Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate.
MIBI scintigraphy
Mild primary hyperparathyroidism
Multiglandular disease
Neck ultrasound
Normocalcemic form
Parathyroidectomy
Sestamibi scan
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
26
11
2018
accepted:
25
03
2019
pubmed:
8
4
2019
medline:
11
1
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
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. We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 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%). 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.
Sections du résumé
BACKGROUND
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
METHODS
We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with
RESULTS
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
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.
Identifiants
pubmed: 30955085
doi: 10.1007/s00423-019-01782-1
pii: 10.1007/s00423-019-01782-1
doi:
Substances chimiques
Radiopharmaceuticals
0
Technetium Tc 99m Sestamibi
971Z4W1S09
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
431-438Références
Surgery. 2007 Feb;141(2):153-9; discussion 159-60
pubmed: 17263969
Eur J Nucl Med Mol Imaging. 2008 Mar;35(3):637-43
pubmed: 17960377
Nuklearmedizin. 2008;47(4):158-62
pubmed: 18690375
J Clin Endocrinol Metab. 2009 Feb;94(2):335-9
pubmed: 19193908
Ann Surg Oncol. 2009 Dec;16(12):3450-4
pubmed: 19760044
Am J Surg. 2010 May;199(5):614-20
pubmed: 20466104
J Clin Densitom. 2011 Apr-Jun;14(2):79-84
pubmed: 21787514
Eur J Endocrinol. 2013 Oct 03;169(5):665-72
pubmed: 23956299
Ann Surg Oncol. 2014 Oct;21(11):3534-40
pubmed: 24823444
Oncologist. 2014 Sep;19(9):919-29
pubmed: 25063228
J Clin Endocrinol Metab. 2014 Oct;99(10):3561-9
pubmed: 25162665
J Clin Endocrinol Metab. 2014 Oct;99(10):3580-94
pubmed: 25162667
J Clin Endocrinol Metab. 2014 Dec;99(12):4531-6
pubmed: 25215560
Nucl Med Commun. 2015 Apr;36(4):363-75
pubmed: 25642803
Langenbecks Arch Surg. 2015 Dec;400(8):887-905
pubmed: 26542689
Int J Surg. 2016 Jan;25:82-7
pubmed: 26646659
Nucl Med Commun. 2016 Dec;37(12):1246-1252
pubmed: 27612033
Surgery. 2017 Jan;161(1):70-77
pubmed: 27847113
Ann Surg Treat Res. 2018 Feb;94(2):69-73
pubmed: 29441335
J Clin Endocrinol Metab. 2018 Nov 1;103(11):3993-4004
pubmed: 30060226
Head Neck. 1998 Oct;20(7):583-7
pubmed: 9744456