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Maldar AN, Shah NF, Chauhan PH, Lala M, Kirtane MV, Chadha M. Differences in the Presentation and Outcome between Premenopausal and Postmenopausal Primary Hyperparathyroidism Indian Women: A Single-Center Experience. J Midlife Health 2023; 14:73-80. [PMID: 38029031 PMCID: PMC10664047 DOI: 10.4103/jmh.jmh_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/29/2023] [Accepted: 03/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Primary hyperparathyroidism (PHPT) is an endocrine disorder wherein enlargement of one or more of the parathyroid glands causes autonomous overproduction of the parathyroid hormone (PTH), which leads to high serum calcium levels. Objective The objective of this study was to compare the clinical, laboratory, and operative variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT. Materials and Methods A retrospective analysis of the data of female patients who underwent surgery for PHPT at a single center, from January 2011 to December 2020, was done. Patients with familial PHPT and secondary hyperparathyroidism were not included. Results Of the 130 women with PHPT, 44.6% were pre-M and 55.4% were post-M. A significantly higher number of pre-M females were symptomatic compared to post-M females (pre-M vs. post-M, 84.5% vs. 68.1%, P = 0.031). Renal calculi were more common in pre-M women (34.5% vs. 18.1%, P = 0.032), while the rest of the clinical features were comparable between the two groups. The proportion of women with osteoporosis (6.7% vs. 19.4%, P = 0.071), hypertension (13.8% vs. 34.7%, P = 0.012), and diabetes mellitus (3.5% vs. 16.7%, P = 0.033) was lesser in the pre-M group. Elevated serum alkaline phosphatase levels were significantly more prevalent in the pre-M group (37.9% vs. 20.8%, P = 0.032). The mean serum calcium (12.35 ± 1.28 vs. 11.96 ± 1.22 mg/dL, P = 0.079), median serum PTH (334 vs. 239 pg/mL, P = 0.051), and median weight of the operated adenomas (1.75 vs. 1.45 g, P = 0.075) were also higher in pre-M females. The proportion of ectopic adenomas and multiple adenomas, presurgery adenoma localization rates, and disease cure rates did not differ according to the menopausal status. The occurrence of postoperative hungry bone syndrome was higher in the pre-M women (15.5% vs. 1.4%, P = 0.008). Conclusion The majority of women with PHPT are post-M, but symptomatic presentation is more common in pre-M females. The severity of the disease appears to be more in pre-M women; however, imaging and operative variables generally did not significantly differ between the two groups.
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Affiliation(s)
- Aasim N. Maldar
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nishitkumar F. Shah
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Phulrenu H. Chauhan
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Murad Lala
- Department of Surgical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Milind V. Kirtane
- Department of ENT Surgery, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Manoj Chadha
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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El-Hajj Fuleihan G, Chakhtoura M, Cipriani C, Eastell R, Karonova T, Liu JM, Minisola S, Mithal A, Moreira CA, Peacock M, Schini M, Silva B, Walker M, El Zein O, Marcocci C. Classical and Nonclassical Manifestations of Primary Hyperparathyroidism. J Bone Miner Res 2022; 37:2330-2350. [PMID: 36245249 DOI: 10.1002/jbmr.4679] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
This narrative review summarizes data on classical and nonclassical manifestations of primary hyperparathyroidism (PHPT). It is based on a rigorous literature search, inclusive of a Medline search for systematic reviews from 1940 to December 2020, coupled with a targeted search for original publications, covering four databases, from January 2013-December 2020, and relevant articles from authors' libraries. We present the most recent information, identify knowledge gaps, and suggest a research agenda. The shift in the presentation of PHPT from a predominantly symptomatic to an asymptomatic disease, with its varied manifestations, has presented several challenges. Subclinical nephrolithiasis and vertebral fractures are common in patients with asymptomatic disease. The natural history of asymptomatic PHPT with no end organ damage at diagnosis is unclear. Some observational and cross-sectional studies continue to show associations between PHPT and cardiovascular and neuropsychological abnormalities, among the different disease phenotypes. Their causal relationship is uncertain. Limited new data are available on the natural history of skeletal, renal, cardiovascular, neuropsychological, and neuromuscular manifestations and quality of life. Normocalcemic PHPT (NPHPT) is often diagnosed without the fulfillment of rigorous criteria. Randomized clinical trials have not demonstrated a consistent long-term benefit of parathyroidectomy (PTX) versus observation on nonclassical manifestations. We propose further refining the definition of asymptomatic disease, into two phenotypes: one without and one with evidence of target organ involvement, upon the standard evaluation detailed in our recommendations. Each of these phenotypes can present with or without non-classical manifestations. We propose multiple albumin-adjusted serum calcium determinations (albumin-adjusted and ionized) and exclusion of all secondary causes of high parathyroid hormone (PTH) when establishing the diagnosis of NPHPT. Refining the definition of asymptomatic disease into the phenotypes proposed will afford insights into their natural history and response to interventions. This would also pave the way for the development of evidence-based guidance and recommendations. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, World Health Organization (WHO) Collaborating Center (CC) for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut, Beirut, Lebanon
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, World Health Organization (WHO) Collaborating Center (CC) for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut, Beirut, Lebanon
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, 'Sapienza', Rome University, Rome, Italy
| | - Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| | - Tatiana Karonova
- Clinical Endocrinology Laboratory, Department of Endocrinology, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Jian-Min Liu
- Department of Endocrine and Metabolic Disease, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, 'Sapienza', Rome University, Rome, Italy
| | - Ambrish Mithal
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Carolina A Moreira
- Endocrine Division (SEMPR), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.,Academic Research Center of Pro-Renal Institute, Curitiba, Brazil
| | - Munro Peacock
- Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marian Schini
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
| | - Barbara Silva
- Endocrinology Unit, Department of Medicine, Centro Universitario de Belo Horizonte (UNI BH), Felicio Rocho Hospital, Belo Horizonte, Brazil.,Endocrinology Unit, Santa Casa Hospital, Belo Horizonte, Brazil
| | - Marcella Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ola El Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Endocrine Unit 2, University Hospital of Pisa Chairman European Group on Graves' Orbitopathy Via Paradisa 2, University of Pisa Head, Pisa, Italy
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Differences in Primary Hyperparathyroidism Between Pre- and Postmenopausal Women in India. Endocr Pract 2021; 27:710-715. [PMID: 33685668 DOI: 10.1016/j.eprac.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is a common endocrine disorder in women which becomes more prevalent after menopause. In this study, we compared the demographic, clinical, and biochemical variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT. METHODS A retrospective analysis (from 2005 to 2019) of enrolled women PHPT patients from an online Indian PHPT registry. RESULTS Of the women with PHPT, 232 and 122 were pre-M and post-M, respectively. The number of post-M PHPT cases registered had a 3.3-fold increase in 2015-2019 from 2005-2009 compared with only a 2.5-fold increase in pre-M cases in the same duration. The majority were symptomatic (90%), although pre-M had a higher proportion of symptomatic than post-M (92% vs 85%; P = .04). Pre-M women showed more prevalence of osteitis fibrosa cystica than post-M women (28% vs 13%; P = .03), although hypertension and gallstone disease were seen more frequently in post-M PHPT women. Pre-M women had a significantly higher median PTH (403 vs 246 pg/mL; P = .02) and median alkaline phosphatase (202 vs 145 pg/mL; P = .02) than post-M women, and vitamin D deficiency was more common in pre-M women (58% vs 45%; P = .03). Gland localization, tumor weight, and disease cure rates did not differ according to menopausal status. CONCLUSION PHPT was more prevalent in pre-M women, although the number of post-M cases had significantly increased in the last 10 years. Pre-M women had generally more severe clinical and biochemical variables than post-M PHPT women.
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Saponaro F, Cetani F, Repaci A, Pagotto U, Cipriani C, Pepe J, Minisola S, Cipri C, Vescini F, Scillitani A, Salcuni A, Palmieri S, Eller-Vainicher C, Chiodini I, Madeo B, Kara E, Castellano E, Borretta G, Gianotti L, Romanelli F, Camozzi V, Faggiano A, Corbetta S, Cianferotti L, Brandi ML, De Feo ML, Palermo A, Vezzoli G, Maino F, Scalese M, Marcocci C. Clinical presentation and management of patients with primary hyperparathyroidism in Italy. J Endocrinol Invest 2018; 41:1339-1348. [PMID: 29616419 DOI: 10.1007/s40618-018-0879-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. METHOD From January 2014-January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up. RESULTS Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2-81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1-37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx. CONCLUSIONS Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.
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Affiliation(s)
- F Saponaro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - F Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - A Repaci
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - U Pagotto
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - C Cipriani
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - J Pepe
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - C Cipri
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - F Vescini
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - A Scillitani
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - A Salcuni
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - S Palmieri
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - C Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - I Chiodini
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - B Madeo
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Kara
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Castellano
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - G Borretta
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - L Gianotti
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - F Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - V Camozzi
- Endocrine Unit, University of Padova, Padua, Italy
| | - A Faggiano
- Endocrinology, Federico II University of Naples, Naples, Italy
| | - S Corbetta
- Endocrinology Service, Department of Biomedical Sciences for Health, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - L Cianferotti
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L De Feo
- Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy
| | - A Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - G Vezzoli
- Nephrology and Dialysis Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Scalese
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
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Castellano E, Attanasio R, Boriano A, Borretta G. THE CLINICAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM: A SOUTHERN EUROPEAN PERSPECTIVE OVER THE LAST 2 DECADES. Endocr Pract 2018; 24:1023-1029. [PMID: 30289298 DOI: 10.4158/ep-2018-0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The clinical presentation of primary hyperparathyroidism (PHPT) has changed widely in developed countries in the last few decades. We evaluated its variations in our series over a 20-year period (i.e., 1997-2016). METHODS A retrospective survey was conducted in our series of 364 well-characterized consecutive patients, arbitrarily divided into 4 consecutive 5-year periods at diagnosis. RESULTS In the overall series, only estimated glomerular function (eGFR) and urinary calcium (UCa) showed a significant upward trend ( P = .032 and .039, respectively), whereas demographic and clinical characteristics were stable. The UCa upward trend was also confirmed for the subgroup of symptomatic patients ( P = .013). No difference was observed in the demographic, clinical, or biochemical characteristics of asymptomatic patients or in the fraction of patients meeting surgical criteria. CONCLUSION The clinical presentation of PHPT was stable over 20 years in our large series. ABBREVIATIONS Ca = calcium; eGFR = estimated glomerular filtration rate; 25OHD = 25-hydroxyvitamin D; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; UCa = urinary calcium.
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Sun B, Guo B, Wu B, Kang J, Deng X, Zhang Z, Fan Y. Characteristics, management, and outcome of primary hyperparathyroidism at a single clinical center from 2005 to 2016. Osteoporos Int 2018; 29:635-642. [PMID: 29198075 DOI: 10.1007/s00198-017-4322-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study presents the clinical and biochemical profiles of patients with PHPT between 2005 and 2016 at our center. Most PHPT patients in China show symptomatic features. The number of symptomatic and asymptomatic patients increased during that time, and the number of individuals with parathyroid carcinoma is now increasing. INTRODUCTION Over the last decade, the prevalence of primary hyperparathyroidism (PHPT) has increased sharply, and the number of individuals with parathyroid cancer is still trending upward. Little is known about the clinical outlook of the disease over the last decade in China. The aim of this study was to describe the clinical characteristics of PHPT patients at our center from January 2005 to December 2016. METHODS Two hundred sixty patients with PHPT visiting Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled retrospectively. The clinical manifestations and biochemical abnormalities of these patients were analyzed. RESULTS Among all patients, 73.1% had symptomatic PHPT, while the number of symptomatic and asymptomatic patients increased 1 to 2.5 times and 1.5 to 3 times, respectively, from 2005 to 2016. Bone pain and single adenoma were the most frequent signs and pathological results. The patients with parathyroid carcinoma over the last 5 years accounted for 90% (9/10) of all parathyroid carcinoma patients from 2005 to 2016, and parathyroid carcinoma patients had higher levels of serum calcium, parathyroid hormone (PTH), and serum creatinine (P < 0.05) than parathyroid hyperplasia and parathyroid adenoma patients. CONCLUSIONS Most patients with PHPT in China still exhibit classic clinical and biochemical features. Both symptomatic and asymptomatic patients have increased over the last 12 years. Although the proportion of parathyroid carcinoma was small, a noticeable upward tendency was observed at our center.
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Affiliation(s)
- B Sun
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - B Guo
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - B Wu
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - J Kang
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - X Deng
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Z Zhang
- Department of Osteoporosis and Bone Diseases and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Y Fan
- Department of General Surgery, Center of Thyroid and Parathyroid, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Bakkar S, Matteucci V, Corsini C, Pagliaro S, Miccoli P. Less is more: time to expand the indications for minimally invasive video-assisted parathyroidectomy. J Endocrinol Invest 2017; 40:979-983. [PMID: 28374221 DOI: 10.1007/s40618-017-0658-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/19/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Minimally invasive video-assisted parathyroidectomy (MIVAP) is one of the most widespread targeted parathyroid surgeries for primary hyperparathyroidism (PHP). The aim of this study was to assess its limits and propose an expansion of its indications in the management of parathyroid pathology. METHODS A retrospective analysis of 77 consecutive patients who underwent MIVAP for PHP between Jan and Oct 2016 was conducted. The adequacy of the procedure and/or the need to convert to a standard cervicotomy was the main outcome of interest. Secondary outcomes of interest included: operative time, postoperative morbidity, postoperative pain assessed by the visual analogue scale (VAS) score, and the length of the surgical incision. RESULTS There were 64 females and 13 males with a mean age of 51 years. In one patient a concomitant en bloc thyroid lobectomy was required due to features suspicious of parathyroid carcinoma while exploration was required in two other patients. None of these three cases required conversion to standard cervicotomy. The mean operative time, length of incision and VAS score was 31 min, 17 mm and 1.6, respectively. Biochemical cure was achieved in all patients, and no postoperative morbidities were reported. CONCLUSION MIVAP offers the ability to perform a neck exploration and/or an en bloc thyroid lobectomy without the need to convert to a standard cervicotomy. Therefore, it not only serves as a targeted parathyroid procedure but also a potential alternative to full neck exploration.
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Affiliation(s)
- S Bakkar
- Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan.
| | - V Matteucci
- Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Corsini
- Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - S Pagliaro
- Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - P Miccoli
- Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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"Silent" kidney stones in "asymptomatic" primary hyperparathyroidism-a comparison of multidetector computed tomography and ultrasound. Langenbecks Arch Surg 2016; 402:289-293. [PMID: 27734157 PMCID: PMC5346427 DOI: 10.1007/s00423-016-1520-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/02/2016] [Indexed: 12/02/2022]
Abstract
Purpose The purpose of this study was to demonstrate the high number of kidney stones in primary hyperparathyroidism (PHPT) and the low number of in fact “asymptomatic” patients. Methods Forty patients with PHPT (28 female, 12 male; median age 58 (range 33–80) years; interquartile range 17 years [51–68]) without known symptoms of kidney stones prospectively underwent multidetector computed tomography (MDCT) and ultrasound (US) examinations of the urinary tract prior to parathyroid surgery. Images were evaluated for the presence and absence of stones, as well as for the number of stones and sizes in the long axis. The MDCT and US examinations were interpreted by two experienced radiologists who were blinded to all clinical and biochemical data. Statistical analysis was performed using the Wilcoxon signed-rank test. Results US revealed a total of 4 kidney stones in 4 (10 %) of 40 patients (median size 6.5 mm, interquartile range 11.5 mm). MDCT showed a total of 41 stones (median size was 3 mm, interquartile range 2.25 mm) in 15 (38 %) of 40 patients. The number of kidney stones detected with MDCT was significantly higher compared to US (p = 0.00124). Conclusions MDCT is a highly sensitive method for the detection of “silent” kidney stones in patients with PHPT. By widely applying this method, the number of asymptomatic courses of PHPT may be substantially reduced. MDCT should be used primarily to detect kidney stones in PHPT and to exclude asymptomatic PHPT.
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