Secondary hyperparathyroidism and vascular calcification are major clinical states in CKD-MBD (chronic kidney disease-mineral and bone disorder) . Recently fibroblast growth factor 23-klotho axis has been shown to be implicated in the pathogenesis of secondary hyperparathyroidism. Vascular calcification has been identified to be a highly regulated process. Novel therapeutic agents for CKD-MBD have been developed. The guidelines of CKD-MBD have been announced from many countries including Japan from the point of view of patient's survival, and it is expected that the development of practice for CKD-MBD will contribute to better survival.
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How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience.
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The standardization of preoperative imaging in primary hyperparathyroidism is one of the current challenges of endocrine surgery. A correct localization of the hypersecretory gland by neck ultrasound and 99mTc-sestamibi (MIBI) scintigraphy are not sufficiently sensitive in some cases. In recent years, CT-4D, 18F-Fluorocholine PET/CT, and radio-guided parathyroidectomy have come into common use.
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Department of Endocrinology Diabetes Nutrition, Hôpital Robert-Debré, CHU de Reims, F-51100 Reims, France. Electronic address:
Persistent primary hyperparathyroidism is defined as the persistence or recurrence of hypercalcemia within 6 months of parathyroid surgery. Recurrent primary hyperparathyroidism is defined as the recurrence of primary hyperparathyroidism more than 6 months after an initially curative parathyroidectomy. In these situations, it is essential to rule out differential diagnoses, and in particular secondary hyperparathyroidism and familial hypocalciuric hypercalcemia.
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Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery, University of Lorraine, CHU Nancy-Hospital Brabois Adultes, Nancy, France.
This consensus on primary hyperparathyroidism, drawn up under the aegises of the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN), provides an update on positive, etiological and differential diagnosis and treatment in primary hyperparathyroidism. These recommendations take account of recent increase in the prevalence of primary hyperparathyroidism, due to 1. more systematic routine measurement of blood calcium and improved quality of parathyroid hormone assays, 2.
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