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Management of patients with persistent or recurrent primary hyperparathyroidism

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Abstract

The surgical management of patients with persistent or recurrent primary hyperparathyroidism is reviewed. The several factors allowing the surgeon to formulate a correct working diagnosis and to successfully remove all abnormal parathyroid tissue are individually discussed and recent results of re-operative parathyroid surgery are presented. In particular, direct surgical exploration based on aggressive pre-operative localization studies, the use of intra-operative ultrasound to facilitate intra-operative dissection, cryopreservation of excised parathyroid tissue with potential for delayed autograft to avoid permanent hypoparathyroidism, and the use of intra-operative monitoring of urinary cyclic adenosine monophosphate levels in patients with parathyroid hyperplasia in whom the surgeon is uncertain whether all abnormal parathyroid tissue has been removed, each contribute to a high rate of successful management (>95%) for patients with the difficult problem of persistent or recurrent primary hyperparathyroidism.

Résumé

Le traitement chirurgical des patients ayant une hyperparathyroÏdie primitive persistante ou récidivante est exposé. Sont énumérés plusieurs facteurs qui permettent au chirurgien d'établir un bon diagnostic et d'enlever tout le tissu parathyroÏdien malade. Les résultats récents de cette expérience sont présentés. L'exploration chirurgicale directe, basée sur la localisation pré-opératoire poussée, l'utilisation de l'échographie per-opératoir pour faciliter la dissection, la conservation de tissu parathyroÏdien par le froid pour réimplantation secondaire et le dosage de l'adénosine monophosphate cyclique urinaire en cas d'hyperplasie parathyroÏdienne, permettant au chirurgien de poursuivre sa dissection jusqu'à ce que tout le tissu parathyroÏdien soit enlevé. Ces méthodes assurent un taux de succès élevé (>95%) dans le traitement difficile de l'hyperparathyroÏdie primitive persistente ou récidivante.

Resumen

Se revisa el manejo quirÚrgico de pacientes con hiperparatiroidismo persistente o recurrente. Se discuten en forma individual los diverses factures que permiten al cirujano formular un diagnóstico de trabajo y resecar exitosamente la totalidad del tejido paratiroideo anormal. En particular la exploración quirÚrgica directa con base en estudios agresivos de localización preoperatoria, el uso de ultrasonido intraoperatorio para facilitar la disección, la criopreservación del tejido paratiroideo resecado con capacidad para autoinjerto tardío para la prevención del hipoparatiroidismo permanente y el uso de la monitoría intraoperatoria de los niveles urinarios de monofosfato de adenosina cíclica en pacientes con hiperplasia paratiroidea en quienes el cirujano no está seguro de haber removido la totalidad del tejido paratiroideo, son todos factores que contribuyen a una elevada tasa de manejo exitoso (>95%) de pacientes con el difícil problema del hiperparatiroidismo persistente o recurrente.

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Carty, S.E., Norton, J.A. Management of patients with persistent or recurrent primary hyperparathyroidism. World J. Surg. 15, 716–723 (1991). https://doi.org/10.1007/BF01665305

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