Press release
Hyperparathyroidism, when the glands “subtract” calcium from the bones
For the first time in Italy The International Workshop on primitive hyperparathyroidism.
The parathyroid hormone, or parathormone (PTH), helps control the concentration of calcium in the blood. An excessive production accelerates bone reabsorption, weakening the mineral structure of the skeleton.
Treatment of hyperparathyroidism is still surgical and it is essential to establish just when to perform surgery.
The leading world experts met in Florence from 19 to 21 September to update the international guidelines on hyperparathyroidism and the parameters that indicate the times for surgical treatment.
Florence, 19 September 2013 - Surgery is still the solution for hyperparathyroidism today. However it is essential for the specialist to know how to assess the patient's condition in order to establish just when to operate. This was the main topic of the IV International Workshop on the Management of Primitive Hyperparathyroidism, organised by the University of Florence, the Columbia University of New York and the Harvard Medical School of Boston in the US, and the Fondazione Internazionale Menarini.
This is the first time the workshop has been held outside the USA. In fact, the first two consensuses were held in the National Institute of Health at Bethesda and the most recent, five years ago, in Orlando, Florida. This is evident recognition of the role that the University of Florence plays in promoting education and clinical practice in the field of parathyroid diseases, and above all, the international influence of the Centre directed by Professor Brandi, which is totally dedicated to parathyroid cancer, with particular emphasis on hereditary forms. The Centre had been operating for twenty years and is an important example in Italy.
At this meeting of the top world experts, led by Maria Luisa Brandi (Milan), John P. Bilezikian (New York) and John T. Potts, Jr. (Boston), new guidelines were drawn up, the most recent updating of which was in 2008. There are at least seven congenital syndromes characterised by hyperparathyroidism, and management of the patient must be entrusted to experts and based on shared intervention by specialists. Precisely for this reason, the new guidelines produced during this congress represent an important reference for all endocrinologists worldwide in the management of such a significant endocrine disorder as primitive hyperparathyroidism.
The parathyroid glands are four small endocrine glands located in the neck, near the thyroid. Their function is to secrete the parathyroid hormone, or parathormone (PTH), which helps control the concentration of calcium in the blood.
The parathormone plays a crucial role in the transmission of nerve signals in muscle contraction, blood coagulation and the functioning of several hormones and enzymes. For this reason its blood concentrations must remain relatively constant.
In normal conditions, the calcaemia, that is, the level of calcium in the blood, is maintained within narrow values ranging between 8.5 and 10.5 mg per decilitre of blood. Hyperparathyroidism causes a pathological increase of the synthesis of parathormone, with a consequent increase in the calcaemia, which gives rise to serious functional alterations of the muscles, with a reduction in the excitability of muscles and nerves, as well as nausea, vomiting, constipation and depression.
In addition, in case of hyperparathyroidism, the parathormone accelerates bone reabsorption, weakening its mineral structure. As a result, the skeleton appears more fragile and susceptible to spontaneous fractures and deformations. The kidneys are also damaged since the increased urinary excretion of calcium and phosphate induces the onset of kidney stones.
''Frequently however, subjects with hyperparathyroidism are asymptomatic and in the past numerous cases went undiagnosed because the key analysis, calcaemia, was not often carried out", explained Maria Luisa Brandi, professor of endocrinology at the University of Florence and co-president of the congress. Gradually, as more tests were conducted, we realized that hyperparathyroidism is a common disorder which is not always accompanied by bone damage, kidney stones or psychic disorders, and can also be asymptomatic. For this reason, the family doctor should pay greater attention to this disease. And in view of the fact that after menopause one women in five has parathyroid problems (twice as many as men), an analysis of the calcaemia should be conducted once a year. In fact, people over this age are at risk of a vitamin D deficiency due to lack of exposure to sunlight, and a reduced capacity by the body to synthesise vitamin D '' continued Prof. Brandi. ''Other conditions that may also favour hyperparathyroidism include insufficient intake of dairy products, digestive deficit due to pancreatic or biliary insufficiency, and the malabsorption syndrome, as occurs in celiac patients and those suffering from chronic intestinal disorders like Crohn's disease and ulcerative colitis. There are also pharmacological causes of hyperparathyroidism. One treatment that may favour the onset of this disease is that with cortisones due to a deficit in transporting calcium in the intestine. And depression, that is sometimes a symptom of hyperparathyroidism, can be treated with lithium, a metal which in turn can increase hyperparathyroidism, so much so that specialists recommend that patients undergo a calcaemia test and basic blood analyses if taking lithium. To conduct this test it is sufficient to take a blood sample from the vein in the arm''.
Treatment of hyperparathyroidism is still surgicaland for the endocrinologist the real challenge is primitive hyperparathyroidism, which may already be present in childhood and often goes undiagnosed due to being asymptomatic or confused with other disorders. "In these cases it is essential to evaluate the parameters in order to decide whether to operate or to wait. In adults hyperparathyroidism is often caused by an adenoma, that is, a benign tumour that affects one of the four parathyroid glands and in this case surgery is obligatory. The situation regarding an asymptomatic child is different however: various studies in literature report diagnostic delays varying from 2 to 5 years and since the extent of bone damage depends on the severity and duration of hypercalcaemia, a timely diagnosis is fundamental'', added Brandi.
In any case before planning surgery, the physician must evaluate the following together with an expert surgeon:
- Bone mineral density;
- Presence of calcium in the urine;
- CBM (bone density);
- Previous bone fractures due to fragility;
- Calcaemia (calcium in the blood);
- Calciuria (calcium in the kidneys);
- Previous episodes of kidney stones.
Following surgery, the parathyroid glands are stimulated to restore normal functioning with a vitamin D and calcium-based treatment. The quantity of these substances must be carefully calculated and modulated over time and consequently the patient must be assisted by an expert endocrinologist. It is therefore recommended to refer to an endocrinology centre.