Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units

Edafe, Ovie; Collins, Emma; Ubhi, C. S.; Balasubramanian, Sabapathy P

doi:10.1308/rcsann.2017.0112

Cited by 24 publications

(19 citation statements)

References 18 publications

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“…The therapy is based on a surgical approach. In MGD, complete removal of all enlarged parathyroid glands is necessary [ 15 , 19 ]. Appropriate surgical therapy of MGD should consist of a bilateral approach in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, the first line test is sestamibi technetium-99m scintigraphy (MIBI), and later, well-performed USG can be a confirmatory method [ 13 , 14 ]. Moreover, the use of the single-photon emission computed tomography (SPECT) technique and 4D-CT provides the high possibility of anatomic detail and affords the high likelihood of achieving a safe and successful operation [ 15 , 16 ]. MRI are useful in the detection of particularly ectopic extra parathyroid mediastinal lesions [ 5 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Multiglandular Parathyroid Disease

Kowalski¹,

Buła²,

Bednarczyk³

et al. 2022

Life

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Introduction: Multiglandular parathyroid disease (MGD) is an uncommon cause of primary hyperparathyroidism (pHPT) and has been reported in the literature in 8–33% of patients with pHPT. The aim of our study was to review the clinical characteristics and management of MGD and evaluation of surgical treatment failures. Methods: We performed a retrospective study of 163 patients with pHPT undergoing parathyroidectomy (PTX) at the Department of General and Endocrine Surgery between 1983 and 2018. All these patients were diagnosed with MGD. This group of patients was compared with a group of 856 patients with solitary disease operated for pHPT in the same period. Results: Among 163 patients—127 (79%) of them had two lesions, 28 (16%) had three, and 8 (5%) four. They were prevalently women over the age of 50. The diagnosis was based on PTH and ionized calcium studies and used sestamibi technetium-99m scintigraphy (MIBI) as well for us. Treatment was surgical. Conclusions: Parathyroidectomy (PTX) for multiglandular parathyroid disease (MGD) is associated with a higher operative risk of failure compared to solitary disease. Preoperative diagnosis and localization of the parathyroid glands is an extremely important element of treatment. Diagnosis is based on PTH and calcium levels. Ultrasonography (USG), MRI, and scintigraphy are very helpful in diagnosis. Mediastinal multiglandular parathyroid disease (MGD) is associated with increased surgical treatment failures. The treatment is surgical and consists of the removal of the masses or complete parathyroidectomy. Based on this study, we support the existence of multiple adenomas and advocate the removal of only macroscopically enlarged parathyroid glands in patients with primary hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multiglandular Parathyroid Disease

Kowalski¹,

Buła²,

Bednarczyk³

et al. 2022

Life

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“…So, based on this article we could not estimate the possibility of a second adenoma clearly, because the chance of finding another adenoma correlates positively with the WIN but negatively with the weight based on the nomogram. In addition, a recent study demonstrates that there is a significant failure to cure PHPT in up to 13%, when only WIN is used to predict multi gland disease without ioPTH assay [ 28 ]. We are wondering whether it is worth reassessing the validity of the WIN index nomogram in future cohort studies in order to create a new more sophisticated system which will give us the possibility of a second pathologic parathyroid gland, after having calculated the WIN preoperatively, based on the weight of the first adenoma found intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Double ipsilateral parathyroid adenomas, with one supernumerary and ectopic at the same time: a case report

et al. 2021

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Background Double adenomas (DA) represents a distinct clinical entity of primary hyperparathyroidism (PHPT). DA may follow various embryologic distribution patterns and could be supernumerary and/or ectopic. Case presentation We describe the first case of PHPT which comes as a result of double ipsilateral adenoma, of which one was both ectopic and supernumerary. A 45 year-old Greek male patient with diagnosed PHPT due to a single lower right parathyroid adenoma was admitted to our department for surgical treatment. The preoperative tests (neck US, Sestamibi scan) were conclusive for single gland disease. The patient underwent focused parathyroidectomy. The frozen section revealed a parathyroid adenoma with a slight possibility for parathyroid carcinoma. Ten minutes after the excision, intact PTH (iPTH) dropped >50% related to preoperative values and was within normal range. Right hemithyroidectomy with additional ipsilateral central neck dissection was performed, because of the possibility for parathyroid carcinoma. The final pathology report showed that the first excised tissue proved to be a parathyroid adenoma, while a second subcapsular one and a normal right upper parathyroid gland were also found. Conclusions Preoperative localization of DA using routine imaging tests and the utility of intraoperative parathyroid hormone assay are still unreliable in detecting multiple adenomas. Furthermore, a slight possibility of a second and simultaneously supernumerary and ectopic adenoma maybe present. Therefore, it would be advisable to establish the use of more advanced imaging tests (such as 4D-CT, 4D-MRI) or other diagnostic tools when DA are suspected.

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“…In 2017, Edafe et al (23) simultaneously applied CaPTHUS and WIN to discriminate between SGD and MGD in their two-center cohort comprising 624 patients. The PPV for predicting SGD of the CaPTHUS ≥3 model was 84.6%.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Serradilla-Martín¹,

Palomares-Cano²,

Cantalejo-Díaz³

et al. 2021

Gland Surg

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Background: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single-and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population.Methods: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant.Results: Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting singlegland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%.Conclusions: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

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Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units

Cited by 24 publications

References 18 publications

Multiglandular Parathyroid Disease

Multiglandular Parathyroid Disease

Double ipsilateral parathyroid adenomas, with one supernumerary and ectopic at the same time: a case report

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

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