D vitamini ve lityum ilişkili hiperparatiroid, paratiroid ototransplantasyon, kriyoprezervasyon ve paratiroid kanseri
N Engl J Med. 2008 Jul 24;359(4):391-403.
Clinical practice. Hypoparathyroidism.
Shoback D.
University of California, San Francisco, Department of Veterans Affairs Medical
Center, San Francisco 94121, USA. dolores.shoback@ucsf.edu
World J Surg. 2009 Nov;33(11):2314-23.
Lithium therapy and hyperparathyroidism: an evidence-based assessment.
Saunders BD, Saunders EF, Gauger PG.
Department of Surgery, Pennsylvania State Milton S. Hershey Medical Center, Penn
State University College of Medicine, Mail Code H070, 500 University Drive, PO
Box 850, Hershey, PA 17033-0850, USA. bsaunders@hmc.psu.edu
BACKGROUND: Prolonged therapeutic exposure to lithium compounds can have adverse consequences on calcium homeostasis. A unique form of hyperparathyroidism appears to be causally linked to chronic lithium exposure. We provide a comprehensive review of relevant literature using a structured, evidence-based approach.
METHODS: Published data were identified from systematic electronic literature searches. References are assigned a level of evidence according to a validated classification schema.
RESULTS: Level III and V evidence supports an etiologic link between sustained lithium therapy and both hypercalcemia and hyperparathormonemia (grade C recommendation). Level V evidence supports the use of preoperative parathyroid imaging if a focused exploration is planned (grade C recommendation). Level V evidence supports the use of intraoperative parathyroid hormone monitoring to guide appropriate surgical therapy (grade C recommendation). There is conflicting and equally weighted level V evidence supporting a routine preoperative plan of bilateral neck exploration versus selective unilateral exploration (no recommendation). There may be a role for calcimimetic drug therapy as an alternate, nonsurgical means of controlling lithium-associated hyperparathyroidism (grade C recommendation).
CONCLUSIONS: Evidence-based recommendations support screening of patients on chronic lithium therapy for hypercalcemia. Appropriate surgical therapy may consist of either a bilateral or a unilateral approach when performed by an experienced endocrine surgeon. Focused approaches should be guided by preoperative imaging and intraoperative hormone monitoring. Calcimimetic therapy is a potential alternative to parathyroidectomy.
World J Surg. 2009 Nov;33(11):2224-33.
Molecular genetics of parathyroid disease.
Westin G, Björklund P, Akerström G.
Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala,
Sweden. gunnar.westin@surgsci.uu.se
BACKGROUND: Primary hyperparathyroidism (HPT) is often caused by a benign parathyroid tumor, adenoma; less commonly by multiglandular parathyroid disease/hyperplasia; and rarely by parathyroid carcinoma. Patients with multiple tumors require wider exploration to avoid recurrence and have increased risk for hereditary disease. Secondary HPT is a common complication of renal failure. Improved knowledge of the molecular background of parathyroid tumor development may help select patients for appropriate surgical treatment and can eventually provide new means of treatment. The present contribution summarizes more recent knowledge of parathyroid molecular genetics.
METHODS: A literature search and review was made to evaluate the level of evidence concerning molecular biology and genetics of primary, secondary, and familial HPT according to criteria proposed by Sackett, with recommendation grading by Heinrich et al. RESULTS: Most parathyroid adenomas and hyperplastic glands are monoclonal lesions. Cyclin D1 gene (CCND1) translocation and oncogene action occur in 8% of adenomas; cyclin D1 overexpression is seen in 20% to 40% of parathyroid adenomas and in 31% of secondary hyperplastic glands. Somatic loss of one MEN1 allele is seen in 25% to 40% of sporadic parathyroid adenomas, half of which have inactivating mutation of the remaining allele. Inactivating somatic HRPT2 mutations are common in parathyroid carcinoma, often causing decreased expression of the protein parafibromin involved in cyclin D1 regulation. Aberrant regulation of Wnt/beta-catenin signaling may be important for parathyroid tumor development.
CONCLUSIONS: Molecular genetic studies of parathyroid tumors are well designed basic experimental studies providing strong level III evidence, with data frequently confirmed by subsequent studies.
ANZ J Surg. 2002 Dec;72(12):902-7.
Parathyroid autotransplantation during thyroidectomy.
Lo CY.
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary
Hospital, China. cylo@hkucc.hku.hk
Comment in ANZ J Surg. 2002 Dec;72(12):852-3.
Permanent hypoparathyroidism is a debilitating morbidity following thyroidectomy, with a reported incidence of up to 43%. Apart from meticulous dissection to preserve parathyroid glands and their blood supply, parathyroid autotransplantation (PA) has been increasingly employed to preserve parathyroid function. The adoption of PA during thyroidectomy has been reported to be associated with a low incidence of permanent hypoparathyroidism. Biochemical function of parathyroid autografts can be demonstrated objectively by forearm reimplantation or during long-term follow up. The clearest indication for PA is for inadvertently removed or devascularized parathyroid glands during thyroid surgery. Other strategies, including routine autotransplantation of at least one parathyroid gland, can be considered, but is associated with a high incidence of transient hypocalcaemia. Apart from refinement in technique to facilitate graft success, a reliable way to assess overall parathyroid function or viability of individual parathyroid gland may assist in monitoring parathyroid function and selecting patients requiring this procedure to prevent permanent hypoparathyroidism.
Endocr Pract. 2011 Mar-Apr;17 Suppl 1:83-9.
Parathyroid autotransplantation.
Moffett JM, Suliburk J.
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston,
Texas 77030, USA.
OBJECTIVE: To summarize the indications and techniques for parathyroid autotransplantation and to explore other aspects of the field that warrant further research and discussion.
METHODS: Review of relevant literature with focus on parathyroid autotransplantation and cryopreservation. RESULTS: Parathyroid autotransplantation is an important technique used by surgeons to circumvent postoperative hypoparathyroidism. Immediate autotransplantation is used intraoperatively, most commonly in the setting of total thyroidectomy or during total parathyroidectomy in a patient with parathyroid hyperplasia. Delayed autotransplantation with cryopreservation is typically used in patients with persistent or recurrent hyperparathyroidism who require repeated cervical exploration.
CONCLUSIONS: The success rate of autotransplantation in preventing postoperative hypoparathyroidism reported in the literature is highly variable and is dependent on timing, disease, and duration of tissue storage. Ultimately, surgical planning for patients with hyperparathyroidism involves finding a balance between decreasing a patient's symptoms, increasing the time of eucalcemia, and avoiding the complications of permanent hypoparathyroidism.
N Engl J Med. 2007 Jul 19;357(3):266-81.
Vitamin D deficiency.
Holick MF.
Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center,
Boston, MA 02118, USA. mfholick@bu.edu
