scholarly journals Re-explorative Parathyroid Surgery for Persistent and Recurrent Primary Hyperparathyroidism

2011 ◽  
Vol 3 (3) ◽  
pp. 107-111 ◽  
Author(s):  
Karolina Afors ◽  
Rachel L O'Connell ◽  
Martin H Thomas
Keyword(s):  
Primary Hyperparathyroidism ◽  
Imaging Techniques ◽  
Parathyroid Tissue ◽  
Parathyroid Surgery ◽  
Redo Surgery ◽  
Normal Gland ◽  
Primary Surgery ◽  
High Calcium ◽  
Targeted Approach

ABSTRACT Primary hyperparathyroidism (HPT) is treated by parathyroidectomy. Excision of abnormal parathyroid tissue is curative in the majority of cases. Postoperative persistent or recurrent HPT has been reported up to 30%. The purpose of this study was to evaluate the role of imaging techniques and determine the efficacy of reexplorative surgery. A total of 306 patients underwent parathyroidectomy between 2000 and 2009. Twelve patients (3.9%) were not cured. Two patients declined further treatment, the other 10 patients underwent further investigation and surgery. Imaging and results of redo surgery together with associated complications were evaluated. All 10 patients were investigated with sestamibi, which accurately localized aberrant parathyroid tissue in three cases and ultrasound scans which also localized three cases. CT was useful in one of the three cases for which it was used. PET and MRI were not helpful. Twelve glands were resected, six adenomas, five hyperplastic and one normal gland. Nine of the 10 reoperated patients became normocalcemic. Complications included a bilateral recurrent laryngeal paresis. In total, 317 operations were performed and 303 of 306 (99%) patients were cured. Redo surgery for HPT is challenging and carries higher risks than primary surgery. Sestamibi and ultrasound scans are the most helpful imaging modalities. When there is concordance a targeted approach may be considered, otherwise a more extensive dissection is required. Redo parathyroid surgery should be considered, even if scans are unhelpful, for patients who are symptomatic or young or have a persistently high calcium level.

scholarly journals Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Fernando Mendoza-Moreno ◽  
Ángel Rodriguez-Pascual ◽  
María Rocío Díez-Gago ◽  
Marina Pérez-González ◽  
Laura Jiménez‐Alvárez ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Imaging Techniques ◽  
High Sensitivity ◽  
Parathyroid Glands ◽  
Parathyroid Surgery ◽  
Thyroid Lobe ◽  
The Impact ◽  
Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

ROLE OF IMAGING TESTS FOR PREOPERATIVE LOCATION OF PATHOLOGIC PARATHYROID TISSUE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

2016 ◽  
Vol 22 (9) ◽  
pp. 1062-1067 ◽  
Author(s):  
Maria Caroline Alves Coelho ◽  
Nathalie Anne de Oliveira e Silva de Morais ◽  
Andrea Cristiani Beuren ◽  
Cristiane Bertolino Lopes ◽  
Camila Vicente Santos ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue

Adaptation to calcium deprivation in the rat: effects of parathyroidectomy.

1977 ◽  
Vol 232 (3) ◽  
pp. E336
Author(s):  
J T Pento ◽  
L C Waite ◽  
P J Tracy ◽  
A D Kenny
Keyword(s):  
Adaptive Response ◽  
Calcium Transport ◽  
Parathyroid Tissue ◽  
Adaptation Period ◽  
Short Term ◽  
High Calcium

The role of parathyroid hormone (PTH) in the adaptive response in gut calcium transport to calcium deprivation has been studied in the rat using both the in vitro everted duodenal sac and the in situ ligated duodenal segment technique. Intact or parathyroidectomized (PTX) young rats were placed on a low calcium (0.01%) diet for 7-, 14-, or 21-day adaptation periods and compared with control rats maintained on a high calcium (1.5%) diet. Prior PTX (3 days before the start of the adaptation period) abolished the adaptive response (enhanced calcium transport) induced by calcium deprivation for a 7-day adaptation period, but did not abolish a response after a 21-day period. A 14-day adaptation period gave equivocal results. It is concluded that PTH appears to be necessary for short-term (7-day) adaptation, but not for long-term (21-day) adaptation to calcium deprivation. However, if accessory parathyroid tissue is present, the data could be interpreted differently: the essentiality of PTH for the adaptive response might be independent of the length of the adaptation period. The data also contribute to a possible resolution of the controversy concerning the involvement of PTH in the regulation of intestinal calcium transport in the rat.

scholarly journals Genes up- or down-regulated by high calcium medium in parathyroid tissue explants from patients with primary hyperparathyroidism

2009 ◽  
Vol 57 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Kishiko NAKAJIMA ◽  
Tomoki OKAZAKI ◽  
Takahiro OKAMOTO ◽  
Hironari KIMURA ◽  
Kazue TAKANO ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Tissue Explants ◽  
High Calcium

scholarly journals Cryopreservation of Parathyroid Glands

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Marlon A. Guerrero
Keyword(s):  
Quality Of Life ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Parathyroid Surgery ◽  
Postoperative Surveillance ◽  
Current Role

The risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1% in the hands of experienced endocrine surgeons. Although this complication is rare, rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient. Immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality. However, since the majority of cases of hypoparathyroidism are transient, immediate autotransplantation can complicate postoperative surveillance in certain patients, especially those with primary hyperparathyroidism. Cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism. This method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed. This article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery.

Is Routine Frozen Section Necessary for Parathyroid Surgery?

2005 ◽  
Vol 133 (6) ◽  
pp. 857-862 ◽  
Author(s):  
Anil K. Dewan ◽  
Silloo B. Kapadia ◽  
Christopher S. Hollenbeak ◽  
Brendan C. Stack
Keyword(s):  
Frozen Section ◽  
Operative Procedure ◽  
Effective Means ◽  
Parathyroid Tissue ◽  
Cost Effective ◽  
Parathyroid Surgery ◽  
Tissue Identification ◽  
Radionuclide Scanning ◽  
Gross Examination

OBJECTIVE: Successful parathyroidectomy requires identification and excision of 1 or more abnormal parathyroid glands. The pathologist confirms or refutes the intraoperative presence of parathyroid tissue in excised material. With the advent of radionuclide scanning and rapid parathyroid hormone assays, the role of routine frozen section (FS) has once again been called into question. Our aim was to assess the need for routine FS in tissue identification during parathyroidectomy in a series of 50 consecutive cases. METHODS: We analyzed 50 consecutive parathyroidectomies performed by a single surgeon from December 2002 to August 2003. Diagnoses on gross examination (GE) of both the surgeon and the pathologist were recorded, cytologic smears made, and FSs performed. A cost analysis was also performed. RESULTS: Of the 50 parathyroidectomies performed (35 adenoma and 15 hyperplasia), both surgeon and pathologist's opinions on GE were concordant. Incorrect gross identification occurred by both in 6% (3) of the cases. GE is a cost-effective means of identifying parathyroid tissue. CONCLUSIONS: Experienced parathyroid surgeons need not routinely request FS examination. The decision to omit intraoperative FS examination must be balanced against the potential implications of misdiagnosis and a repeat operative procedure. EBM RATING: C

Changes in total Body Calcium Content in Primary Hyperparathyroidism

1972 ◽  
Vol 43 (5) ◽  
pp. 627-637 ◽  
Author(s):  
D. J. Hosking ◽  
M. J. Chamberlain ◽  
J. H. Fremlin
Keyword(s):  
Neutron Activation Analysis ◽  
Activation Analysis ◽  
Neutron Activation ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Calcium Content ◽  
Whole Body ◽  
Total Body Calcium ◽  
Total Body

1. The change in total body calcium content after surgery for primary hyperparathyroidism was studied in seven patients by whole body neutron activation analysis. Three patients who remained in the uncontrolled state for up to 12 months were also studied by this technique. 2. The technique and its reproducibility are described. Changes in total body calcium greater than ±4% should be detectable using this method. 3. The change in total body calcium after surgery was variable. Total body calcium content decreased in three cases after apparently successful parathyroidectomy. Not all the cases experiencing an increase in body calcium content had radiological evidence of bone disease. 4. The role of relative hypoparathyroidism due to suppression of normal parathyroid tissue by a functioning adenoma is discussed.

The Localisation of Parathyroid Tumours—A Comparison of Computed Tomography with Cervical Vein Hormone Assay

1983 ◽  
Vol 28 (2) ◽  
pp. 153-156 ◽  
Author(s):  
N. C. McMillan ◽  
Linda Smith ◽  
N. J. McKellar ◽  
G. H. Beastall ◽  
I. Fogelman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Venous Catheter ◽  
Parathyroid Surgery ◽  
Parathyroid Hormone Assay ◽  
Parathyroid Tumours ◽  
Hormone Assay

Computed tomography has been employed for the localisation of parathyroid tissue in 26 patients with primary hyperparathyroidism. In 14 of these selective venous catheter studies with parathyroid hormone assay were also undertaken. Computed tomography proved unreliable, identifying only 39 per cent whereas the cervical venous hormone assay studies localised 69 per cent of lesions correctly—a figure which is in agreement with several other groups. On balance our results suggest that neither technique should be routinely employed pre-operatively but that, following unsuccessful parathyroid surgery, the most useful localisation technique remains venous hormone assay.

PARATHYROID HORMONE SECRETION IN DISORDERS OF CALCIUM METABOLISM STUDIED BY MEANS OF EDTA

1974 ◽  
Vol 75 (2) ◽  
pp. 286-296 ◽  
Author(s):  
J. H. Lockefeer ◽  
W. H. L. Hackeng ◽  
J. C. Birkenhäger
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Calcium Metabolism ◽  
Hormone Secretion ◽  
Parathyroid Tissue ◽  
Small Mass ◽  
Idiopathic Hypercalciuria ◽  
List Type ◽  
Immunoreactive Parathyroid Hormone ◽  
Pth Level

ABSTRACT In 22 of 28 cases of primary hyperparathyroidism (PHP) the rise in the serum immunoreactive parathyroid hormone (IRPTH or PTH) level observed in response to lowering of the serum calcium by EDTA, exceeded that obtained in 8 control subjects. In 5 of these 22 patients who were studied again after parathyroidectomy the supranormal response was abolished. Fifteen of these 22 hyper-responsive PHP patients had basal IRPTH levels not exceeding the highest level in the controls and that of other groups of patients investigated (idiopathic hypercalciuria, non-parathyroid hypercalcaemia, operated PHP). Fourteen of the 22 hyper-reactive patients with PHP did not show hypocalcaemia during the infusion of EDTA. The extent of the release of PTH elicited by EDTA in cases of PHP does not as yet allow a prediction of the amount of pathological parathyroid tissue present, although all the PHP patients showing a normal release of PTH had a relatively small mass of parathyroid tissue (up to about 1 g) subsequently removed. In 9 cases of nephrolithiasis (8 of whom had idiopathic hypercalciuria) and in 7 cases of non-parathyroid hypercalcaemia, a normal PTH release was found.

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