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      The Relationship between Primary Hyperparathyroidism and Thrombotic Events: Report of Three Cases and a Review of Potential Mechanisms

      case-report

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          Abstract

          We have described three uncommon cases of patients who presented with clinical thrombotic events (stroke, pulmonary embolism and deep venous thrombosis) during the course of a hypercalcemia-induced hypercoagulable state. After thorough investigation, the diagnosis of primary hyperparathyroidism - due to a parathyroid adenoma - was established in all cases. The association between hypercalcemia and venous or arterial thrombosis has been previously described; however, relevant data are still insufficient. The existing evidence in the field was reviewed and the interesting underlying pathophysiologic mechanisms were also discussed. Further studies are required to shed more light on the unusual, still intriguing relationship between calcium and thrombosis.

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          Clinical practice. Asymptomatic primary hyperparathyroidism.

          Donald S. Silverberg, John Bilezikian (2004)
          Article 0 comments Cited 38 times – based on 0 reviews     Review now
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            Increased mortality and morbidity in mild primary hyperparathyroid patients. The Parathyroid Epidemiology and Audit Research Study (PEARS).

            Ning Yu, A Rudman, Graham Leese … (2010)
            To describe mortality and disease-specific morbidities in patients with mild primary hyperparathyroidism (PHPT). Retrospective population-based observational study. Tayside, Scotland, from 1997 to 2006. Patients with mild PHPT were selected from a predefined PHPT cohort between 1997 and 2006. Standardised mortality ratios (SMRs) were examined for all-cause mortality, as well as cardiovascular and cancer mortality. Standardised morbidity ratios and standardised incidence ratios were also calculated for eleven observed co-morbidities. In total, there were 1683 (69.1% female) patients identified with mild PHPT in Tayside. Patients were found to have an increased risk of all-cause mortality and cardiovascular mortality (SMR-all cause 2.62, 95% CI 2.39-2.86; SMR-cardiovascular 2.68, 95% CI 2.34-3.05). Patients with mild PHPT had a significantly increased risk of developing cardiovascular and cerebrovascular disease, renal dysfunction and fractures compared to the age- and sex-adjusted general population. Mortality and morbidity were increased for patients with mild untreated PHPT, which is similar to more severe PHPT.
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              Primary hyperparathyroidism: a current perspective.

              Peter Mazzaglia, S Mangray, R A DeLellis (2008)
              Primary hyperparathyroidism (P-HPT) is one of the most common of all endocrine disorders. Eighty percent to 85% of cases are due to parathyroid adenomas while hyperplasia and carcinoma account for 10% to 15% and less than 1%, of cases, respectively. The past decade has witnessed remarkable advances in the understanding of the molecular basis of parathyroid hyperplasia and neoplasia. Additionally, imaging studies and the development of the intraoperative assay for parathyroid hormone have transformed the diagnosis and management of patients with these disorders. To review the pathology of parathyroid lesions associated with P-HPT, their molecular and genetic bases, including heritable hyperparathyroidism syndromes, and their clinical diagnosis and management. Review of pertinent epidemiology, pathology, radiology, and surgery literature on the diagnosis, classification, and treatment of P-HPT. Although heritable causes of P-HPT including multiple endocrine neoplasia 1 and 2A and hyperparathyroidism-jaw tumor syndrome account for a minority of cases of P-HPT, advances in the characterization of the affected genes have provided insights into the genetic basis of sporadic parathyroid neoplasms. Alterations in cyclin D1 and loss of heterozygosity of chromosome 11q in adenomas and hyperplasias have provided support for clonality of these lesions. Parafibromin, the protein product of the HRPT2 gene responsible for hyperparathyroidism-jaw tumor syndrome, has been implicated in the development of sporadic parathyroid carcinomas and loss of immunohistochemical expression of this protein has been suggested to be of value in making the diagnosis of parathyroid carcinoma. Sestamibi scanning and ultrasound have revolutionized the planning of surgical approaches and the intraoperative parathyroid hormone assay has become the standard in guiding completion or extension of surgery.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Hematol Oncol Stem Cell Res
                Journal ID (iso-abbrev): Int J Hematol Oncol Stem Cell Res
                Journal ID (publisher-id): IJHOSCR
                Title: International Journal of Hematology-Oncology and Stem Cell Research
                Publisher: Tehran University of Medical Sciences, Hematology-Oncology and Stem Cell Transplantation Research Center (Tehran, Iran )
                ISSN (Print): 2008-3009
                ISSN (Electronic): 2008-2207
                Publication date (Print): 1 July 2018
                Volume: 12
                Issue: 3
                Pages: 175-180
                Affiliations
                [1 ]Division of Endocrinology and Metabolism, Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
                [2 ]Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds Ringgold Standard Institution, Leeds, UK
                Author notes
                Corresponding Author: Kalliopi Kotsa, Division of Endocrinology and Metabolism, Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece. Tel: +302310994706. Fax: +302310994706. Email: kalmanthou@ 123456yahoo.gr
                Article
                Publisher ID: IJHOSCR-12-175
                PMC ID: 6305263
                PubMed ID: 30595818
                SO-VID: 015c7e2d-6299-42c9-a4df-ae7d6196a537
                Copyright © Copyright : © International Journal of Hematology-Oncology and Stem Cell Research & Tehran University of Medical Sciences
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 September 2017
                Date accepted : 6 December 2017
                Categories
                Subject: Case Report

                Keywords: calcium,primary hyperparathyroidism,thrombosis,stroke,pulmonary embolism,deep venous thrombosis
                Data availability:
                Keywords: calcium, primary hyperparathyroidism, thrombosis, stroke, pulmonary embolism, deep venous thrombosis

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