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Metabolic Bone Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Plain radiography: Radiological evidence of osteitis fibrosa cystica is present in less than 5% of patients at diagnosis. It consists of subperiosteal bone resorption (best seen along the radial aspect of middle phalanges), erosions of the tufts of the terminal phalanges and mottling of the skull vault (‘salt-and-pepper appearance’). There may also be radiological evidence of nephrocalcinosis.
Management of Hyperparathyroidism
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The annual incidence of PHPT is around 20 cases per 100,000 population. Classical skeletal complications (osteitis fibrosa cystica) are present in less than 5% of newly presenting patients, and the incidence of renal stones has fallen to around 15–20%. Neuromuscular manifestations tend to be vague and include fatigue and subjective weakness, as opposed to a definable myopathy. Reduction in neurocognitive function that sometimes ameliorates following successful parathyroidectomy has been described. Peptic ulcer disease and pancreatitis are associations of classical PHPT. Pancreatitis is rarely seen nowadays because most PHPT is ‘mild’. Peptic ulcer disease may be seen in patients who have PHPT in association with multiple endocrine neoplasia type 1 (MEN 1). Cardiovascular risk is increased in PHPT, particularly with respect to increased vascular stiffness. There is an increased incidence of hypertension with PHPT, although the underlying mechanisms are not fully understood.
Partial Body Neutron Activation — Truncal
Published in Stanton H. Cohn, Non-Invasive Measurements of Bone Mass and Their Clinical Application, 2020
Kenneth G. McNeill, Joan E. Harrison
The diagnosis of primary hyperparathyroidism is made on the basis of abnormal biochemistry (hypercalcemia, hypophosphatemia, and elevated serum parathyroid hormone activity). With early diagnosis, classic manifestations of osteitis fibrosa cystica (hyperparathyroid bone disease) is rare.
Bone health in patients undergoing surgery for primary hyperparathyroidism at Tygerberg Hospital, Cape Town, South Africa
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
M Budge, W Conradie, K Beviss-Challinor, L Martin, M Conradie, A Coetzee
The once common and pathognomonic mode of presentation of PHPT, osteitis fibrosa cystica, is considered a rarity in high-income nations today.1,6,53 Developing countries such as Brazil, India and Thailand, however, still report rates of OFC between 6.7% and 47%.10 In South Africa, a 1976 study30 reported three cases of PHPT with gross bone disease, which the authors ascribed to a severe variant as opposed to delayed presentation and management. Paruk et al. reported a 47.6% (n = 10/21) prevalence of hyperparathyroidism-related bone disease on plain radiographs (a combined value given for subperiosteal resorption, bone cysts, loss of skull lamina dura, bone sclerosis and brown tumours).23 Despite very few dedicated skeletal surveys in our study, OFC was seen in five patients (9.6%). These were likely patients who were suspected of having more severe PHPT or were symptomatic from skeletal disease. This figure may well have been higher had all patients undergone screening radiographs.
Occult urolithiasis in asymptomatic primary hyperparathyroidism
Published in Endocrine Research, 2018
Yu-Kwang Donovan Tay, Minghao Liu, Leonardo Bandeira, Mariana Bucovsky, James A. Lee, Shonni J. Silverberg, Marcella D. Walker
As shown in Table 1, participants were predominantly Caucasian (81.3%) and postmenopausal women (71.9%). They had evidence of mild PHPT: mean serum calcium 10.5 ± 0.5 mg/dL (range: 9.9–11.8 mg/dl); PTH 86.9 ± 42 pg/mL (range: 26–290 pg/ml); 25OHD 31.1 ± 12 ng/dL. In the cohort, 34.4% had osteoporosis by DXA criteria, 20.8% had a history of fracture, 8.3% had an estimated glomerular filtration rate <60 ml/min (all 8 with stage 3 CKD), 10.4% were <50 years old, 12.4% had 24-hour urinary calcium excretion >400 mg/day (but no clinical stones) and 92.7% met ≥ 1 criterion for parathyroidectomy based on 2014 guidelines. No one had osteitis fibrosa cystica or nephrocalcinosis. Mean T-scores were in the osteopenic range at the femoral neck and distal 1/3- radius while they were normal at the spine and total hip (Table 1). Twenty-three percent of participants were taking calcium supplements while 61.5% were taking vitamin D supplements. The average doses are shown in Table 1.
The pathophysiology and management of vascular calcification in chronic kidney disease patients
Published in Expert Review of Cardiovascular Therapy, 2023
Mehmet Kanbay, Sidar Copur, Cem Tanriover, Furkan Yavuz, Andrea Galassi, Paola Ciceri, Mario Cozzolino
Although there are several potential therapeutic alternatives for VC in CKD patients identified on multiple clinical trials, targeted therapies are yet to be developed. The main therapeutic goals include the suppression or minimalization of inflammatory response, avoidance of high and low turnover bone mineral disorders including osteitis fibrosa cystica and adynamic bone disease, avoidance of positive calcium or phosphate balance and correction of vitamin D and vitamin K deficiencies [102] (Figure 3).