1
|
Park D, Cho H, Lee E, Oh MY, Kim K, Chai YJ, Kim HY. Feasibility and Safety of transoral robotic parathyroidectomy: Initial experience with a new approach for parathyroid surgery. Asian J Surg 2024:S1015-9584(24)01535-5. [PMID: 39068075 DOI: 10.1016/j.asjsur.2024.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/05/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND We present the initial outcomes of transoral robotic parathyroidectomy (TORP) using the transoral vestibular approach in patients with primary hyperparathyroidism (PHPT). METHOD A retrospective case series analysis was performed on patients diagnosed with PHPT between October 2016 and July 2019 who underwent transoral robotic surgery for parathyroidectomy. RESULTS Thirteen patients (five males and eight females) successfully underwent TORP at our institution from October 2016 to July 2019. Eight patients underwent TORP alone, and five underwent TORP combined with transoral robotic thyroidectomy for papillary thyroid carcinoma. No intra- or postoperative complications were observed. Serum levels of parathyroid hormone, total calcium, and ionized calcium decreased to normal postoperatively and continued to decrease during the follow-up period. CONCLUSION This study suggests that TORP holds promise for the treatment of patients with PHPT with the advantages of the robotic procedure, including dynamic visualization and meticulous dissection.
Collapse
Affiliation(s)
- Dawon Park
- Department of Surgery, Korea University Anam Hospital, Republic of Korea
| | - Hyewon Cho
- Korea University Medical Center, Seoul, Republic of Korea
| | - Eunbee Lee
- Korea University Medical Center, Seoul, Republic of Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University Anam Hospital, Republic of Korea.
| |
Collapse
|
2
|
Zhan L, Ding H, Zhao Q, Liu J, Liang J, Xuan M, Kuang J, Yan J, Chen L, Cai W, Qiu W. Parathyroidectomy for solitary parathyroid adenoma via trans-areola single site endoscopic approach: Results of a case-match study. Cancer Med 2024; 13:e7290. [PMID: 38770646 PMCID: PMC11106683 DOI: 10.1002/cam4.7290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/22/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND This study aimed to establish the standardized procedure of trans-areola single site endoscopic parathyroidectomy (TASSEP), and to compare the performance of TASSEP with that of conventional open parathyroidectomy (COP). METHODS This study enrolled 40 patients with primary hyperparathyroidism (PHPT) who underwent TASSEP, and included 40 of 176 PHPT patients who underwent COP based on propensity score matching. The retrospective analysis was conducted based on prospectively collected data. Perioperative outcomes, including surgical profile, surgical burden and cosmetic results and follow-up were reported. The learning curve was described using a cumulative sum (CUSUM) analysis. RESULTS 40 TASSEPs were completed successfully without conversions or severe complications. There was no statistically significant difference in operation time between TASSEP and COP groups (80.83 ± 11.95 vs. 76.95 ± 7.30 min, p = 0.084). Experience of 17 cases was necessitated to reach the learning curve of TASSEP. Postoperative pain score and traumatic index (C-reactive protein and erythrocyte sedimentation rate) in TASSEP were apparently lower than those in COP group (p < 0.05). During the proliferation and stabilization phases, TASSEP was associated with significantly better incision recovery and cosmetic scores. Postoperative serum calcium and PTH levels throughout the follow-up period indicated satisfactory surgical qualities in both groups. CONCLUSION Based on precise preoperative localization and intraoperative planning facilitated by three-dimensional (3D) virtual modeling, TASSEP can be feasibly performed on selected patients with satisfactory success rates and low complication rates, providing preferable cosmetic results and alleviating the surgical burden to a certain extent.
Collapse
Affiliation(s)
- Ling Zhan
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hao Ding
- Department of General Surgery, Ruijin Hospital Gubei CampusShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qiwu Zhao
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jinyue Liu
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Juyong Liang
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ming Xuan
- Department of General Surgery, Ruijin Hospital Gubei CampusShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jie Kuang
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiqi Yan
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lingxie Chen
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei Cai
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weihua Qiu
- Department of General Surgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| |
Collapse
|
3
|
Lee JS, Lee JS, Jeong H, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS. Robotic parathyroidectomy is a feasible technique for primary hyperparathyroidism. Langenbecks Arch Surg 2023; 409:10. [PMID: 38103090 PMCID: PMC10725346 DOI: 10.1007/s00423-023-03182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center. METHODS We assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time. RESULTS Of the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15-65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively. CONCLUSIONS Robotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.
Collapse
Affiliation(s)
- Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojung Jeong
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea.
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 135-720, Korea
| |
Collapse
|
4
|
Milicic Stanic B, Ilincic B, Zeravica R, Milicic Ivanovski D, Cabarkapa V, Mijovic R. The Importance of Correlation between Aldosterone and Parathyroid Hormone in Patients with Primary Hyperparathyroidism. Int J Endocrinol 2022; 2022:3804899. [PMID: 36389124 PMCID: PMC9663215 DOI: 10.1155/2022/3804899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
In primary hyperparathyroidism, an increased risk of developing the cardiovascular disease may exist due to increased activity of the renin-angiotensin-aldosterone system. The aim of this study was to evaluate the relationship between parathyroid hormone and aldosterone in patients with primary hyperparathyroidism. The study included 48 patients with primary hyperparathyroidism and 30 healthy subjects who matched age and gender to the study group. This study was conducted at the Center for Laboratory medicine, Clinical center of Vojvodina, Novi Sad, Serbia. In addition to clinical data and laboratory determination of the concentration of total and ionized calcium, phosphorus, measurements of parathyroid hormone, vitamin D, direct renin, and aldosterone were performed by the method of chemiluminescent technology. Compared to the controls, the study group had statistically significantly higher values of aldosterone (p=0.028), total calcium (p=0.01), ionized calcium (p=0.003) and parathyroid hormone (P ≤ 0.001) Serum aldosterone and parathyroid hormone levels were correlated positively in patients with primary hyperparathyroidism (r=0.509, p < 0.05). A statistically significant positive correlation between renin and parathyroid hormone (r=0.688, p < 0.05) and renin and calcium (r=0.673, p < 0.05) was determined in hyperparathyroid patients. In multivariate regression analysis, the strongest predictive variable of aldosterone secretion was parathyroid hormone (p=0.011). An independent relationship between parathyroid hormone and aldosterone in patients with primary hyperparathyroidism and the correlation between renin and parathyroid hormone as well as with calcium indicate not only the direct but also the indirect associations between parathyroid hormone and aldosterone in primary hyperparathyroidism. These findings may represent another possible model of renin-angiotensin-aldosterone-induced organ damage.
Collapse
Affiliation(s)
- Branka Milicic Stanic
- Department of Medicine, Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC 20057, USA
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
| | - Branislava Ilincic
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Radmila Zeravica
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Dragana Milicic Ivanovski
- Center for Pathophysiology of Breathing and Respiratory Sleep Disorders, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4, Sr Kamenica 21204, Serbia
| | - Velibor Cabarkapa
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Romana Mijovic
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| |
Collapse
|
5
|
Qin Z, Yang Q, Liao R, Su B. The Association Between Dietary Inflammatory Index and Parathyroid Hormone in Adults With/Without Chronic Kidney Disease. Front Nutr 2021; 8:688369. [PMID: 34249998 PMCID: PMC8266995 DOI: 10.3389/fnut.2021.688369] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/01/2021] [Indexed: 02/05/2023] Open
Abstract
Aims: We aimed to assess the association between dietary inflammation index (DII) with parathyroid hormone (PTH) and hyperparathyroidism (HP) in adults with/without chronic kidney disease (CKD). Methods: Data were obtained from the 2003–2006 National Health and Nutrition Examination Survey (NHANES). The participants who were <18 years old, pregnant, or missing the data of DII, PTH, and CKD were excluded. DII was calculated based on a 24-h dietary recall interview for each participant. Weighted multivariable regression analysis and subgroup analysis were conducted to estimate the independent relationship between DII with PTH and the HP in the population with CKD/non-CKD. Results: A total of 7,679 participants were included with the median DII of −0.24 (−2.20 to 1.80) and a mean PTH level of 43.42 ± 23.21 pg/ml. The average PTH was 45.53 ± 26.63 pg/ml for the participants in the highest tertile group compared with 41.42 ± 19.74 pg/ml in the lowest tertile group (P < 0.0001). The rate of HP was 11.15% overall, while the rate in the highest DII tertile was 13.28 and 8.60% in the lowest DII tertile (P < 0.0001). The participants with CKD tended to have higher PTH levels compared with their counterparts (61.23 ± 45.62 vs. 41.80 ± 19.16 pg/ml, P < 0.0001). A positive association between DII scores and PTH was observed (β = 0.46, 95% CI: 0.25, 0.66, P ≤ 0.0001), and higher DII was associated with an increased risk of HP (OR = 1.05, 95% CI: 1.02, 1.08, P = 0.0023). The results from subgroup analysis indicated that this association was similar in the participants with different renal function, gender, age, BMI, hypertension, and diabetes statuses and could also be appropriate for the population with CKD. Conclusions: Higher consumption of a pro-inflammatory diet appeared to cause a higher PTH level and an increased risk of HP. Anti-inflammatory dietary management may be beneficial to reduce the risk of HP both in the population with and without CKD.
Collapse
Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Role of 11C-Methionine PET/CT in 99mTc-Sestamibi-Negative Parathyroid Adenoma: A Case Report. Diagnostics (Basel) 2021; 11:diagnostics11050831. [PMID: 34064482 PMCID: PMC8147981 DOI: 10.3390/diagnostics11050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and 99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent 11C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid adenoma, which then was confirmed pathologically.
Collapse
|
7
|
Zheng MH, Li FXZ, Xu F, Lin X, Wang Y, Xu QS, Guo B, Yuan LQ. The Interplay Between the Renin-Angiotensin-Aldosterone System and Parathyroid Hormone. Front Endocrinol (Lausanne) 2020; 11:539. [PMID: 32973674 PMCID: PMC7468498 DOI: 10.3389/fendo.2020.00539] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) is the regulatory system by which renin induces aldosterone production. Angiotensin II (Ang II) is the main effector substance of the RAAS. The RAAS regulates blood pressure and electrolyte balance by controlling blood volume and peripheral resistance. Excessive activation of the RAAS is an important factor in the onset of cardiovascular disease and the deterioration of this disease. The most common RAAS abnormality is primary aldosteronism (PA). Parathyroid hormone (PTH) is a peptide secreted by the main cells of the parathyroid gland, which promotes elevated blood calcium (Ca2+) levels and decreased blood phosphorus (Pi) levels. Excessive secretion of PTH can cause primary hyperparathyroidism (PHPT). Parathyroidism is highly prevalent in postmenopausal women and is often associated with secondary osteoporosis. PA and PHPT are common endocrine system diseases. However, studies have shown a link between the RAAS and PTH, indicating a positive relationship between them. In this review, we explore the complex bidirectional relationship between the RAAS and PTH. We also point out possible future treatment options for related diseases based on this relationship.
Collapse
Affiliation(s)
- Ming-Hui Zheng
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fu-Xing-Zi Li
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Lin
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Wang
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiu-Shuang Xu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bei Guo
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Qing Yuan
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ling-Qing Yuan
| |
Collapse
|
8
|
Gómez-Ramírez J, Gómez-Valdazo A, Luengo P, Porrero B, Osorio I, Rivas S. Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form? Am J Surg 2019; 219:150-153. [PMID: 31662196 DOI: 10.1016/j.amjsurg.2019.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/29/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some patients with primary hyperparathyroidism (PHPT) have an elevated PTH that does not always correlate with high blood calcium levels. We aimed to compare the clinical presentation between normocalcaemic and hypercalcaemic forms using ionized calcium levels as an inclusion criterion. METHODS We included all patients referred for surgery for PHPT between January 2015 and December 2017. Patients were divided into 2 groups (hypercalcaemic (hPHTP)/normocalcaemic (nPHPT)). RESULTS 104 patients were included.64% of the patients who were initially classified as normocalcaemic had high ionized calcium levels. There were no differences between groups except in terms of bone resorption parameters:patients with hypercalcaemia had higher osteocalcin (37.4vs23.5 ng/mL,P = .02), collagen amino-terminal propeptide (73.5vs49.2 ng/mL,P = .005), and beta-CTX levels (0.68vs0.38 ng/mL,P = .001). Bone involvement as measured by densitometry was similar. CONCLUSSIONS When these patients' diagnosis and classification is accurate, their clinical presentation and symptoms are similar to those of the classical form. Since the only difference is in terms of bone resorption parameters, in most cases it seems to be an attenuated form or even similar to the classical presentation. The improvement in diagnostic sensitivity supports the use of ionized calcium levels in patients suspected to have nPHPT.
Collapse
Affiliation(s)
- Joaquin Gómez-Ramírez
- Endocrine Surgery Unit, General Surgery Department, Hospital Ramón y Cajal, Madrid, Spain.
| | - Adela Gómez-Valdazo
- Endocrine Surgery Unit, General Surgery Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Patricia Luengo
- Endocrine Surgery Unit, General Surgery Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Belen Porrero
- Endocrine Surgery Unit, General Surgery Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Irene Osorio
- Endocrine Surgery Unit, General Surgery Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Sonia Rivas
- Endocrine Surgery Unit, General Surgery Department, Hospital Ramón y Cajal, Madrid, Spain
| |
Collapse
|
9
|
Liu X, Sun L, Shao M, Li P, Liu W, Zhang X, Zhang L, Ma Y, Li W. Primary hyperparathyroidism due to ectopic parathyroid adenoma in an adolescent: a case report and review of the literature. Endocrine 2019; 64:38-42. [PMID: 30805889 DOI: 10.1007/s12020-019-01875-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) is a common endocrine disorder and is usually diagnosed in adults. PHPT due to ectopic parathyroid adenoma in adolescents is rare. METHODS We describe the case of a 15-year-old boy with PHPT due to ectopic parathyroid adenoma. A review of the literature of PHPT in adolescents was performed, focusing on etiology, clinical presentation, preoperative localization methods, pathology, and treatment. RESULTS The patient was successfully treated with surgery and was followed up for 5 years with no signs or symptoms of hyperparathyroidism. By reviewing the literature, only seven cases of PHPT associated with ectopic parathyroid lesions in adolescents have been reported. Parathyroidectomy is the only known curative treatment. Accurate preoperative localization of the target lesion is critical. CONCLUSIONS This study should raise awareness of the diagnosis and treatment of PHPT due to ectopic parathyroid adenoma/carcinoma in adolescents.
Collapse
Affiliation(s)
- Xiangli Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lei Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mingrui Shao
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - PeiWen Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wenke Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xinyu Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yingjun Ma
- Department of Thoracic Surgery, Meihekou City Central Hospital, Meihekou, Jilin Province, China
| | - Wenya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| |
Collapse
|
10
|
Hassan-Smith ZK, Criseno S, Gittoes NJL. Mild primary hyperparathyroidism-to treat or not to treat? Br Med Bull 2019; 129:53-67. [PMID: 30576424 DOI: 10.1093/bmb/ldy042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The presentation of primary hyperparathyroidism (PHPT) has shifted from a disease characterized by renal and skeletal complications to a mild or asymptomatic condition. Modern imaging allows localization of a surgical target in the majority of cases. SOURCES OF DATA Data were collected from literature searches of online databases including PUBMED, MEDLINE and Cochrane. A narrative review was performed. AREAS OF AGREEMENT Parathyroidectomy is the only therapy with curative potential with good outcomes and low risk of complications in experienced hands. Current guidelines advocate that surgery is offered in all symptomatic cases and in those who meet criteria depending on age, serum calcium concentration, skeletal and renal parameters. A structured monitoring approach should be offered to those who do not undergo surgery. AREAS OF CONTROVERSY Thresholds for intervention to improve skeletal and renal outcomes are debatable. In addition, controversy persists over the benefit of surgery for non-skeletal/renal outcomes. GROWING POINTS The role of medical management of PHPT using agents such as bisphosphonates, denosumab and cinacalcet are discussed. AREAS TIMELY FOR DEVELOPING RESEARCH In summary, further data on the natural history and effects of treatment of mild and asymptomatic PHPT are required to determine thresholds for surgery. In particular, further investigations of non-skeletal and non-renal parameters, such as neurocognitive quality of life and cardiovascular disease are required. Data on normocalcaemic PHPT are lacking. Large-scale randomized controlled trials would be welcome in these areas, however in view of the cost implications a more pragmatic approach may be to develop collaborative multi-centre registries.
Collapse
Affiliation(s)
- Zaki K Hassan-Smith
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Sherwin Criseno
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Neil J L Gittoes
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| |
Collapse
|
11
|
Normocalcaemic primary hyperparathyroidism: a diagnostic and therapeutic algorithm. Langenbecks Arch Surg 2017; 402:1103-1108. [DOI: 10.1007/s00423-017-1617-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
|
12
|
Smith ME, Pfleiderer AG, Shamil E. Open minimally invasive versus video-assisted minimally invasive parathyroidectomy for primary hyperparathyroidism. Hippokratia 2017. [DOI: 10.1002/14651858.cd012512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew E Smith
- Cambridge University Hospitals NHS Foundation Trust; Department of ENT Surgery; Hills Road Cambridge Cambridgeshire UK CB2 0QQ
| | - Andrew G Pfleiderer
- Peterborough and Stamford Hospitals Trust; Department of ENT Surgery; Peterborough City Hospital, Bretton Gate Peterborough Cambridgeshire UK PE3 9GZ
| | - Eamon Shamil
- Peterborough and Stamford Hospitals Trust; Department of ENT Surgery; Peterborough City Hospital, Bretton Gate Peterborough Cambridgeshire UK PE3 9GZ
| |
Collapse
|
13
|
Sasanakietkul T, Jitpratoom P, Anuwong A. Transoral endoscopic parathyroidectomy vestibular approach: a novel scarless parathyroid surgery. Surg Endosc 2016; 31:3755-3763. [PMID: 28032220 DOI: 10.1007/s00464-016-5397-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/15/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery developed for neck surgery become increasing popular. Herein, an innovative transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was developed for primary hyperparathyroidism (PHPT) and renal hyperparathyroidism (rHPT). METHODS Incisions were made at the oral vestibule under the inferior lip. A 10-mm trocar was inserted through the center of the oral vestibule with two 5-mm trocars laterally. The subplatysmal space was created down to the sternal notch, and carbon dioxide pressure was insufflated at 6 mmHg to maintain the working space. Parathyroidectomy was performed using laparoscopic instruments. Intraoperative parathyroid hormone level and frozen section were conducted. Autotransplantation of the parathyroid gland was performed at the non-dominant forearm in an rHPT patient. RESULTS From March 2015 to June 2016, TOEPVA was successfully performed in 12 patients (six PHPT and six rHPT). The mean operative time for parathyroidectomy in PHPT patients was 107.5 min (range 88-127) and 185.8 min in rHPT patients (range 155-214). One patient experienced a transient recurrent laryngeal nerve injury which was spontaneously resolved within 1 month. No permanent recurrent laryngeal nerve injury was found. Serum calcium level returned to normal range in all patients. The serum parathyroid hormone level of the PHPT and the rHPT group at 30 days was 36.38 ± 7.1 pg/mL (range 27.7-46.5) and 60.35 ± 15.94 pg/mL (range 38.7-87.2), respectively. The postoperative cosmetic outcome was excellent. No mental nerve injury or infection was found. CONCLUSIONS TOEPVA is a feasible, safe, and reasonable surgical option for patients with hyperparathyroidism, especially those with cosmetic concerns.
Collapse
Affiliation(s)
- Thanyawat Sasanakietkul
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Pornpeera Jitpratoom
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
| |
Collapse
|
14
|
Brunaud L, Li Z, Van Den Heede K, Cuny T, Van Slycke S. Endoscopic and robotic parathyroidectomy in patients with primary hyperparathyroidism. Gland Surg 2016; 5:352-60. [PMID: 27294044 DOI: 10.21037/gs.2016.01.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders for which parathyroidectomy is the most effective therapy. Until late 1970s, the standard approach to parathyroidectomy was a four-gland exploration using a large skin incision. However, 80 to 85 percent of cases of PHPT are caused by a single adenoma. As such, the concept of performing a bilateral exploration in order to visualize all four glands has been argued to be excessive since in the majority of cases, there is only one abnormal gland. Focused exploration (one gland) is currently the standard technique for parathyroidectomy worldwide. Despite a rapid acceptance of minimally invasive approaches in most endocrine surgery centers, the use of an endoscope with or without the use of a robotic system to perform parathyroidectomy remains controversial. The goal of this study was to review current available data about surgical approaches using an endoscope with or without the use of a robotic system in the management of patients with PHPT. For conventional endoscopic and video assisted parathyroidectomy, several comparative studies have demonstrated some advantages in terms of reduced postoperative pain, better cosmetic results and higher patient satisfaction compared to open non-endoscopic minimally invasive parathyroidectomy. Robot-assisted transaxillary parathyroidectomy has the advantage of leaving no scar in the neck but its role has not yet been delineated clearly given the limited number of published series. Subjective postoperative cosmetic evaluation is good by concealing the scar in the axilla or infraclavicular area. However, this approach is associated with more extensive dissection than during conventional open or endoscopic neck access surgical procedures. Patients with true ectopic mediastinal parathyroid glands are good candidates for conventional or robot-assisted thoracoscopic approaches because these glands are in remote and narrow anatomical locations.
Collapse
Affiliation(s)
- Laurent Brunaud
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Zhen Li
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Klaas Van Den Heede
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Thomas Cuny
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| | - Sam Van Slycke
- 1 Department of Digestive, Hepato-Biliary and Endocrine Surgery, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France ; 2 INSERM U954, Université de Lorraine, Faculté de médecine, 54511 Vandoeuvre les Nancy, France ; 3 Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China ; 4 Department of General and Endocrine Surgery, Onze-Lieve-Vrouw Clinic, Aalst, Belgium ; 5 Department of Head and Neck Surgery, Ghent University Hospital, 9000 Ghent, Belgium ; 6 Department of Endocrinology, Université de Lorraine, CHU Nancy (Hopital Brabois Adultes), 54511 Vandoeuvre les Nancy, France
| |
Collapse
|
15
|
Braeuning U, Pfannenberg C, Gallwitz B, Teichmann R, Mueller M, Dittmann H, Reimold M, Bares R. 11C-methionine PET/CT after inconclusive 99mTc-MIBI-SPECT/CT for localisation of parathyroid adenomas in primary hyperparathyroidism. Nuklearmedizin 2014; 54:26-30. [PMID: 25427653 DOI: 10.3413/nukmed-0686-14-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
AIM To investigate the efficacy of PET/CT with 11C-methionine for localizing parathyroid adenomas in patients with suspected primary hyperparathyroidism and inconclusive results of cervical ultrasonography and 99mTc-MIBI-SPECT/CT. PATIENTS, METHOD Retrospective analysis of imaging data of 18 patients and correlation with clinical outcome, in particular intraoperative findings and histopathology of excised tissue. RESULTS 12 of 18 patients received surgery. In 10 patients single parathyroid adenomas were found (diameter: 5-20 mm), 2 patients presented parathyroid hyperplasia (5 excised hyperplastic glands (diameter: 2-12 mm). PET/CT correctly localized all adenomas and 1 of 5 hyperplastic glands. The sensitivity per patient was 91.7% (11 of 12), the sensitivity per lesion 73.3% (11 of 15). All lesions missed by PET/CT had a size smaller than 9 mm and a volume of less than 0.2 ml. In 6 patients no surgery was performed. Five of them had a negative or atypical PET/CT. Further follow-up indicated familial hypocalciuric hypercalcemia in 3 of them (thus, PET/CT true negative), in the remaining 2 patients no validation is available. One patient with 2 highly suggestive lesions rejected surgery so far. CONCLUSION PET/CT with 11C-methionine is a very sensitive method for the detection of parathyroid adenomas, even if they are too small to be visualized by 99mTc-MIBI-SPECT/CT.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - R Bares
- Prof. Dr. Roland Bares, Department Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Mueller-Str. 14, 72076 Tuebingen, Germany
| |
Collapse
|
16
|
Ringrose JS, Jen H, O'Hara C, Toth E. Severe metabolic bone disease in pregnancy mimicking malignancy. CMAJ 2014; 186:603-6. [PMID: 24688007 DOI: 10.1503/cmaj.111540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
17
|
Agrawal L, Habib Z, Emanuele NV. Neurologic disorders of mineral metabolism and parathyroid disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 120:737-48. [PMID: 24365349 DOI: 10.1016/b978-0-7020-4087-0.00049-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Disorders of mineral metabolism may cause neurologic manifestations of the central and peripheral nervous systems. This is because plasma calcium stabilizes excitable membranes in the nerve and muscle tissue, magnesium is predominantly intracellular and is required for activation of many intracellular enzymes, and extracellular magnesium affects synaptic transmission. This chapter reviews abnormalities in electrolytes and minerals which can be associated with several neuromuscular symptoms including neuromuscular irritability, mental status changes, cardiac and smooth muscle changes, etc.
Collapse
Affiliation(s)
- Lily Agrawal
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA.
| | - Zeina Habib
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas V Emanuele
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL, USA; Endocrinology Section, Edward Hines Jr. VA Hospital, Hines, IL, USA
| |
Collapse
|
18
|
Tee MC, Chan SK, Nguyen V, Strugnell SS, Yang J, Jones S, Tiwari P, Levine DS, Wiseman SM. Incremental value and clinical impact of neck sonography for primary hyperparathyroidism: a risk-adjusted analysis. Can J Surg 2013; 56:325-31. [PMID: 24067517 DOI: 10.1503/cjs.015612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Despite the different preoperative imaging modalities available for parathyroid adenoma localization, there is currently no uniform consensus on the most appropriate preoperative imaging algorithm that should be routinely followed prior to the surgical management of primary hyperparathyroidism (PHPT). We sought to determine the incremental value of adding neck ultrasonography to scintigraphy-based imaging tests. METHODS In a single institution, surgically naive patients with PHPT underwent the following localization studies before parathyroidectomy: 1) Tc-99m sestamibi imaging with single photon emission computed tomography/computed tomography (SPECT/CT) or Tc-99m sestamibi imaging with SPECT alone, or 2) ultrasonography in addition to those tests. We retrospectively collected data and performed a multivariate analysis comparing group I (single study) to group II (addition of ultrasonography) and risk of bilateral (BNE) compared with unilateral (UNE) neck exploration. RESULTS Our study included 208 patients. Group II had 0.45 times the odds of BNE versus UNE compared with group I (unadjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81, p = 0.008). When adjusting for patient age, sex, preoperative calcium level, use of intraoperative PTH monitoring, preoperative PTH level, adenoma size, and number of abnormal parathyroid glands, Group II had 0.48 times the odds of BNE versus UNE compared with group I (adjusted OR 0.48, 95% CI 0.23-1.03, p = 0.06). In a subgroup analysis, only the addition of ultrasonography to SPECT decreased the risk of undergoing BNE compared with SPECT alone (unadjusted OR 0.40, 95% CI 0.19-0.84, p = 0.015; adjusted OR 0.38, 95% CI 0.15-0.96, p = 0.043). CONCLUSION The addition of ultrasonography to SPECT, but not to SPECT/CT, has incremental value in decreasing the extent of surgery during parathyroidectomy, even after adjusting for multiple confounding factors.
Collapse
Affiliation(s)
- May C Tee
- From St. Paul's Hospital, Department of Surgery and University of British Columbia, Vancouver, BC
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Berger M, Riedel M, Tomova N, Obermeier M, Seemüller F, Dittmann S, Moeller HJ, Severus E. Do current screening recommendations allow for early detection of lithium-induced hyperparathyroidism in patients with bipolar disorder? Int J Bipolar Disord 2013; 1:7. [PMID: 25505674 PMCID: PMC4230432 DOI: 10.1186/2194-7511-1-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/13/2013] [Indexed: 11/21/2022] Open
Abstract
Background Current screening recommendations for early detection of lithium-associated hyperparathyroidism propose an exclusive measurement of serum albumin-adjusted calcium (Aac) concentration as a single first step. However, longitudinal data in patients with recurrent affective disorders suggest that increases in serum intact parathyroid hormone (iPTH) levels in lithium-treated patients may not necessarily be accompanied by a parallel increase in the concentration of Aac. If true, patients with an isolated increase in iPTH concentration above the reference range might be missed following current screening recommendations. Therefore, this study set out to examine key parameters of calcium metabolism, including iPTH and 25-hydroxycholecalciferol concentrations in patients with bipolar disorder that was or was not managed with lithium. Methods Sixty patients with bipolar disorder according to DSM-IV were enrolled, 30 of whom had received long-term lithium treatment (lithium group), whereas the other 30 patients were on psychopharmacological treatment not including lithium (non-lithium group) at the time of the study. Owing to exclusion criteria (e.g., lithium < 6 months, laboratory results indicative of secondary hyperparathyroidism), 23 bipolar patients composed the final lithium group, whereas 28 patients remained in the non-lithium group for statistical analyses. Results Patients in the lithium group showed a significantly higher concentration of iPTH compared to the non-lithium group (p < 0.05). Similarly, Aac concentrations were significantly increased in the lithium group compared to the non-lithium group (p < 0.05). However, in a multivariate linear regression model, group affiliation only predicted iPTH concentration (p < 0.05). In line with this, none of the four patients in the lithium group with an iPTH concentration above the reference range had an Aac concentration above the reference range. Discussion This study suggests that the biochemical characteristics between primary hyperparathyroidism and lithium-induced hyperparathyroidism differ substantially with regard to regulation of calcium homeostasis. As such, current screening practice does not reliably detect iPTH concentrations above the reference range. Therefore, further research is needed to elucidate the consequences of an isolated iPTH concentration above the reference range in order to develop the most appropriate screening tools for hyperparathyroidism in lithium-treated patients with bipolar disorder.
Collapse
Affiliation(s)
- Michael Berger
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany
| | - Michael Riedel
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany ; Vinzenz von Paul Hospital, Abt. Psychiatrie, Schwenninger Str. 55, Rottweil, 78628 Germany
| | - Nora Tomova
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany ; Isar-Amper Klinikum München, Ost Vockestrasse 72, Haar, 85540 Germany
| | - Michael Obermeier
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany
| | - Florian Seemüller
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany
| | - Sandra Dittmann
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany
| | - Hans-Jürgen Moeller
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München, Nussbaumstrasse 7, Munich, 80336 Germany
| | - Emanuel Severus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany
| |
Collapse
|
20
|
Venkat R, Kouniavsky G, Tufano RP, Schneider EB, Dackiw APB, Zeiger MA. Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy. World J Surg 2012; 36:55-60. [PMID: 22089919 DOI: 10.1007/s00268-011-1344-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism (PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine both the long-term symptom resolution and biochemical cure following MIP for PHPT. METHODS A total of 460 PHPT patients who underwent a MIP between 2004 and 2009 were successfully mailed a questionnaire that assessed preoperative and postoperative Parathyroidectomy Assessment of Symptoms (PAS) scores, most recent calcium and parathyroid hormone (PTH) levels, and information about any reoperation for PHPT. Long-term evaluation of symptomatic and biochemical cure was performed. RESULTS A total of 200 patients (43.5%) responded to our correspondence. The mean age of the patients was 58.7 ± 11.9 years, 74.5% were female, and 78.5% were Caucasian. The mean follow-up was 37 ± 19 months. The mean PAS scores fell by 117 ± 14 at long-term follow-up after MIP (P < 0.0001). All 13 symptoms comprising the PAS score diminished, of which ten did so significantly (P < 0.01). There was a significant drop in the mean serum calcium (preop. 11.1 mg/dl, postop. 9.6 mg/dl; P < 0.0001) and PTH (preop. 130.9 pg/ml, postop. 45.7 pg/ml; P < 0.0001) at long-term follow-up. Five patients (2.5%) developed recurrent disease (calcium > 10.5 mg/dl), and one (0.5%) underwent a reoperation for persistent disease and was subsequently cured. CONCLUSIONS This study demonstrates that MIP has long-term benefits in terms of excellent symptom resolution and a high biochemical cure rate (97%) in selected patients who have PHPT, preoperative localization with sestamibi scans, and assessment of intraoperative PTH level.
Collapse
Affiliation(s)
- Raghunandan Venkat
- Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | | | | | | | | | | |
Collapse
|
21
|
Montenegro FM, Brandão LG, Ferreira GF, Lourenço DM, Martin RM, Cunha-Neto MB, Helou CB, Toledo SA, Cordeiro AC, Ianhez LE. Transitory increase in creatinine levels after parathyroidectomy: evidence of another action of the parathyroid glands? ACTA ACUST UNITED AC 2012; 55:249-55. [PMID: 21779626 DOI: 10.1590/s0004-27302011000400002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 01/28/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. MATERIAL AND METHODS Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. RESULTS In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). CONCLUSION Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations.
Collapse
Affiliation(s)
- Fábio M Montenegro
- Head and Neck Surgery, Department of Surgery, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Gómez-Ramírez J, Posada M, Rodríguez A, Bravo JM, Domínguez L, Martín-Pérez ME, Larrañaga E. [Thyroid suppression in patients with primary hyperparathyroidism: does it improve the pre-surgical scintigraphy localisation?]. Cir Esp 2011; 89:595-8. [PMID: 21867995 DOI: 10.1016/j.ciresp.2011.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/16/2011] [Accepted: 06/24/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Scintigraphy with technetium-sestamibi (MIBI) is the test of choice for localising adenomas in patients with primary hyperparathyroidism (PHPT). In some studies it has emerged that the increase in sensitivity of this test could be associated with a decrease in the uptake of the radiotracer by the thyroid gland. The aim of this study is to analyse our experience in patients with a negative scintigraphy with MIBI, and in whom the study was repeated after suppression of thyroid function with thyroxine. MATERIAL AND METHODS A prospective evaluation was performed on 17 patients who, between January 2006 and April 2011, had PHPT and negative imaging using scintigraphy with MIBI and who had the test repeated after the administration of thyroxine. The scintigraphy data and the correlation with the findings in the surgical intervention are reviewed. RESULTS The mean TSH at the time of repeating the MIBI was 0.12+0.1mlU/L. Of the 17 patients included, the scintigraphy under thyroid suppression was positive in 13 of them (76.5%), and in the other 4 (23.5%) patients no image suggestive of adenoma was found. In the cases where the MIBI was positive after suppression, the positive predictive value (PPV) was 100%. CONCLUSION Suppression of thyroid function by giving thyroxine can help to improve the sensitivity of MIBI in patients with previously negative scintigraphy studies and help in the minimally invasive treatment of patients with PHPT.
Collapse
Affiliation(s)
- Joaquín Gómez-Ramírez
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de la Princesa, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
23
|
Peña Irún A, González Santamaría A, Fontanillas Garmilla N, Arenal Barquín S. El adenoma paratiroideo también puede ser una urgencia. Semergen 2011. [DOI: 10.1016/j.semerg.2010.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
van Ginhoven T, Morks A, Schepers T, de Graaf P, Smit P. Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism. Eur Surg Res 2011; 47:70-4. [DOI: 10.1159/000327969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 03/31/2011] [Indexed: 11/19/2022]
|
25
|
Ruggieri F, Chiesa A, Schorn K, Strobel K, Maggiorini M, Schmid C. Vanishing polyuria and respiratory failure. BMJ Case Rep 2010; 2010:2010/oct18_2/bcr1020092416. [PMID: 22791497 DOI: 10.1136/bcr.10.2009.2416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 44-year-old man with headache, sweating, subfebrile temperature and profound fatigue was found to have hypercalcaemic crisis with renal failure. Despite standard therapy, calcium levels remained high, he became anuric and developed multi-organ failure with acute respiratory distress syndrome requiring high ventilatory support, norepinephrine, dobutamine and continuous veno-venous haemodiafiltration. Ectopic calcification was found in the lungs, in the thyroid, kidneys, heart and stomach. A large parathyroid adenoma was then removed. When last seen, 11 months after surgery, the patient no longer required oxygen, and total lung capacity had returned to normal.
Collapse
Affiliation(s)
- Fabio Ruggieri
- Department of Internal Medicine, Division of General Internal Medicine, University of Zurich, Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|
26
|
Ayuk J, Cooper MS, Gittoes NJL. New perspectives in the management of primary hyperparathyroidism. Ther Adv Endocrinol Metab 2010; 1:197-205. [PMID: 23148164 PMCID: PMC3474620 DOI: 10.1177/2042018810382326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is a biochemical syndrome caused by the inappropriate or unregulated overproduction of parathyroid hormone, Leading to hypercalcae-mia. It was previously considered a relatively rare disorder, with clinical manifestations dominated by renal and/or bone disease. However, in modern times the diagnosis is most frequently recognized coincidentally on biochemical testing in patients evaluated for unrelated complaints. Parathyroidectomy is the only curative treatment for PHPT, with improved outcomes in symptomatic patients following this procedure. However, surgical intervention in patients with no clear clinical features remains controversial. The National Institutes for Health (NIH) have developed consensus guidelines giving specific indications for when surgery is recommended in patients with asymptomatic PHPT. This article examines the impact of treatment on asymptomatic PHPT, focusing on bone disease, neurocognitive function, quality of Life, cardiovascular disease and mortality. Medical treatment options, including bisphospho-nates and cinacalcet, are also discussed.
Collapse
Affiliation(s)
- John Ayuk
- John Ayuk, MD, MRCP Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
| | - Mark S. Cooper
- Mark S. Cooper, PhD MRCP Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Neil J. L. Gittoes
- Correspondence to: Dr Neil J. L. Gittoes, PhD, FRCP Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
| |
Collapse
|
27
|
Fouquet T, Germain A, Zarnegar R, Klein M, De Talance N, Claude Mayer J, Ayav A, Bresler L, Brunaud L. Totally endoscopic lateral parathyroidectomy: prospective evaluation of 200 patients. ESES 2010 Vienna presentation. Langenbecks Arch Surg 2010; 395:935-40. [PMID: 20694475 DOI: 10.1007/s00423-010-0687-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 07/05/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE Several new minimally invasive techniques (mini-open, video-assisted, and endoscopic procedures) for parathyroidectomy have been described. However, totally endoscopic lateral approach parathyroidectomy (Henry technique) is not routinely performed. METHODS This is a prospective study of 200 consecutive patients that underwent totally endoscopic lateral parathyroidectomy. RESULTS Two hundred of 387 patients (52%) with primary hyperparathyroidism were included. Fifty-six patients (28%) were converted to open parathyroidectomy. Causes for conversion were lack of intraoperative localization (11%), difficult dissection (10%), bleeding (4%), failure of normalization of IOPTH results (2%), and other causes (1%). Gland localization (areas 1 to 2 versus area 3) and CaPTHus score (<3 versus ≥3) were not associated with the risk of conversion. Mean postoperative follow-up was 13 months, and 196 patients (98%) were cured. CONCLUSIONS Totally endoscopic lateral approach can be proposed in more than half of the patients with good immediate results. Conversion rate remains important and may explain low acceptance rate of this technique.
Collapse
Affiliation(s)
- Thibaut Fouquet
- Department of Digestive, Hepatobiliary, and Endocrine Surgery, CHU Nancy-Brabois (Hopital Adultes), University of Nancy, 11 allée du morvan, 54511 Vandoeuvre-les-Nancy, France
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Goasguen N, Chirica M, Roger N, Munoz-Bongrand N, Zohar S, Noullet S, de Roquancourt A, Cattan P, Sarfati E. Primary hyperparathyroidism from parathyroid microadenoma: specific features and implications for a surgical strategy in the era of minimally invasive parathyroidectomy. J Am Coll Surg 2010; 210:456-62. [PMID: 20347738 DOI: 10.1016/j.jamcollsurg.2009.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to identify the specific preoperative characteristics of patients with parathyroid microadenoma and to report their outcomes after surgical treatment. STUDY DESIGN Parathyroid microadenomas (weight < 100 mg) were identified in 62 (6%) of the 1,012 patients operated on for a parathyroid adenoma between 1995 and 2004. Presentation and outcomes after surgery were compared with those of 124 patients operated on consecutively for parathyroid adenoma (>100 mg) during the last year of the study. All patients underwent bilateral surgical exploration of the neck. Success was defined as resection of a pathologic gland combined with normocalcemia at 6 months after operation. Logistic regression was used to test the relationship between groups and potential predictive factors of microadenoma. RESULTS There were 57 women (92%) and the median age was 57 years (range 29 to 77 years). Median preoperative calcemia and parathyroid hormone (PTH) serum levels were 2.64 mmol/L (range 2.31 to 3 mmol/L) and 79 pg/mL (range 30 to 189 pg/mL), respectively. There was no difference in the clinical presentation between patients with microadenoma and adenoma. Preoperative calcium (p < 0.001) and PTH serum levels (p = 0.014) were significantly higher in patients with adenoma. Calcium and PTH serum levels lower than 2.6 mmol/L and 60 pg/mL, respectively, predicted the presence of microadenoma with respective specificities of 0.89 and 0.87. Success rates were similar in the microadenoma and adenoma groups (92% vs 98%; p = 0.11). CONCLUSIONS Mild preoperative elevations of calcium or PTH serum levels should warn about the risk of microadenoma. In this setting, intraoperative difficulties should be expected in identifying the pathologic gland, and bilateral neck exploration should be the preferred surgical approach.
Collapse
Affiliation(s)
- Nicolas Goasguen
- Department of Endocrine and Digestive Surgery, Hôpital Saint-Louis, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hessman O, Westerdahl J, Al-Suliman N, Christiansen P, Hellman P, Bergenfelz A. Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism. Br J Surg 2010; 97:177-84. [PMID: 20035529 DOI: 10.1002/bjs.6810] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND : Previous studies of video-assisted techniques for parathyroidectomy in patients with primary hyperparathyroidism have found similar or better results compared with bilateral neck exploration. The aim of the present study was to compare open minimally invasive parathyroidectomy with the video-assisted technique for primary hyperparathyroidism in a multicentre randomized trial. METHODS : Some 143 patients were randomized to open (n = 75) or video-assisted (n = 68) parathyroidectomy after positive sestamibi scintigraphy. There were no differences in preoperative data. The open operation was performed through a 15-mm incision. The video-assisted techniques used were minimally invasive video-assisted parathyroidectomy (MIVAP) or video-assisted parathyroidectomy using the lateral approach (VAPLA). Data were collected prospectively including postoperative pain scoring. RESULTS : The procedure was significantly quicker for the open compared to the video assisted operations: mean(s.d.) 60(35) versus 84(47) min (P = 0.001). Both groups of patients had similar conversion rates and the same outcome, with comparable incision lengths, low scores for postoperative neck discomfort, high cosmetic satisfaction and low complication rates. CONCLUSION : Open minimally invasive parathyroidectomy for primary hyperparathyroidism was quicker than either video-assisted technique. REGISTRATION NUMBER NCT00877981 (http://www.clinicaltrials.gov)
Collapse
Affiliation(s)
- O Hessman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
30
|
Should Routine Analysis of the MEN1 Gene be Performed in all Patients with Primary Hyperparathyroidism Under 40 Years of Age? World J Surg 2010; 34:1294-8. [DOI: 10.1007/s00268-009-0388-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Brunaud L, Germain A, Zarnegar R, Rancier M, Alrasheedi S, Caillard C, Ayav A, Weryha G, Mirallie E, Bresler L. Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism. Surgery 2009; 146:1035-41. [DOI: 10.1016/j.surg.2009.09.041] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
|
32
|
|
33
|
|