Navegando por Palavras-chave "Hiperparatiroidismo primário"
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- ItemAcesso aberto (Open Access)Avaliação da relevância clínica e densitométrica das medidas de 25 hidroxivitamina D (25OHD) biodisponível e livre em população com hiperparatiroidismo primário e em controles antes e após a suplementação com colecalciferol(Universidade Federal de São Paulo, 2021-12-15) Santos, Lívia Marcela dos [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Vieira, José Gilberto Henriques [UNIFESP]; http://lattes.cnpq.br/3960356411666309; http://lattes.cnpq.br/8253870907570489; http://lattes.cnpq.br/2305144569495023Introdução: O hiperparatireoidismo primário (HPP) está associado à hipovitaminose D, apesar disso a maioria das publicações avalia apenas a 25OHD total. Objetivo: O objetivo principal desse projeto é avaliar os níveis de 25OHD biodisponível e livre em pacientes com HPP e indivíduos sem HPP (CTRL), antes e após a suplementação com vitamina D3 14.000 UI (unidades internacionais) por semana por 12 semanas. Métodos: Foram incluídos 70 indivíduos com HPP e 73 controles, desses 64 HPP e 63 CTRL realizaram a densitometria óssea e Trabecular Bone Score (TBS). Os indivíduos que cumpriram o protocolo foram 56 HPP e 63 CTRL. Foram avaliados pré e pós suplementação com vitamina D3 os níveis séricos de 25OHD total, proteína de ligação da vitamina D (DBP), paratormônio (PTH), cálcio total e marcadores de remodelação óssea. Além disso, a 25OHD biodisponível e livre, foram calculadas através da fórmula que utiliza a concentração de albumina, a concentração da DBP e a constante de afinidade que cada genótipo da DBP tem com a 25OHD determinada pelo SNP (1f-1f, 1f-1s, 1s-1s, 1f-2, 1s-2, 2-2), pré e pós uso de vitamina D3. Resultados: Não houve diferença significativa entre os grupos na idade, no gênero e IMC. O grupo HPP apresentou mais nefrolítiase, osteoporose e uso de bisfosfonato. Na pré suplementação, os níveis de 25OHD total, biodisponível e livre não diferiram entre os HPP (22.1 ± 6.4 ng/mL, 1.39 ng/mL e 3.5 pg/mL) e os CTRL (20.7 ± 6.7 ng/mL, 1.18 ng/mL e 3.0 pg/mL), respectivamente. A fratura vertebral por fragilidade foi melhor diagnosticada pelo TBS, comparado a todos os sítios densitometricos. Os níveis de 25OHD total, biodisponível e livre se correlacionaram positivamente com TBS (r= 0.42, p<0.01; r=0.43, p=<0.01; r=0.42, <0.01) nos CTRL, mas não houve a mesma correlação nos HPP (r= 0.28, p<0.05; r=0.14, p=0.28; r=0.18, p=0.30). A distribuição dos haplótipos da DBP foi semelhante nos grupos. Após a suplementação com vitamina D3 houve elevação da 25OHD total, biodisponível e livre, em ambos os grupos. No grupo HPP não houve diferença no cálcio sérico e urinário pré e pós suplementação. O grupo CTRL teve uma elevação maior de 25OHD total comparado ao HPP. Apenas no grupo CTRL teve queda significativa do PTH. Conclusões: Concluímos que a reposição da vitamina D3 na dose de 14.000 UI semanais por 12 semanas foi segura e eficaz nos grupos analisados de pacientes com HPP. Não houve vantagem adicionais em dosar as formas livre e biodisponível em HPP comparada a 25OHD total em HPP e CTRL analisados nesse trabalho.
- ItemAcesso aberto (Open Access)Carcinoma de paratiróide(Sociedade Brasileira de Endocrinologia e Metabologia, 2005-10-01) Vieira, José Gilberto H. [UNIFESP]; Ohe, Monique Nakayama [UNIFESP]; Hauache, Omar M.; Oliveira, Ulisses Maia de [UNIFESP]; Delana, Janaina Martins [UNIFESP]; Gonçalves, André [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto FleuryParathyroid carcinoma is a rare condition, comprising less than 1% of the cases of primary hyperparathyroidism (PHP). Nonetheless, due to its aggressiveness, and having prognosis dependent on the precocity of diagnosis and radical therapeutic approach, it is paramount that the clinical suspicion be made before surgery. Clinical presentation is typical of severe PHP, with a parathyroid tumor >1.5cm, usually palpable. The pathologic features sometimes are difficult to characterize. Our experience with this condition (from 1983 to 2004) includes 7 cases, all symptomatic, hypercalcemic syndrome and bone disease present in most of them. In 6/7 the tumor was palpable, and in all the biochemical profile was compatible with severe PHP. Three patients died of complications of hypercalcemia. Recent findings point to a mutation on the gene HRPT2 as the molecular base for the development of this kind of tumor. The therapeutic approach is surgical and should include ipsilateral thyroidectomy and cervical exploration in order to find possible local metastasis. Post-surgical complications (mainly hypocalcemia) are proportional to the pre-existing metabolic alterations. The long-term prognosis depends upon the precocity of diagnosis, surgical success and control of hypercalcemia. New therapeutic approaches, based on bisphosphonates and calcimimetic drugs, as well as the possibility of genetic diagnosis, tend to ameliorate the prognosis of this severe affection.
- ItemAcesso aberto (Open Access)Carcinoma de paratiróide: características clínicas e anátomo-patológicas de cinco casos(Sociedade Brasileira de Endocrinologia e Metabologia, 2001-04-01) Morimitsu, Lilian K. [UNIFESP]; Uyeno, Monique N.o. [UNIFESP]; Goulart, Marcio L. [UNIFESP]; Hauache, Omar M. [UNIFESP]; Vieira, José Gilberto H. [UNIFESP]; Alberti, Vânia N. [UNIFESP]; Abrahão, Márcio [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Parathyroid carcinoma is a rare disease, with about 535 cases reported in the literature until now. In this paper, we reviewed 5 cases of parathyroid carcinoma followed at Universidade Federal de São Paulo (UNIFESP) from 1983 to 1998, and discuss aspects of clinical presentation, diagnosis and treatment. Four patients were female and 1 male, with median ages of 52 years (10 to 77 years). Initial clinical complains were bone pain and weight loss in 4 patients, traumatic fracture in 2, and fracture without trauma in 3. Kidney stone was present in 1 patient. All had a palpable mass in the cervical region and presented with high calcium levels: 14.9±1.7mg/dL (mean±SD). Parathyroid hormone (PTH) levels were extremely high, showing the severity of the disease. All patients had surgical exploration where a tumor mass was recognized and removed. Pathologic examination demonstrated parathyroid carcinoma in all. On follow-up, 2 patients had recurrence and died due to complications of hyperparathyroidism. To date, the other 3 patients have no evidences of recurrence.
- ItemAcesso aberto (Open Access)Diagnóstico Laboratorial do Hiperparatiroidismo Primário(Sociedade Brasileira de Endocrinologia e Metabologia, 2002-02-01) Hauache, Omar M. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fleury - Centro de Medicina DiagnósticaPrimary hyperparathyroidism (PHP) is a frequent endocrinopathy. Increased serum calcium levels may be considered as a potential marker for parathyroid autonomy and this explains why PHP should be routinely investigated in whoever presents with hypercalcemia. High or inappropriately normal PTH levels in the presence of hypercalcemia are very suggestive of PHP. On the other hand, PHP is very unlikely in the absence of hypercalcemia. Extracellular calcium concentrations may be evaluated by the measurement of total or ionized calcium, but the serum protein levels do not affect ionized calcium level. Regarding PTH, the current methods available detect the intact molecule of PTH (immunoradiometric and immunochemiluminescent assays), including PTH 1-84 and 7-84. Recently, assays that only detect the so-called bioactive PTH (1-84 PTH) are available. PTH levels are undetectable in humoral hypercalcemia of malignancy. In short, measuring serum calcium and PTH should be enough for the diagnosis of PHP. To further evaluate a patient with PHP and its potential bone and renal complications, one can order other exams such as evaluation of renal function, daily urinary calcium excretion, renal ultrassonography and bone densitometry. These exams may be useful to help the physician decide whether surgery should be indicated or not.
- ItemAcesso aberto (Open Access)Utilidade da medida de PTH intra-operatório no tratamento cirúrgico do hiperparatiroidismo primário e secundário: análise de 109 casos(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-10-01) Ohe, Monique Nakayama [UNIFESP]; Santos, Rodrigo Oliveira [UNIFESP]; Kunii, Ilda Shizue [UNIFESP]; Abrahão, Márcio [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Carvalho, Aluizio Barbosa de [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Vieira, José Gilberto H. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Intraoperative parathyroid hormone measurement (IO-PTH) was first described in 1988 and it's potentially useful in predicting cure after parathyroidectomy. The aim of this study was to evaluate IO-PTH decay profile and the utility of this procedure in predicting cure in primary (PHH) and secondary (SHH) hyperparathyroidism due to renal disease. PATIENTS AND METHODS: 109 patients were evaluated from 06/2000 to 12/2004. 33 had PHH and 76 SHH (52 in dialysis, 24 with renal graft). IO-PTH was measured at times 0 (before resection), 10, 20 minutes after parathyroidectomy using immunometric assay (Elecsys-PTH/Immunoassay-Roche). Time necessary to perform assay: 10 minutes. RESULTS: HPP patients: IO-PTH average decrease 79.2% from basal levels after 10 minutes. HPS: IO-PTH average decrease 85.8% and 87.6% after 10 minutes in dialysis and renal graft patients respectively. All patients were cured, except 2 (1 PHH, 1 SHH), because of a double adenoma and ectopic (mediastinal) parathyroid respectively. Failure in IO-PTH decrease was observed in both. CONCLUSION: IO-PTH measurement is useful in improving surgical success rates in PHH and SHH.