Single Centre Experience in Patients with Primary
                    Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine
                    Neoplasia

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

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

Endocrine Connections ◽

10.1530/ec-19-0321 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1416-1424 ◽

Cited By ~ 3

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.

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Primary Hyperparathyroidism: Redefining Cure

The American Surgeon ◽

10.1177/000313481908500231 ◽

2019 ◽

Vol 85 (2) ◽

pp. 214-218 ◽

Cited By ~ 2

Author(s):

Anatoliy V. Rudin ◽

Travis J. McKenzie ◽

Roberta Wermer ◽

Geoffrey B. Thompson ◽

Melanie L. Lyden

Keyword(s):

Primary Hyperparathyroidism ◽

Inclusion Criteria ◽

Cure Rate ◽

Tertiary Hyperparathyroidism ◽

Gland Weight ◽

Significant Difference ◽

Intraoperative Pth ◽

Multiple Endocrine Neoplasia Syndrome ◽

History Of

Primary hyperparathyroidism is the most common cause of hypercalcemia. Follow-up can be resource-intensive and costly. The aim of this study was to determine if there is a subset of patients who can be defined cured earlier than six months. This was a retrospective study of patients who underwent parathyroidectomy between January 2012 and March 2014. Patients with a history of multiple endocrine neoplasia syndrome, and secondary or tertiary hyperparathyroidism were excluded. Patients with normal preoperative calcium and parathyroid hormone (PTH) and those without six months follow-up were excluded. Patients were divided into two groups: cured and not cured. Data analysis was performed between the two groups. A total of 509 patients were screened, and 214 met our inclusion criteria: 202 in the cured category and 12 in the not cured category (94% cure rate). There was no significant difference between age, gland weight, or pre-operative PTH. There was a statistically significant difference between final intraoperative PTH (IOPTH) (37 vs 55, P = 0.008) and per cent PTH decrease (69 vs 43%, P < 0.0001). There was a significant difference between intraoperative cure rate (P < 0.0006), imaging concordance (P = 0.0115), and solitary versus multiglandular disease (P = 0.0151). Subgroup analysis in patients with concordant imaging, solitary parathyroid adenoma, and IOPTH decrease by 50 per cent to normal or near-normal correlated with a six-month cure rate of 97 per cent. Patients with primary hyperparathyroidism with concordant imaging, single-adenoma pathology, and IOPTH decrease by 50 per cent to normal or near-normal levels (15–65 pg/mL) can be considered cured and may need less frequent follow-up.

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Primary hyperparathyroidism in familial multiple endocrine neoplasia type I. Long-term follow-up of serum calcium levels after parathyroidectomy

The American Journal of Medicine ◽

10.1016/0002-9343(85)90340-7 ◽

1985 ◽

Vol 78 (3) ◽

pp. 467-474 ◽

Cited By ~ 94

Author(s):

René Rizzoli ◽

Joseph Green ◽

Stephen J. Marx

Keyword(s):

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Multiple Endocrine Neoplasia ◽

Multiple Endocrine Neoplasia Type ◽

Type I ◽

Endocrine Neoplasia ◽

Endocrine Neoplasia Type ◽

Long Term Follow Up

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Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

International Cardiovascular Forum Journal ◽

10.17987/icfj.v3i0.113 ◽

2015 ◽

Vol 3 ◽

pp. 14 ◽

Cited By ~ 1

Author(s):

Robert Erich Michael Weitemeyer ◽

Shane Peter Murphy ◽

Ruth Gillen ◽

Catriona Ahern ◽

Yousif Abusalma ◽

...

Keyword(s):

Medical Management ◽

University Hospital ◽

Cardiac Events ◽

Index Procedure ◽

Adverse Cardiac Events ◽

Significant Difference ◽

St Elevation ◽

Percutaneous Revascularization ◽

The University

BACKGROUND In the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.METHODS 86 patients with STEMI and MVD were identified from a database of STEMI presentations to the University Hospital Limerick from Jan 2011 to April 2013. The occurrence of MACE was established by follow up with patients’ general practitioners.RESULTS 48% of presentations had MVD. Predominant management for non-CLs was medical therapy alone comprising 58% (n=50) of patients, while 23% (n=20) of patients underwent PCI for non-CL, and 19% (n=16) had CABG.Median follow up was 1.8 years (range 9–36 months). We found no significant difference in the occurrence of MACE between medical management of non-CLs and PCI of non-CLs (OR 1.10 95%CI 0.34, 3.56; p= 0.88). CABG however does show a trend to be superior to both PCI (OR 3.10 95%CI 0.54, 17.88; p= 0.21) and medical management (OR 2.83 95%CI 0.65, 12.27; P= 0.17) in non-CLs.CONCLUSIONS CABG appears superior to both PCI or medical management in preventing MACE over time, and PCI is not superior to medical management alone.

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