+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism



Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism



Surgery 134(6): 1038-41; Discussion 1041-2



The development of localization studies and quick parathyroid hormone assay (QPTH) has allowed the development of focused surgery in sporadic primary hyperparathyroidism. The aim of this investigation was to determine whether localization studies select a specific population of patients. From 1999 to 2001, 213 patients underwent surgery for sporadic primary hyperparathyroidism. All were investigated with sestamibi scanning and ultrasonography. When at least 1 study showed a positive result (n=175), the patient underwent a video-assisted approach with QPTH. When results were negative (n=38), the patient underwent cervicotomy and exploratory procedures of all 4 parathyroid glands. All patients are cured (mean follow-up, 17.8+/-10.3 months [SD]). Patients with negative preoperative study results had a high risk of multiglandular disease (12/38 patients; 31,6%), compared with patients with 1 positive study result (3/83 patients; 3.6%; P<.0001) and those with 2 concordant positive study results (0/92 patients; P<.0001). When preoperative localization study results are negative, the patient has a high risk of multiglandular disease, and a conventional cervicotomy with identification of the 4 glands is recommended strongly. When only 1 localization study is positive, the risk of multiglandular disease justifies the use of QPTH during a focused approach. When positive localization study results are concordant, the use of QPTH is questionable during a focused approach.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 012344398

Download citation: RISBibTeXText

PMID: 14668738

DOI: 10.1016/j.surg.2003.07.021


Related references

Incidence of multiglandular disease in sporadic primary hyperparathyroidism. B-Ent 10(1): 1-6, 2014

Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? A plea against unilateral parathyroid exploration. Surgery 112(6): 1118-1122, 1992

Limitations of technetium 99m sestamibi scintigraphic localization for primary hyperparathyroidism associated with multiglandular disease. American Surgeon 69(2): 170-175, 2003

Role of preoperative intact parathyroid hormone levels in predicting the likelihood of multiglandular disease in primary hyperparathyroidism. Head and Neck 33(4): 543-546, 2011

Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: A 10-year outcome. Yearbook of Surgery 2010: 158-159, 2010

Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: a 10-year outcome. Surgery 146(6): 1021-1027, 2009

Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate. Langenbeck's Archives of Surgery 2019, 2019

Does contrast-enhanced cervical ultrasonography improve preoperative localization results in patients with sporadic primary hyperparathyroidism?. Journal of Clinical Imaging Science 2: 64, 2012

Predictors of multiglandular disease in primary hyperparathyroidism. Langenbeck's Archives of Surgery 403(1): 103-109, 2018

Prevalence of thyroid disease among patients with primary hyperparathyroidism in an area of endemic goiter Impact on preoperative localization studies and surgical approach. Journal of Endocrinological Investigation 23(6 Suppl ): 37, 2000

The value of preoperative localization studies in primary hyperparathyroidism. Der Chirurg; Zeitschrift für Alle Gebiete der Operativen Medizen 70(10): 1082-1088, 1999

Value of preoperative ultrasound-guided fine-needle aspiration for localization in Tc-99m MIBI-negative primary hyperparathyroidism patients. Medicine 96(49): E9051, 2017

Incidence of multiglandular disease in primary hyperparathyroidism determined by parathyroid hormone secretion. Surgery (st Louis). 120(6): 934-937, 1996

Role of preoperative localization studies in the surgical treatment of primary hyperparathyroidism. Medicina Clinica 111(17): 679, 1999

Intraoperative PTH May Not Be Necessary in the Management of Primary Hyperparathyroidism Even with Only One Positive or Only Indeterminate Preoperative Localization Studies. World Journal of Surgery 41(6): 1500-1505, 2017