American Association of Endocrine Surgeons highlights - Nashville April 2015

 

Does impotence improve after parathyroidectomy - Dr McCoy, University of Pittsburgh

 

A prospective study of 143 men undergoing surgery for hyperparathyroidism reported that 13% had impotence pre-operatively, and that after surgery, 68% of that group reported resolution of their impotence. This was associated with a significantly lower mean arterial blood pressure in the group where impotence resolved compared to the group where it did not (96mmHg vs 107mmHg).

LD COMMENT: In male patients with hyperparathyroidism impotence is likley to improve with surgery 

 

Cost effectiveness of gene expression testing for  thyroid nodules - Dr Yeh, UCLA

 

A model was developed to compare conventonal management vs routine gene expression testing of indeterminate (Bethesda 3 and 4) thyroid nodules. The sensitivity of GEC testing was 96% but the specificity was only 60%. The malignancy rate in the study was 25% and so routine GEC testing added  $1,154 per patient with the incremental cost-effectiveness being $115,400 per QALY (Qualtiy Adjusted Life Years), making it not a cost-effective procedure.

LD COMMENT; Gene testing of thyroid fine needle biopsies does not yet have a clinical role in most patients

 

Minimal impact of calcimimetics for chronic dialysis - Dr Frimat, Cornell Medical Center

 

A retrospective study of 2137 paients on chronic dialysis reported that 12% had tertiary hyperparathyroidism. 67% of those had been managed with cinicalcet whereas 33% were not. After 2 years the mean improvememt in PTH in the cinacalcet group was 12% vs 10% in the untreated group. The routine use of cinacalcet did not significantly impact mean PTH levels or the proportion of patients meeting the guidelines for control of tertiary hyperparathyroidism. It also delayed parathyroidectomy

LD COMMENT: Medical treatment of tertiary hyperparathyroidism is not really as effective as had been initially believed

 

Parathyroidectomy reduces risk factors for atherosclerosis - Dr Pernow, Karolinska Institute

 

FGF23 is a risk factor for atherosclerosis and is increased in primary hyperparathyroidism.  In a study of 150 patients undergoing parathyroidectomy, FGF23 levels dropped significantly (45.2 down to 36.8, p<0.001) and this correlated with the drop in serum calcium levels.  This drop was associated with larger adenomas, as well higher serum levels of insulin and IGF1. This indicates that s parathyroidectomy may well reduce risk factors for atherosclerosis.

LD COMMENT: This  goes a long way to explaining how untreated hyperparathyroidism increases the risk of heart disease