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Hyperparathyroidism, an emerging disease

Updates in Surgery volume 62, pages 175–181 (2010)Cite this article

Abstract

A retrospective study based on 35 years of personal experience was done. Up to today 2,175 patients were operated, 1,318 for primary hyperparathyroidism (HPT) and 857 for secondary and tertiary HPT. Considering recent years (1999 to July 2010), 918 patients were operated for primary HPT. Preoperatively all the patients performed a cervical ultrasound and/or a sestamibi scan. Open mininvasive procedure was preferred: it is an easily reproducible and costless technique. Using magnifying glasses up to 2.5, an excellent three-dimensional vision was obtained. The operating time is short and if there are any doubts it is possible to extend the exploration to the other side of the neck. Immediate and long-term results were excellent, with a cure rate greater than 99%. Complications in the treatment of a single adenoma are around 0.3%. Patients can be discharged 24–48 h after the operation. Regarding reoperations, a correct diagnostic and therapeutic approach is essential. CT, MRI and SPECT must correlate with the information given by ultrasound and scintigraphy. The intraoperative PTH assay (io-PTH) is required and the approach should be limited to the area where the missed gland probably is. The functionality of the autotransplantation (AT) performed immediately was good. The functionality of the cryopreserved tissue is better for the HPT I in comparison with HPT II. Considering HPT I or HPT II the use of io-PTH is helpful. MIBI scanning is helpful but not essential, except in reoperations. Surgeon experience is another very important factor for good results.

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References

  1. Owen R (1862) On the anatomy of the Indian Rhinoceros (Rh Unicornis). Trans Zool Soc Lond (31):58

  2. Organ CH Jr (2000) The history of parathyroid surgery, 1850–1996: the Excelsior Surgical Society. 1998 Edward D Churchill Lecture. J Am Coll Surg 191:284–299

    Article  PubMed  Google Scholar 

  3. Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS, Melton LJ (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res 21:171–177

    Article  PubMed  Google Scholar 

  4. Weber T, Keller M, Hense I, Pietsch A, Hinz U, Schilling T, Nawroth P, Klar E, Büchler MW (2007) Effect of parathyroidectomy on quality of life and neuropsychological symptoms in primary hyperparathyroidism. World J Surg 31:1202–1209

    Article  PubMed  Google Scholar 

  5. Luboshitzky R, Chertok-Schaham Y, Lavi I, Ishay A (2009) Cardiovascular risk factors in primary hyperparathyroidism. J Endocrinol Invest 32:317–321

    CAS  PubMed  Google Scholar 

  6. Wells SA Jr, Gunnells JC, Shelburne JD, Schneider AB, Sherwood LM (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34–44

    PubMed  Google Scholar 

  7. Brennan MF, Brown EM, Spiegel AM, Marx SJ, Doppman JL, Jones DC, Aurbach GD (1979) Autotransplantation of cryopreserved parathyroid tissue in man. Ann Surg 189:139–142

    CAS  Article  PubMed  Google Scholar 

  8. Malmaeus J, Akerström G, Johansson H, Ljunghall S, Nilsson P, Wide L (1983) Parathyroid autotransplantation. An investigation of parathyroid autograft function. Acta Chir Scand 149:545–554

    CAS  PubMed  Google Scholar 

  9. Rothmund M, Wagner PK, Schark C (1991) Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 15:745–750

    CAS  Article  PubMed  Google Scholar 

  10. Irvin GL, Deriso GT (1994) A new, practical intraoperative parathyroid hormone assay. Am J Surg 168:466–468

    Article  PubMed  Google Scholar 

  11. Gawande AA, Monchik JM, Abbruzzese TA, Iannuccilli JD, Ibrahim SI, Moore FD (2006) Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg 141:381–384

    CAS  Article  PubMed  Google Scholar 

  12. Lew JI, Rivera M, Irvin GL, Solorzano CC (2010) Operative failure in the era of focused parathyroidectomy: a contemporary series of 845 patients. Arch Surg 145:628–633

    CAS  Article  PubMed  Google Scholar 

  13. Mandl F (1925) Therapeutischer versuch bei Ostitis fibrosa generalisata mittels. Extirpation eines Epithelkozperchentumors. Wien Klin Wschr 50:1343–1344

    Google Scholar 

  14. Doppman JL, Brown EM, Brennan MF, Spiegel AM, Marx SJ, Aurbach GD (1979) Angiographic ablation of parathyroid adenomas. Radiology 130:577–582

    CAS  PubMed  Google Scholar 

  15. Jacobson SR, van Heerden JA, Farley DR, Grant CS, Thompson GB, Mullan BP, Curlee KJ (2004) Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 28:1127–1131

    Article  PubMed  Google Scholar 

  16. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    CAS  Article  PubMed  Google Scholar 

  17. Henry JF, Sebag F, Tamagnini P, Forman C, Silaghi H (2004) Endoscopic parathyroid surgery: results of 365 consecutive procedures. World J Surg 28:1219–1223

    Article  PubMed  Google Scholar 

  18. Miccoli P, Berti P, Materazzi G, Massi M, Picone A, Minuto MN (2004) Results of video-assisted parathyroidectomy: single institution’s six-year experience. World J Surg 28:1216–1218

    Article  PubMed  Google Scholar 

  19. Lombardi CP, Raffaelli M, Traini E, De Crea C, Corsello SM, Bellantone R (2009) Video-assisted minimally invasive parathyroidectomy: benefits and long-term results. World J Surg 33:2266–2281

    Article  PubMed  Google Scholar 

  20. Lumachi F, Iacobone M, Favia G (2003) Minimally invasive radioguided parathyroidectomy. Ann It Chir 74:413–416

    CAS  Google Scholar 

  21. Mengozzi G, Baldi C, Aimo G, Mullineris B, Salvo R, Biasiol S, Pagni R, Gasparri G (2000) Optimizing efficacy of quick parathyroid hormone determination in the operating theater. Int J Biol Markers 15:153–160

    CAS  PubMed  Google Scholar 

  22. Gasparri G, Camandona M, Bertoldo U, Sargiotto A, Papotti M, Raggio E, Nati L, Martino P, Felletti G, Mengozzi G (2009) The usefulness of preoperative dual-phase 99mTc MIBI-scintigraphy and IO-PTH assay in the treatment of secondary and tertiary hyperparathyroidism. Ann Surg 250:868–871

    Article  PubMed  Google Scholar 

  23. Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, Mullineris B, Dei Poli M (2001) Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233:65–69

    CAS  Article  PubMed  Google Scholar 

  24. Bilezikian JP, Khan AA, Potts JT Jr (2009) Guidelines for the management of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:335–339

    CAS  Article  PubMed  Google Scholar 

  25. Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR (2009) Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:351–365

    CAS  Article  PubMed  Google Scholar 

  26. Udelsman R, Pasieka JL, Sturgeon C, Young JEM, Clark OH (2009) Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:366–372

    CAS  Article  PubMed  Google Scholar 

  27. Pasieka JL, Parsons LL, Demeure MJ, Wilson S, Malycha P, Jones J, Krzywda B (2002) Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 26:942–949

    Article  PubMed  Google Scholar 

  28. Kestenbaum B, Seliger SL, Gillen DL, Wasse H, Young B, Sherrard DJ, Weiss NS, Stehman-Breen CO (2004) Parathyroidectomy rates among United States dialysis patients: 1990–1999. Kidney Int 65:282–288

    Article  PubMed  Google Scholar 

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Affiliations

  1. 3rd General and Esophageal Surgical Unit, Department of Clinical Fisiopathology, University of Turin, Turin, Italy

    Guido Gasparri, Nicola Palestini, Silvia Catalano, Francesca Talarico, Clemente Ronchetta, Gregorio Balbo & Michele Camandona

  2. Azienda Ospedaliero-Universitaria San Giovanni Battista della Città di Torino, Via Genova, 3, 10126, Turin, Italy

    Guido Gasparri

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  1. Guido Gasparri
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  2. Nicola Palestini
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  3. Silvia Catalano
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  4. Francesca Talarico
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  5. Clemente Ronchetta
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  6. Gregorio Balbo
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  7. Michele Camandona
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Correspondence to Guido Gasparri.

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Gasparri, G., Palestini, N., Catalano, S. et al. Hyperparathyroidism, an emerging disease. Updates Surg 62, 175–181 (2010). https://doi.org/10.1007/s13304-010-0031-x

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Keywords

  • Hyperparathyroidism
  • Multiglandular disease
  • Parathyroidectomy
  • Quick intraoperative PTH assay
  • Autotransplantation
  • Chronic renal failure