Chapter 11: TREATMENT MODALITIES.

Treatment modalities for primary hyperparathyroidism must take account of the expected benefits and risks of each treatment envisaged, before choosing the definitive option to be proposed to the patient. In this section, a Foreword puts in perspective the difficulties involved in choosing the criteria for a particular treatment method. Treatments are then considered one after the other: surgery, local destruction and medical management.

Chapter 0: Introduction to the Consensus on Primary Hyperparathyroidism from the French Society of Endocrinology, French Association of Endocrine Surgery and French Society of Nuclear Medicine.

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.

Chapter 13: 2022 WHO CLASSIFICATION OF PARATHYROID TUMORS.

The latest 2022 WHO classification of the parathyroid tumors incorporates recent data on parathyroid pathophysiology, in particular from genetic sequencing. It highlights histological features potentially indicative of underlying genetic abnormalities, because of their implications for patient management. Immunohistochemical markers can help characterize parathyroid lesions and molecular screening.

Chapter 10: WHAT PARATHYROID IMAGING IS REQUIRED FOR HYPERPARATHYROIDISM?

In over 80% of cases, primary hyperparathyroidism results from hypersecretion of PTH by a single parathyroid adenoma. Multi-glandular involvement, combining adenoma and/or hyperplasia in varying proportions, is also possible, although less frequent. When the diagnosis of hyperparathyroidism is certain and surgery is envisaged, imaging is useful for locating the hyperfunctioning gland or glands.

Chapter 7: CLINICAL FORMS AT DIFFERENT AGES OF LIFE: CHILDHOOD, PREGNANCY, LACTATION, OLD AGE.

Primary hyperparathyroidism is rare in children. A germline mutation is identified in half of all children with primary hyperparathyroidism (70% of newborns and infants, and 40% of children and adolescents). The clinical manifestations of primary hyperparathyroidism in children are highly variable (often absent in newborns, rather severe and symptomatic in children and adolescents) and depend on the genetic cause, as well as the severity, rapidity of onset and duration of hypercalcemia.

Chapter 4: DIFFERENTIAL DIAGNOSIS of PRIMARY HYPERPARATHYROIDISM.

The differential diagnosis of primary hyperparathyroidism can be considered clinically, biologically and radiologically. Clinically, primary hyperparathyroidism should be suspected in case of diffuse pain, renal lithiasis, osteoporosis, repeated fracture, cognitive or psychiatric disorder, or disturbance of consciousness. Nevertheless, the differential diagnosis of primary hyperparathyroidism is mainly biological, particularly in atypical forms, which must be differentiated from hypercalcemia with hypocalciuria or non- elevated PTH on the one hand, and from normo-calcemia with elevated PTH, hypophosphatemia or hypercalciuria on the other.

Determinants of cerebrospinal fluid leakage in a large cohort of macroprolactinomas.

Background: Non-functional adrenal incidentaloma (NFAI) is associated with increased risk of adverse cardiometabolic outcome. Identifying predictors of atherosclerotic cardiovascular disease (ASCVD) may enable more appropriate management strategies in patients with NFAI. We aimed to investigate body composition parameters and ASCVD risk in patients with NFAI.

Chapter 1: EPIDEMIOLOGY OF PRIMARY HYPERPARATHYROIDISM.

Primary hyperparathyroidism (PHPT) is a frequent disease. Prevalence continues to rise in Europe, long after the advent of automated calcemia meters, while incidence has stabilized. The disease is much more common in women, at around 75% of cases, and is more prevalent with advancing age, and particularly post-menopause.

Gonadotropic axis following endoscopic surgery for pituitary neuroendocrine tumor in patients of reproductive age.

Purpose: Pituitary neuroendocrine tumor (PitNET), excluding prolactinoma, often requires endoscopic endonasal surgery (EES). Identifying predictive factors for complications, and particularly rare ones such as hypogonadotropic hypogonadism (HH) that may affect fertility, is challenging. This study investigated de-novo postoperative HH and its potential impact on fertility.

Chapter 3: IMPACT OF PRIMARY HYPERPARATHYROIDISM.

At present, primary hyperparathyroidism is most often discovered in an asymptomatic patient, but can sometimes be revealed by a renal or bone complications. In all cases, a full work-up is recommended, with assessment of renal function (glomerular filtration rate), 24-hour calciuria, screening for risk factors for lithiasis, and renal and urinary tract imaging (ultrasound or CT scan) to look for stones or nephrocalcinosis. Bone densitometry, with measurements of the spine, femur and radius, is the recommended reference test for demineralization.

Chapter 2: PRIMARY HYPERPARATHYROIDISM: DIAGNOSIS.

Primary hyperparathyroidism is now predominantly an asymptomatic pathology, as blood calcium assay has become systematic. Diagnosis therefore requires screening for target organ damage when this is not already indicative of primary hyperparathyroidism.Classical clinical manifestations include bone, kidney and muscle signs, and are characterized by reversibility after parathyroid surgery.

Chapter 12: PREPARATION FOR PARATHYROID SURGERY.

Preoperative treatment of PHPT aims to 1) manage severe and/or symptomatic hypercalcemia and 2) prevent postoperative hypocalcemia. Severe hypercalcemia, defined as a blood calcium level ≥ 3.5 mmol/L, requires admission to hospital in a conventional or critical care unit, depending on clinical symptoms and comorbidities.

Chapter 9: INDICATIONS FOR TREATMENT.

The choice of therapeutic method for the management of primary hyperparathyroidism depends on the severity of the disease and its complications at the time of diagnosis, the specific situation of each patient and his/her natural history, and assessment of the risk/benefit ratio for each method (surgery, local destruction or drugs). This chapter summarizes the indications for the treatment of primary hyperparathyroidism, based on the international literature available as of December 31, 2023.

Baricitinib in early polymyalgia rheumatica (BACHELOR): a randomised, double-blind, placebo-controlled, parallel-group trial.

Background: Moderate doses of glucocorticoids result in improvements in nearly all patients with polymyalgia rheumatica, but related adverse events are common in older individuals. We aimed to evaluate whether treatment with baricitinib (a Janus kinase 1/2 inhibitor) results in disease control without the use of oral glucocorticoids in people with recent-onset polymyalgia rheumatica.

Methods: We conducted a randomised, double-blind, placebo-controlled, parallel-group trial at six expert centres in France.

Finerenone and new-onset diabetes in heart failure: a prespecified analysis of the FINEARTS-HF trial.

Background: Data on the effect of mineralocorticoid receptor antagonist therapy on HbA levels and new-onset diabetes are conflicting. We aimed to examine the effect of oral finerenone, compared with placebo, on incident diabetes in the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure (FINEARTS-HF) trial.

Methods: In this randomised, double-blind, placebo-controlled trial, 6001 participants with heart failure with New York Heart Association functional class II-IV, left ventricular ejection fraction 40% or higher, evidence of structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide levels were randomly assigned to finerenone or placebo, administered orally.

Dissection of type 2 diabetes: a genetic perspective.

Diabetes is a leading cause of global mortality and disability, and its economic burden is substantial. This Review focuses on type 2 diabetes, which makes up 90-95% of all diabetes cases. Type 2 diabetes involves a progressive loss of insulin secretion often alongside insulin resistance and metabolic syndrome.

Quantifying Plasmodium vivax radical cure efficacy: a modelling study integrating clinical trial data and transmission dynamics.

Background: Plasmodium vivax forms dormant liver stages (hypnozoites) that can reactivate weeks to months after primary infection. Radical cure requires a combination of antimalarial drugs to kill both the blood-stage and liver-stage parasites. Hypnozoiticidal efficacy of the liver-stage drugs primaquine and tafenoquine cannot be estimated directly because hypnozoites are undetectable.

Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation.

Background: Many signs of spatial dysgraphia and drawing errors after right hemispheric stroke (RHS) have been attributed to spatial neglect or impaired sensory feedback. Counterclockwise (contralesional) tilts of graphomotor productions remained to be explained.

Objective: To test whether graphomotor tilts stem from a tilted representation of verticality transposed to the top/bottom axis of the sheet of paper, using data from the DOBRAS cohort.

Quantifying intestinal lipolysis with MRI and TD-NMR: Proof of concept using dairy cream digested in vitro.

Understanding lipid digestion is crucial for promoting human health. Traditional methods for studying lipolysis face challenges in sample representativeness and pre-treatment, and cannot measure real-time lipolysis in vivo. Thus, non-invasive techniques like magnetic resonance imaging (MRI) need to be developed.

Assessment of residential renewable energy investment under dynamic market environment: Aspect from household benefits.

The adoption of residential renewable energy is pivotal for achieving the 'Net Zero' goal, yet financial assessments of household investments in this area remain complex due to dynamic market conditions. This study introduces a novel closed-form financial valuation framework for residential solar photovoltaic (PV) systems, explicitly addressing the uncertainties of electricity market price fluctuations (market risk) and energy policy changes (policy risk) using Geometric Brownian Motion (GBM). A case study in France demonstrates the framework's application, revealing that the discount rate is the most influential factor in solar PV valuation, followed by system lifespan and policy-driven Feed-in Tariff (FiT) rates.

Calcium oxalate crystals in cacao trees and their interactions with cadmium.

Cadmium (Cd) concentrations in cacao beans from Latin America often exceed limits for trading. A better understanding of the mechanisms of Cd accumulation in Theobroma cacao L. trees is necessary to advance mitigation strategies.