A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003

2005 ◽  
Vol 132 (3) ◽  
pp. 359-372 ◽  
Author(s):  
James M. Ruda ◽  
Christopher S. Hollenbeak ◽  
Brendan C. Stack
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Intraoperative Pth ◽  
Multiple Gland Disease ◽  
Preoperative Diagnostic ◽  
Diagnostic Modalities ◽  
Surgical Treatments ◽  
Double Adenomas

OBJECTIVE: To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism. STUDY DESIGN: A systematic literature review. RESULTS: Of the 20,225 cases of primary hyperpara-thyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc99m-sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries. CONCLUSION: The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normo-calcemia than is typically quoted. IOPTH was a helpful but not “fool-proof” adjunct in parathyroid exploration surgery. SIGNIFICANCE: These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.

scholarly journals Surgeon-performed Ultrasound in Preoperative Parathyroid Localization: The Cutting Edge of Endocrine Surgeon

2009 ◽  
Vol 1 (1) ◽  
pp. 19-22
Author(s):  
MA Yahya ◽  
K Normayah ◽  
AN Hisham
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Preoperative Localization ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Cure Rate ◽  
Unilateral Approach ◽  
Unilateral Exploration ◽  
Parathyroid Localization ◽  
Unilateral Neck Exploration

ABSTRACT Background Over the years surgery for primary hyperparathyroidism has evolved from bilateral neck exploration to focus unilateral approach. This has been made possible by the advancement in localization technique and availability of the preoperative imaging. This study aimed to determine the feasibility and accuracy of focus unilateral neck approach for primary hyperparathyroidism with surgeon- performed ultrasound as the main decisive preoperative localization imaging technique. Method The decision of focus unilateral approach was stipulated if an enlarged parathyroid adenoma was confidently seen in the preoperative localization by surgeon-performed ultrasound. The focus unilateral exploration was terminated if the diseased gland was found. Nonetheless if in doubt, the exploration was extended to include the opposite side of the neck. More importantly any negative preoperative ultrasound will be considered for bilateral neck exploration. Results 118 consecutive patients were accrued in this study, 76 females and 42 males with mean age of 50 years. Focus unilateral neck exploration was performed on 86 (72.9%) patients and 96.5% of them were successfully explored and cured. 13 (13.1%) patients had exploration of both sides of the neck although the initial decision was only to explore one side. The overall cure rate was 93.2% with the sensitivity and specificity of ultrasound were 78.3% and 95.1% respectively. Conclusion Surgeon-performed ultrasound in parathyroid localization in coupled with focus unilateral approach in primary HPT can be performed 73% of patients with a success rate of more than 96%.

scholarly journals Multiglandular Parathyroid Disease: the Results of Surgical Treatment

2020 ◽  
Vol 5 (4) ◽  
pp. 90-97
Author(s):  
E. A. Ilyicheva ◽  
G. A. Bersenev ◽  
A. V. Zharkaya ◽  
D. A. Bulgatov ◽  
V. N. Makhutov
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Intraoperative Monitoring ◽  
Parathyroid Glands ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Multiple Lesions ◽  
Multiple Gland Disease

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

scholarly journals Correlation of perioperative biochemical variables with single adenoma weight in patients with primary hyperparathyroidism

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marios Papadakis ◽  
Norbert Weyerbrock ◽  
Hubert Zirngibl ◽  
Cornelia Dotzenrath
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Bilateral Neck Exploration ◽  
University Hospital ◽  
Neck Exploration ◽  
Single Adenoma ◽  
Preoperative Serum ◽  
Intraoperative Pth ◽  
The Relationship

Abstract Background Single parathyroid adenoma is the main cause of primary hyperparathyroidism (PHPT), with surgery remaining the gold standard for its treatment. The ability to preoperatively predict the parathyroid adenoma size and could facilitate the decision about the extent of surgical exploration. It is reasonable to hypothesize that the perioperative levels of PHPT-related variables (i.e. calcium, parathormone, phosphate) may predict the adenoma weight or/and demonstrate whether the adenoma is successfully removed or not. Aim of this study is to explore the relationship between perioperative biochemical values and adenoma weight. Secondarily, we investigated the relationship between adenoma weight and uni-/bilateral neck exploration. Methods Retrospective study of all patients undergone surgery for primary hyperparathyroidism due to single adenoma in a tertiary university hospital in Germany during a 6-year period. Following variables were analyzed: preoperative serum calcium, phosphorus and parathormone, intraoperative parathormone before and after adenoma excision, intraoperative PTH decrease, postoperative serum calcium and parathormone (PTHpostop—pg/ml), calcium and PTH decrease. Bivariate correlations were calculated by the Spearman's correlation test at the 95% significance level. Results A total of 339 patients were included in the study. The median age of the patients was 60 years (range 21–90) and 77% were females. The median adenoma weight was 1 g (range 0.1–11). Adenoma weight correlated strong with maximum adenoma diameter (r = 0.72, p < 0.05), moderate with preoperative parathormone (r = 0.44) and parathormone decrease (r = 0.27), whereas there was no correlation with the intraoperative PTH decrease (r = 0.02). There was also a borderline (moderate to weak) correlation with pre- and postoperative calcium levels (r = 0.21 and r = 0.23 respectively) and a negative borderline correlation with phosphorus (r = − 0.21). Patients who required bilateral neck exploration, had significantly lighter adenomas (median weight 0.8 g vs 1.1 g, p = 0.005). Conclusions We conclude that preoperative PTH levels may only serve as an approximate guide to adenoma weight, as direct preoperative prediction is not possible. Serum calcium levels, PTH and calcium decrease correlate only weak with adenoma weight. Patients who require bilateral neck exploration, have significantly (20–25%) lighter adenomas.

Ambulatory bilateral neck exploration for primary hyperparathyroidism: is it safe?

2016 ◽  
Vol 212 (4) ◽  
pp. 722-727 ◽  
Author(s):  
Colleen M. Kiernan ◽  
Cameron Schlegel ◽  
Chelsea Isom ◽  
Sandra Kavalukas ◽  
Mary F. Peters ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration

Ambulatory bilateral neck exploration for primary hyperparathyroidism: Is it safe?

2017 ◽  
Vol 213 (6) ◽  
pp. 1191-1192
Author(s):  
Chandan Kumar Jha ◽  
Raouef Ahmed Bichoo ◽  
Sanjay Kumar Yadav ◽  
Chaitra Sonthineni ◽  
Sapana Bothra
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration

scholarly journals Long standing hypercalcemia in a 78-years old woman

2021 ◽  
Author(s):  
Andreas Kiriakopoulos ◽  
Dimitrios Linos
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Memory Loss ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Imaging Studies ◽  
The Past

A 78 years-old woman was found with worsening hypercalcemia, osteopenia and memory loss during the past 2 years. Multiple, repeated imaging studies failed to reveal the aetiology of the primary hyperparathyroidism. Bilateral neck exploration revealed a 4.5X2,3 cm right superior parathyroid adenoma in an ectopic position.

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