhillo WS (2011) Utility of the urine calcium-to-creatinine ratio to diagnose primary hyperparathyroidism in asymptomatic hypercalcaemic patients with vitamin D deficiency. Ann Clin Biochem 48(Pt 2):126–129. doi:10.1258/acb.2010.010202 CrossRefPubMed

21.

Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Rejnmark L, Brixen K, Mosekilde L (2008) Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism. Eur J Endocrinol 159(6):719–727. doi:10.1530/EJE-08-0440 CrossRefPubMed

22.

Isaksen T, Nielsen CS, Christensen SE, Nissen PH, Heickendorff L, Mosekilde L (2011) Forearm bone mineral density in familial hypocalciuric hypercalcemia and primary hyperparathyroidism: a comparative study. Calcif Tissue Int 89(4):285–294. doi:10.1007/s00223-011-9517-x CrossRefPubMed

23.

Zini M, Attanasio R, Cesareo R, Emmolo I, Frasoldati A, Gianotti L, Guglielmi R, Piovesan A, Procopio M, Scillitani A, Versari A, Bollerslev J, Rao DS, Marcocci C, Borretta G, Italian Association of Clinical E (2012) AME position statement: primary hyperparathyroidism in clinical practice. J Endocrinol Invest 35(7 Suppl):2–21PubMed

24.

Shinall MC Jr, Dahir KM, Broome JT (2013) Differentiating familial hypocalciuric hypercalcemia from primary hyperparathyroidism. Endocr Pract 19(4):697–702. doi:10.4158/EP12284.RA CrossRefPubMed

25.

Pollak MR, Brown EM, Chou YH, Hebert SC, Marx SJ, Steinmann B, Levi T, Seidman CE, Seidman JG (1993) Mutations in the human Ca(2+)-sensing receptor gene cause familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Cell 75(7):1297–1303CrossRefPubMed

26.

Nesbit MA, Hannan FM, Howles SA, Babinsky VN, Head RA, Cranston T, Rust N, Hobbs MR, Heath H 3rd, Thakker RV (2013) Mutations affecting G-protein subunit alpha11 in hypercalcemia and hypocalcemia. N Engl J Med 368(26):2476–2486. doi:10.1056/NEJMoa1300253 CrossRefPubMedCentralPubMed

27.

Nesbit MA, Hannan FM, Howles SA, Reed AA, Cranston T, Thakker CE, Gregory L, Rimmer AJ, Rust N, Graham U, Morrison PJ, Hunter SJ, Whyte MP, McVean G, Buck D, Thakker RV (2013) Mutations in AP2S1 cause familial hypocalciuric hypercalcemia type 3. Nat Genet 45(1):93–97. doi:10.1038/ng.2492 CrossRefPubMedCentralPubMed

28.

Eller-Vainicher C, Chiodini I, Battista C, Viti R, Mascia ML, Massironi S, Peracchi M, D’Agruma L, Minisola S, Corbetta S, Cole DE, Spada A, Scillitani A (2009) Sporadic and MEN1-related primary hyperparathyroidism: differences in clinical expression and severity. J Bone Miner Res 24(8):1404–1410. doi:10.1359/jbmr.090304 CrossRefPubMed

29.

Georgitsi M, Raitila A, Karhu A, van der Luijt RB, Aalfs CM, Sane T, Vierimaa O, Makinen MJ, Tuppurainen K, Paschke R, Gimm O, Koch CA, Gundogdu S, Lucassen A, Tischkowitz M, Izatt L, Aylwin S, Bano G, Hodgson S, De Menis E, Launonen V, Vahteristo P, Aaltonen LA (2007) Germline CDKN1B/p27Kip1 mutation in multiple endocrine neoplasia. J Clin Endocrinol Metab 92(8):3321–3325. doi:10.1210/jc.2006-2843 CrossRefPubMed

30.

Malanga D, De Gisi S, Riccardi M, Scrima M, De Marco C, Robledo M, Viglietto G (2012) Functional characterization of a rare germline mutation in the gene encoding the cyclin-dependent kinase inhibitor p27Kip1 (CDKN1B) in a Spanish patient with multiple endocrine neoplasia-like phenotype. Eur J Endocrinol 166(3):551–560. doi:10.1530/EJE-11-0929 CrossRefPubMed

31.

Pardi E, Mariotti S, Pellegata NS, Benfini K, Borsari S, Saponaro F, Torregrossa L, Cappai A, Satta C, Mastinu M, Marcocci C, Cetani F (2014) Functional characterization of a CDKN1B mutation in a Sardinian kindred with multiple endocrine neoplasia type 4 (MEN4). Endocr Connect 2015(4):1–8. doi:10.1530/EC-14-0116 CrossRef

32.

Alevizaki M (2013) Management of hyperparathyrodism (PHP) in MEN2 syndrome in Europe. Thyroid Res 6(Suppl1):S1–S10. doi:10.1186/1756-6614-6-S1-S10

33.

Masi G, Barzon L, Iacobone M, Viel G, Porzionato A, Macchi V, De Caro R, Favia G, Palu G (2008) Clinical, genetic, and histopathologic investigation of CDC73-related familial hyperparathyroidism. Endocr Relat Cancer 15(4):1115–1126. doi:10.1677/ERC-08-0066 CrossRefPubMed

34.

Frank-Raue K, Leidig-Bruckner G, Haag C, Schulze E, Lorenz A, Schmitz-Winnenthal H, Raue F (2011) Inactivating calcium-sensing receptor mutations in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 75(1):50–55. doi:10.1111/j.1365-2265.2011.04059.x CrossRef

35.

Newey PJ, Bowl MR, Cranston T, Thakker RV (2010) Cell division cycle protein 73 homolog (CDC73) mutations in the hyperparathyroidism–jaw tumor syndrome (HPT–JT) and parathyroid tumors. Hum Mutat 31(3):295–307. doi:10.1002/humu.21188 CrossRefPubMed

36.

Cetani F, Pardi E, Ambrogini E, Lemmi M, Borsari S, Cianferotti L, Vignali E, Viacava P, Berti P, Mariotti S, Pinchera A, Marcocci C (2006) Genetic analyses in familial isolated hyperparathyroidism: implication for clinical assessment and surgical management. Clin Endocrinol (Oxf) 64(2):146–152. doi:10.1111/j.1365-2265.2006.02438.x CrossRef

37.

Mizusawa N, Uchino S, Iwata T, Tsuyuguchi M, Suzuki Y, Mizukoshi T, Yamashita Y, Sakurai A, Suzuki S, Beniko M, Tahara H, Fujisawa M, Kamata N, Fujisawa K, Yashiro T, Nagao D, Golam HM, Sano T, Noguchi S, Yoshimoto K (2006) Genetic analyses in patients with familial isolated hyperparathyroidism and hyperparathyroidism-jaw tumour syndrome. Clin Endocrinol (Oxf) 65(1):9–16. doi:10.1111/j.1365-2265.2006.02534.x CrossRef

38.

Starker LF, Akerstrom T, Long WD, Delgado-Verdugo A, Donovan P, Udelsman R, Lifton RP, Carling T (2012) Frequent germ-line mutations of the MEN1, CASR, and HRPT2/CDC73 genes in young patients with clinically non-familial primary hyperparathyroidism. Horm Cancer 3(1–2):44–51. doi:10.1007/s12672-011-0100-8 CrossRefPubMed

39.

Vignali E, Viccica G, Diacinti D, Cetani F, Cianferotti L, Ambrogini E, Banti C, Del Fiacco R, Bilezikian JP, Pinchera A, Marcocci C (2009) Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 94(7):2306–2312. doi:10.1210/jc.2008-2006 CrossRefPubMedCentralPubMed

40.

Eastell R, Arnold A, Brandi ML, Brown EM, D’Amour P, Hanley DA, Rao DS, Rubin MR, Goltzman D, Silverberg SJ, Marx SJ, Peacock M, Mosekilde L, Bouillon R, Lewiecki EM (2009) Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94(2):340–350. doi:10.1210/jc.2008-1758 CrossRefPubMed

41.

Rolighed L, Rejnmark L, Sikjaer T, Heickendorff L, Vestergaard P, Mosekilde L, Christiansen P (2014) Vitamin D treatment in primary hyperparathyroidism: a randomized placebo controlled trial. J Clin Endocrinol Metab 99(3):1072–1080. doi:10.1210/jc.2013-3978 PubMed

42.

Shah VN, Shah CS, Bhadada SK, Rao DS (2014) Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: a meta-analysis and review of literature. Clin Endocrinol (Oxf) 80(6):797–803. doi:10.1111/cen.12398 CrossRef

43.

Corbetta S, Baccarelli A, Aroldi A, Vicentini L, Fogazzi GB, Eller-Vainicher C, Ponticelli C, Beck-Peccoz P, Spada A (2005) Risk factors associated to kidney stones in primary hyperparathyroidism. J Endocrinol Invest 28(2):122–128CrossRefPubMed

44.

Gutteridge DH, Gruber HE, Kermode DG, Worth GK (1999) Thirty cases of concurrent Paget’s disease and primary hyperparathyroidism: sex distribution, histomorphometry, and prediction of the skeletal response to parathyroidectomy. Calcif Tissue Int 65(6):427–435CrossRefPubMed

45.

Tassone F, Gianotti L, Emmolo I, Ghio M, Borretta G (2009) Glomerular filtration rate and parathyroid hormone secretion in primary hyperparathyroidism. J Clin Endocrinol Metab 94(11):4458–4461. doi:10.1210/jc.2009-0587 CrossRefPubMed

46.

Marangella M, Petrarulo M, Daniele PG, Sammartano S (2002) LithoRisk: a software for calculating and visualising nephrolithiasis risk profiles. G Ital Nefrol 19(6):693–698PubMed

47.

Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, Dempster D, Lewiecki EM, Jian-Min L, Minisola S, Rejnmark L, Silva BC, Walker MD, Bilezikian JP (2014) Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99(10):3580–3594. doi:10.1210/jc.2014-1415 CrossRefPubMed

48.

Lewiecki EM, Laster AJ (2006) Clinical review: clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 91(11):4215–4222. doi:10.1210/jc.2006-1178 CrossRefPubMed

49.

Gianotti L, Tassone F, Cesario F, Pia A, Razzore P, Magro G, Piovesan A, Borretta G (2006) A slight decrease in renal function further impairs bone mineral density in primary hyperparathyroidism. J Clin Endocrinol Metab 91(8):3011–3016. doi:10.1210/jc.2006-0070 CrossRefPubMed

50.

Walker MD, Dempster DW, McMahon DJ, Udesky J, Shane E, Bilezikian JP, Silverberg SJ (2012) Effect of renal function on skeletal health in primary hyperparathyroidism. J Clin Endocrinol Metab 97(5):1501–1507. doi:10.1210/jc.2011-3072 CrossRefPubMedCentralPubMed

51.

Eller-Vainicher C, Battista C, Guarnieri V, Muscarella S, Palmieri S, Salcuni AS, Guglielmi G, Corbetta S, Minisola S, Spada A, Hendy GN, Cole DE, Chiodini I, Scillitani A (2014) Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism. Eur J Endocrinol 171(3):399–406. doi:10.1530/EJE-14-0343 CrossRefPubMed

52.

Romagnoli E, Cipriani C, Nofroni I, Castro C, Angelozzi M, Scarpiello A, Pepe J, Diacinti D, Piemonte S, Carnevale V, Minisola S (2013) “Trabecular Bone Score” (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 53(1):154–159. doi:10.1016/j.bone.2012.11.041 CrossRefPubMed

53.

Walker MD, Rubin M, Silverberg SJ (2013) Nontraditional manifestations of primary hyperparathyroidism. J Clin Densitom 16(1):40–47. doi:10.1016/j.jocd.2012.11.008 CrossRefPubMedCentralPubMed

54.

Yu N, Donnan PT, Flynn RW, Murphy MJ, Smith D, Rudman A, Leese GP (2010) Increased mortality and morbidity in mild primary hyperparathyroid patients. The Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf) 73(1):30–34. doi:10.1111/j.1365-2265.2009.03766.x

55.

Bollerslev J, Rosen T, Mollerup CL, Nordenstrom J, Baranowski M, Franco C, Pernow Y, Isaksen GA, Godang K, Ueland T, Jansson S, Group SS (2009) Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. J Clin Endocrinol Metab 94(7):2255–2261. doi:10.1210/jc.2008-2742 CrossRefPubMed

56.

Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T (2007) Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab 92(5):1687–1692. doi:10.1210/jc.2006-1836 CrossRefPubMed

57.

Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89(11):5415–5422. doi:10.1210/jc.2004-0028 CrossRefPubMed

58.

Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92(8):3114–3121. doi:10.1210/jc.2007-0219 CrossRefPubMed

59.

Blanchard C, Mathonnet M, Sebag F, Caillard C, Hamy A, Volteau C, Heymann MF, Wyart V, Drui D, Roy M, Cariou B, Archambeaud F, Rodien P, Henry JF, Zarnegar R, Hardouin JB, Mirallie E (2013) Surgery for ‘asymptomatic’ mild primary hyperparathyroidism improves some clinical symptoms postoperatively. Eur J Endocrinol 169(5):665–672. doi:10.1530/EJE-13-0502 CrossRefPubMed

60.

Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93(9):3462–3470. doi:10.1210/jc.2007-1215 CrossRefPubMedCentralPubMed

61.

Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, Erik Varhaug J, Hessman O, Rosen T, Nordenstrom J, Jansson S, Hellstrom M, Bollerslev J (2015) Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. J Clin Endocrinol Metab. doi:10.1210/jc.2014-3441 PubMed

62.

Cassibba S, Pellegrino M, Gianotti L, Baffoni C, Baralis E, Attanasio R, Guarnieri A, Borretta G, Tassone F (2014) Silent renal stones in primary hyperparathyroidism: prevalence and clinical features. Endocr Pract 20(11):1137–1142. doi:10.4158/EP14074.OR CrossRefPubMed

63.

Rejnmark L, Vestergaard P, Mosekilde L (2011) Nephrolithiasis and renal calcifications in primary hyperparathyroidism. J Clin Endocrinol Metab 96(8):2377–2385. doi:10.1210/jc.2011-0569 CrossRefPubMed

64.

NIH conference (1991) Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med 115(12):956–961CrossRef

65.

Bilezikian JP, Potts JT Jr, Fuleihan Gel H, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg SJ, Udelsman R, Wells SA (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87(12):5353–5361. doi:10.1210/jc.2002-021370 CrossRefPubMed

66.

Walker MD, McMahon DJ, Inabnet WB, Lazar RM, Brown I, Vardy S, Cosman F, Silverberg SJ (2009) Neuropsychological features in primary hyperparathyroidism: a prospective study. J Clin Endocrinol Metab 94(6):1951–1958. doi:10.1210/jc.2008-2574 CrossRefPubMedCentralPubMed

67.

Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341(17):1249–1255. doi:10.1056/NEJM199910213411701 CrossRefPubMed

68.

Schneider DF, Burke JF, Ojomo KA, Clark N, Mazeh H, Sippel RS, Chen H (2013) Multigland disease and slower decline in intraoperative PTH characterize mild primary hyperparathyroidism. Ann Surg Oncol 20(13):4205–4211. doi:10.1245/s10434-013-3190-4 CrossRefPubMedCentralPubMed

69.

Udelsman R, Akerstrom G, Biagini C, Duh QY, Miccoli P, Niederle B, Tonelli F (2014) The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99(10):3595–3606. doi:10.1210/jc.2014-2000 CrossRefPubMed

70.

Civelek AC, Ozalp E, Donovan P, Udelsman R (2002) Prospective evaluation of delayed technetium-99 m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 131(2):149–157CrossRefPubMed

71.

Van Husen R, Kim LT (2004) Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 28(11):1122–1126. doi:10.1007/s00268-004-7485-2 CrossRefPubMed

72.

Goswami S, Ghosh S (2012) Hyperparathyroidism: cancer and mortality. Indian J Endocrinol Metab 16(Suppl 2):S217–S220. doi:10.4103/2230-8210.104042 PubMedCentralPubMed

73.

Espiritu RP, Kearns AE, Vickers KS, Grant C, Ryu E, Wermers RA (2011) Depression in primary hyperparathyroidism: prevalence and benefit of surgery. J Clin Endocrinol Metab 96(11):E1737–E1745. doi:10.1210/jc.2011-1486 CrossRefPubMed

74.

Kahal H, Aye M, Rigby AS, Sathyapalan T, England RJ, Atkin SL (2012) The effect of parathyroidectomy on neuropsychological symptoms and biochemical parameters in patients with asymptomatic primary hyperparathyroidism. Clin Endocrinol (Oxf) 76(2):196–200. doi:10.1111/j.1365-2265.2011.04197.x CrossRef

75.

Insogna KL, Mitnick ME, Stewart AF, Burtis WJ, Mallette LE, Broadus AE (1985) Sensitivity of the parathyroid hormone-1,25-dihydroxyvitamin D axis to variations in calcium intake in patients with primary hyperparathyroidism. N Engl J Med 313(18):1126–1130. doi:10.1056/NEJM198510313131805 CrossRefPubMed

76.

Jorde R, Szumlas K, Haug E, Sundsfjord J (2002) The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake. Eur J Nutr 41(6):258–263. doi:10.1007/s00394-002-0383-1 CrossRefPubMed

77.

Locker FG, Silverberg SJ, Bilezikian JP (1997) Optimal dietary calcium intake in primary hyperparathyroidism. Am J Med 102(6):543–550CrossRefPubMed

78.

Marcocci C, Bollerslev J, Khan AA, Shoback DM (2014) Medical management of primary hyperparathyroidism: proceedings of the Fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab 99(10):3607–3618. doi:10.1210/jc.2014-1417 CrossRefPubMed

79.

Minisola S, Romagnoli E, Scillitani A, Rao SD (2014) Hypovitaminosis D in primary hyperparathyroidism: to treat or not to treat? That is the question. J Endocrinol Invest 37(5):413–414. doi:10.1007/s40618-014-0060-2 CrossRefPubMed

80.

Romagnoli E, Pepe J, Piemonte S, Cipriani C, Minisola S (2013) Management of endocrine disease: value and limitations of assessing vitamin D nutritional status and advised levels of vitamin D supplementation. Eur J Endocrinol 169(4):R59–R69. doi:10.1530/EJE-13-0435 CrossRefPubMed

81.

Romagnoli E, Carnevale V, Biondi P, Minisola S (2014) Vitamin D supplementation: when and how? J Endocrinol Invest 37(7):603–607. doi:10.1007/s40618-014-0071-z CrossRefPubMed

82.

Khan AA (2013) Medical management of primary hyperparathyroidism. J Clin Densitom 16(1):60–63. doi:10.1016/j.jocd.2012.11.010 CrossRefPubMed

83.

Sankaran S, Gamble G, Bolland M, Reid IR, Grey A (2010) Skeletal effects of interventions in mild primary hyperparathyroidism: a meta-analysis. J Clin Endocrinol Metab 95(4):1653–1662. doi:10.1210/jc.2009-2384 CrossRefPubMed

84.

EMA (2008) http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000570/human_med_000903.jsp&mid=WC0p01ac058001d124. Accessed 18 Nov 2013

85.

FDA (2011) www.accessdata.fda.gov/drugsatfda_docs/label/2011/021688s017lbl.pdf. Accessed 18 Nov 2013

86.

Saponaro F, Faggiano A, Grimaldi F, Borretta G, Brandi ML, Minisola S, Frasoldati A, Papini E, Scillitani A, Banti C, Del Prete M, Vescini F, Gianotti L, Cavalli L, Romagnoli E, Colao A, Cetani F, Marcocci C (2013) Cinacalcet in the management of primary hyperparathyroidism: post marketing experience of an Italian multicentre group. Clin Endocrinol (Oxf) 79(1):20–26. doi:10.1111/cen.12108 CrossRef

87.

Cetani F, Saponaro F, Banti C, Cianferotti L, Vignali E, Chiavistelli S, Viccica G, Pinchera A, Marcocci C (2012) Cinacalcet efficacy in patients with moderately severe primary hyperparathyroidism according to the European Medicine Agency prescription labeling. J Endocrinol Invest 35(7):655–660. doi:10.3275/7970 PubMed

88.

Diaz-Soto G, Linglart A, Senat MV, Kamenicky P, Chanson P (2013) Primary hyperparathyroidism in pregnancy. Endocrine 44(3):591–597. doi:10.1007/s12020-013-9980-4 CrossRefPubMed

89.

Som M, Stroup JS (2011) Primary hyperparathyroidism and pregnancy. Proc (Bayl Univ Med Cent) 24(3):220–223

90.

Horjus C, Groot I, Telting D, van Setten P, van Sorge A, Kovacs CS, Hermus A, de Boer H (2009) Cinacalcet for hyperparathyroidism in pregnancy and puerperium. J Pediatr Endocrinol Metab 22(8):741–749CrossRefPubMed

91.

Thakker RV, Newey PJ, Walls GV, Bilezikian J, Dralle H, Ebeling PR, Melmed S, Sakurai A, Tonelli F, Brandi ML, Endocrine S (2012) Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1). J Clin Endocrinol Metab 97(9):2990–3011. doi:10.1210/jc.2012-1230 CrossRefPubMed

Title: Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism
Authors: C. Marcocci
M. L. Brandi
A. Scillitani
S. Corbetta
A. Faggiano
L. Gianotti
S. Migliaccio
S. Minisola
Publication date: 01-05-2015
Publisher: Springer International Publishing
Published in: Journal of Endocrinological Investigation / Issue 5/2015
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-015-0261-3

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 5/2015

Methodological limitations of an etiological framing of Ariarathes’ goitre: response to Tekiner et al.

Prematurity and low birth weight lead to altered bone geometry, strength, and quality in children

Osteocalcin, under-carboxylated osteocalcin and osteopontin are not associated with gestational diabetes mellitus but are inversely associated with leptin in non-diabetic women

Genetic defects of the CYP21A2 gene in girls with premature adrenarche

The impact of prenatal exposure to a single dose of testosterone on insulin resistance, glucose tolerance and lipid profile of female rat’s offspring in adulthood

Characterization of V804M-mutated RET proto-oncogene associated with familial medullary thyroid cancer, report of the largest Turkish family

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage