Is Intraoperative Parathyroid Hormone Assay Mandatory for the Success of Targeted Parathyroidectomy?

Gil-Cárdenas, Alejandra; Gamino, Rosa; Reza, Alfredo; Pantoja, Juan Pablo; Herrera, Miguel F.

doi:10.1016/j.jamcollsurg.2006.10.034

Cited by 35 publications

(22 citation statements)

References 22 publications

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“…3,5,9 Traditional use of perioperative or intraoperative gamma probe or IOPTHA to confirm the adequacy of resection have not increased the success rate for single gland disease when sestamibi and ultrasound were concordant, even in high volume endocrine surgery centers. 3,[9][10][11][12] In our study, the CT and MRI scan have been successful in localizing the diseased parathyroid in only three cases, in both of which a giant parathyroid was found.…”

Section: Discussionmentioning

confidence: 91%

Minimally invasive parathyroidectomy in patients with previous neck surgery

Dimas¹,

Michas²,

Christakis³

et al. 2012

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ObJEctIVE: Previous neck surgery (PNs) in patients with primary hyperparathyroidism (PHP) is considered as a contraindication for minimally invasive parathyroidectomy (MIP). the purpose of our study was to determine the effectiveness of MIP in such patients. DEsIGN: From January 2003 to June 2011, 380 patients with PHP were treated in our department; 42 had had previous neck surgery. twenty-seven (27/42) were selected to have MIP; the remaining 15 patients had traditional neck explorations. selection criteria for MIP were unilateral single or two gland disease localized preoperatively with at least two imaging techniques and patient's informed consent. Imaging studies included high resolution neck ultrasound and sestamibi scan in the majority, and ct scan, selective venous sampling and MrI in seven patients. the type of operation done included unilateral approach under local anesthesia (UALA) (22 cases) with one conversion to general anesthesia and minimally invasive parathyroidectomy under general anesthesia (MIPG) (5 cases). rEsULts: twenty-six of the 27 patients became normocalcemic after the operation. the patient with persistent hypercalcemia underwent successful parathyroidectomy 8 months later via mesothoracoscopy, since the parathyroid gland was localized correctly but was beyond access via neck. A single adenoma was found in 21 cases and hyperplasia in six. there were no conversions to traditional exploration and no postoperative complications. Mean duration of the procedure and length of stay were similar to MIP in patients without PNs. Mean follow-up of 40 months (4-89 months) did not reveal any recurrence. cONcLUsION: these results illustrate that MIP is a valuable option in selected patients with PHP and PNs associated with no morbidity (0%), high biochemical cure rate (96.3% in this series) and rapid recovery, while it also substantially lowers the cost of the procedure. Preoperative localization with two or more agreeing imaging techniques eliminates the need for intraoperative sestamibi or qPtH test.

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Section: Discussionmentioning

confidence: 91%

Minimally invasive parathyroidectomy in patients with previous neck surgery

Dimas¹,

Michas²,

Christakis³

et al. 2012

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“…Accordingly, it is concluded that the adenoma has been successfully excised if serum PTH concentration decreases by 50% after surgery versus before surgery. [7] Nevertheless, "in vivo" versus "ex vivo" count under the guidance of gamma probe ascertains that there is no pathological tissue left and thereby the surgery can be completed in the centers where rapid PTH level counting is not available. [8] In conclusion, parathyroid surgery performed under the guidance of parathyroid scintigraphy and gamma probe facilitates the localization and surgical excision of ectopic parathyroid pathologies.…”

Section: Discussionmentioning

confidence: 99%

Excision of mediastinal parathyroid adenoma under the guidance of gamma probe

Sakallı¹

2016

Turk Gogus Kalp Dama

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ÖZParatiroid adenomları primer hiperparatiroidizmin en sık nedenidir. Bu yazıda yorgunluk, hiperkalsemi ve hiperparatiroidisi olan 44 yaşında bir erkek hasta sunuldu. Paratiroid sintigrafisi ve torasik bilgisayarlı tomografisinde, ektopik olarak ön mediastende yerleşim gösteren paratiroid adenomu ile uyumlu bir lezyon görüldü. Paratiroid adenomu ameliyat sırası gama prob kılavuzluğunda başarı ile eksize edildi. Paratiroid adenomlarının yerleşiminin ameliyat öncesinde belirlenmesi gereklidir. Bu nedenle; ultrasonografi, paratiroid sintigrafisi ve paratiroid sintigrafisi pozitif olan hastalarda ameliyat sırasında yapılan gama prob kılavuzluğu tanı ve cerrahi tedavinin başarısı için çok önemlidir.Anah tar söz cük ler: Gama prob; ameliyat sırası; paratiroid adenomu. ABSTRACTParathyroid adenomas are the most frequent cause of primary hyperparathyroidism. In this article, we report a 44-year-old male patient with fatigue, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy and thoracic computed tomography revealed a lesion consistent with parathyroid adenoma ectopically located in the anterior mediastinum. The parathyroid adenoma was excised successfully under the guidance of intraoperative gamma probe. It is essential to determine the localization of parathyroid adenomas preoperatively. Therefore; ultrasonography, parathyroid scintigraphy and guidance of intraoperative gamma probe in patients with positive parathyroid scintigraphy are crucial for diagnosis and success of surgical treatment.Keywords: Gamma probe; intraoperative; parathyroid adenoma.Primary hyperparathyroidism (PHPT) is among the rarely encountered endocrine disorders and frequently manifests with hypercalcemia. Its incidence in adult population is approximately less than 1%. Whilst adenoma in a single parathyroid gland accounts for 85% to 90% of PHPT patients, hyperplasia is responsible for the etiology in 10% to 15% and parathyroid carcinoma is responsible for the etiology in 1% to 2%. Parathyroid adenomas are localized adjacent to thyroid gland by 80% to 90%, whereas they are ectopic by 10%. Ectopic adenomas are found in the anterior mediastinum primarily in the parathymic localization.[1]The main scanning methods used in the diagnosis of primary hyperparathyroidism include ultrasonography and parathyroid scintigraphy performed using technetium-99m (99mTc) methoxyisobutylisonitrile (sestamibi). Computed tomography (CT) and magnetic resonance imaging (MRI) are useful additional scanning methods particularly to localize ectopic parathyroid adenomas.[2] The use of combined radiological methods such as scintigraphy and ultrasonography or scintigraphy and CT enhances the success of clinical approach. For this purpose, the use of hybrid scanning systems such as single-photon emission computed tomography (SPECT)/CT is preferred. SPECT/CT gives more information on the anatomic localization of the lesion particularly in ectopic lesions and in the cases with the history of neck surgery.[3] The basic therapeutic approach for PHPT is surgery. Surgic...

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“…Advantages of this surgical option include better cosmetic outcome, as the incision is smaller, use of local or light general anesthesia, shorter operating time and hospital stay, lower hospital costs, better surgical conditions if reoperation is needed, preservation of normal parathyroid glands, decreased post-operative hypocalcemia, and/or risk of bilateral recurrent laryngeal nerve injury. However, adjuvant techniques as IOPTH increase the final cost of MIP (18)(19)(20)(21)(22)(23)(24).…”

Section: Treatmentmentioning

confidence: 99%

“…It is not an advisable option for patients with negative or discordant imaging localization studies, known genetic syndromes, secondary or tertiary hyperparathyroidism, multiglandular disease, extra-cervical ectopy, parathyroid carcinoma, large goiter, or need for thyroidectomy (18)(19)(20)(21)(22)(23)25,26).…”

Section: Treatmentmentioning

confidence: 99%

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Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review

Gouveia

Rodrigues

Barros

et al. 2012

Arq Bras Endocrinol Metab

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SUMMARYPrimary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middleaged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Ima ging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, Tc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99m Tc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroi dectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99m Tc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window. Arq Bras Endocrinol Metab. 2012;56(6):393-403 SUMÁRIO O hiperparatiroidismo primário (HPP) é uma endocrinopatia frequente que afeta maioritariamente mulheres de meia-idade e é geralmente assintomática. A doença pode ser atribuível a hiperplasia, carcinoma, adenomas únicos ou múltiplos. O HPP inclui formas esporádicas e familiares. As formas familiares englobam neoplasia endócrina múltipla tipo 1 ou 2A, hipercalcemia hipocalciúrica familiar e síndrome hiperparatiroidismo/tumor mandibular-maxilar. As causas mais frequentes de HPP persistente são a presença de doença multiglandular ou de paratiroide anômala ectópica ou ortotópica não identificada previamente. É recomendável que a localização imagiológica preceda a reintervenção cirúrgica. A janela aortopulmonar é uma localização ectópica rara, sendo o 99m Tcsestamibi SPECT/TC um exame de confirmação vantajoso ou, alternativamente o 99m Tc-sestamibi seguido de TC ou RM torácica. A paratiroidectomia pode ser efetuada por meio de esternotomia mediana, toracotomia ou toracoscopia videoassistida. Descrevemos um caso de HPP persistente atribuível à presença de uma glândula paratiroide ectópica localizada à janela aortopulmonar. O diagnóstico de HPP foi estabelecido na sequência da investigação requisitada para esclarecimento etiológico da nefrolitíase recidivante constatada nessa doente. Foi submetida à paratiroidec...

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Is Intraoperative Parathyroid Hormone Assay Mandatory for the Success of Targeted Parathyroidectomy?

Cited by 35 publications

References 22 publications

Minimally invasive parathyroidectomy in patients with previous neck surgery

Minimally invasive parathyroidectomy in patients with previous neck surgery

Excision of mediastinal parathyroid adenoma under the guidance of gamma probe

Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review

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