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Ghaffar T, Kanwal S, Aamir AH, Din N. Diagnostic accuracy of ultrasonography and 99m-Technetium Sestamibi scintigraphy for the preoperative localization of Parathyroid Adenoma keeping histopathological findings as reference standard. Pak J Med Sci 2024; 40:2405-2409. [PMID: 39554654 PMCID: PMC11568711 DOI: 10.12669/pjms.40.10.8575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 07/31/2024] [Accepted: 08/18/2024] [Indexed: 11/19/2024] Open
Abstract
Objective To determine the diagnostic accuracy of Ultrasound (US) and 99m-Tc Sestamibi scan in patients with primary hyperparathyroidism (PHPT) for the localization of parathyroid adenoma before surgery keeping Parathyroid histopathology as reference standard. Method This three years retrospective study was performed in the Department of Endocrinology, Hayatabad Medical Complex, Peshawar. Patients with PHPT who underwent parathyroidectomy from July 2019 to June 2022 were included in the study. Information relating to localization studies prior to surgical management like US and 99m-Tc Sestamibi scan was documented. These imaging findings were subsequently compared with the findings of parathyroid surgery and histopathology results which were taken as reference standard. Results The sensitivity, positive predictive value (PPV) and overall accuracy of US for the preoperative localization of parathyroid adenoma was 77%, 95.7% and 75%, respectively. Whereas the sensitivity, PPV and accuracy of 99m-Tc Sestamibi scintigraphy was 89.5%, 95% and 86% respectively. Conclusion Ultrasound despite its cost effectiveness has a lower sensitivity compared to 99m-Tc Sestamibi scintigraphy. Similarly, the sensitivity and overall accuracy of US and 99m-Tc Sestamibi scan when taken in combination is higher compared to either modality. It is thus recommended that the combination of these modalities should be employed to localize the adenomas accurately for surgery of the parathyroid gland for a better outcome.
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Affiliation(s)
- Tahir Ghaffar
- Tahir Ghaffar, MBBS, FCPS, MRCP, Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Shaista Kanwal
- Shaista Kanwal, MBBS, FCPS, MRCP, Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Azizul Hasan Aamir
- Azizul Hasan Aamir, MRCP, FRCP, FACE, Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nizamud Din
- Nizamud Din, MBBS, FCPS, Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
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Zhong H, Liao Q, Liu J. Expert consensus on multidisciplinary approach to the diagnosis and treatment of primary hyperparathyroidism in pregnancy in China. Endocrine 2023; 82:282-295. [PMID: 37221429 DOI: 10.1007/s12020-023-03392-w] [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: 03/15/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
Primary hyperparathyroidism in pregnancy is a rare disease that can have detrimental effects on both maternal and fetal/neonatal outcomes. The physiological changes that occur during pregnancy can complicate the diagnosis, imaging examinations, and treatment of this disorder. To enhance our understanding and management of primary hyperparathyroidism in pregnancy, experts from various fields, including endocrinology, obstetrics, surgery, ultrasonography, nuclear medicine, pediatrics, nephrology, and general practice in China, collaborated to develop a consensus addressing the critical aspects of the diagnosis and treatment of primary hyperparathyroidism in pregnancy with a multidisciplinary team approach. This consensus provides valuable guidance for healthcare professionals in managing this condition, ultimately improving outcomes for both mothers and their babies.
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Affiliation(s)
- Huiping Zhong
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jianmin Liu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Chen J, Tang G, Peng Y, Cheng H. Parathyroid adenoma with rare severe pathological osteolytic lesion: a case report and literature review. Front Oncol 2023; 13:1218863. [PMID: 37601648 PMCID: PMC10435972 DOI: 10.3389/fonc.2023.1218863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
Parathyroid adenomas are benign proliferative disorders of parathyroid glands. Patients typically exhibit hyperparathyroidism and elevated serum calcium levels due to elevated levels of parathyroid hormone (PTH). We report a newly diagnosed case of a rare pathological osteolytic lesion. Radiological evaluation revealed multiple bony lesions in multiple parts of the pelvis, vertebral body, and spinous process, suggesting hematological neoplasms or bone marrow metastatic carcinoma. The morphology revealed many abnormal cells in the bone marrow smear. Furthermore, serum calcium and PTH levels were significantly increased compared to normal levels. Doppler color ultrasound showed a thyroid mass (left), suspected parathyroid adenoma, thyroid, and isthmus nodular goiter (right). The patient underwent bilateral neck exploration with parathyroidectomy, and serum calcium and PTH levels significantly decreased on the second day after surgery and had a surgical cure.
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Affiliation(s)
- Jia Chen
- Department of Hematology, Naval Military Medical University, First Affiliated Hospital, Shanghai, China
| | - Gusheng Tang
- Department of Hematology, Naval Military Medical University, First Affiliated Hospital, Shanghai, China
| | - Ye Peng
- Department of Nuclear Medicine, Naval Military Medical University, First Affiliated Hospital, Shanghai, China
| | - Hui Cheng
- Department of Hematology, Naval Military Medical University, First Affiliated Hospital, Shanghai, China
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Fu CH, Chen HF. Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review. Medicine (Baltimore) 2022; 101:e31750. [PMID: 36401406 PMCID: PMC9678528 DOI: 10.1097/md.0000000000031750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most patients with parathyroid adenomas are asymptomatic and rarely present with chronic pancreatitis (CP). Several studies have reported a positive association between primary hyperparathyroidism (PHPT) and pancreatitis. Parathyroidectomy is the definitive treatment for PHPT. IV bisphosphonates can be considered the drug of choice for bridge to surgery. METHODS We reported a 57-year-old female patient was admitted to the emergency room with left upper quadrant abdominal pain and a diagnosis of recurrent pancreatitis. Magnetic Resonance Cholangiopancreatography confirmed the diagnosis of CP. The patient had no common etiology of pancreatitis. Persistent hypercalcemia was noted despite administering intravenous fluids, and Calcitonin. Intravenous Pamidronate, a Bisphosphonate derivative, was also administered. Although calcium levels initially decreased, they were later found to rebound to previous levels. RESULTS A diagnosis of parathyroid adenoma and PHPT was made based on the elevated parathyroid hormone levels and cervical ultrasonography indicated right inferior parathyroid adenoma. Technetium-99m methoxy-isobutyl-isonitrile scintigraphy revealed a focal hot spot of tracer accumulation at the right lower thyroid bed. The patient underwent right lower parathyroidectomy smoothly and successfully. After right lower parathyroidectomy, she had normal serum calcium levels (9.2 mg/dL) and parathyroid hormone (16.1 pg/mL). There was no recurrent abdominal pain after the operation. CONCLUSION CP is a rare manifestation of parathyroid adenoma. When patients with a history of recurrent pancreatitis, without common causes of pancreatitis, present persistent elevated serum calcium levels, PHPT could be suspected.
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Affiliation(s)
- Chih-Hsuan Fu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- Division of Hospital Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- * Correspondence: Chih-Hsuan Fu, Division of Endocrinology and Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banqiao District, New Taipei City 220, Taiwan. R.O.C. (e-mail: )
| | - Hua-Fen Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan. R.O.C
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Hillyar CR, Rizki H, Begum R, Patel A, Nagabhushan N, Lee PH, Smith S. A Retrospective Cohort Study of the Utility of Ultrasound, 99mTc-Sestamibi Scintigraphy, and Four-Dimensional Computed Tomography for Pre-Operative Localization of Parathyroid Disease To Facilitate Minimally Invasive Parathyroidectomy. Cureus 2022; 14:e21177. [PMID: 35165625 PMCID: PMC8837380 DOI: 10.7759/cureus.21177] [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] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study investigated the utility of ultrasound (US), 99mTc-Sestamibi scintigraphy (Sestamibi), and four-dimensional computed tomography (4DCT) for pre-operative localization of a single abnormal parathyroid gland prior to minimally invasive parathyroidectomy (MIP) to determine the optimum pre-operative scans to facilitate a MIP. Methods Patients with primary hyperparathyroidism who underwent curative parathyroidectomy at Broomfield Hospital, Mid and South Essex NHS Foundation Trust between 2009 and 2018 were included. Diagnostic performance parameters and the agreement between US, Sestamibi, and 4DCT were evaluated. Cohen’s κ was used to assess the strength of agreement between imaging modalities. Results At localizing pathology to the correct side of the neck, Sestamibi had the highest sensitivity (87%), followed by US (76%) and 4DCT (64%). 4DCT had a positive predictive value (PPV) of 95%, similar to Sestamibi (96%), but higher than US (92%). Amongst patients who underwent both US and Sestamibi, the abnormal parathyroid gland was localized to the same area by both imaging modalities in 77% of patients (Cohen’s κ: 0.383). Following an inconclusive US or Sestamibi scan, or discordance between the two modalities, 4DCT was correct at localization in 63% of patients. Conclusion Sestamibi has the highest sensitivity and PPV for accurately localizing parathyroid pathology. The addition of US to a positive Sestamibi scan adds little additional value. 4DCT is the preferred imaging modality following an inconclusive Sestamibi or US.
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de Jong MC, Jamal K, Morley S, Beale T, Chung T, Jawad S, Hurel S, Simpson H, Srirangalingam U, Baldeweg SE, Rozalén García V, Otero S, Shawky M, Abdel-Aziz TE, Kurzawinski TR. The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism. Hormones (Athens) 2021; 20:499-506. [PMID: 32405929 DOI: 10.1007/s42000-020-00205-x] [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: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. METHODS An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. RESULTS All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99). CONCLUSION The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.
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Affiliation(s)
- Mechteld C de Jong
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - K Jamal
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Morley
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Beale
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Chung
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Jawad
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Hurel
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - H Simpson
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - U Srirangalingam
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S E Baldeweg
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - V Rozalén García
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Otero
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - M Shawky
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Characterization of Glycosphingolipids in the Human Parathyroid and Thyroid Glands. Int J Mol Sci 2021; 22:ijms22137044. [PMID: 34208903 PMCID: PMC8269270 DOI: 10.3390/ijms22137044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
As part of a systematic investigation of the glycosphingolipids in human tissues, acid and non-acid glycosphingolipids from human thyroid and parathyroid glands were isolated and characterized with mass spectrometry and binding of carbohydrate-recognizing ligands, with a focus on complex compounds. The glycosphingolipid patterns of the human parathyroid and thyroid glands were very similar. The major acid glycosphingolipids were sulfatide and the gangliosides GM3, GD3, GD1a, GD1b, GT1b and Neu5Ac-neolactotetraosylceramide, and the major non-acid glycosphingolipids were globotriaosylceramide and globoside. We also found neolactotetra- and neolactohexaosylceramide, the x2 glycosphingolipid, and complex glycosphingolipids with terminal blood group O and A determinants in both tissues. A glycosphingolipid with blood group Leb determinant was identified in the thyroid gland, and the parathyroid sample had a glycosphingolipid with terminal blood group B determinant. Immunohistochemistry demonstrated the expression of blood group A antigens in both the thyroid and parathyroid glands. A weak cytoplasmatic expression of the GD1a ganglioside was present in the thyroid, while the parathyroid gland had a strong GD1a expression on the cell surface. Thus, the glycosylation of human thyroid and parathyroid glands is more complex than previously appreciated. Our findings provide a platform for further studies of alterations of cell surface glycosphingolipids in thyroid and parathyroid cancers.
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Lu R, Zhao W, Yin L, Guo R, Wei B, Jin M, Zhou X, Zhang C, Lv X. Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism. BMC Med Imaging 2021; 21:87. [PMID: 34020602 PMCID: PMC8139103 DOI: 10.1186/s12880-021-00616-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas. Methods A total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated. Results In this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; 2=26.224, 18.227 respectively, P<0.001). The differences between US+Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (2=33.410, 21.587 respectively, P<0.001), yet there were no significant differences in the sensitivity or accuracy between US+Tc-99m MIBI SPECT/CT and US-alone (2=0.866, 0.187 respectively, P=0.352 and 0.665). Conclusions US shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.
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Affiliation(s)
- Ruigang Lu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Wei Zhao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Li Yin
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Xiang Zhou
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Chun Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiuzhang Lv
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China.
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Zhu M, He Y, Liu T, Tao B, Zhan W, Zhang Y, Xie J, Chen X, Zhao H, Sun L, Liu J. Factors That Affect the Sensitivity of Imaging Modalities in Primary Hyperparathyroidism. Int J Endocrinol 2021; 2021:3108395. [PMID: 34840566 PMCID: PMC8616673 DOI: 10.1155/2021/3108395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cervical ultrasound, 99mTc-sestamibi single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT), and cervical CT are routinely used in preoperative localization of primary hyperparathyroidism (PHPT). However, false-negative imaging results are also frequently encountered in clinical practice. Exploring the factors that affect the sensitivity of these imaging modalities is important for the surgical management of PHPT patients. METHODS Clinical data of 352 PHPT patients hospitalized in our center from January 2011 to December 2015 were retrospectively collected to evaluate the sensitivity of 3 imaging modalities in the preoperative localization of parathyroid lesions. The ROC curve analysis was used to explore the clinical factors affecting the sensitivity of localization, and the cut-point(s) of related factors were determined. RESULTS 99mTc-MIBI SPECT/CT has the highest sensitivity among the localization modalities commonly used, reaching 91.1% (86.0%-94.8%). When the lengths of parathyroid lesions were ≤1.3 cm, the sensitivity of neck ultrasonography significantly decreased, while the sensitivity of 99mTc-MIBI SPECT/CT decreased with parathyroid lesions ≤1.3 cm or serum PTH≤252 pg/ml. 99mTc-MIBI SPECT/CT was less effective in localizing the hyperplasia lesions. Neck ultrasonography combined with 99mTc-MIBI SPECT/CT can effectively improve the accuracy of preoperative localization of parathyroid lesions to 96.2% (92.7%-98.1%). CONCLUSIONS Small parathyroid lesion and mild elevation of serum PTH would reduce the accuracy of parathyroid localization in PHPT patients.
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Affiliation(s)
- Minting Zhu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Yang He
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Tingting Liu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Bei Tao
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Weiwei Zhan
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yifan Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jing Xie
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Chen
- Department of Thyroid and Vascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hongyan Zhao
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Lihao Sun
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
| | - Jianmin Liu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai 200025, China
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Malipedda S, Kamaleshwaran KK, Muthusamy D, Veerasamy M, Soundararajan AP, Jayaraj AV. Rare Imaging Findings of Concomitant Presence of Multiple Parathyroid Adenomas and Carcinoma in a Chronic Kidney Disease Patient with Tertiary Hyperparathyroidism Detected on 99mTc-Sestamibi Single-Photon-Emission Computed Tomography/Computed Tomography Scintigraphy. Indian J Nucl Med 2020; 35:333-335. [PMID: 33642760 PMCID: PMC7905269 DOI: 10.4103/ijnm.ijnm_100_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/21/2022] Open
Abstract
Parathyroid carcinoma (PC) is a rare endocrine carcinoma. It is one of the rare causes for primary hyperparathyroidism. It is very uncommon in individuals with secondary or tertiary hyperparathyroidism. We report a rare case of 53-year-old male, a known case of chronic kidney disease on dialysis, who presented with fatigue and muscle cramps. Lab reports revealed elevated parathyroid hormone (PTH) and serum calcium levels. 99mTc-Sestamibi single-photon-emission computed tomography/computed tomography scintigraphy showed 4 foci of increased tracer uptake with retention, suggestive of parathyroid adenomas, including two ectopic foci in the mediastinum. At surgery, the enlarged bilateral superior, left inferior parathyroid gland, and two calcified left superior mediastinal lesions were removed. Histopathology revealed parathyroid adenomas in the right superior, left inferior, supernumerary ectopic left superior mediastinum lesion and PC in the left superior parathyroid lesion. Intraoperative serum PTH became normal, and the patient is asymptomatic now.
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Affiliation(s)
- Suneelkumar Malipedda
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | | | - Dhiwakar Muthusamy
- Department of Head and Neck Surgery, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Mangalakumar Veerasamy
- Department of Nephrology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Arun Pandiyan Soundararajan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Arnold Vasumathi Jayaraj
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
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11
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Fatima T, Das B, Sattar S, Jabeen S, Khan AA, Islam N. The Utility of Ultrasound in the Preoperative Localization of Primary Hyperparathyroidism: Insights from Pakistan. Cureus 2020; 12:e9835. [PMID: 32953342 PMCID: PMC7496491 DOI: 10.7759/cureus.9835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to evaluate and compare the diagnostic performance of ultrasound (US) and 99m-Tc sestamibi scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT). Methods This retrospective study was conducted at the Aga Khan University Hospital in Karachi, Pakistan, and comprised the data of patients with PHPT who underwent parathyroidectomy from 2008 to 2017. Preoperative US and 99m-Tc sestamibi scintigraphy findings were recorded and compared to surgical and histological findings, which were taken as a reference standard. Results The sensitivity of US in the preoperative localization of PHPT was 88.3%, positive predictive value (PPV) was 94.6%, and accuracy was 84.1%. The sensitivity of 99m-Tc sestamibi scintigraphy was 90.4%, PPV was 94.3%, and accuracy was 85.7%. Conclusion US neck is an efficient tool for the preoperative localization of PHPT, demonstrating a comparable diagnostic yield with 99m-Tc sestamibi, and can serve as a credible first-line imaging modality in a resource-constrained healthcare setup.
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Application of transoral endoscopic parathyroidectomy via vestibular approach, endoscopic parathyroidectomy via areola approach for parathyroid adenoma. Eur Arch Otorhinolaryngol 2020; 278:1559-1565. [PMID: 32700236 DOI: 10.1007/s00405-020-06231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transoral endoscopic parathyroidectomy via vestibular approach (TOEPVA) and total endoscopic parathyroidectomy via areola approach (EPA) are commonly used endoscopic parathyroidectomy approaches. This study compares effectiveness of these approaches with conventional open parathyroidectomy (COP) in relation to safety, associated trauma, and feasibility in the treatment of parathyroid adenoma (PTA). METHODS We examined patients who had undergone TOEPVA (n = 15), EPA (n = 14), and COP (n = 30). All patients had a pathological diagnosis of PTA. We analyzed operative time, intraoperative blood loss, postoperative visual analog scale (VAS) score, postoperative drainage volume, hospital stay and complications such as changes in parathyroid hormone (PTH) and serum calcium before and after surgery. RESULTS Clinical variables across the three experimental groups were similar except for patient age. TOEPVA and EPA groups had a higher proportion of young patients than COP group. Operation time for endoscopic group was longer than that of open group, and the longest operation time was recorded in TOEPVA group (P = 0.000). Postoperative VAS score: postoperative pain in patients in the endoscopic group was less than that of patients in the open group on the first day (P = 0.001). Postoperative pain in patients of the endoscopic group was significant on the second day (P = 0.044). Pain experienced by patients in the three groups was the same on the third day after surgery (P = 0.312). Postoperative drainage volume in the endoscopic group was more than that in the open group (P = 0.000). There were no significant differences between intraoperative blood loss (P = 0.089), complications (P = 0.407) and hospital stay (P = 0.389) in TOEPVA, EPA and COP groups. PTH and serum calcium levels in the three experimental groups were considerably lower after surgery (P < 0.05). Tumor recurrence was not recorded in the three groups during a follow-up period of between 3 and 36 months. CONCLUSIONS TOEPVA and EPA are safe treatment options for PTA. The therapeutic effects of TOEPVA and EPA were similar to those of COP in the treatment of PTA.
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Lee J, Hong N, Kim BM, Kim DJ, Yun M, Jeong JJ, Rhee Y. Evaluation of an optimal cutoff of parathyroid venous sampling gradient for localizing primary hyperparathyroidism. J Bone Miner Metab 2020; 38:570-580. [PMID: 32100109 DOI: 10.1007/s00774-020-01085-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/17/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Parathyroid venous sampling (PVS) has been reported to be a useful adjunctive test in localizing lesions in elusive cases of primary hyperparathyroidism (PHPT). Conventional cutoff (twofold) is now widely being used, but optimal cutoff threshold for PVS gradient based on discriminatory performance remains unclear. MATERIALS AND METHODS Among a total of 197 consecutive patients (mean age 58.2 years, female 74.6%) with PHPT who underwent parathyroidectomy at a tertiary center between 2012 and 2018, we retrospectively analyzed 59 subjects who underwent PVS for persistent or recurrent disease after previous parathyroidectomy, or for equivocal or negative results from conventional imaging modalities including ultrasonography (US) and Tc99m-Sestamibi SPECT-CT (MIBI). True parathyroid lesions were confirmed by combination of surgical, pathological findings, and intraoperative parathyroid hormone (PTH) changes. Optimal PVS cutoff were determined by receiver-operating characteristics (ROC) analysis with Youden and Liu method. RESULTS Compared to subjects who did not require PVS, PVS group tends to have lower PTH (119.8 pg/mL vs 133.7 pg/mL, p = 0.075). A total of 79 culprit parathyroid lesions (left 40; right 39) from 59 patients (left 24; right 26; bilateral 9) were confirmed by surgery. The optimal cutoff for PVS gradient was estimated as 1.5-fold gradient (1.5 ×) with sensitivity of 61.8% and specificity of 84%. When 1.5 × cutoff was applied, PVS improved the discrimination for true parathyroid lesions substantially based on area under ROC (0.892 to 0.942, p < 0.001) when added to US and MIBI. CONCLUSION Our findings suggest that PVS with cutoff threshold 1.5 × can provide useful complementary information for pre-operative localization in selected cases.
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Affiliation(s)
- Jooyeon Lee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Ju Jeong
- Department of Surgery, Thyroid Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Pushpasekaran N, Vasudevan G, Khaleel VM, Sebastain A, Das S. Overt metabolic bone failure as the initial manifestation of neglected primary hyperparathyroidism: An unusual presentation and review of current practice guidelines. J Clin Orthop Trauma 2020; 11:S671-S674. [PMID: 32774048 PMCID: PMC7394783 DOI: 10.1016/j.jcot.2020.01.006] [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: 11/11/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 11/18/2022] Open
Abstract
Varied symptomatology exists in hyperparathyroidism. The current approaches and evaluation of altered calcium homeostasis have led to the practice of early identification and subsequent management of the adenomas. Hence, bony manifestations (deformities, lesions, and fractures) termed to be end stage of bone metabolism failure, have rarely been encountered in the last two decades. We report this infrequent presentation in a 47-year-old female, who visited the emergency department following a trivial fall. Her background history recorded left superior parathyroidectomy three months prior to fall. The clinical and radiological evaluations were suggestive of insufficiency fractures of right proximal humerus and right shaft of femur, multiple lytic lesions and other bony manifestations pathognomonic of hyperparathyroidism. Metabolic profile revealed a primary cause despite prior adenectomy, and targeted scintigraphy demonstrated a hyper-functioning right inferior parathyroid gland. The high resolution ultrasound used before the prior surgery failed to localise additional hyper-functioning glands. Post-parathyroidectomy, the hungry bone disease was adequately managed. The femur fracture required surgical stabilization. In conclusion, bony manifestations of hyperparathyroidism can be disabling and difficult to treat. Although a rare clinical presentation, the severity of bony manifestations arise from a preventable cause and that the initial evaluation of hyperparathyroidism should also include parathyroid scintigraphy, and not limited to screening of the neck with ultrasonography, for its combined additive information and improved diagnostic value.
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Affiliation(s)
| | - Gokuldev Vasudevan
- Department of Orthopaedics, Medical Trust Hospital, Cochin, Kerala, India
| | | | - Antony Sebastain
- Department of Cardiothoracic and Vascular Surgery, Medical Trust Hospital, Cochin, Kerala, India
| | - Saubhik Das
- Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
- Corresponding author. Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi, 834009, India.
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[Imaging of medullary thyroid carcinoma]. Radiologe 2019; 59:992-1001. [PMID: 31367891 DOI: 10.1007/s00117-019-0575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND About 10% of thyroid cancers are medullary thyroid carcinoma (MTC) and can occur sporadically, familially and in the context of type II multiple endocrine neoplasia (MEN). Imaging plays a pivotal role in screening family members and in diagnosis. DIAGNOSTIC METHODS Diagnosis is based on ultrasound (US), thyroid scintigraphy, serum calcitonin and carcinoembryonic antigen (CEA) as well as fine needle biopsy. High-resolution US is the most important imaging method for locoregional staging, combined with computed tomography (CT) of the mediastinum. Positron emission tomography (PET-CT) using 18-F-DOPA is particularly suited for suspected occult metastases in case of rising tumor markers in serum. FINDINGS AND COURSE OF DISEASE Diagnosis is made based on cytologic findings in a hypoechoic, cold thyroid nodule, combined with an elevation of serum calcitonin and CEA. US is the most important imaging modality during routine follow-up. CT is indicated for suspected mediastinal, lung, or liver metastases. CT should be replaced by MRI as early as possible to prevent significant cumulative radiation doses over time. RECENT CLINICAL DEVELOPMENTS Although MTC is curable by surgery only, owing to its radio- and chemoresistance, the disease will often progress only slowly, and even patients with metastases will frequently survive 10 years or longer. For more aggressive variants and late symptomatic stages, targeted drugs that have the potential to indicate stabilization or even a partial remission of the disease are under clinical investigation or already approved.
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Pekkolay Z, Altun Tuzcu Ş. Importance of Parathyroid Hormone Needle Aspiration Washout in Adenoma Localization in Primary Hyperparathyroidism. Med Sci Monit 2019; 25:1694-1698. [PMID: 30834899 PMCID: PMC6413563 DOI: 10.12659/msm.915192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Primary hyperparathyroidism is an endocrine disease characterized by excessive secretion of parathyroid hormone and hypercalcemia. Although scintigraphy is commonly used for pre-operative localization, it does not always localize the parathyroid lesion. In such patients, ultrasonography can visualize the suspected lesion and needle washout sample for parathyroid hormone titer can be used to confirm parathyroid tissue. The aim of this study was to investigate the accuracy of the parathyroid hormone needle aspiration washout method in detecting the localization of parathyroid adenoma. Material/Methods Patients with primary hyperparathyroidism who underwent surgery between 2010 and 2017 at the Dicle University Medical Faculty Hospital were retrospectively evaluated using medical records. Patients undergoing parathyroid hormone needle aspiration washout were performed in the suspected lesion were included in the study. Accompanied by ultrasonography, the suspected area was penetrated with needle, and negative aspiration was performed. Pre-operative scintigraphic data of patients were evaluated. Patients with positive scintigraphy, negative scintigraphy or patients who did not undergo scintigraphy were included in our study. Demographic data were presented as continuous data means ± standard deviation. Categorical variables were presented as frequency and percentage. Results Forty-nine patients (female/male, 40/9) who underwent parathyroid hormone needle aspiration washout were included in the study. Parathyroid hormone washout result was positive in 47 patients (47/49) and negative in 2 patients (2/49), sensitivity/positive predictive value (PPV) 95.91%. Twenty-six patients who had negative/suspicious scintigraphic results were diagnosed using the parathyroid hormone needle aspiration washout method (24/26, 92.3% accuracy). Parathyroid hormone needle aspiration washout without scintigraphy was performed in 13 patients (13/13, 100% accuracy). Conclusions Parathyroid adenoma localization can be easily done using parathyroid hormone needle aspiration washout in centers experienced in adenoma localization in primary hyperparathyroidism cases in which scintigraphic results are negative or scintigraphy cannot be performed. We believe that primary parathyroid hormone needle aspiration washout can be a new localization method for adenoma localization.
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Affiliation(s)
- Zafer Pekkolay
- Department of Adult Endocrinology, School of Medicine, Dicle Universty, Sur, Diyarbakır, Turkey
| | - Şadiye Altun Tuzcu
- Department of Nuclear Medicine, Gazi Yaşargil Training and Research Hospital, Yenişehir, Diyarbakır, Turkey
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Current practice in the surgical management of parathyroid disorders: a United Kingdom survey. Eur Arch Otorhinolaryngol 2018; 275:2549-2553. [PMID: 30116879 DOI: 10.1007/s00405-018-5094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Surgery for primary hyperparathyroidism is undertaken by many specialties but predominantly endocrine and ear, nose and throat (ENT) surgeons. There is currently no consensus on the peri-operative management of primary hyperparathyroidism. We sought to determine current surgical practice and identify any inter-specialty variation in the United Kingdom (UK). METHODS An online survey was disseminated to members of the British Association of Endocrine & Thyroid Surgeons (BAETS) in the UK. RESULTS 78 surgeons responded (40 Endocrine, 37 ENT and 1 maxillofacial). 90% of surgeons used ultrasound and sestamibi for pre-operative localisation. Intraoperative frozen section (31%) and parathyroid hormone monitoring (41%) were the most common adjuncts used intraoperatively. 68% of surgeons did not use any wound drains. Nearly two-thirds of surgeons (64%) discharged patients from the clinic within 3 months, There were some significant differences (p < 0.05) in particular areas of practice between endocrine and ENT surgeons (%, p): use of single-photon emission computed tomography (SPECT) (Endocrine 25% vs. ENT 5%), preoperative laryngeal assessment (endocrine 58% vs. ENT 95%), intraoperative laryngeal nerve monitoring (endocrine 35% vs. ENT 68%), use of monopolar diathermy (endocrine 58% vs. ENT 22%), bipolar diathermy (endocrine 60% vs. 89%) and surgical ties (endocrine 48% vs. ENT 19%). CONCLUSION Our study demonstrates some similarities as well as some notable differences in practice between endocrine and ENT surgeons, and therefore, highlights the need for national consensus with respect to some key areas in parathyroid surgery.
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Chiriac IA, Goldstein AL. ACTUALITIES IN ENDOCRINOLOGY- PARATHYROID IMAGING. ACTA ENDOCRINOLOGICA-BUCHAREST 2018; 14:142-144. [PMID: 31149250 DOI: 10.4183/aeb.2018.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parathyroid imaging modalities have been used to guide clinicians and surgeons in finding the source of hyperparathyroidism for over 40 years. Primary hyperparathyroidism (PHPT) is generally caused by a parathyroid gland(s) autonomous production of parathyroid hormone (PTH), associated by enlargement of one or more glands. Noninvasive imaging procedures that are used in the management of hyperparathyroidism are anatomical (ultrasound, computer tomography, magnetic resonance imaging) and/or functional (nuclear medicine techniques: planar scintigraphy, single photon emission tomography, positron emission imaging) and/or hybrid imaging.
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Affiliation(s)
- I A Chiriac
- "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - A L Goldstein
- "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
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