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Li X, Li J, Li Y, Wang H, Yang J, Mou S, Zhou M, Jiang C, Ning C. The role of preoperative ultrasound, contrast-enhanced ultrasound, and 99mTc-MIBI scanning with single-photon emission computed tomography/X-ray computed tomography localization in refractory secondary hyperparathyroidism. Clin Hemorheol Microcirc 2020; 75:35-46. [PMID: 31868660 DOI: 10.3233/ch-190723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the role of preoperative US, CEUS, and 99mTc-MIBI scanning with SPECT/CT in localizing diseased parathyroid glands in cases of refractory secondary hyperparathyroidism (SHPT). MATERIAL AND METHODS Using pathological results as the gold standard, we compared the operative findings with the preoperative localization of each modality in 73 nodules and evaluated the accuracy, and sensitivity of each modality and combinations of the four modalities. RESULTS The sensitivity of US, CEUS, 99mTc-MIBI and SPECT/CT was 98.59%, 94.37%, 50.70% and 78.87%, respectively. US had the highest sensitivity of the four imaging methods and the diagnostic sensitivity of US and CEUS was superior to that of 99mTc-MIBI (p < 0.001 and p < 0.001) and SPECT/CT (p = 0.001 and p = 0.012). In addition, we found that the sensitivity of the combination of US with CEUS, US with 99mTc-MIBI and/or SPECT/CT, CEUS with 99mTc-MIBI and/or SPECT/CT, US with CEUS and two other imaging modalities (99mTc-MIBI and/or SPECT/CT) was 98.59%, 100%, 95.77%, and 100%, respectively. CONCLUSIONS The combination of US with SPECT/CT is the best choice for the comprehensive preoperative localization of glands in refractory SHPT. CEUS can elevate the accuracy of US in differential diagnosis via the interpretation of dynamic microvascular features.
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Affiliation(s)
- XiuMei Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jun Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yong Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - HongQiao Wang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - JingRu Yang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - MaoPing Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - CaiYun Jiang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - ChunPing Ning
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Enevoldsen LH, Heaf J, Højgaard L, Zerahn B, Hasbak P. Increased technetium-99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism: correlation with hyperphosphataemia. Clin Physiol Funct Imaging 2015; 37:131-136. [DOI: 10.1111/cpf.12276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lotte Hahn Enevoldsen
- Department of Clinical Physiology, Nuclear Medicine and PET; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - James Heaf
- Department of Nephrology; Herlev Hospital; Herlev Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Bo Zerahn
- Department of Clinical Physiology; Herlev Hospital; University of Copenhagen; Copenhagen Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine and PET; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Relevance of Bilateral Cervical Thymectomy in Patients with Renal Hyperparathyroidism: Analysis of 161 Patients Undergoing Reoperative Parathyroidectomy. World J Surg 2013; 37:2155-61. [DOI: 10.1007/s00268-013-2091-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sugi O, Kimata N, Miwa N, Otsubo S, Nitta K, Akiba T. Successful cinacalcet treatment of refractory secondary hyperparathyroidism due to multiple lung parathyroid adenomas. Clin Kidney J 2010; 3:60-3. [PMID: 25984040 PMCID: PMC4421561 DOI: 10.1093/ndtplus/sfp116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 08/03/2009] [Indexed: 11/12/2022] Open
Abstract
We describe a 56-year-old woman who presented with end-stage renal disease due to pregnancy-induced hypertension and secondary hyperparathyroidism (sHPT). She had started hemodialysis and underwent a subtotal parathyroidectomy (PTx). However, intact parathyroid hormone (iPTH) levels increased gradually. Eventually, she underwent a second PTx. However, therapy failed to significantly decrease iPTH levels. A third PTx was performed, but no pathological parathyroid tissue was found. Computed tomography scan indicated the presence of multiple ectopic lung nodules and 26 nodules were surgically removed from the left lung. Despite surgical treatment, iPTH levels remained high. Additional maxacalcitol failed to decrease iPTH levels, cinacalcet was then started. iPTH levels decreased and the cinacalcet dose could be reduced to maintenance doses of 60 mg/day. Throughout the 1.6 years of treatment, serum iPTH, alkaline phosphatase (ALP) and bone alkaline phosphatase (BAP) were normalized. As a consequence, bone pain gradually disappeared. Bone mineral density (BMD) was improved by administration of cinacalcet. In conclusion, cinacalcet was effective in this patient with refractory and inoperable sHPT. In addition, it improves their BMD and relieves bone pain.
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Affiliation(s)
| | - Naoki Kimata
- Division of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoko Miwa
- Division of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Takashi Akiba
- Division of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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Matsuoka S, Tominaga Y, Sato T, Uno N, Hiramitu T, Goto N, Nagasaka T, Uchida K. Relationship Between the Dimension of Parathyroid Glands Estimated by Ultrasonography and the Hyperplastic Pattern in Patients With Renal Hyperparathyroidism. Ther Apher Dial 2008; 12:391-5. [DOI: 10.1111/j.1744-9987.2008.00615.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Re-operation for secondary hyperparathyroidism. The Journal of Laryngology & Otology 2007; 122:942-7. [PMID: 18047758 DOI: 10.1017/s0022215107001120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In cases of re-operation for secondary hyperparathyroidism, to evaluate the extent to which the location of recurrent hyperplasia was predicted by (1) operative data from the first intervention, and (2) pre-operative imaging (before the re-operation). METHODS The files of 18 patients undergoing surgery for recurrent secondary hyperparathyroidism were reviewed. The surgical findings were compared both with the report of the initial operation and with the results of pre-operative imaging (i.e. ultrasonography, Mibi scintigraphy or computed tomography). RESULTS The location of the recurrent hyperplasia corresponded with the data for the primary intervention in about one-third of patients. There was a partial correlation in one-third of patients, and no correlation at all in one-third. Pre-operative imaging enabled better prediction of the location of recurrent disease. CONCLUSION Surgeons should have both sources of information at their disposal when planning a re-intervention for secondary hyperparathyroidism. However, in our series, the predictive value of imaging was superior to that of information deduced from the previous surgical record.
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Matsuoka S, Tominaga Y, Sato T, Uno N, Goto N, Katayama A, Uchida K, Takami H. QuiCk-IntraOperative Bio-Intact PTH assay at parathyroidectomy for secondary hyperparathyroidism. World J Surg 2007; 31:824-31. [PMID: 17354020 DOI: 10.1007/s00268-006-0601-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In uremic patients, metabolism of 1-84 parathyroid hormone (PTH) and fragments are delayed, and in these patients, the usefulness of intraoperative PTH assay may be problematic. We evaluated the usefulness of the QuiCk-IntraOperative Bio-Intact PTH (QPTH) assay for uremic patients with secondary hyperparathyroidism who required total parathyroidectomy (PTx) with forearm autograft. The purpose of our study was to recognize whether QPTH in uremic patients was useful to determine during operation whether complete PTx had been achieved. METHODS Forty-four patients who underwent initial PTx were enrolled in this study. Blood samples were drawn just after induction of general anesthesia (basal samples), immediately after removal of the last gland, and at 5, 10, 15, and 30 minutes, and at the first morning after PTx. The assay was performed immediately after sample collection. Reductions of PTH levels were evaluated and expressed in percentage of basal levels. RESULTS The mean PTH levels in 41 patients, excluding 3 in whom the PTH level did not drop significantly (>60 pg/ml), measured by QPTH at anesthesia, 0, 5, 10, 15, and 30 minutes were 734.3, 104.7, 58.8, 37.4, 27.0, 16.3 pg/ml, corresponding to 100%, 17.1%, 9.3%, 5.8%, 4.1%, 2.4% of the preexcision values, respectively. If the cutoff value was defined as 10.8% at 10 minutes, the sensitivity was 100% and specificity 90%. When the QPTH level dropped to under 10.8% at 10 minutes, we could consider that all glands were removed. CONCLUSIONS QPTH in uremic patients is very useful to determine whether complete PTx is achieved during operation.
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Affiliation(s)
- Susumu Matsuoka
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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Matsuoka S, Tominaga Y, Sato T, Uno N, Goto N, Katayama A, Uchida K, Tsuzuki T. Recurrent renal hyperparathyroidism caused by parathyromatosis. World J Surg 2007; 31:299-305. [PMID: 17219279 DOI: 10.1007/s00268-006-0391-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parathyromatosis is defined as multiple foci of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is a problematic cause of recurrent hyperparathyroidism (HPT). In renal HPT, the stimuli of the parathyroid cells persist after parathyroidectomy (PTx), and for this reason, parathyromatosis might be important in renal HPT. METHODS Between July 1973 and December 2005, 1,932 patients underwent PTx for advanced renal HPT in our department. We evaluated the frequency, clinical findings and the prognosis of this kind of parathyroid disorder. RESULTS After total PTx with forearm autograft for renal HPT, which was performed initially in our department, the risk for developing parathyromatosis was 0.11% (2/1837); after sub-total PTx, it was 5% (1/20). The risk for developing parathyromatosis was lower after total PTx with forearm autograft than after sub-total PTx (P < 0.05). In patients who developed persistent or recurrent HPT and were referred to our department for neck re-operation, parathyromatosis occurred in 12.1% (7/58); in those originally operated on at our hospital, the corresponding figure was 7.1% (3/42). This difference was not significant (P = 0.42). Only in 4 of 10 patients was parathyromatosis suggested before re-operation. However, in spite of several re-operations, high parathyroid hormone (PTH) levels persisted in 6 of 10 patients with parathyromatosis. CONCLUSION Parathyromatosis is a non-negligible cause of recurrent renal HPT in patients who require neck re-exploration. Parathyromatosis is difficult to diagnose pre-operatively and completely controlled by re-operation. Parathyromatosis should be kept in mind when performing neck re-exploration for recurrent renal HPT.
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Affiliation(s)
- Susumu Matsuoka
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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Kaida H, Ishibashi M, Nishida H, Baba K, Hiromatsu Y, Okuda S, Hayabuchi N. Assessment of therapeutic effect in patients with secondary hyperparathyroidism using bone scintigraphy. Ann Nucl Med 2005; 19:367-72. [PMID: 16164192 DOI: 10.1007/bf03027400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The semi-quantitative method of bone scintigraphy [bone to soft tissue (B/ST) ratio] has been used in diagnosing and evaluating systemic metabolic bone diseases. The aim of this study is to evaluate of the therapeutic effect of secondary hyperparathyroidism (SHP). METHODS The subjects were ten hemodialysis patients with SHP. Seven patients underwent parathyroidectomy (PTX), and 22-Oxacalcitoriol (derivative of 1,25-dihydroxyvitamin D3) (OCT) was given to three patients. Bone scintigraphy and blood tests [intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), bone alkaline phosphatase (BALP), and deoxypridinoline (DPYD)] were performed before and after treatment. Regions of interest were drown around cranium, lumbar vertebrae, femoral neck and soft tissue of left medial thigh to calculate the B/ST ratio. RESULT The B/ST ratios of cranium, lumbar vertebrae, and femoral neck were reduced significantly after PTX (cranium, p = 0.0079, lumbar vertebrae, p = 0.0282, femoral neck, p = 0.0252). Intact PTH, ALP, Ca, P, BALP and DPYD levels were reduced significantly after PTX (intact PTH, p = 0.003, Ca, p = 0.0005, P, p = 0.0393, ALP, p = 0.0051, DPYD, p = 0.0232, BALP, p = 0.0324). After OCT administration, the B/ST ratio of each bony region showed tendency to diminish, although not significantly. Intact PTH levels were reduced significantly, although ALP, BALP, and DPYD levels were not. Ca and P levels were increased significantly because of the medicinal action of OCT. CONCLUSION The B/ST ratio of cranium may be non-invasive method and have potential in evaluating the therapeutic effect of SHP.
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Affiliation(s)
- Hayato Kaida
- Division of Nuclear Medicine, PET Center and Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
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Nishida H, Ishibashi M, Hiromatsu Y, Kaida H, Baba K, Miyake I, Ikedo H, Kato S, Fukami K, Iida S, Okuda S. Comparison of histological findings and parathyroid scintigraphy in hemodialysis patients with secondary hyperparathyroid glands. Endocr J 2005; 52:223-8. [PMID: 15863952 DOI: 10.1507/endocrj.52.223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To determine the usefulness of parathyroid scintigraphy in histological estimation for secondary hyperparathyroidism (2HPT) using Tc-99m sestamibi or Tc-99m tetrofosmin. Tc-99m sestamibi (MIBI) and Tc-99m tetrofosmin (Tetro) parathyroid imaging following double-phase study, magnetic resonance imaging (MRI), and ultrasound were performed on 14 patients with 2HPT. All patients underwent parathyroidectomy. The uptake of two tracers in parathyroid areas was compared with the histopathologic findings. Forty-nine parathyroid glands were surgically explored and histologically proven to be hyperplastic. Of these, 42 were diagnosed with nodular type (N-type) hyperplasia, and 7 with diffuse type (D-type) hyperplasia. MIBI and Tetro parathyroid imagings detected 34 and 35 parathyroid glands, respectively. The sensitivity of MIBI was determined to be 76.2% (32/42) for N-type, and 28.6% (2/7) for D-type. The sensitivity of Tetro was determined to be 78.6% (33/42) for N-type and 28.6% (2/7) for D-type. The sensitivity of both MIBI and Tetro was significantly higher for N-type than for D-type, 76.2% (32/42) vs. 28.6% (2/7) in MIBI, P = 0.022; 78.6% (33/42) vs. 28.6% (2/7) in Tetro, P = 0.015. The sensitivity of MRI was determined to be 76.2% (32/42) for N-type and 42.9% (3/7) for D-type, and the sensitivity of ultrasound was 71.4% (30/42) for N-type and 71.4% (5/7) for D-type. There was no significant difference in the sensitivity of MRI or ultrasound between N-type and D-type. The uptake ratios of MIBI and Tetro were also greater for N-type than for D-type. The detectability of both MIBI and Tetro was greater for N-type than for D-type. Tc-99m MIBI or Tc-99m Tetro parathyroid scintigraphy therefore may be used clinically to distinguish N-type from D-type parathyroid gland hyperplasia.
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Affiliation(s)
- Hidemi Nishida
- Department of Nephrology and Dialysis Unit, Kurume University School of Medicine, Asahimachi, Fukuoka, Japan
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Olson JA, Leight GS. Surgical management of secondary hyperparathyroidism. ADVANCES IN RENAL REPLACEMENT THERAPY 2002; 9:209-18. [PMID: 12203203 DOI: 10.1053/jarr.2002.34840] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most patients with renal failure maintained on chronic dialysis have elevated parathyroid hormone (PTH) levels and PTH-mediated bone disease (secondary hyperparathyroidism [sHPT]). Elevated PTH production in this setting represents a progressive, exaggerated physiologic response to hypocalcemia by the parathyroid glands, and generalized growth of the parathyroids is an adaptive response to chronic stimulation. Effective medical strategies to reduce PTH secretion and PTH-mediated bone turnover in sHPT (eg, controlling hyperphosphatemia, normalizing serum calcium, and administering vitamin D analogs) has decreased the need for parathyroidectomy in recent years. However, failure of medical therapy because of inadequate treatment, persistent hyperphosphatemia, or acquired parathyroid neoplasia still leads to recommendations for parathyroidectomy in select patients. Furthermore, increased awareness of potential long-term, irreversible cardiovascular effects of uncorrected hyperparathyroidism has led some to advocate parathyroidectomy earlier in the course of this disease. This monograph will review parathyroidectomy for secondary and tertiary hyperparathyroidism.
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Affiliation(s)
- John A Olson
- Department of Surgery, Division of General Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Tominaga Y, Uchida K, Haba T, Katayama A, Sato T, Hibi Y, Numano M, Tanaka Y, Inagaki H, Watanabe I, Hachisuka T, Takagi H. More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 2001; 38:S168-71. [PMID: 11576947 DOI: 10.1053/ajkd.2001.27432] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Between March 1981 and December 2000, we performed 1,053 total parathyroidectomies with forearm autograft for advanced renal hyperparathyroidism (HPT). Based on histopathologic and pathophysiologic investigations, surgical treatment should be considered when parathyroid glands show nodular hyperplasia. Measuring parathyroid volume by ultrasonography was useful to detect nodular glands and to determine surgical indications. The clinical effect of parathyroidectomy on the symptoms and biochemical variables was striking. Skeletal deformity, progressive bone loss, and vessel calcification leading to high mortality risk could not be alleviated by even successful surgery, however. To prevent cardiovascular complications, parathyroidectomy should be performed in the relatively early stage of renal HPT. Total parathyroidectomy with forearm autograft is a suitable procedure for renal HPT, especially in patients who require long-term hemodialysis. For surgeons, it is important to remove all parathyroid glands, including supernumerary glands, at the initial operation and to choose adequate parathyroid tissue for the autograft to prevent persistent and recurrent HPT. Although the risk of graft-dependent recurrent HPT is not negligible, enlarged transplanted parathyroid tissue can be removed easily and noninvasively from the forearm under local anesthesia. There is no risk of hypofunction of the autograft.
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Affiliation(s)
- Y Tominaga
- Department of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital, Nagoya.
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