Predictive value of characteristics of resected parathyroid glands for persistent secondary hyperparathyroidism during parathyroidectomy.
Minimum weight
Parathyroidectomy
Persistent secondary hyperparathyroidism
Secondary hyperparathyroidism
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
14 Feb 2023
14 Feb 2023
Historique:
received:
27
11
2022
accepted:
10
02
2023
entrez:
15
2
2023
pubmed:
16
2
2023
medline:
17
2
2023
Statut:
epublish
Résumé
Parathyroidectomy (PTX), an effective treatment for refractory secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, still has a high persistent rate. This study aimed to analyze the predictive value of characteristics of resected parathyroid glands for postoperative persistent SHPT. The clinical data of patients with persistent SHPT and successful PTX controls who had or underwent total parathyroidectomy with forearm autotransplantation (TPTX + AT) was retrospectively collected. The characteristics including the number, minimum weight, maximum weight and total weight of resected parathyroid glands from each patient were recorded. Characteristics and cutoff value of resected parathyroid glands for the prediction of persistent SHPT were analyzed. A total of 227 patients (62 persistent SHPT patients and 165 successful PTX controls) were enrolled in the study. Forty-one (66%) persistent SHPT cases related to supernumerary parathyroid and the remaining 21 (34%) cases related to residual undetected parathyroid. In addition, ectopic parathyroid was found in 8 patients (13%) before PTX. The average number of resected glands in the persistent SHPT group and successful PTX group was 3.53 ± 0.72 and 3.93 ± 0.25 respectively (p < 0.001). There was significance in the number of patients with different resected parathyroid glands between two groups (p < 0.001). When the resected gland number was 4, minimum weight of the parathyroid was noted to be heavier in the persistent SHPT group than that in the successful PTX group (0.52 ± 0.31 g vs. 0.38 ± 0.19 g, p < 0.001). For persistent SHPT prediction, cutoff value of minimum weight was 0.535 g, with sensitivity of 46% and specificity of 82% (AUC = 0.611; p = 0.029). Major reason for the persistent SHPT is the existence of supernumerary parathyroid glands or resection of less than 4 glands. When 4 glands were resected, a minimum total parathyroid gland weight heavier than 0.535 g implied the potential presence of a missed supernumerary parathyroid gland, which also contributed to the persistent SHPT.
Sections du résumé
BACKGROUND
BACKGROUND
Parathyroidectomy (PTX), an effective treatment for refractory secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, still has a high persistent rate. This study aimed to analyze the predictive value of characteristics of resected parathyroid glands for postoperative persistent SHPT.
METHODS
METHODS
The clinical data of patients with persistent SHPT and successful PTX controls who had or underwent total parathyroidectomy with forearm autotransplantation (TPTX + AT) was retrospectively collected. The characteristics including the number, minimum weight, maximum weight and total weight of resected parathyroid glands from each patient were recorded. Characteristics and cutoff value of resected parathyroid glands for the prediction of persistent SHPT were analyzed.
RESULTS
RESULTS
A total of 227 patients (62 persistent SHPT patients and 165 successful PTX controls) were enrolled in the study. Forty-one (66%) persistent SHPT cases related to supernumerary parathyroid and the remaining 21 (34%) cases related to residual undetected parathyroid. In addition, ectopic parathyroid was found in 8 patients (13%) before PTX. The average number of resected glands in the persistent SHPT group and successful PTX group was 3.53 ± 0.72 and 3.93 ± 0.25 respectively (p < 0.001). There was significance in the number of patients with different resected parathyroid glands between two groups (p < 0.001). When the resected gland number was 4, minimum weight of the parathyroid was noted to be heavier in the persistent SHPT group than that in the successful PTX group (0.52 ± 0.31 g vs. 0.38 ± 0.19 g, p < 0.001). For persistent SHPT prediction, cutoff value of minimum weight was 0.535 g, with sensitivity of 46% and specificity of 82% (AUC = 0.611; p = 0.029).
CONCLUSIONS
CONCLUSIONS
Major reason for the persistent SHPT is the existence of supernumerary parathyroid glands or resection of less than 4 glands. When 4 glands were resected, a minimum total parathyroid gland weight heavier than 0.535 g implied the potential presence of a missed supernumerary parathyroid gland, which also contributed to the persistent SHPT.
Identifiants
pubmed: 36788539
doi: 10.1186/s12893-023-01936-5
pii: 10.1186/s12893-023-01936-5
pmc: PMC9926574
doi:
Substances chimiques
Parathyroid Hormone
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
36Subventions
Organisme : National Natural Science Foundation of China
ID : 81270408
Informations de copyright
© 2023. The Author(s).
Références
Acta Biomed. 2017 Oct 23;88(3):325-328
pubmed: 29083339
Eur Arch Otorhinolaryngol. 2012 Jun;269(6):1565-76
pubmed: 22101574
Am J Kidney Dis. 2017 Dec;70(6):737-751
pubmed: 28941764
J Korean Surg Soc. 2012 Jul;83(1):1-6
pubmed: 22792527
Laryngoscope. 2010 Aug;120(8):1538-44
pubmed: 20641075
World J Surg. 2011 Jun;35(6):1260-5
pubmed: 21479685
Ren Fail. 2019 Nov;41(1):885-892
pubmed: 31537128
J Endocrinol Invest. 2012 Jan;35(1):8-13
pubmed: 21427530
Surgery. 2018 Nov;164(5):978-985
pubmed: 30082137
Clin J Am Soc Nephrol. 2011 Apr;6(4):913-21
pubmed: 21454719
Kidney Int Suppl (2011). 2017 Jul;7(1):1-59
pubmed: 30675420
Sci Rep. 2016 May 27;6:26841
pubmed: 27231027
Ren Fail. 2022 Dec;44(1):23-29
pubmed: 35094636
Ther Apher Dial. 2015 Dec;19(6):540-74
pubmed: 26768810
Nephron Clin Pract. 2009;111(2):c102-9
pubmed: 19142022
Ann Surg. 2001 Jan;233(1):65-9
pubmed: 11141227
Semin Dial. 2019 Sep;32(5):444-451
pubmed: 30656752
Langenbecks Arch Surg. 2015 Dec;400(8):907-27
pubmed: 26429790
Braz J Otorhinolaryngol. 2013 Aug;79(4):494-9
pubmed: 23929152