Sestamibi Scanning and Intraoperative Parathyroid Hormone Results for Parathyroid Resection in Primary Hyperparathyroidism

2018 ◽  
Vol 84 (8) ◽  
pp. 325-327
Author(s):  
Andrew A. Rosenthal ◽  
Rachele J. Solomon ◽  
Thomas Capasso ◽  
Stephanie A. Eyerly-Webb
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Sestamibi Scanning ◽  
Intraoperative Parathyroid Hormone

scholarly journals The CaPTHUS Scoring Model revisited: Applicability from a UK Cohort with Primary Hyperparathyroidism

2017 ◽  
Vol 9 (1) ◽  
pp. 7-12
Author(s):  
David M Scott-Coombes ◽  
Tobias W James ◽  
Michael J Stechman
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
High Recurrence Rate ◽  
Scoring Model ◽  
Upper Limit ◽  
Single Positive ◽  
Sestamibi Scanning ◽  
Focused Parathyroidectomy ◽  
The Uk ◽  
Intraoperative Parathyroid Hormone

ABSTRACT Introduction Focused parathyroidectomy for primary hyperparathyroidism (pHPT) in patients with a single positive localizing scan may have an unacceptably high recurrence rate unless intraoperative parathyroid hormone (ioPTH) is used. The CaPTHUS score was previously developed to predict singlegland disease in such instances. We evaluated the accuracy of this model in a cohort of patients with pHPT in the UK. Materials and methods CaPTHUS scores were calculated from prospectively collected data on consecutive patients undergoing surgery for pHPT [(1 point each for: Preoperative calcium ≥3 mmol/L; PTH ≥2 times upper limit; ultrasound (1 point) and sestamibi (1 point) positive for single enlarged gland; concordant positive scans]. Diagnosis of single or multigland disease was confirmed on pathology. Results From June 2007 to October 2011, 324 patients (251 female, median age 66, 10.89) underwent surgery for pHPT guided with ioPTH. Single-gland pathology was observed in 291 (89.8%) patients and multi-gland disease seen in 33 (10.2%). In single-gland disease patients, significantly higher preoperative calcium (p = 0.030) and PTH levels (p = 0.033) were seen with sensitivities of 65.6% for ultrasound and 66.0% for sestamibi scanning. A CaPTHUS score ≥3 was seen in 51.2% of all patients with a positive predictive value (PPV) for single-gland disease of 99.4%. Conclusion A CaPTHUS score ≥3 was accurate at predicting single-gland disease in >50% of patients with pHPT, providing a similar PPV and reducing the need for ioPTH implementation in this population. However, recent conflicting literature suggests the CaPTHUS score may not be universally applicable, local audit is recommended before implementation. How to cite this article James TW, Stechman MJ, Scott- Coombes DM. The CaPTHUS Scoring Model revisited: Applicability from a UK Cohort with Primary Hyperparathyroidism. World J Endoc Surg 2017;9(1):7-12.

Primary Hyperparathyroidism: A Current Perspective

2008 ◽  
Vol 132 (8) ◽  
pp. 1251-1262 ◽  
Author(s):  
Ronald A. DeLellis ◽  
Peter Mazzaglia ◽  
Shamlal Mangray
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Protein Product ◽  
Surgical Approaches ◽  
Endocrine Disorders ◽  
Diagnosis And Management ◽  
Current Perspective ◽  
Parathyroid Lesions ◽  
Sestamibi Scanning ◽  
Intraoperative Parathyroid Hormone

Abstract Context.—Primary hyperparathyroidism (P-HPT) is one of the most common of all endocrine disorders. Eighty percent to 85% of cases are due to parathyroid adenomas while hyperplasia and carcinoma account for 10% to 15% and less than 1%, of cases, respectively. The past decade has witnessed remarkable advances in the understanding of the molecular basis of parathyroid hyperplasia and neoplasia. Additionally, imaging studies and the development of the intraoperative assay for parathyroid hormone have transformed the diagnosis and management of patients with these disorders. Objective.—To review the pathology of parathyroid lesions associated with P-HPT, their molecular and genetic bases, including heritable hyperparathyroidism syndromes, and their clinical diagnosis and management. Data Sources.—Review of pertinent epidemiology, pathology, radiology, and surgery literature on the diagnosis, classification, and treatment of P-HPT. Conclusions.—Although heritable causes of P-HPT including multiple endocrine neoplasia 1 and 2A and hyperparathyroidism–jaw tumor syndrome account for a minority of cases of P-HPT, advances in the characterization of the affected genes have provided insights into the genetic basis of sporadic parathyroid neoplasms. Alterations in cyclin D1 and loss of heterozygosity of chromosome 11q in adenomas and hyperplasias have provided support for clonality of these lesions. Parafibromin, the protein product of the HRPT2 gene responsible for hyperparathyroidism–jaw tumor syndrome, has been implicated in the development of sporadic parathyroid carcinomas and loss of immunohistochemical expression of this protein has been suggested to be of value in making the diagnosis of parathyroid carcinoma. Sestamibi scanning and ultrasound have revolutionized the planning of surgical approaches and the intraoperative parathyroid hormone assay has become the standard in guiding completion or extension of surgery.

Surgical Therapy for Familial Hyperparathyroidism

2009 ◽  
Vol 75 (7) ◽  
pp. 579-583 ◽  
Author(s):  
Jyotirmay Sharma ◽  
Collin J. Weber
Keyword(s):  
Primary Hyperparathyroidism ◽  
Cure Rate ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Sestamibi Scanning ◽  
Recurrence Patterns ◽  
Sporadic Primary Hyperparathyroidism ◽  
Intraoperative Parathyroid Hormone ◽  
Familial Hyperparathyroidism

Isolated familial hyperparathyroidism (FHPT) not associated with multiple endocrine neoplasia is a rare and aggressive form of primary hyperparathyroidism. The traditional management of FHPT is a bilateral neck exploration with an increased rate of multigland hyperplasia, supernumerary glands, and recurrence. A prospective database was queried, which included 1383 consecutive parathyroidectomies between 1992 and 2008, and 28 patients with FHPT were identified. Patient demographics, pathology, intraoperative parathyroid hormone (IOPTH) kinetics, recurrence patterns, and accuracy of localization studies were analyzed. Twenty-one patients underwent bilateral neck explorations as an initial surgery, and seven patients had nine unilateral neck explorations for recurrent hyperparathyroidism. Overall cure rate was 89.2 per cent with a mean follow-up of 2.9 years (range: 6 months to 9.2 years); 64.3 per cent of patients had multigland disease. IOPTH helped identify supernumerary glands in three (12.5%) patients and accurately lateralized recurrent disease in eight of nine surgeries (88.8%). Tc-99m-Sestamibi failed to identify multigland disease in 11 patients (52.3%). FHPT has a greater prevalence of multigland disease, decreased utility of sestamibi scanning, and a higher recurrence rate than sporadic primary hyperparathyroidism. In FHPT, IOPTH is a useful adjunct in identifying additional tumors and in select cases may play a role in tumor localization.

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