Parathyroid Gland Disorders

MDNG Endocrinology, November 2010, Volume 12, Issue 8

//Medical Websites

Thyroid and Paraythroid Cancers

The 12th edition of Cancer Management: A Multidisciplinary Approach is available free-of-charge to registered members of CancerNetwork.com (registration is also free). Authored by Mimi I. Hu, MD, Peter Ahn, MD , and Jeffrey P. Lamont, MD, this 11-page work covers tumor types (eg, anaplastic carcinoma, follicular thyroid carcinoma), epidemiology, etiology and risk factors, signs and symptoms, imaging modalities, genetic testing, staging and prognosis, and more.

Practice Guideline for Thyroid and Parathyroid Ultrasound

This guideline from the American Institute of Ultrasound in Medicine is short and direct. In three pages, the authors cover indications for ultrasound examination, qualifiations and responsibilities of personnel, the written request for the examination, specifications of the examination, producing adequate documentation, equipment specifications, quality control and improvement, and safety, infection, and patient education concerns.

Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

Produced jointly by the American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association, this set of guidelines utilizes the “AACE protocol for standardized production of clinical practice guidelines…to rate the evidence level of each reference (on a scale of 1 to 4) and to link the guidelines to the strength of recommendations on the basis of grade designations A (action based on strong evidence) through D (action not based on any evidence of not recommended). Among other topics, the authors discuss, diagnostic imaging studies, thyroid biopsy, radionuclide scanning, and pregnancy and childhood.

Diseases of Bone and Calcium Metabolism

Edited by Frederick Singer, MD, Director of the Endocrine/Bone Disease Program at the John Wayne Cancer Institute, Diseases of Bone and Calcium Metabolism is available free-of-charge at EndoText.org. Chapters 5, 6, and 9 cover Primary Hyperparathyroidism, Hyperparathyroidism in Renal Failure, and Hypoparathyroidism and Psuedohypoparathyroidism.

//The Educated PatientTM

Overactivity of the Parathyroid Gland

This guide from EndocrineWeb covers the basics of hyperparathyroidism (What Causes Excess Hormone Production?, How Many Parathyroids Are Affected?, Symptoms of Hyperparathyroidism, Potential Dangers of Hyperparathyroidism) and should be a good place for your patients to start their education about the disorder.

Secondary Hyperparathyroidism

This Medline primer, last updated Robert Cooper, MD, Endocinology Specialist and Chief of Medicine at Holyoke Medical Center, explains the causes and symptoms of, and treatment, tests, exams, and outlook for secondary hyperparathyroidism.

Hypothyroidism UK

This brand new page was “produced by HPTH UK and the HPTH UK Clinical Advisory Team working in conjunction with the Society for Endocrinology” and features a Patient Information Leaflet on hypoparathyroidism that you can distribute in your office. It covers all the basics, however, one cause for concern is the mention of brand name drugs such as Calcichew that are not available in the United States; some quick edits to the document can fix that, though.

//Online CME

Biopsying the Thyroid, Parathyroid, and Cervical Lymph Nodes: How to Do It

Credits: 1.50

Fee: $95.00 (member); $190.00 (non-member)

Expiration Date: December 31, 2013

Multimedia:Video

This program from the American Institute of Ultrasound Medicine “discusses the number of fine-needle aspirations that are optimal versus the size of the needle used as well as other controversies in the technique, with an emphasis on complications and pitfalls to avoid.” Purchase of the activity comes with five test and evaluation forms, “allow[ing] you and up to 4 colleagues to earn CME credit at no addition charge.”

Advances in Thyroid and Parathyroid Surgery

Credits: 5.75

Fee: $35.00

Expiration Date: September 20, 2012

Multimedia: Video/Slides

This activity comprises five presentations: ATA Guidelines for Workup of Thyroid Nodule; FNA Cytopathology — Bethesda System for Reporting; Preoperative Considerations for Thyroid Surgery; Avoiding Surgical Complications in Thyroid Surgery; and Reoperative Thyroid Surgery for Malignancy. Each addresses specific controversies regarding “recommendations for the diagnosis and treatment” of thyroid and parathyroid tumors that have arisen due to advances “in diagnostic modalities and treatment options for thyroid cancer.”

Parathyroid Carcinoma: Current Understanding and New Insights into Gene Expression and Intraoperative Parathyroid Hormone Kinetics

Credits: 1.00

Fee: None

Expiration Date: January 29, 2012

Multimedia: None

After reading the article from which this activity derives its name, participants will take a nine-question quiz to obtain credit for this activity.

//Video

Minimally Invasive Parathyroid Surgery

Tampa General Hospital has archived the broadcast of this parathyroid surgery on its ORLive.com channel. Visitors can also view seven “Physician Insight” videos in which James Norman, MD, FACS, FACE, the physician performing the procedure, discusses minimally invasive surgery compared to old-style operations, detecting a parathyroid tumor, diagnosis, patient symptoms, and more.

Parathyroid.TV

Run jointly by Parathyroid.com and the National Parathyroid Education Foundation, Parathyroid.TV features three types of video: Featured Flicks (“3-10 minute videos with detailed information on many subjects”), Quick Flicks (“short 1-3 minute videos about very specific areas”), and Patient Flicks (“video stories uploaded by patients about their experience with high calcium, being diagnosed, and cured). The bulk of the site content can be found under Featured Flicks (16 videos focusing on such topics as hypercalcemia and sestamibi scans). Quick Flicks and Patient Flicks house a combined total of one video.

//eAbstracts

Chasing “Shadows”: Discovering the Subtleties of Sestamibi Scans to Facilitate Minimally Invasive Parathyroidectomy

Journal: World Journal of Surgery (October 1, 2009)

Authors: Neychev V, Kouniavsky G, Shiue Z, et al

Purpose: Though sestamibi scans are now “considered the standard of care for patients with primary hyperthyroidism,” preoperative imaging “can be negative more than 20% of the time.” Because of this, researchers “chose to examine one surgeon’s experience with patients who presented with primary hyperparathyroidism and negative or indeterminate preoperative imaging from July 1993 to September 2009.”

Results: “A total of 126 patients had a negative or indeterminate sestamibi scan and a negative or no US report,” and “each sestamibi scan had been re-reviewed preoperatively by the surgeon with a nuclear medicine physician.” Researchers found that “with careful preoperative re-review of a negative or indeterminate sestamibi scan and the identification of subtleties in patients with a negative preoperative US scan, a successful MIP can be performed 91% of the time with a 98% cure rate.”

Effects of Smoking on Severity of Disease in Primary Hyperparathyroidism

Journal: Calcified Tissue International (September 23, 2010)

Authors: Amstrup A, Rejnmark L, Vestergaard P, et al

Purpose: Though “smoking is associated with lower plasma levels of parathyroid hormone (PTH) and decreased bone mineral density (BMD),” its effects on “PTH, skeletal metabolism, and size/histology of the parathyroid glands in primary hyperparathyroidism (PHPT) is unknown.” Investigators pursued this by examining “removed parathyroid tissue” in 344 subjects, 24% of whom were smokers.

Results: “After adjustment for body weight, age, sex, and 25OHD levels, smokers had slightly lower BMD at the whole body but not at the spine, hip, or forearm,” while “surgical cure caused a significant increase in BMD at all measurement sites” independent of smoking status. “In contrast to healthy subjects, smoking seems not to decrease BMD in PHPT. Smoking may compromise the correct diagnostic evaluation of borderline hyperparathyroidism. It is unknown to what extent smoking in PHPT affects fracture risk and indication for surgery.”

Pharma Focus

Sensipar (cinacalcet)

//Clinical Trials

Efficacy and Safety Study of Cinacalcet for the Treatment of Hypercalcemia in Subjects with PHPT Unable to Undergo Parathyroidectomy

Study Type:Interventional

Age/Gender Requirements:18 years (male/female)

Sponsor:Amgen

Purpose:Researchers will be comparing cinacalcet HCl to placebo in order to determine “the efficacy of cinacalcet for normalizing serum calcium” and “reducing corrected total serum calcium and plasma PTH levels.

Evaluation of the Effectiveness of Paricalcitol Versus Cinacalcet With Low-Dose Vitamin D

Study Type:Interventional

Age/Gender Requirements:18 years (male/female)

Sponsor:Abbot

Purpose:Participants will receive paricalcitol or cinacalcet with low dose vitamin D therapy over a 28-week period in order to determine “the proportion of subjects that achieve a mean iPTH value between 150 to 300 pg/mL in Weeks 21 to 28” and those “achieving at least 30% reduction from baseline in iPTH as assessed by the mean iPTH obtained in Weeks 21 to 28.”

Cinacalcet Effectively Reduces Parathyroid Hormone Secretion and Gland Volume Regardless of Pretreatment Gland Size in Patients with Secondary Hyperparathyroidism

Journal: Clinical Journal of the American Society of Nephrology(August 26, 2010)

Authors: Komaba H, Nakanishi S, Fujimori A, et al

Purpose: Though “cinacalcet is effective in reducingserum parathyroid hormone in patients with secondary hyperparathyroidism…it has not been proven whether parathyroid gland sizepredicts response to therapy and whether cinacalcet is capableof inducing a reduction in parathyroid volume.”

Results: Over 52 weeks, researchers administered doses of cinacalcet, “adjusted between 25 and 100 mg to achieve intact PTH <180pg/ml,” to “patients with moderate to severe secondary hyperparathyroidism.” Parathyroid gland size was measured via ultrasound at baseline, week 26, and week 52. Compared to historical controls, “where parathyroid glandvolume progressively increased with traditional therapy alone,” cinacalcet therapy significantly reduced “parathyroidgland volume regardless of pretreatment size.” Intact PTH decreased by a similar amount in patients with parathyroid glands smaller and larger than 500 mm3.