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    Tradeoff-in-the-Nephron: A Theory to Explain the Primacy of Phosphate in the Pathogenesis of Secondary Hyperparathyroidism.
    Nutrients 2017 Apr 26;9(5). Epub 2017 Apr 26.
    Research Service, Stratton Veterans' Affairs Medical Center, Albany, NY 12208, USA.
    Chronic kidney disease (CKD) causes secondary hyperparathyroidism (SHPT). The cardinal features of SHPT are persistence of normocalcemia as CKD progresses and dependence of the parathyroid hormone concentration ([PTH]) on phosphate influx (IP). The tradeoff-in-the-nephron hypothesis integrates these features. Read More

    Childhood sustained hypercalcemia: A diagnostic challenge.
    J Clin Res Pediatr Endocrinol 2017 Apr 26. Epub 2017 Apr 26.
    Objective: This study aimed to call attention to hypercalcemia, a rare finding in children, which carries the potential of leading serious complications without proper intervention.

    Methods: Diagnosis, treatment and clinical course of children with sustained hypercalcemia between 2006-2016 were reviewed. Group 1 (PTH-dependent) consisted of patients with high/unsupressed PTH level and Group 2 (PTH-independent) included cases with normal/supressed PTH level. Read More

    The High Calcium, High Phosphorus Rescue Diet Is Not Suitable to Prevent Secondary Hyperparathyroidism in Vitamin D Receptor Deficient Mice.
    Front Physiol 2017 10;8:212. Epub 2017 Apr 10.
    Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-WittenbergHalle, Germany.
    The vitamin D receptor (VDR) knockout (KO) mouse is a common model to unravel novel metabolic functions of vitamin D. It is recommended to feed these mice a high calcium (2%), high phosphorus (1.25%) diet, termed rescue diet (RD) to prevent hypocalcaemia and secondary hyperparathyroidism. Read More

    Parathyroidectomy Decreases Insulin Resistance Index in Patients with Primary Hyperparathyroidism.
    Indian J Surg 2017 Apr 15;79(2):101-105. Epub 2016 Jan 15.
    Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey.
    Primary hyperparathyroidism (PHPT) has been considered a cause of insulin resistance (IR) and impaired glucose metabolism. However, there are conflicting results related with the recovery of insulin resistance in patients with PHPT following curative parathyroidectomy. Our aim is to evaluate the effects of curative parathyroidectomy on IR in patients with PHPT. Read More

    Impact of calcimimetics in surgery of secondary hyperparathyroidism.
    Endocrinol Diabetes Nutr 2017 Jan 19;64(1):59-61. Epub 2017 Jan 19.
    Departamento de Cirugía, Ginecología, Obstetricia y Pediatría, Universidad de Murcia, Murcia, España; Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, España.

    Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism - own experience.
    J Ultrason 2017 Mar 31;17(68):17-22. Epub 2017 Mar 31.
    Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland.
    Background: The imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians.

    Aim: Aim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in own material. Read More

    Early introduction of oral paricalcitol in renal transplant recipients. An open-label randomized study.
    Transpl Int 2017 Apr 24. Epub 2017 Apr 24.
    Department of Surgery, Inflammation Medicine and Transplantation, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    In stable renal transplant recipients with hyperparathyroidism, previous studies have indicated that vitamin D agonist treatment might have anti-proteinuric effects. Animal studies indicate possible anti-fibrotic and anti-inflammatory effects. Early introduction of paricalcitol in de-novo renal transplant recipients might reduce proteinuria and prevent progressive allograft fibrosis. Read More

    Persistent and recurrent hyperparathyroidism.
    Updates Surg 2017 Apr 22. Epub 2017 Apr 22.
    Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France.
    Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. Read More

    Low-grade inflammation and tryptophan-kynurenine pathway activation are associated with adverse cardiac remodeling in primary hyperparathyroidism: the EPATH trial.
    Clin Chem Lab Med 2017 Apr 22. Epub 2017 Apr 22.
    Medical Clinic V (Nephrology, Hypertensiology, Endocrinology), Medical Faculty Mannheim, Ruperto Carola University Heidelberg, Mannheim.
    Background: Primary hyperparathyroidism (pHPT) is associated with low-grade inflammation, left ventricular hypertrophy and increased cardiovascular mortality, but the association between inflammatory markers and parameters of adverse cardiac remodeling is unknown. We investigated the relationship between C-reactive protein (CRP), the essential amino acid tryptophan and its pro-inflammatory derivatives kynurenine and quinolinic acid (QUIN) with echocardiographic parameters.

    Methods: Cross-sectional baseline data from the "Eplerenone in Primary Hyperparathyroidism" trial were analyzed. Read More

    Osteoporosis, bone mineral density and CKD-MBD: treatment considerations.
    J Nephrol 2017 Apr 21. Epub 2017 Apr 21.
    Laboratory of Experimental Nephrology, Renal Division, San Paolo Hospital, DiSS University of Milan, Milan, Italy.
    Osteoporosis and chronic kidney disease (CKD) have both independently important potential impact on bone health. A significant number of patients with CKD stages 3a-5D have been shown to have low bone mineral density (BMD), leading to a strikingly elevated risk of fractures (mainly hip fractures) and higher associated morbidity and mortality. Mechanical properties of bone beyond age and menopausal status are additionally affected by intrinsic uremic factors. Read More

    Maintenance vitamin D3 dosage requirements in Chinese women with post menopausal osteoporosis living in the tropics.
    Asia Pac J Clin Nutr 2017 May;26(3):412-420
    Department of Medicine, University of Malaya, Lembah Pantai,59100 Kuala Lumpur,Malaysia.
    Background And Objectives: Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics. Read More

    Pursuing the second ipsilateral gland during minimally invasive video-assisted parathyroidectomy.
    ANZ J Surg 2017 Apr 21. Epub 2017 Apr 21.
    Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia.
    Background: In patients with primary hyperparathyroidism (PHPT) and preoperative imaging suggesting a solitary parathyroid adenoma (SPA), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT. Unilateral neck exploration (UNE) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. Read More

    Management of mineral and bone disorders in renal transplant recipients.
    Nephrology (Carlton) 2017 Mar;22 Suppl 2:65-69
    Department of Endocrinology, Monash Health, Melbourne, Australia.
    The management of post-transplantation bone disease is a complex problem that remains under-appreciated in clinical practice. In these patients, pre-existing metabolic bone disorder is further impacted by the use of immunosuppressive medications (glucocorticoids and calcineurin-inhibitors), variable post-transplantation renal allograft function and post-transplantation diabetes mellitus. The treatment of post-transplantation bone loss should begin pre-transplantation. Read More

    Parathyroid hormone targets in chronic kidney disease and managing severe hyperparathyroidism.
    Nephrology (Carlton) 2017 Mar;22 Suppl 2:47-50
    Department Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
    Appropriate targets for parathyroid hormone (PTH) in patients with chronic kidney disease (CKD) stages 3-5D are controversial, as are the means by which these targets might be achieved. Secondary hyperparathyroidism is linked to symptoms like bone pain and itch, in addition to less clinically overt issues like bone fragility as well as vascular and soft tissue calcification which may lead to adverse hard endpoints, particularly fracture and death. Recognized therapies for managing a rising PTH include vitamin D analogues, with or without calcimimetic (where available), in addition to management of serum mineral concentrations with diet, binders and dialysis. Read More

    Do the benefits of using calcitriol and other vitamin D receptor activators in patients with chronic kidney disease outweigh the harms?
    Nephrology (Carlton) 2017 Mar;22 Suppl 2:51-56
    Department of Nephrology, Monash Health, Clayton, Victoria, Australia.
    The primary indication for administration of calcitriol or other vitamin D receptor activators (VDRA) in chronic kidney disease (CKD) is secondary hyperparathyroidism (SHPT). Prevention and treatment of SHPT appears important, as imbalances in mineral metabolism are associated with renal osteodystrophy, and higher parathyroid hormone (PTH) levels are associated with increased rates of mortality and morbidity in CKD patients. There is, however, a lack of controlled trial data that show lowering PTH with calcitriol/VDRA equates to improved clinical outcomes. Read More

    Obesity, Bariatric Surgery, and Vitamin D.
    J Clin Densitom 2017 Apr 17. Epub 2017 Apr 17.
    University of Wisconsin Medical School, USA.
    The high prevalence of obesity is a worldwide problem associated with multiple comorbidities, including cardiovascular diseases. Vitamin D deficiency with secondary hyperparathyroidism is common in obese individuals and can be aggravated after bariatric surgery. Moreover, there is no consensus on the optimal supplementation dose of vitamin D in postbariatric surgical patients. Read More

    Parathyroid Diseases and T Cells.
    Curr Osteoporos Rep 2017 Apr 18. Epub 2017 Apr 18.
    Division of Endocrinology and Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, 1305 WMB, Atlanta, GA, 30322, USA.
    Purpose Of Review: This review summarizes studies into the permissive role of T cells in the bone catabolic effects of hyperparathyroidism and parathyroid hormone (PTH).

    Recent Findings: Work in animals combined with recent translational studies in humans now highlight the potent amplificatory action of T cells on PTH-induced bone resorption. Mechanistic animal studies reveal a complex pathway by which PTH exploits natural self-renewal functions of CD4(+) T cells, to drive TNFα production that promotes formation of IL-17A secreting Th17 T cells. Read More

    Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia.
    Clin Exp Nephrol 2017 Apr 18. Epub 2017 Apr 18.
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan.
    Background: Hyperkalemia is prevalent in end-stage renal disease patients, being involved in life-threatening arrhythmias. Although polystyrene sulfonate (PS) is commonly used for the treatment of hyperkalemia, direct comparison of effects between calcium and sodium PS (CPS and SPS) on mineral and bone metabolism has not yet been studied.

    Methods: In a randomized and crossover design, 20 pre-dialysis patients with hyperkalemia (>5 mmol/l) received either oral CPS or SPS therapy for 4 weeks. Read More

    Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease.
    Biomed Res Int 2017 22;2017:3485785. Epub 2017 Mar 22.
    Division of Nephrology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan.
    Prevention of bone fractures is one goal of therapy for patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), as indicated by the Kidney Disease: Improving Global Outcomes guidelines. CKD patients, including those on hemodialysis, are at higher risk for fractures and fracture-related death compared to people with normal kidney function. However, few clinicians focus on this issue as it is very difficult to estimate bone fragility. Read More

    The many guises of primary hyperparathyroidism: An unchanged scenario.
    J Pak Med Assoc 2017 Apr;67(4):580-585
    Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
    Objective: To study the causes, characteristics and outcome of treatment of patients with primary hyperparathyroidism.

    Methods: This retrospective cohort analysis was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with primary hyperparathyroidism between 2004 and 2014. . Read More

    Fibroblast Growth Factor-23 Concentration in Dogs with Chronic Kidney Disease.
    J Vet Intern Med 2017 Apr 17. Epub 2017 Apr 17.
    Veterinary Clinical Sciences, The Ohio State University, Columbus, OH.
    Background: Chronic kidney disease (CKD) is associated with hyperphosphatemia, decreased vitamin D metabolite concentrations, and hyperparathyroidism. This syndrome is known as CKD-mineral bone disorder (CKD-MBD). Recently, it has been shown that an increase in fibroblast growth factor-23 (FGF-23) concentration is an early biomarker of CKD in people. Read More

    Calciphylaxis Presenting with Various Symptoms: A Case Report.
    Case Rep Dermatol 2017 Jan-Apr;9(1):25-29. Epub 2017 Feb 8.
    Department of Dermatology, School of Medicine, Iwate Medical University, Morioka, Japan.
    Calciphylaxis causes ischemia in multiple organs and skin ulcers owing to progressive calcification in small and medial arteries. It has a poor prognosis and often occurs in patients with hyperparathyroidism associated with end-stage renal failure and those undergoing hemodialysis. Here, we present a case of calciphylaxis associated with a wide range of symptoms, including lower thigh skin ulcers, a rectovaginal fistula, and femoral neck fracture. Read More

    Endocrine Comorbidities in Patients with Psoriatic Arthritis: A Population-based Case-controlled Study.
    J Rheumatol 2017 Apr 15. Epub 2017 Apr 15.
    From the Department of Rheumatology, and the Department of Internal Medicine, and the Department of Community Medicine and Epidemiology, Carmel Medical Center; Bruce and Ruth Rappaport Faculty of Medicine Technion, Haifa; Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel. A. Haddad, MD, Department of Rheumatology, Carmel Medical Center; R.I. Ashkenazi, MD, Department of Internal Medicine, Carmel Medical Center; H. Bitterman, MD, Chief Physician's Office, Central Headquarters, Clalit Health Services, and Bruce and Ruth Rappaport Faculty of Medicine Technion; I. Feldhamer, MA, Chief Physician's Office, Central Headquarters, Clalit Health Services; S. Greenberg-Dotan, PhD, Chief Physician's Office, Central Headquarters, Clalit Health Services; I. Lavi, MA, MPH, Department of Community Medicine and Epidemiology, Carmel Medical Center; E. Batat, MBA, Chief Physician's Office, Central Headquarters, Clalit Health Services; I. Bergman, MD, Professor, Department of Internal Medicine, Carmel Medical Center; A.D. Cohen, PhD, MD, MPH, Chief Physician's Office, Central Headquarters, Clalit Health Services, and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev; D. Zisman, MD, Department of Rheumatology, and Department of Community Medicine and Epidemiology, Carmel Medical Center. Dr. Haddad and Dr. Ashkenazi contributed equally to this work. Dr. Cohen and Dr. Zisman contributed equally to this work. Address correspondence to Dr. D. Zisman, Department of Rheumatology, Carmel Medical Center, 7 Michal St., Haifa 34362, Israel. E-mail: Accepted for publication February 21, 2017.
    Objective: To investigate endocrine comorbidities in patients with psoriatic arthritis (PsA).

    Methods: A retrospective, cross-sectional study was performed with the database of Clalit Health Services, the largest healthcare provider in Israel, between 2002 and 2014. Patients with PsA were identified and matched by age and sex to healthy controls. Read More

    Hyperparathyroidism Diagnosed Due to Brown Tumors of the Jaw: A Case Report and Literature Review.
    J Oral Maxillofac Surg 2017 Mar 20. Epub 2017 Mar 20.
    Resident, Oral and Maxillofacial Department, Hospital Universitario La Princesa, Madrid, Spain.
    This report describes the case of a 42-year-old woman who consulted with a maxillofacial specialist for pain and an exophytic lesion in the maxilla. Biopsy examination disclosed a bone cyst with abundant giant cells, and head and neck computed tomography was performed. A diagnosis of brown tumor in the maxilla and mandible was made, and primary hyperparathyroidism (parathyroid adenoma) was determined as the origin of the bone lesions. Read More

    Primary hyperparathyroidism treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA).
    Surg Endosc 2017 Apr 13. Epub 2017 Apr 13.
    Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, 333 Cedar Street, FMB130A, Box 208062, New Haven, CT, 06520, USA.
    Background: Bilateral open cervical exploration with identifying all parathyroid glands and removing one or more enlarged parathyroid tumor(s) was the standard of care in primary hyperparathyroidism (pHPT). With the introduction of preoperative imaging and intraoperative parathyroid hormone (IOPTH) measurements [1, 2], various minimally invasive parathyroidectomy approaches have been developed, both open and endoscopic [3-8]. The most commonly used approach currently in the USA is the minimally invasive open parathyroidectomy (MIP), which can be performed in the ambulatory setting with excellent cure and minimal complication rates [9-12]. Read More

    Relationship between bone turnover and left ventricular function in primary hyperparathyroidism: The EPATH trial.
    PLoS One 2017 13;12(4):e0173799. Epub 2017 Apr 13.
    Department of Cardiology, Medical University of Graz, Graz, Austria.
    Observational studies suggested a link between bone disease and left ventricular (LV) dysfunction that may be pronounced in hyperparathyroid conditions. We therefore aimed to test the hypothesis that circulating markers of bone turnover correlate with LV function in a cohort of patients with primary hyperparathyroidism (pHPT). Cross-sectional data of 155 subjects with pHPT were analyzed who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH) Trial. Read More

    Adynamic bone disease is a predominant bone pattern in early stages of chronic kidney disease.
    J Nephrol 2017 Apr 12. Epub 2017 Apr 12.
    Inserm U-1018, Team 5, Paris-Sud University (UPS) and Versailles Saint-Quentin-en-Yvelines University (Paris-Ile-de-France-Ouest University, UVSQ), Villejuif, France.
    Chronic kidney disease (CKD) is complicated by disturbances of mineral and bone metabolism which start early in the course of the disease. It has long been assumed that high turnover bone lesions induced by secondary hyperparathyroidism are the predominant type of renal osteodystrophy from the start. However, there is increasing evidence in favor of the view that in early CKD stages low bone turnover is prevailing, with adynamic bone disease being the predominant form. Read More

    Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.
    Nephrol Dial Transplant 2017 Apr 10. Epub 2017 Apr 10.
    Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
    Background.: Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. Read More

    Risk Factors for Intraoperative Hypertension during the Surgery of Primary Hyperparathyroidism.
    Med Princ Pract 2017 Apr 10. Epub 2017 Apr 10.
    Objective: To investigate the incidence and to identify risk factors for the occurrence of intraoperative hypertension (IOH) during the surgery of primary hyperparathyroidism (pHPT).

    Subjects And Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. The IOH was defined as an increase in systolic blood pressure ≥ 20% compared to baseline values which lasted for 15 minutes. Read More

    Klotho expression in osteocytes regulates bone metabolism and controls bone formation.
    Kidney Int 2017 Apr 8. Epub 2017 Apr 8.
    Division of Bone and Mineral Research, Harvard School of Dental Medicine, Boston, Massachusetts, USA. Electronic address:
    Osteocytes within the mineralized bone matrix control bone remodeling by regulating osteoblast and osteoclast activity. Osteocytes express the aging suppressor Klotho, but the functional role of this protein in skeletal homeostasis is unknown. Here we identify Klotho expression in osteocytes as a potent regulator of bone formation and bone mass. Read More

    Recurrent Hyperparathyroidism Due to a Novel CDC73 Splice Mutation.
    J Bone Miner Res 2017 Apr 10. Epub 2017 Apr 10.
    Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Department of Pathology, University of Michigan, Ann Arbor MI 48109.
    Context: The recognition of hereditary causes of primary hyperparathyroidism (pHPT) is important as clinical care and surveillance differ significantly between sporadic and hereditary pHPT. In addition, the increasing number of genetic tests poses a challenge to classify mutations as benign or pathogenic. Functional work-up of variants remains a mainstay to provide evidence for pathogenicity. Read More

    Cystic parathyroid adenoma: Primary hyperparathyroidism without (99m)Tc-MIBI uptake.
    Rev Esp Med Nucl Imagen Mol 2017 Apr 6. Epub 2017 Apr 6.
    Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón, Zaragoza, España.
    Cystic parathyroid adenoma is a rare disease (<0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Read More

    Successful treatment of early allograft dysfunction with cinacalcet in a patient with nephrocalcinosis caused by severe hyperparathyroidism: a case report.
    BMC Res Notes 2017 Apr 8;10(1):153. Epub 2017 Apr 8.
    Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Background: Hyperparathyroidism is common in patients undergoing kidney transplantation. Occasionally, this condition can cause early allograft dysfunction by inducing calcium phosphate deposition in the allograft, which results in nephrocalcinosis. Although nephrocalcinosis occurs occasionally in kidney allografts, it has only rarely been reported in the literature. Read More

    Thiazide Treatment in Primary Hyperparathyroidism-A New Indication for an Old Medication?
    J Clin Endocrinol Metab 2017 Apr;102(4):1270-1276
    Institute of Endocrinology, Diabetes and Metabolism, and.
    Context: There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT. Read More

    Klotho preservation via histone deacetylase inhibition attenuates chronic kidney disease-associated bone injury in mice.
    Sci Rep 2017 Apr 7;7:46195. Epub 2017 Apr 7.
    National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
    Bone loss and increased fracture are the devastating outcomes of chronic kidney disease-mineral and bone disorder (CKD-MBD) resulting from Klotho deficit-related mineral disturbance and hyperparathyroidism. Because Klotho down-regulation after renal injury is presumably affected by aberrant histone deacetylase (HDAC) activities, here we assess whether HDAC inhibition prevents Klotho loss and attenuates the CKD-associated bone complication in a mouse model of CKD-MBD. Mice fed adenine-containing diet developed the expected renal damage, a substantial Klotho loss and the deregulated key factors causally affecting bone remodeling, which were accompanied by a marked reduction of bone mineral density. Read More

    Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation.
    J Transplant 2017 13;2017:8720283. Epub 2017 Mar 13.
    Division of Nephrology, Maisonneuve-Rosemont Hospital and the Department of Medicine, University of Montreal, Montreal, QC, Canada.
    Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Read More

    Osteoblast-specific deletion of Hrpt2/Cdc73 results in high bone mass and increased bone turnover.
    Bone 2017 May 3;98:68-78. Epub 2017 Apr 3.
    Program for Skeletal Disease and Tumor Microenvironment, Grand Rapids, MI, USA; Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, MI, USA. Electronic address:
    Inactivating mutations that lead to loss of heterozygosity within the HRPT2/Cdc73 gene are directly linked to the development of primary hyperparathyroidism, parathyroid adenomas, and ossifying fibromas of the jaw (HPT-JT). The protein product of the Cdc73 gene, parafibromin, is a core member of the polymerase-associated factors (PAF) complex, which coordinates epigenetic modifiers and transcriptional machinery to control gene expression. We conditionally deleted Cdc73 within mesenchymal progenitors or within mature osteoblasts and osteocytes to determine the consequences of parafibromin loss within the mesenchymal lineage. Read More

    The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: A 12-month follow-up study.
    PLoS One 2017 6;12(4):e0174811. Epub 2017 Apr 6.
    Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
    Parathyroidectomy (PTX) may cause low levels of PTH, leading to an excessive reduction of bone turnover, which is associated with poor outcomes in dialysis patients, including vascular calcification (VC). We aimed to prospectively investigate the impact of PTX on bone remodeling and its potential consequence on the progression of VC in hemodialysis patients. In this prospective study, 19 hemodialysis patients with severe secondary hyperparathyroidism (sHPT) were evaluated. Read More

    Factors influencing preoperative urinary calcium excretion in primary hyperparathyroidism.
    Clin Endocrinol (Oxf) 2017 Apr 6. Epub 2017 Apr 6.
    Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria.
    Objective: Normal or elevated 24-hour urinary calcium (Ca) excretion is a diagnostic marker in primary hyperparathyroidism (PHPT). It is used to distinguish familial hypocalciuric hypercalcaemia (FHH) from PHPT by calculating the Ca/creatinine clearance ratio (CCCR). The variance of CCCR in patients with PHPT is considerable. Read More

    The medical and surgical treatment in secondary and tertiary hyperparathyroidism. Review.
    Clin Ter 2017 Mar-Apr;168(2):e158-e167
    Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo.
    Introduction: Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism).

    Aims: There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods. Read More

    Water Clear Cell Adenoma of the Parathyroid Gland: A Forgotten Cause of Primary Hyperparathyroidism.
    Int J Surg Pathol 2017 Apr 1:1066896917701577. Epub 2017 Apr 1.
    1 Mount Sinai Medical Center, Miami Beach, FL, USA.
    Water clear cell adenoma of the parathyroid gland is a rare neoplasm composed of large clear cells with foamy cytoplasm and mild nuclear pleomorphism, compressing the residual nonneoplastic parathyroid tissue. The differential diagnosis includes a variety of neoplasms with clear cell features. In this article, we provide an overview of the entity with a historical perspective, in order to help pathologists in distinguishing it from other neoplasms in their daily practice. Read More

    Imaging in Chronic Kidney Disease-Metabolic Bone Disease.
    Semin Dial 2017 Apr 5. Epub 2017 Apr 5.
    Department of Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
    Musculoskeletal manifestations in chronic kidney disease (CKD) are the result of a series of complex alterations in mineral metabolism, which has been defined as chronic kidney disease - mineral and bone-related disorder (CKD-MBD). Biochemical assessment and, at times, bone biopsy remains the mainstay of disease assessment, however, radiological imaging is an important adjunct in evaluating disease severity. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, osteopenia, and extra-skeletal calcifications. Read More

    The Resection of Thyroid Cancer Was Associated with the Resolution of Hyporesponsiveness to an Erythropoiesis-stimulating Agent in a Hemodialysis Patient with Aceruloplasminemia.
    Intern Med 2017 1;56(7):805-810. Epub 2017 Apr 1.
    Department of Medicine, Yaizu City Hospital, Japan.
    We herein report the case of a hemodialysis patient whose response to an erythropoiesis-stimulating agent (ESA) improved following the resection of thyroid cancer. Her hemoglobin level remained below 7 g/dL, despite the use of ESA. During the search for the causes of her hyporesponsiveness to ESA, papillary thyroid cancer and aceruloplasminemia were found. Read More

    A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status.
    Nutr Res 2017 Feb 8;38:13-26. Epub 2016 Dec 8.
    Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT. Electronic address:
    Obesity is a major global health problem and has been associated with vitamin D deficiency. Intentional weight loss may alter vitamin D status and, conversely, vitamin D supplementation has been hypothesized to aid in weight loss. A systematic literature search in PubMed/Medline identified 3173 articles of which 37 studies (randomized controlled trials (RCT) [n=17], non-RCTs [n=20]) are summarized as effect of: (I) diet-induced weight loss on vitamin D status (n=7), (II) vitamin D supplementation on diet-induced weight loss (n=11), (III) surgery-induced weight loss on vitamin D status (n=15), and (IV) vitamin D supplementation after surgery-induced weight loss on vitamin D status (n=5). Read More

    Serum 25-Hydroxyvitamin D Insufficiency in Search of a Bone Disease.
    J Clin Endocrinol Metab 2017 Mar 30. Epub 2017 Mar 30.
    Department of Endocrinology, Austin Health, University of Melbourne.
    Introduction: Vitamin D 'insufficiency' and 'deficiency' are defined as a serum 25-hydroxyvitamin D (25(OH)D) below 75 and 30 nmol/L respectively. We aimed to determine whether these values signal hypocalcaemia and hypophosphatemia, secondary hyperparathyroidism, high bone remodeling, low areal bone mineral density (aBMD), microstructural deterioration, or reduced matric mineralization density (MMD), and so suggest whether bone fragility is present.

    Method: Concentrations of 25(OH)D, calcium, phosphate, creatinine and parathyroid hormone (PTH) were measured in 11,855 subjects. Read More

    Secondary Hyperparthyroidism: Pathogenesis, Diagnosis, Preventive and Therapeutic Strategies.
    Rev Endocr Metab Disord 2017 Mar;18(1):79-95
    Laboratory of Nephrology, IIS Fundación Jiménez Díaz, REDinREN, Madrid, Spain.
    Uremic secondary hyperparathyroidism is a multifactorial and complex disease often present in advanced stages of chronic kidney disease. The accumulation of phosphate, the increased FGF23 levels, the reduction in active vitamin D production, and the tendency to hypocalcemia are persistent stimuli for the development and progression of parathyroid hyperplasia with increased secretion of PTH. Parathyroid proliferation may become nodular mainly in cases of advanced hyperparathyroidism. Read More

    Resurgence of parathyroidectomy: evidence and outcomes.
    Curr Opin Nephrol Hypertens 2017 Apr 1. Epub 2017 Apr 1.
    aDivision of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine bThe Institute of Medical Sciences, Tokai University cDepartment of Transplant Surgery, Tokai University School of Medicine, Isehara, Japan.
    Purpose Of Review: Parathyroidectomy (PTx) is the definitive therapy for refractory secondary hyperparathyroidism (SHPT). The drastic effects of PTx on biochemical parameters of SHPT increases the possibility that this intervention will lead to a reduction in the adverse outcomes related to uncontrolled SHPT.

    Recent Findings: The effect of PTx on mortality and cardiovascular outcomes among dialysis patients with severe SHPT have been evaluated in many observational studies from different regions of the world, including Asia, Europe, North America, and South America. Read More

    Hungry bone syndrome.
    Curr Opin Nephrol Hypertens 2017 Apr 1. Epub 2017 Apr 1.
    aDivision of Nephrology, University of Arkansas for Medical Sciences bCentral Arkansas Veterans Affairs Healthcare System, Little Rock, Arkansas cOffice of Education, Central Alabama Veterans Healthcare System, Montgomery, Alabama, USA.
    Purpose Of Review: In the United States, the number of parathyroidectomies among patients with chronic dialysis has remained stable in the last decade. A fall in serum calcium concentration is common postparathyroidectomy in patients with hyperparathyroidism, which usually resolves in 2-4 days. A severe drop in serum total calcium concentration less than 2. Read More

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