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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Classical and Nonclassical Manifestations of Primary Hyperparathyroidism
Journal of Bone and Mineral Research, Volume 37, No. 11, Year 2022
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Description
This narrative review summarizes data on classical and nonclassical manifestations of primary hyperparathyroidism (PHPT). It is based on a rigorous literature search, inclusive of a Medline search for systematic reviews from 1940 to December 2020, coupled with a targeted search for original publications, covering four databases, from January 2013–December 2020, and relevant articles from authors’ libraries. We present the most recent information, identify knowledge gaps, and suggest a research agenda. The shift in the presentation of PHPT from a predominantly symptomatic to an asymptomatic disease, with its varied manifestations, has presented several challenges. Subclinical nephrolithiasis and vertebral fractures are common in patients with asymptomatic disease. The natural history of asymptomatic PHPT with no end organ damage at diagnosis is unclear. Some observational and cross-sectional studies continue to show associations between PHPT and cardiovascular and neuropsychological abnormalities, among the different disease phenotypes. Their causal relationship is uncertain. Limited new data are available on the natural history of skeletal, renal, cardiovascular, neuropsychological, and neuromuscular manifestations and quality of life. Normocalcemic PHPT (NPHPT) is often diagnosed without the fulfillment of rigorous criteria. Randomized clinical trials have not demonstrated a consistent long-term benefit of parathyroidectomy (PTX) versus observation on nonclassical manifestations. We propose further refining the definition of asymptomatic disease, into two phenotypes: one without and one with evidence of target organ involvement, upon the standard evaluation detailed in our recommendations. Each of these phenotypes can present with or without non-classical manifestations. We propose multiple albumin-adjusted serum calcium determinations (albumin-adjusted and ionized) and exclusion of all secondary causes of high parathyroid hormone (PTH) when establishing the diagnosis of NPHPT. Refining the definition of asymptomatic disease into the phenotypes proposed will afford insights into their natural history and response to interventions. This would also pave the way for the development of evidence-based guidance and recommendations. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Authors & Co-Authors
El-Hajj Fuleihan, Ghada
Lebanon, Beirut
American University of Beirut
Chakhtoura, Marlene
Lebanon, Beirut
American University of Beirut
Cipriani, Cristiana
Italy, Rome
Sapienza Università Di Roma
Eastell, R.
United Kingdom, Sheffield
The Sheffield Medical School
Karonova, Tatiana
Russian Federation, Saint Petersburg
Almazov National Medical Research Centre
Liu, Jian Min
China, Shanghai
Shanghai Jiao Tong University School of Medicine
Minisola, Salvatore
Italy, Rome
Sapienza Università Di Roma
Mithal, Ambrish
India, New Delhi
Max Healthcare
Moreira, Carolina A.
Brazil, Curitiba
Universidade Federal do Parana
Brazil, Curitiba
Academic Research Center of Pro-renal Institute
Peacock, Munro
United States, Indianapolis
Indiana University School of Medicine
Schini, Marian
United Kingdom, Sheffield
The Sheffield Medical School
Silva, Barbara
Brazil, Belo Horizonte
Centro Universitario de Belo Horizonte
Brazil, Belo Horizonte
Hospital Santa Casa Belo Horizonte
Walker, Marcella
United States, New York
Columbia University Irving Medical Center
El Zein, Ola
Lebanon, Beirut
American University of Beirut
Marcocci, Claudio
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Statistics
Citations: 18
Authors: 15
Affiliations: 13
Identifiers
Doi:
10.1002/jbmr.4679
ISSN:
08840431
e-ISSN:
15234681
Research Areas
Disability
Noncommunicable Diseases
Violence And Injury
Study Design
Randomised Control Trial
Cross Sectional Study
Narrative Study
Study Approach
Qualitative