Preoperative parathyroid localization does not improve surgical outcomes for patients with primary hyperparathyroidism

2020 ◽  
Vol 220 (3) ◽  
pp. 533-535 ◽  
Author(s):  
Jessica M. Fazendin ◽  
Brenessa Lindeman ◽  
Herbert Chen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Surgical Outcomes ◽  
Parathyroid Localization

scholarly journals Presentation, diagnostic assessment and surgical outcomes in primary hyperparathyroidism: a single centre’s experience

2018 ◽  
Vol 7 (10) ◽  
pp. 1105-1115 ◽  
Author(s):  
Laura J Reid ◽  
Bala Muthukrishnan ◽  
Dilip Patel ◽  
Mike S Crane ◽  
Murat Akyol ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Evidence Base ◽  
University Hospital ◽  
Clearance Ratio ◽  
Curative Surgery ◽  
History Of ◽  
Surgical Failure

Objective Primary hyperparathyroidism (PHPT) is a common reason for referral to endocrinology but the evidence base guiding assessment is limited. We evaluated the clinical presentation, assessment and subsequent management in PHPT. Design Retrospective cohort study. Patients PHPT assessed between 2006 and 2014 (n = 611) in a university hospital. Measurements Symptoms, clinical features, biochemistry, neck radiology and surgical outcomes. Results Fatigue (23.8%), polyuria (15.6%) and polydipsia (14.9%) were associated with PHPT biochemistry. Bone fracture was present in 16.4% but was not associated with biochemistry. A history of nephrolithiasis (10.0%) was associated only with younger age (P = 0.006) and male gender (P = 0.037). Thiazide diuretic discontinuation was not associated with any subsequent change in calcium (P = 0.514). Urine calcium creatinine clearance ratio (CCCR) was <0.01 in 18.2% of patients with confirmed PHPT. Older age (P < 0.001) and lower PTH (P = 0.043) were associated with failure to locate an adenoma on ultrasound (44.0% of scans). When an adenoma was identified on ultrasound the lateralisation was correct in 94.5%. Non-curative surgery occurred in 8.2% and was greater in those requiring more than one neck imaging modality (OR 2.42, P = 0.035). Conclusions Clinical features associated with PHPT are not strongly related to biochemistry. Thiazide cessation does not appear to attenuate hypercalcaemia. PHPT remains the likeliest diagnosis in the presence of low CCCR. Ultrasound is highly discriminant when an adenoma is identified but surgical failure is more likely when more than one imaging modality is required.

scholarly journals MEN1-associated primary hyperparathyroidism in the Spanish Registry: clinical characterictics and surgical outcomes

2019 ◽  
Vol 8 (10) ◽  
pp. 1416-1424 ◽  
Author(s):  
Cristina Lamas ◽  
Elena Navarro ◽  
Anna Casterás ◽  
Paloma Portillo ◽  
Victoria Alcázar ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Surgical Outcomes ◽  
Multiple Endocrine Neoplasia ◽  
Disease Free Survival ◽  
Total Parathyroidectomy ◽  
Permanent Hypoparathyroidism ◽  
Subtotal Parathyroidectomy ◽  
Endocrine Neoplasia

Primary hyperparathyroidism is the most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1) syndrome. Bone and renal complications are common. Surgery is the treatment of choice, but the best timing for surgery is controversial and predictors of persistence and recurrence are not well known. Our study describes the clinical characteristics and the surgical outcomes, after surgery and in the long term, of the patients with MEN1 and primary hyperparathyroidism included in the Spanish Registry of Multiple Endocrine Neoplasia, Pheochromocytomas and Paragangliomas (REGMEN). Eighty-nine patients (49 men and 40 women, 34.2 ± 13 years old) were included. Sixty-four out of the 89 underwent surgery: a total parathyroidectomy was done in 13 patients, a subtotal parathyroidectomy in 34 and a less than subtotal parathyroidectomy in 15. Remission rates were higher after a total or a subtotal parathyroidectomy than after a less than subtotal (3/4 and 20/22 vs 7/12, P < 0.05), without significant differences in permanent hypoparathyroidism (1/5, 9/23 and 0/11, N.S.). After a median follow-up of 111 months, 20 of the 41 operated patients with long-term follow-up had persistent or recurrent hyperparathyroidism. We did not find differences in disease-free survival rates between different techniques, patients with or without permanent hypoparathyroidism and patients with different mutated exons, but a second surgery was more frequent after a less than subtotal parathyroidectomy.

Comparison of the diagnostic accuracy of 18F-Fluorocholine PET and 11C-Methionine PET for parathyroid localization in primary hyperparathyroidism: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Fabio Bioletto ◽  
Marco Barale ◽  
Mirko Parasiliti-Caprino ◽  
Nunzia Prencipe ◽  
Alessandro Maria Berton ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Superior Performance ◽  
Parathyroid Localization ◽  
The Moment

Background. Primary hyperparathyroidism is characterized by an autonomous hypersecretion of parathyroid hormone by one or more parathyroid glands. Preoperative localization of the affected gland(s) is of key importance in order to allow minimally invasive surgery. At the moment, 11C-Methionine and 18F-Fluorocholine PET studies appear to be among the most promising second-line localization techniques; their comparative diagnostic performance, however, is still unknown. Methods. PubMed/Medline and Embase databases were searched up to October 2020 for studies estimating the diagnostic accuracy of 11C-Methionine PET or 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Pooled sensitivity and positive predictive value were calculated for each tracer on a “per-lesion” basis and then compared using a random-effect model subgroup analysis. Results. Twenty-two studies were finally considered in the meta-analysis. Among these, 8 evaluated the diagnostic accuracy of 11C-Methionine and 14 that of 18F-Fluorocholine. No study directly comparing the two tracers was found. The pooled sensitivity of 18F-Fluorocholine was higher than that of 11C-Methionine (92% vs 80%, p < 0.01), while the positive predictive value was similar (95% vs 94%, p = 0.99). These findings were confirmed in multivariable meta-regression models, demonstrating their apparent independence from other possible predictors or confounders at a study level. Conclusion. This was the first meta-analysis that specifically compared the diagnostic accuracy of 11C-Methionine and 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Our results suggested a superior performance of 18F-Fluorocholine in terms of sensitivity, while the two tracers had comparable accuracy in terms of positive predictive value.

Impact of BMI on Surgical Outcomes in 1076 Consecutive Patients With Sporadic Primary Hyperparathyroidism

2013 ◽  
Vol 179 (2) ◽  
pp. 335
Author(s):  
A.J. Lewis ◽  
K.L. McCoy ◽  
M.J. Armstrong ◽  
M.T. Stang ◽  
N.H. Chen ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Surgical Outcomes ◽  
Sporadic Primary Hyperparathyroidism

scholarly journals Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Loredana De Pasquale ◽  
Eleonora Lori ◽  
Antonio Mario Bulfamante ◽  
Giovanni Felisati ◽  
Luca Castellani ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Multiglandular Disease ◽  
Single Adenoma ◽  
Single Center Experience ◽  
Disease Outcomes ◽  
Main Challenge ◽  
Intraoperative Pth ◽  
Focused Parathyroidectomy ◽  
Parathyroid Localization

Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.

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