Clinical Manifestations of Primary Hyperparathyroidism (PHPT)

• Despite what most of the literature reports:PHPT is symptomatic in more than 95% of the cases:If proper attention is payed to the subtle symptoms and signs that this disease can produce due to the fluctuating calcium levels.
• The “classic”pentad of PHPT:Kidney stonesPainful bonesAbdominal groansPsychic moansFatigue overtones The “classic”pentad of PHPT is rarely seen today since the advent and general use of automated blood analyzers in the early 1970s.

• Today most patients present with:Fatigue (# 1 symptom)General malaiseDecrease levels of energyAnxietyIrritability leading to decrease social interactionDepression (10% of cases)
  • Memory loss
  • Decrease concentration
  • Decrease ability to learn new things
  • Decrease ability to complete daily tasks at home
  • Decrease ability to complete daily tasks at work
  • Decrease social interaction
  • Insomnia
  • Arthralgia’s (32% of the cases)
  • Myalgia’s (14% to 41% of the cases)
  • Bone pain
  • Muscle weakness (specially proximal muscle groups)
  • Intermittent headaches
  • Polydipsia
  • Polyuria
  • Nocturia
  • Nausea (24% of the cases)
  • Anorexia (15% of the cases)
  • Non-specific abdominal pain
  • Heartburn (30% of the cases)  
  • Constipation (33% of the cases)
  • Palpitations
  • Arrhythmias (usually atrial fibrillation)
  • Elevated blood pressure
  • Thinning of the hair (specially in women in the frontal region)
  • Pruritus

• Patients with PHPT also tend to score lower than healthy controls when evaluated by general multidimensional health assessment tools such as the Medical Outcomes Study Short-Form Health Survey(SF-36) and other specific questionnaires.
• PHPT that is truly “asymptomatic” is a rare occurrence:Seen in less than five percent of patients:This is important when talking about management based on current guidelines.
• Patients with PHPT have some degree of renal dysfunction or symptoms:In approximately 80% of the cases:The renal manifestations implicated with PHPT are:Decreased glomerular filtration rate
  • • • Hypercalciuria
      • Nephrolithiasis:Nephrolithiasis was previously reported in approximately 40% to 80% of patients but now occur only in about 20% to 25% of the cases:The pathophysiology is thought to be related to the filtered load of calcium in the glomerulus that increases proportionately with the degree of hypercalcaemia.
        • • Most renal stones in patients with PHPT are composed of calcium oxalate, although slightly alkaline urine may favor the precipitation of calcium phosphate stones:Stone formers are more likely to be hypercalciuric, but less than one-third of the hypercalciuric patients with PHPT actually develop renal stones Hypercalciuria is not a predictor of nephrolithiasis in patients with PHPT and is no longer considered as an indication for surgery
      • Nephrocalcinosis
      • Impaired urinary concentrating ability sometimes leading to polyuria, polydipsia, and nocturia
      • Reduced fractional phosphate reabsorption leading to hypophosphatemia
      • Increased urinary exertion of magnesium

      •  

Rodrigo Arrangoiz MS, MD, FACS, FSSO cirujano de tumores de cabeza y cuello / cirugía endocrina / cirugía oncológica miembro de Center for Advanced Surgical Oncology (CASO) experto en el manejo del hiperparatiroidismo:

• Rodrigo Arrangoiz MS, MD, FACS, FSSO es miembro de la American Thyroid Association:

Publicaciones sobre el hiperparatiroidismo del miembro de CASO Rodrigo Arrangoiz MS, MD, FACS, FSSO experto en cirugía endocrina:

 

Entrenamiento:

• Cirugia general y gastrointestinal:

• Michigan State University: 2004- 2010

 

• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Maestria en ciencias (Clinical research for healthprofessionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Cirugia de tumores de cabeza y cuello / cirugiaendocrina

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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