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Yang L, Jing X, Pang H, Guan L, Li M. Primary hyperparathyroidism: predictors of sporadic multi-gland disease. Endocr Connect 2024; 13:e230492. [PMID: 38513354 PMCID: PMC11046330 DOI: 10.1530/ec-23-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
In this review, we discuss the definition, prevalence, and etiology of sporadic multiglandular disease (MGD), with an emphasis on its preoperative and intraoperative predictors. Primary hyperparathyroidism (PHPT) is the third-most common endocrine disorder, and multiglandular parathyroid disease (MGD) is a cause of PHPT. Hereditary MGD can be definitively diagnosed with detailed family history and genetic testing, whereas sporadic MGD presents a greater challenge in clinical practice, and parathyroidectomy for MGD is associated with a higher risk of surgical failure than single gland disease (SGD). Therefore, it is crucial to be able to predict the presence of sporadic MGD in a timely manner, either preoperatively or intraoperatively. Various predictive methods cannot accurately identify all cases of sporadic MGD, but they can greatly optimize the management of MGD diagnosis and treatment and optimize the cure rate. Future research will urge us to investigate more integrative predictive models as well as increase our understanding of MGD pathogenesis.
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Affiliation(s)
- Lu Yang
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingguo Jing
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Pang
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Guan
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengdan Li
- Department of Nuclear Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lawrence E, Johri G, Dave R, Li R, Gandhi A. A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease. Langenbecks Arch Surg 2023; 408:389. [PMID: 37806985 PMCID: PMC10560634 DOI: 10.1007/s00423-023-03087-w] [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: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. METHODS We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. CONCLUSION Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.
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Affiliation(s)
- E Lawrence
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - G Johri
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Dave
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - R Li
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - A Gandhi
- Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, M20 4GJ, Manchester, UK.
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Frye CC, Sanka SA, Sullivan J, Brunt LM, Gillanders WE, Pandian T, Brown TC. Analysis of Preoperative Predictors of Single and Multigland Primary Hyperparathyroidism. J Surg Res 2023; 288:148-156. [PMID: 36966595 DOI: 10.1016/j.jss.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Preoperative differentiation of single-gland (SG) versus multigland (MG) primary hyperparathyroidism (PHPT) can assist with surgical planning, treatment prognostication, and patient counseling. The aim of this study was to identify preoperative predictors of SG-PHPT. METHODS Retrospective analysis of 408 patients with PHPT who underwent parathyroidectomy at a tertiary referral center. Comprehensive preoperative parameters, including demographic, laboratory, clinical, and imaging results were analyzed. Univariate analysis and binary logistic regression identified preoperative predictors of SG-PHPT. Receiver operator curves were used to analyze the predictive values of existing and novel preoperative predictive models. RESULTS Elevated parathyroid hormone (PTH) (99.1 pg/mL in SG versus 93.0 pg/mL in MG), elevated calcium (10.8 mg/dL in SG versus 10.6 mg/dL in MG), lower phosphate levels (2.80 mg/dL in SG versus 2.95 mg/dL in MG), and positive imaging (ultrasound 75.6% in SG versus 56.5% in MG; sestamibi 70.8% in SG versus 45.5% in MG) were significantly associated with SG-PHPT. The Washington University Score (a predictive scoring system made from calcium, PTH, phosphate, ultrasound, and sestamibi) and the Washington University Index ([calcium × PTH]/phosphate) were comparable to previous scoring systems used to predict SG versus MG-PHPT. CONCLUSIONS The association of lower phosphate with SG-PHPT is a novel finding. Previously identified predictors of SG-PHPT, including elevated PTH and positive imaging were confirmed. The Washington University Score and Index are comparable to previously described models and can be used to help surgeons predict if a patient may have SG versus MG-PHPT.
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Luo Y, Jin S, He Y, Fang S, Wang O, Liao Q, Li J, Jiang Y, Zhu Q, Liu H. Predicting multigland disease in primary hyperparathyroidism using ultrasound and clinical features. Front Endocrinol (Lausanne) 2023; 14:1088045. [PMID: 37051192 PMCID: PMC10083379 DOI: 10.3389/fendo.2023.1088045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/26/2023] [Indexed: 03/28/2023] Open
Abstract
Background The identification of multigland disease (MGD) in primary hyperparathyroidism (PHPT) patients is essential for minimally invasive surgical decision-making. Objective To develop a nomogram based on ultrasound (US) findings and clinical factors to predict MGD in PHPT patients. Materials and methods Patients with PHPT who had surgery between March 2021 and January 2022 were consecutively enrolled to this study. Biochemical and clinicopathological data were recorded. US images were analyzed to extract US features for prediction. Logistic regression analyses were used to identify MGD risk factors. A nomogram was constructed based on these factors and its performance evaluated by area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow tests, and decision curve analysis (DCA). Results A total of 102 PHPT patients were included; 82 (80.4%) had single-gland disease (SGD) and 20 (19.6%) had MGD. Using multivariate analyses, MGD was positively correlated with age (odds ratio (OR) = 1.033, 95% confidence interval (CI): 0.190-4.047), PTH levels (OR = 1.001, 95% CI: 1.000-1.002), multiple endocrine neoplasia type 1 (MEN1) (OR = 29.730, 95% CI: 3.089-836.785), US size (OR = 1.198, 95% CI: 0.647-2.088), and US texture (cystic-solid) (OR = 5.357, 95% CI: 0.499-62.912). MGD was negatively correlated with gender (OR = 0.985, 95% CI: 0.190-4.047), calcium levels (OR = 0.453, 95% CI: 0.070-2.448), and symptoms (yes) (OR = 0.935, 95% CI: 0.257-13.365). The nomogram showed good discrimination with an AUC = 0.77 (0.68-0.85) and good agreement in predicting MGD in PHPT patients. Also, 65 points was recommended as a cut-off value, with specificity = 0.94 and sensitivity = 0.50. Conclusion US was useful in evaluating MGD. Combining US and clinical features in a nomogram showed good diagnostic performance for predicting MGD.
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Affiliation(s)
- Yanwen Luo
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Siqi Jin
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yudi He
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Song Fang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ou Wang
- Key Laboratory of Endocrinology, Department of Endocrinology, National Commission of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Buzanakov DM, Sleptsov IV, Semenov AA, Chernikov RA, Novokshonov KY, Karelina YV, Timofeeva NI, Uspenskaya AA, Makarin VA, Chinchuk IK, Fedorov EA, Gorskaya NA, Sablin IV, Malugov YN, Alekseeva SA, Gerasimova KA, Pushkaruk AA, Lyubimov MV, Rebrova DV, Shikhmagomedov SS, Dzhumatov TA, Zolotoukho AV, Bubnov AN. Persistence of primary hyperparathyroidism: a single-center experience. Langenbecks Arch Surg 2022; 407:3651-3659. [PMID: 36251078 DOI: 10.1007/s00423-022-02711-5] [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: 04/27/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism (PHPT). Precise localization of abnormal glands is a key to a successful surgery. Most patients are expected to be successfully treated with focused parathyroidectomy. However, this approach is associated with a risk of existing multiglandular disease which may lead to the postoperative persistence of PHPT. METHODS Eight hundred ten patients who underwent an initial surgery for PHPT at SPBU Hospital in 2017-2018 were included in the study. Preoperative imaging results were evaluated. Multivariate logistic regressions were calculated to estimate predictive values of preoperative data for the risk of postoperative persistence and risk of MGD. RESULTS Multiglandular disease was found to be a leading cause of persistent hyperparathyroidism. An anamnesis of thyroid surgery was found to be a significant risk factor for the persistence of hyperparathyroidism. The rate of persistence did not differ significantly between groups with bilateral neck exploration and focused parathyroidectomy. Age, sex, body mass index as well as negative results of preoperative US, MIBI, and 4D CT were not independently associated with a higher risk of MGD. All preoperative imaging modalities showed from low to moderate sensitivity for the detection of MGD. The frequency of cases of a missed second adenoma did not differ significantly between patients with concordant and discordant preoperative data. There were 7 cases with previously unsuspected second adenomas found solely due to bilateral neck exploration. CONCLUSIONS None of the combination of preoperative visualization modalities was able to rule out the MGD and reliably identify patients for focused parathyroidectomy. Additional preoperative visualization failed to improve overall results. Bilateral neck exploration appeared to have a slight benefit for the patients with concordant preoperative imaging results.
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Affiliation(s)
- Dmitrii M Buzanakov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation.
| | - Ilya V Sleptsov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Arseny A Semenov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Roman A Chernikov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Konstantin Y Novokshonov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Yulia V Karelina
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Natalya I Timofeeva
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Anna A Uspenskaya
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Viktor A Makarin
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Igor K Chinchuk
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Elisey A Fedorov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Natalya A Gorskaya
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Ilya V Sablin
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Yuriy N Malugov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Svetlana A Alekseeva
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Ksenya A Gerasimova
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Alexander A Pushkaruk
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Mikhail V Lyubimov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Dina V Rebrova
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Shamil S Shikhmagomedov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
| | - Timur A Dzhumatov
- Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Anna V Zolotoukho
- Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Alexander N Bubnov
- Saint Petersburg State University Hospital, Saint Petersburg, Saint Petersburg, Russian Federation
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De Pasquale L, Lori E, Bulfamante AM, Felisati G, Castellani L, Saibene AM. Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience. Int J Endocrinol 2021; 2021:2040284. [PMID: 34671396 PMCID: PMC8523259 DOI: 10.1155/2021/2040284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80-85% of the cases) or by a multiglandular disease (15-20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. METHODS A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. RESULTS 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. CONCLUSION Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.
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Affiliation(s)
- Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service (Head Dott. Loredana De Pasquale)-Otolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, Italy
| | - Eleonora Lori
- Department of Surgical Science, “Sapienza” University of Rome, Rome 00161, Italy
| | - Antonio Mario Bulfamante
- Otolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, Italy
| | - Giovanni Felisati
- Otolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, Italy
| | - Luca Castellani
- Otolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, Italy
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