Pub Date : 2025-05-01Epub Date: 2025-05-23DOI: 10.1016/j.beem.2025.102006
Shumaila Hasan , Chris Uff
Traumatic brain injury (TBI) is not a singular event with finite boundaries, but a complex and evolving pathology. While the initial mechanical insult may be fleeting, its consequences can ripple across physiological systems for months or years. One of the most underappreciated yet clinically significant consequences is the disruption of the hypothalamic-pituitary axis (HPA). Neuroendocrine dysfunction after TBI can present in various forms—some subtle, others life-altering—affecting metabolic regulation, sexual health, psychological wellbeing, and rehabilitation potential. This review explores the pathophysiology and clinical implications of HPA dysfunction in TBI, highlighting current gaps in diagnosis and proposing an approach that recognises the chronic nature of these sequelae.
{"title":"Neuroendocrine dysfunction following traumatic brain injury: Current insights and emerging perspectives","authors":"Shumaila Hasan , Chris Uff","doi":"10.1016/j.beem.2025.102006","DOIUrl":"10.1016/j.beem.2025.102006","url":null,"abstract":"<div><div>Traumatic brain injury (TBI) is not a singular event with finite boundaries, but a complex and evolving pathology. While the initial mechanical insult may be fleeting, its consequences can ripple across physiological systems for months or years. One of the most underappreciated yet clinically significant consequences is the disruption of the hypothalamic-pituitary axis (HPA). Neuroendocrine dysfunction after TBI can present in various forms—some subtle, others life-altering—affecting metabolic regulation, sexual health, psychological wellbeing, and rehabilitation potential. This review explores the pathophysiology and clinical implications of HPA dysfunction in TBI, highlighting current gaps in diagnosis and proposing an approach that recognises the chronic nature of these sequelae.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 3","pages":"Article 102006"},"PeriodicalIF":6.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-06-18DOI: 10.1016/j.beem.2025.102020
Ulla Feldt-Rasmussen , Marianne Christina Klose
One of the possible clinical complications following traumatic brain injury (TBI) is post-traumatic hypopituitarism. Severe TBI can disrupt the hypothalamus-pituitary-peripheral hormone axes, not only in the acute phase but also over the long term, potentially resulting in persistent pituitary dysfunction. Acute critical illness and its management can alter the normal adaptive response of the hypothalamus-pituitary axis through changes in metabolism, hormone binding, and hormone production. In the context of TBI, structural brain damage may further impair hypothalamus-pituitary function by directly disrupting its anatomical integrity. Diagnosing pituitary hormone imbalances in the acute phase after TBI is challenging, and the clinical significance remains debatable. However, adrenal insufficiency and ADH deficiency poses a life-threatening risk if left untreated and requires prompt intervention. Practical points are provided on how to recognize, avoid, and manage both over- and underdiagnosis of hypopituitarism in patients with TBI.
{"title":"Pathophysiology and diagnosis of neuroendocrine abnormalities in patients with traumatic brain injury","authors":"Ulla Feldt-Rasmussen , Marianne Christina Klose","doi":"10.1016/j.beem.2025.102020","DOIUrl":"10.1016/j.beem.2025.102020","url":null,"abstract":"<div><div>One of the possible clinical complications following traumatic brain injury (TBI) is post-traumatic hypopituitarism. Severe TBI can disrupt the hypothalamus-pituitary-peripheral hormone axes, not only in the acute phase but also over the long term, potentially resulting in persistent pituitary dysfunction. Acute critical illness and its management can alter the normal adaptive response of the hypothalamus-pituitary axis through changes in metabolism, hormone binding, and hormone production. In the context of TBI, structural brain damage may further impair hypothalamus-pituitary function by directly disrupting its anatomical integrity. Diagnosing pituitary hormone imbalances in the acute phase after TBI is challenging, and the clinical significance remains debatable. However, adrenal insufficiency and ADH deficiency poses a life-threatening risk if left untreated and requires prompt intervention. Practical points are provided on how to recognize, avoid, and manage both over- and underdiagnosis of hypopituitarism in patients with TBI.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 3","pages":"Article 102020"},"PeriodicalIF":6.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-17DOI: 10.1016/j.beem.2025.101997
Kursad Unluhizarci, Emre Urhan
During the last two decades traumatic brain injury (TBI) was also found as an important cause of hypopituitarism. Although the most common causes of TBI are traffic accidents and falls, others such as blast-related injuries, acts of violence and combative sports are also considered in the etiology. TBI may lead to transient or permanent pituitary dysfunction. The definition of TBI-induced hypopituitarism cover alterations in pituitary hormone levels which may occur even after five years of injury and characterised by hormonal deficiencies but rarely recovery of some hormones during the course of the disease. It has been shown that between 5 % and 70 % of the TBI patients suffer from hypopituitarism. This large variation in the prevalence may be explained by diverse diagnostic criteria used in different studies, different time points of interventions after TBI, severity of trauma etc. Patients with advanced age, low Glasgow Coma Scale, needing intensive care unit stay, presence of skull fractures, brain edema are particularly make patients vulnerable to TBI-induced hypopituitarism.
{"title":"Epidemiology and risk factors for hypopituitarism due to traumatic brain injury","authors":"Kursad Unluhizarci, Emre Urhan","doi":"10.1016/j.beem.2025.101997","DOIUrl":"10.1016/j.beem.2025.101997","url":null,"abstract":"<div><div>During the last two decades traumatic brain injury (TBI) was also found as an important cause of hypopituitarism. Although the most common causes of TBI are traffic accidents and falls, others such as blast-related injuries, acts of violence and combative sports are also considered in the etiology. TBI may lead to transient or permanent pituitary dysfunction. The definition of TBI-induced hypopituitarism cover alterations in pituitary hormone levels which may occur even after five years of injury and characterised by hormonal deficiencies but rarely recovery of some hormones during the course of the disease. It has been shown that between 5 % and 70 % of the TBI patients suffer from hypopituitarism. This large variation in the prevalence may be explained by diverse diagnostic criteria used in different studies, different time points of interventions after TBI, severity of trauma etc. Patients with advanced age, low Glasgow Coma Scale, needing intensive care unit stay, presence of skull fractures, brain edema are particularly make patients vulnerable to TBI-induced hypopituitarism.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 3","pages":"Article 101997"},"PeriodicalIF":6.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-12-30DOI: 10.1016/j.beem.2024.101967
Piyush Aggarwal, Vinisha Gunasekaran, Ashwani Sood, Bhagwant Rai Mittal
Primary hyperparathyroidism is the main cause of hypercalcemia, resulting predominantly from parathyroid adenomas followed by hyperplasia. Diagnosis relies on clinical and biochemical parameters. Accurate pre-operative localization is mandatory for better surgical outcome. Various non-invasive imaging modalities includes cervical ultrasound, radionuclide scintigraphy with 99mTc-Methoxyisobutyl isonitrile combined with SPECT/CT, 4DCT, MRI and 18F-Choline PET/CT. Functional imaging has shown higher accuracy in localization especially in ectopic parathyroid adenomas and persistent or recurrent hyperparathyroidism. Combined ultrasound and 99mTc-MIBI has shown high sensitivity and specificity than individual imaging modality. 18F-Choline PET/CT has better diagnostic performance in identifying parathyroid hyperplasia and multiple adenomas. In patients with equivocal findings and concurrent thyroid nodular diseases, 18F-Choline PET/MRI and 4DCT helps in better characterization of lesion. Intraoperative probe guided surgery facilitates targeted and minimally invasive surgery resulting in better surgical outcome. More specific radiopharmaceuticals for parathyroid imaging need to be developed to reduce false positive results.
{"title":"Localization in primary hyperparathyroidism","authors":"Piyush Aggarwal, Vinisha Gunasekaran, Ashwani Sood, Bhagwant Rai Mittal","doi":"10.1016/j.beem.2024.101967","DOIUrl":"10.1016/j.beem.2024.101967","url":null,"abstract":"<div><div>Primary hyperparathyroidism is the main cause of hypercalcemia, resulting predominantly from parathyroid adenomas followed by hyperplasia. Diagnosis relies on clinical and biochemical parameters. Accurate pre-operative localization is mandatory for better surgical outcome. Various non-invasive imaging modalities includes cervical ultrasound, radionuclide scintigraphy with <sup>99m</sup>Tc-Methoxyisobutyl isonitrile combined with SPECT/CT, 4DCT, MRI and <sup>18</sup>F-Choline PET/CT. Functional imaging has shown higher accuracy in localization especially in ectopic parathyroid adenomas and persistent or recurrent hyperparathyroidism. Combined ultrasound and <sup>99m</sup>Tc-MIBI has shown high sensitivity and specificity than individual imaging modality. <sup>18</sup>F-Choline PET/CT has better diagnostic performance in identifying parathyroid hyperplasia and multiple adenomas. In patients with equivocal findings and concurrent thyroid nodular diseases, <sup>18</sup>F-Choline PET/MRI and 4DCT helps in better characterization of lesion. Intraoperative probe guided surgery facilitates targeted and minimally invasive surgery resulting in better surgical outcome. More specific radiopharmaceuticals for parathyroid imaging need to be developed to reduce false positive results.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101967"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.beem.2025.101984
Ashna Grover , Smita Jha
Familial or heritable hyperparathyroidism (FHPT) is seen in approximately 10–15 % of patients with primary hyperparathyroidism (PHPT). Once the diagnosis of PHPT is established, consideration of heritable forms should be made in patients with positive family history, young onset, multi-glandular disease, and recurrent or persistent disease. FHPT encompasses both syndromic and non-syndromic forms. Syndromic forms include multiple endocrine neoplasia (MEN) types 1, 2, 3 and 4, hyperparathyroidism-jaw tumor syndrome, hereditary pheochromocytoma and paraganglioma, and the more recently reported, Birt-Hogg-Dubé (BHD) syndrome, and X-linked intellectual disability syndrome. Non-syndromic forms include familial hypocalciuric hypercalcemia (FHH)- types 1,2, and 3, neonatal severe hyperparathyroidism, GCM2-mediated hyperparathyroidism, transient neonatal hyperparathyroidism, and familial isolated hyperparathyroidism. In this review we aim to review the heritable forms of PHPT and highlight the important genetics insights and clinical implications.
{"title":"Heritable hyperparathyroidism: Genetic insights and clinical implications","authors":"Ashna Grover , Smita Jha","doi":"10.1016/j.beem.2025.101984","DOIUrl":"10.1016/j.beem.2025.101984","url":null,"abstract":"<div><div>Familial or heritable hyperparathyroidism (FHPT) is seen in approximately 10–15 % of patients with primary hyperparathyroidism (PHPT). Once the diagnosis of PHPT is established, consideration of heritable forms should be made in patients with positive family history, young onset, multi-glandular disease, and recurrent or persistent disease. FHPT encompasses both syndromic and non-syndromic forms. Syndromic forms include multiple endocrine neoplasia (MEN) types 1, 2, 3 and 4, hyperparathyroidism-jaw tumor syndrome, hereditary pheochromocytoma and paraganglioma, and the more recently reported, Birt-Hogg-Dubé (BHD) syndrome, and X-linked intellectual disability syndrome. Non-syndromic forms include familial hypocalciuric hypercalcemia (FHH)- types 1,2, and 3, neonatal severe hyperparathyroidism, <em>GCM2</em>-mediated hyperparathyroidism, transient neonatal hyperparathyroidism, and familial isolated hyperparathyroidism. In this review we aim to review the heritable forms of PHPT and highlight the important genetics insights and clinical implications.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101984"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2024-12-27DOI: 10.1016/j.beem.2024.101966
Abhishek Viswanath , Eftychia E. Drakou , Fannie Lajeunesse-Trempe , Ashley B. Grossman , Georgios K. Dimitriadis
Parathyroid carcinoma (PC) is a rare malignancy, comprising 1 % of all cases of primary hyperparathyroidism (PHPT). This narrative review explores recent advances in PC management, with a focus on molecular insights, diagnostic advancements, surgical innovations, and emerging targeted therapies. Manuscripts published between 2023 and 2024 were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The review highlights advances in biochemical markers, such as circulating tumour cells (CTCs), and imaging modalities such as 18F-FDG PET/CT and 4D-CT, which are improving diagnostic accuracy. Surgical resection remains central to localised and metastatic disease management. For patients with widespread metastatic or unresectable disease, newer targeted approaches such as tyrosine kinase inhibitors (TKIs), temozolomide, and immune checkpoint inhibitors (ICIs) may offer clinical benefit to specific patient cohorts. This review identifies future research areas to improve outcomes and recommends that patients with advanced PC continue to be managed in centres of excellence.
{"title":"Parathyroid carcinoma: New insights","authors":"Abhishek Viswanath , Eftychia E. Drakou , Fannie Lajeunesse-Trempe , Ashley B. Grossman , Georgios K. Dimitriadis","doi":"10.1016/j.beem.2024.101966","DOIUrl":"10.1016/j.beem.2024.101966","url":null,"abstract":"<div><div>Parathyroid carcinoma (PC) is a rare malignancy, comprising 1 % of all cases of primary hyperparathyroidism (PHPT). This narrative review explores recent advances in PC management, with a focus on molecular insights, diagnostic advancements, surgical innovations, and emerging targeted therapies. Manuscripts published between 2023 and 2024 were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The review highlights advances in biochemical markers, such as circulating tumour cells (CTCs), and imaging modalities such as <sup>18</sup>F-FDG PET/CT and 4D-CT, which are improving diagnostic accuracy. Surgical resection remains central to localised and metastatic disease management. For patients with widespread metastatic or unresectable disease, newer targeted approaches such as tyrosine kinase inhibitors (TKIs), temozolomide, and immune checkpoint inhibitors (ICIs) may offer clinical benefit to specific patient cohorts. This review identifies future research areas to improve outcomes and recommends that patients with advanced PC continue to be managed in centres of excellence.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101966"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary hyperparathyroidism is a common endocrine disorder characterized by inappropriate elevation of parathyroid hormone and hypercalcemia. While predominantly an asymptomatic disease in Western populations, symptomatic presentations are more prevalent in Eastern countries. The molecular pathogenesis of sporadic PHPT primarily involves genetic and epigenetic alterations leading to abnormal parathyroid cell proliferation and altered calcium sensing mechanism. To date, MEN1 and cyclin D1 are the only established drivers of sporadic PHPT. Somatic MEN1 gene mutations occur in 30–40 % of sporadic parathyroid adenomas (PA), with a recent study on symptomatic cases reporting germline variants.Cyclin D1 overexpression in sporadic PA has been observed in 20–40 % of cases in Western populations and 80 % of cases in Eastern populations, with an inverse association with cyclin-dependent kinase inhibitors CDKN2A and CDKN2B expression. The calcium-sensing receptor expression was significantly lower in symptomatic compared to asymptomatic PHPT, strongly supported by epigenetic deregulation (promoter hypermethylation and histone methylation). Recent studies have highlighted the potential involvement of EZH2, a histone methyltransferase, in parathyroid tumorigenesis. Additionally, parathyroid-specific transcription factors like GCM2, PAX1, and GATA3 are emerging as putative tumor suppressors, especially from the symptomatic PHPT. Next-generation sequencing has identified novel potential drivers such as PIK3CA, MTOR, and NF1 in sporadic PC, alongside CDC73. The molecular landscape of sporadic PHPT appears to differ between Eastern and Western populations. This heterogeneity underscores the need for further large-scale studies, particularly in symptomatic cases from developing nations, to comprehensively elucidate the molecular drivers of parathyroid tumorigenesis.
{"title":"Molecular basis of symptomatic sporadic primary hyperparathyroidism: New frontiers in pathogenesis","authors":"Ashutosh Kumar Arya , Poonam Kumari , Priyanka Singh , Sanjay Kumar Bhadada","doi":"10.1016/j.beem.2025.101985","DOIUrl":"10.1016/j.beem.2025.101985","url":null,"abstract":"<div><div>Primary hyperparathyroidism is a common endocrine disorder characterized by inappropriate elevation of parathyroid hormone and hypercalcemia. While predominantly an asymptomatic disease in Western populations, symptomatic presentations are more prevalent in Eastern countries. The molecular pathogenesis of sporadic PHPT primarily involves genetic and epigenetic alterations leading to abnormal parathyroid cell proliferation and altered calcium sensing mechanism. To date, MEN1 and cyclin D1 are the only established drivers of sporadic PHPT. Somatic MEN1 gene mutations occur in 30–40 % of sporadic parathyroid adenomas (PA), with a recent study on symptomatic cases reporting germline variants.Cyclin D1 overexpression in sporadic PA has been observed in 20–40 % of cases in Western populations and 80 % of cases in Eastern populations, with an inverse association with cyclin-dependent kinase inhibitors CDKN2A and CDKN2B expression. The calcium-sensing receptor expression was significantly lower in symptomatic compared to asymptomatic PHPT, strongly supported by epigenetic deregulation (promoter hypermethylation and histone methylation). Recent studies have highlighted the potential involvement of EZH2, a histone methyltransferase, in parathyroid tumorigenesis. Additionally, parathyroid-specific transcription factors like GCM2, PAX1, and GATA3 are emerging as putative tumor suppressors, especially from the symptomatic PHPT. Next-generation sequencing has identified novel potential drivers such as PIK3CA, MTOR, and NF1 in sporadic PC, alongside CDC73. The molecular landscape of sporadic PHPT appears to differ between Eastern and Western populations. This heterogeneity underscores the need for further large-scale studies, particularly in symptomatic cases from developing nations, to comprehensively elucidate the molecular drivers of parathyroid tumorigenesis.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101985"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2025-01-28DOI: 10.1016/j.beem.2025.101980
Durairaj Arjunan , Salvatore Minisola , Sudhaker D. Rao , Sanjay K. Bhadada
Primary hyperparathyroidism (PHPT), the third most common endocrine disorder, was so eloquently described first by Fuller Albright as a polymorphic condition in his classic paper and monograph as early as 1934. Over the decades, the clinical presentation of PHPT in developed countries has shifted significantly from a disease primarily affecting the bones and kidneys to an asymptomatic condition often discovered incidentally. In developing countries, the high prevalence of vitamin D deficiency is one of the main factors influencing the clinical presentation of PHPT. In Europe and North America, PHPT is predominantly asymptomatic. In South America, China, and Eastern parts of Europe, such as Turkey, Bulgaria, and Russia, there is an ongoing transition from symptomatic to asymptomatic cases. Asia shows variability: symptomatic cases dominate in the Indian subcontinent, Middle East, and Southeast Asia, while transitional patterns with predominant asymptomatic cases have now been reported in China, and Japan reports mostly asymptomatic cases. Factors influencing these changes include advancements in diagnostic technologies, detection of incidental parathyroid adenomas during thyroid ultrasonography, regional differences in vitamin D deficiency, dietary habits, and genetic polymorphisms in vitamin D and calcium-sensing receptors. A higher prevalence of nephrolithiasis in certain climates contributes to regional variations. This review examines the dynamic nature of PHPT's clinical presentation, shaped by geographic, genetic, and environmental influences. Also, this review highlights the importance of addressing global disparities in an attempt to optimize patient outcomes.
{"title":"Changing trends in clinical presentation of primary hyperparathyroidism across countries over time","authors":"Durairaj Arjunan , Salvatore Minisola , Sudhaker D. Rao , Sanjay K. Bhadada","doi":"10.1016/j.beem.2025.101980","DOIUrl":"10.1016/j.beem.2025.101980","url":null,"abstract":"<div><div>Primary hyperparathyroidism (PHPT), the third most common endocrine disorder, was so eloquently described first by Fuller Albright as a polymorphic condition in his classic paper and monograph as early as 1934. Over the decades, the clinical presentation of PHPT in developed countries has shifted significantly from a disease primarily affecting the bones and kidneys to an asymptomatic condition often discovered incidentally. In developing countries, the high prevalence of vitamin D deficiency is one of the main factors influencing the clinical presentation of PHPT. In Europe and North America, PHPT is predominantly asymptomatic. In South America, China, and Eastern parts of Europe, such as Turkey, Bulgaria, and Russia, there is an ongoing transition from symptomatic to asymptomatic cases. Asia shows variability: symptomatic cases dominate in the Indian subcontinent, Middle East, and Southeast Asia, while transitional patterns with predominant asymptomatic cases have now been reported in China, and Japan reports mostly asymptomatic cases. Factors influencing these changes include advancements in diagnostic technologies, detection of incidental parathyroid adenomas during thyroid ultrasonography, regional differences in vitamin D deficiency, dietary habits, and genetic polymorphisms in vitamin D and calcium-sensing receptors. A higher prevalence of nephrolithiasis in certain climates contributes to regional variations. This review examines the dynamic nature of PHPT's clinical presentation, shaped by geographic, genetic, and environmental influences. Also, this review highlights the importance of addressing global disparities in an attempt to optimize patient outcomes.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101980"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2025-03-08DOI: 10.1016/j.beem.2025.101986
Rasha A.Y. Alnajmi , Dalal S. Ali , Aliya A. Khan
Persistent and recurrent primary hyperparathyroidism (PHPT) represent significant challenges in the management of PHPT. Persistent PHPT is defined as persistence of hypercalcemia following parathyroidectomy (PTX) or the recurrence of hypercalcemia within the first 6 months following surgery. Recurrent PHPT is defined as recurrence of hypercalcemia after 6 months following PTX and requires normalization of serum calcium prior to the recurrence. These conditions are often attributed to missed or ectopic glands, multiglandular disease, surgeon inexperience, or rare causes such as parathyromatosis and parathyroid carcinoma. Diagnosis requires a detailed biochemical evaluation, imaging studies, and exclusion of other causes of hypercalcemia as well as secondary causes of hyperparathyroidism. Preoperative imaging modalities, including neck ultrasound, SPECT-CT with 99m Tc-sestamibi scan, 4D-CT, 18F-Fluorocholine PET/CT, and PET/MRI are helpful in localizing abnormal parathyroid glands in cases requiring repeat surgery. Repeat surgery is associated with higher risk and requires an experienced surgeon. When surgery is not indicated or possible, medical management with cinacalcet and antiresorptive therapies may be considered. This review highlights the etiology, diagnostic approaches, and management strategies for persistent and recurrent PHPT, emphasizing the importance of multidisciplinary care in order to optimize outcomes.
{"title":"Persistence and Recurrence of Primary Hyperparathyroidism","authors":"Rasha A.Y. Alnajmi , Dalal S. Ali , Aliya A. Khan","doi":"10.1016/j.beem.2025.101986","DOIUrl":"10.1016/j.beem.2025.101986","url":null,"abstract":"<div><div>Persistent and recurrent primary hyperparathyroidism (PHPT) represent significant challenges in the management of PHPT. Persistent PHPT is defined as persistence of hypercalcemia following parathyroidectomy (PTX) or the recurrence of hypercalcemia within the first 6 months following surgery. Recurrent PHPT is defined as recurrence of hypercalcemia after 6 months following PTX and requires normalization of serum calcium prior to the recurrence. These conditions are often attributed to missed or ectopic glands, multiglandular disease, surgeon inexperience, or rare causes such as parathyromatosis and parathyroid carcinoma. Diagnosis requires a detailed biochemical evaluation, imaging studies, and exclusion of other causes of hypercalcemia as well as secondary causes of hyperparathyroidism. Preoperative imaging modalities, including neck ultrasound, SPECT-CT with 99m Tc-sestamibi scan, 4D-CT, 18F-Fluorocholine PET/CT, and PET/MRI are helpful in localizing abnormal parathyroid glands in cases requiring repeat surgery. Repeat surgery is associated with higher risk and requires an experienced surgeon. When surgery is not indicated or possible, medical management with cinacalcet and antiresorptive therapies may be considered. This review highlights the etiology, diagnostic approaches, and management strategies for persistent and recurrent PHPT, emphasizing the importance of multidisciplinary care in order to optimize outcomes.</div></div>","PeriodicalId":8810,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":"39 2","pages":"Article 101986"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01Epub Date: 2025-01-31DOI: 10.1016/j.beem.2025.101982
Francesca Marini , Francesca Giusti , Maria Luisa Brandi
Primary hyperparathyroidism is a constitutive excess of parathyroid hormone (PTH) in the blood, caused by an idiopathic defect of growth and/or function of the parathyroid glands. PHPT is usually an acquired disease, due to the sporadic development of parathyroid hyperplasia, adenoma, and, in extremely rare cases, malignant carcinoma, mainly occurring by the sixth decade of life. In about 5–10 % of cases PHPT manifests in the context of congenital disorders, having a genetic base and occurring much earlier in life, compared to the sporadic counterpart. Congenital PHPT can manifest as isolated PHPT or as syndromic PHPT in the context of complex multiorgan disorders. Non-syndromic inherited PHPT includes Familial Hypocalciuric Hypercalcemia types 1, 2 and 3, Neonatal Severe Primary Hyperparathyroidism, and three different genetic forms of Familial Isolated Hyperparathyroidism, while syndromic inherited PHPT includes Hyperparathyroidism-Jaw Tumor Syndrome and Multiple Endocrine Neoplasias types 1, 2 A and 4.
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