Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)

Weber, Theresia; Dotzenrath, Cornelia; Dralle, Henning; Niederle, Bruno; Riss, Philipp; Holzer, Katharina; Kußmann, J; Trupka, A.; Negele, Thomas; Kaderli, Reto; Karakas, Elias; Weber, Frank; Rayes, Nada; Zielke, A.; Hermann, Michael; Wicke, Corinna; Ladurner, Roland; Vorländer, Christian; Waldmann, Jens; Heizmann, Oleg; Wächter, Sabine; Schöpf, Stefan; Timmermann, W.; Bartsch, Detlef K.; Schmidmaier, Ralf; Luster, Markus; Schmid, Kurt Werner; Ketteler, Markus; Dierks, Christine; Schabram, P; Steinmüller, Thomas; Lorenz, Kerstin

doi:10.1007/s00423-021-02173-1

Cited by 26 publications

(38 citation statements)

References 105 publications

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“…The operative success then ranges between 97% and 99%, which makes PTH an important predictor for postoperative success and outcomes [ 20 , 21 , 22 ]. The guidelines from the German association of endocrine surgeons for the management of primary and renal hyperparathyroidism strongly recommends (consensus ++) the intraoperative PTH measurement for focused procedures when adenoma is preoperatively localized [ 7 ]. The time of IOPTH measurement is related to the dynamics of the marker.…”

Section: Discussionmentioning

confidence: 99%

“…Women are three to four times more likely to be affected than men, and the prevalence rises with increasing age [ 4 , 5 , 6 ]. pHPT results from excessive release of PTH from the parathyroid glands and is caused in 85–90% of cases by adenoma [ 7 ]. The clinical presentation of pHPT includes the typical signs for hypercalcemia with recurrent nephrolithiasis and fragility fractures due to renal calcium reabsorption and osteoclast-mediated bone resorption.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

Radulova-Mauersberger

Keßler

Keßler³

et al. 2022

JCM

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Background: Cinacalcet is a calcimimetic drug that has increasingly been used as a bridging therapy for primary hyperparathyroidism (pHPT), especially during the COVID-19 pandemic. The aim of our study was to investigate if preoperative cinacalcet therapy affects intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy, which is an important indicator for the success of surgery. Methods: In this single-center retrospective analysis, we studied the outcomes of 72 patients who underwent surgery for pHPT. We evaluated two groups: those with cinacalcet therapy before operation—the cinacalcet group (CG)—and those without medical therapy preoperatively (non-CG). In order to perform a between-group comparison of time trends, we fit a linear mixed-effects model with PTH as the response variable and predictors PTH levels preoperatively, group (cinacalcet yes/no), time, the group-by-time interaction, and a random intercept (per subject). Results: Our cohort included 51 (71%) women and 21 (29%) men, who were operated upon for pHPT in the period from January 2018 until August 2021. All patients were diagnosed with pHPT and 54% of the cohort were symptomatic for hypercalcemia. Moreover, 30% of the patients were treated with cinacalcet as a bridging therapy preoperatively, and this increased during the COVID-19 pandemic, as 64% of this group were treated in the last two years. Calcium values were significantly different before (p < 0.001) and after (p = 0.0089) surgery, but calcium level change did not differ significantly between the CG and non-CG. Parathyroid hormone (PTH) levels dropped significantly in both groups during 10 min IOPTH monitoring (p < 0.001), but there was no significant difference between the two groups (p = 0.212). Conclusions: In the examined patient cohort, the use of cinacalcet did not affect the value of IOPTH monitoring during surgery for pHPT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

Radulova-Mauersberger

Keßler

Keßler³

et al. 2022

JCM

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“…However, as mentioned above, minimally invasive parathyroidectomy is preferable to bilateral exploration of the neck, which has increased risk of surgery, longer operation time, complications, and hospitalization. In the case of a negative preoperative localization diagnosis (ultrasound or MIBI), the current German guidelines on surgery for pHPT recommend discussing with the patient individually the two options of bilateral surgical exploration with a slightly reduced healing rate or, alternatively, planning further localization diagnostics, e.g., choline PET/CT to allow a focused, minimally invasive parathyroidectomy with its advantages, if possible [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the group of patients with equivocal PET/CT results did received resection due to missing morphological imaging correlates. In the knowledge of the true negative results from the patient cohort without any correlates on PET/CT images, a watchful waiting strategy and pharmaceutical treatment might be valuable options, and the decision to perform a bilateral neck dissection should be discussed with the patients individually, as suggested by the German guidelines on surgery for pHPT [ 28 ]. Further studies have to evaluate if a follow-up with choline PET/CT after 6–12 months might increase the detection rate under the condition that the parathyroid adenoma might grow or increase its pathological function.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Dekorsy

Beyer

Spitzweg

et al. 2022

JCM

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Primary hyperparathyroidism (pHPT) is a common endocrine disorder due to hyperfunctioning parathyroid glands. To date, the only curing therapy is surgical removal of the dysfunctional gland, making correct detection and localization crucial in order to perform a minimally invasive parathyroidectomy. 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has shown promising results for the detection of pHPT, suggesting superiority over conventional imaging with ultrasounds or scintigraphy. A total of 33 patients with pHPT who had negative or equivocal findings in conventional imaging received 18F-FCH PET/CT preoperatively and were retrospectively included. A pathological hyperfunctional parathyroid gland was diagnosed in 24 cases (positive PET, 72.7%), 4 cases showed equivocal choline uptake (equivocal PET, 12.1%), and in 5 cases, no enhanced choline uptake was evident (negative PET, 15.2%). Twelve of the twenty-four detected adenoma patients underwent surgery, and in all cases, a pathological parathyroid adenoma was resected at the site detected by PET/CT. Two of the six patients without pathological choline uptake who received a parathyroidectomy revealed no evidence of parathyroid adenoma tissue in the histopathological evaluation. This retrospective study analyzes 18F-FCH PET/CT in a challenging patient cohort with pHPT and negative or equivocal conventional imaging results and supports the use of 18F-FCH for the diagnosis of hyperfunctional parathyroid tissue, especially in this patient setting, with a 100% true positive and true negative detection rate. Our study further demonstrates the importance of 18F-FCH PET/CT for successful surgical guidance.

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“…Bilateral neck exploration (BNE) through the Kocher collar incision with subtotal parathyroidectomy or total parathyroidectomy with or without autotransplantation of the parathyroid gland is a well-studied and standardized procedure for the treatment of rHPT [ 4 – 8 ]. Numerous minimally invasive procedures have been developed to treat primary hyperparathyroidism (pHPT) with a focused approach based on precise localization of the hyperplastic parathyroid gland and were eventually adapted for BNE in nonlocalized pHPT and rHPT [ 7 , 9 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional parathyroidectomy for renal hyperparathyroidism: a retrospective multicenter study

et al. 2022

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To compare minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional surgery for renal hyperparathyroidism (rHPT). Between 2006 and 2020, 53 patients underwent MIVAP and 182 underwent conventional parathyroidectomy for rHPT at the Kliniken Essen-Mitte and Knappschaftskrankenhaus Bochum, respectively. Two propensity score-matched groups were retrospectively analyzed: the MIVAP group (VG; n = 53) and the conventional group (CG; n = 53). To assess long-term results, the patients were questioned prospectively (VG; n = 17, and CG; n = 26). The VG had a smaller incision (2.8 vs. 4.8 cm), shorter operation duration (81.0 vs. 13.9 min), and shorter duration of stay (2.4 vs. 5.7 days) (p < 0.0001) but a smaller drop in parathyroid hormone (PTH) postoperatively (81.3 vs. 85.5%. p = 0.022) than the CG. The conversion rate was 9.4% (n = 5). The VG had better Patient Scar Assessment Scale (PSAS) scores (10.8 vs. 11.7 p = 0.001) but worse SF-12 health survey scores (38.7 vs. 45.8 for physical health and 46.7 vs. 53.4 for mental health) (p < 0.0001). The PTH level at follow-up was higher in the VG (162.7 vs. 59.1 ng/l, p < 0.0001). There were no differences in morbidity, number of removed parathyroid glands, disease persistence, late rHPT relapse and need for repeat surgery between groups. MIVAP was superior to conventional parathyroidectomy regarding aesthetic outcomes and cost effectiveness. Conventional surgery showed better control of PTH levels and health scores on follow-up than MIVAP, without any impact on rHPT relapse and need for repeat surgery.Trail registration number and date of registration: DRKS00022545 on 14.12.2020. Graphical abstract

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Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)

Cited by 26 publications

References 105 publications

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional parathyroidectomy for renal hyperparathyroidism: a retrospective multicenter study

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