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Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

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Abstract

Background

Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate.

Methods

We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland.

Results

We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%.

The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1–96.2%).

Conclusions

MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.

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Authors and Affiliations

  1. Service d’Endocrinologie, CHU de Nantes, Boulevard Jacques Monod, 44093, Nantes Cedex 1, France

    Emmanuelle Trébouet, Matthieu Wargny & Lucy Chaillous

  2. Clinique de Chirurgie Digestive et Endocrinienne, CHU de Nantes, Hôtel Dieu, Place Ricordeau, 44093, Nantes Cedex 1, France

    Sahar Bannani, Cécile Caillard & Éric Mirallié

  3. Service d’Information Médicale, CHU de Nantes, 5 allée de l’île Gloriette, 44093, Nantes Cedex 1, France

    Christophe Leux

  4. Service de Médecine Nucléaire, CHU de Nantes, Hôtel Dieu, Paris, France

    Françoise Kraeber-Bodéré & Catherine Ansquer

  5. CRCINA, INSERM, CNRS, Université d’Angers, Université de Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France

    Françoise Kraeber-Bodéré & Catherine Ansquer

  6. Service d’Anatomie Cytologie Pathologique, CHU de Nantes, Hôtel Dieu, Place Ricordeau, 44093, Nantes Cedex 1, France

    Karine Renaudin

Authors
  1. Emmanuelle Trébouet
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  2. Sahar Bannani
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  10. Catherine Ansquer
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Contributions

Dr. Emmanuelle Trébouet contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Dr. Sahar Bannani contributed to the study conception and design, analysis and interpretation of the data, drafting of manuscript, and critical revision of the manuscript.

Dr. Matthieu Wargny contributed to the acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Dr. Christophe Leux contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, and critical revision of the manuscript.

Dr. Cécile Caillard contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Prof. Françoise Kraeber-Bodéré contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Dr. Karine Autain-Renaudin contributed to the acquisition of the data, analysis and interpretation of the data, and critical revision of manuscript.

Dr. Lucy Chaillous contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, and critical revision of the manuscript.

Prof. Eric Mirallié contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Dr. Catherine Ansquer contributed to the study conception and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript.

Corresponding author

Correspondence to Catherine Ansquer.

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Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional, the national research committee and with the 1964 Helsinki Declaration and its later amendments.

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Trébouet, E., Bannani, S., Wargny, M. et al. Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate. Langenbecks Arch Surg 404, 431–438 (2019). https://doi.org/10.1007/s00423-019-01782-1

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