Primary Hyperparathyroidism Associated With MEN 1: Experience in 71 Cases
Publication date: Available online 1 December 2018Source: Cirugía Española (English Edition)Author(s): María Balsalobre Salmeron, Jose Manuel Rodriguez Gonzalez, Antonio Ríos, Beatriz Febrero, Pascual Parrilla ParicioAbstractIntroductionPrimary hyperparathyroidism (pHPT) in MEN1 is characterized by multiglandular disease and early involvement of parathyroid glands at different times. Persistence and recurrence range from 25% to 35%.The purpose was: (a) to describe the experience and the treatment of patients with pHPT in MEN1; (b) to analyze the variables related with clinical presentation and recurrence.MethodA total of 97 patients with MEN1 were diagnosed in a tertiary hospital. A retrospective analysis was made in patients with pHPT (n = 71). Study variables: age at diagnosis, mutation, clinical presentation, laboratory tests, surgical technique, and recurrence of HPT.ResultsMean age was 38 years, and 50 patients were asymptomatic. The surgical technique was: subtotal parathyroidectomy (n = 55), resection of three glands (n = 7), and resection of less glands (n = 9). Transcervical thymectomy was performed in 53 patients. Mean follow-up was 102.9 months. There were 21 recurrences, There were correlations between age at diagnosis and serum calcium levels with the presence of symptoms (P
Conclusions The results of our study indicate that 99mTc-MIBI SPECT/CT is more accurate than ultrasound for the preoperative identification of single PTAs in patients with pHPT who are candidates for MIP.
ConclusionConcomitant use of ultrasonography and MIBI SPECT/CT is highly recommended for better preoperative depiction and localization of parathyroid adenoma.
Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease that requires vigilant treatment due to its high mortality rate. Pharmacologic therapy is recommended as an initia...
Persistent hyperparathyroidism after kidney transplantation has been associated with adverse outcomes. Parathyroidectomy is the definitive treatment approach, but the success of parathyroidectomy relies on the...
ConclusionIn patients with CRF it’s difficult to diagnose parathyroid carcinoma, because its presentation mimics the most common secondary hyperparathyroidism; the concomitant presence of metastases should lead us to suspect malignant parathyroid lesions.Surgery is the only effective therapy and therefore should be always performed.
DR. CHRISTOPHER R. McHENRY (Cleveland, Ohio): Your results document the excellent outcomes of an experienced high volume endocrine surgeon with a 2.8 percent rate of persistent disease and a 1.1 percent rate of recurrent disease for patients with sporadic hyperparathyroidism undergoing initial parathyroidectomy. The authors report an increase in the rate of bilateral neck exploration from 30 percent in 2010 to 50 percent in 2017, and an increase in the detection of multiglandular from 22 percent in 2010 to 41 percent in 2017.
Abstract BACKGROUND: Primary hyperparathyroidism is a prevalent disease with proven benefits for appropriately selected patients who undergo parathyroidectomy. The ability to accurately predict expected single adenoma gland weight as the cause based on preoperative biochemical tests could improve cure rates in a minimally invasive approach. OBJECTIVE: To assess the correlation between parathyroid weight and preoperative parathyroid hormone and calcium levels in patients with primary hyperparathyroidism with a solitary adenoma and determine if these could be used to predict expected parathyroid weight. ME...
ConclusionThe parathyroid oxyphil cell proportion was associated with preoperative PTH and total weight of removed parathyroid glands in the patients with CKD. Patients with more parathyroid oxyphil proportion had lower preoperative PTH level and smaller total weight of the removed parathyroid glands.
CONCLUSION: Parathyroidectomy provided more BMD gain in the lumbar spine and femoral neck in patients with symptomatic PHPT when compared to patients with asymptomatic PHPT 1-year after parathyroidectomy. PMID: 31655512 [PubMed - as supplied by publisher]
The diagnosis of primary hyperparathyroidism is characterized by hypercalcemia in the setting of either elevated or inappropriately nonsuppressed parathyroid hormone (PTH) or in the case of normocalcemic primary hyperparathyroidism as elevation of PTH with normal total and ionized calcium.1 Cure after parathyroidectomy for primary hyperparathyroidism has traditionally been defined as the re-establishment of normal calcium homeostasis lasting a minimum of 6 months after parathyroidectomy. Failure of parathyroidectomy with persistent primary hyperparathyroidism is characterized by continued hypercalcemia within 6 months of surgery.