Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience

Piccin, Ottavio; D'Alessio, Pasquale; Cioccoloni, Eleonora; Burgio, Luca; Preda, Cristina; Altieri, Paola; Vicennati, Valentina; Repaci, Andrea; Pagotto, Uberto; Cavicchi, Ottavio

doi:10.1016/j.amjoto.2020.102819

Cited by 8 publications

(21 citation statements)

References 30 publications

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“…In case of ineffective CDUS results, 4D‐CT is recommended. In patients with associated goiter, the combination of CDUS and 4D‐CT represents a reliable modality 22 …”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Contrast‐Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism

Piccin

D'Alessio

Serra

et al. 2022

J of Ultrasound Medicine

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Objectives Preoperative localization of pathological parathyroid glands with imaging is essential for focused unilateral neck exploration and minimally invasive techniques. Recently published studies suggested that contrast‐enhanced ultrasonography (CEUS) had high accuracy in the localization of hyperfunctioning parathyroid glands, with a general increase in the sensitivity as compared to conventional sonography. The purpose of this study was to determine the usefulness of CEUS in the localization of parathyroid lesions relating to surgical and histopathological data, in comparison to color Doppler ultrasound (CDUS), in the same series of patients. Methods Records of 142 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings. Results The overall sensitivity of CEUS was 77.6% compared with 74.6% for CDUS, although no significative differences were found (P = .516). Conversely, CDUS has shown higher sensitivity than CEUS in the group of patients with associated thyroid pathology but there was no statistical difference (P = .529). The sensitivity for detection of multiple adenomas was the same for both procedures. Conclusions We found no significative superior sensitivity of CEUS also in case of concomitant thyroid pathology and multiple glands disease.

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“…In case of ineffective CDUS results, 4D‐CT is recommended. In patients with associated goiter, the combination of CDUS and 4D‐CT represents a reliable modality 22 …”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Contrast‐Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism

Piccin

D'Alessio

Serra

et al. 2022

J of Ultrasound Medicine

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“…In studies that compared cinacalcet and parathyroidectomy, the most frequent side effect of cinacalcet was gastric intolerance, which may have limited dosing and compliance [ 88 ]. Complications after parathyroidectomy include surgical wound infection, temporary or permanent recurrent laryngeal nerve palsy and transient or permanent hypocalcemia, the most frequent being transient hypocalcemia related to hungry bone syndrome [ 93 , 94 ]. Other parathyroidectomy complications include mortality during hospitalization or within 1 month of parathyroidectomy (2%), rehospitalization (24% required), the need for intensive care (29%) and a 39% increase in 1-year hospitalizations, according to United States Renal Data System information on parathyroidectomies performed from 2007 to 2009.…”

Section: Introductionmentioning

confidence: 99%

“…The most frequent disorders were hypocalcemia, myocardial infarction and arrhythmias. The number of adverse events varied significantly based on the patient's clinical history [ 93 ].…”

Section: Introductionmentioning

confidence: 99%

A roadmap to parathyroidectomy for kidney transplant candidates

Cianciolo

Tondolo

Barbuto

et al. 2022

Clinical Kidney Journal

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Chronic kidney disease Mineral and Bone Disorder may persist after successful kidney transplantation. Persistent hyperparathyroidism has been identified in up to 80% of patients throughout the first year after kidney transplantation. International Guidelines lack strict recommendations about the management of persistent hyperparathyroidism. However, it is associated with adverse graft and patients’ outcomes such as higher fracture risk and an increased risk of all-cause mortality and allograft loss. Secondary hyperparathyroidism may be treated medically (vitamin D, phosphate binders and calcimimetics) or surgically (parathyroidectomy). Guideline recommendations suggest medical therapy first but do not clarify optimal PTH targets or indications and timing of parathyroidectomy. There are no clear guidelines or long-term studies about the impact of hyperparathyroidism therapy. Parathyroidectomy is more effective than medical treatment although associated to increased short term risks. Ideally, parathyroidectomy should be performed before kidney transplantation to prevent persistent hyperparathyroidism and improve graft outcomes. We now propose a roadmap for the management of secondary hyperparathyroidism in patients eligible for kidney transplantation that includes the indications and timing (pre- or post-kidney transplantation) of parathyroidectomy, the evaluation of parathyroid gland size and the integration of parathyroid gland size in the decision-making process by a multidisciplinary team of nephrologists, radiologists and surgeons.

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“…The introduction of ioPTH and the optimization of its interpretative models, together with the refinement of techniques for localization of pathological parathyroid glands have allowed the implementation of focused approach for PTx 13 , 14 and the extension of surgical indications, with an overall improvement of treatment optimization, especially in terms of complications of HPT1 15 . In addition, ioPTH may be a useful tool in difficult settings, such as concurrent thyroid disease or unlocalized parathyroid gland 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

Graceffa

Cipolla

Calagna

et al. 2022

Sci Rep

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Intraoperative parathyroid hormone dosage allows real-time monitoring of the decrease in PTH levels during parathyroidectomy and verify procedure’s efficacy. Currently, none of the interpretative criteria used has absolute accuracy. The aim of this study is to evaluate diagnostic accuracy of the Rome criterion verifying diagnostic significance of the individual assays. A total of 205 patients with primary hyperparathyroidism from a single adenoma were retrospectively evaluated and monitored with baseline PTH, PTH at 10 min and PTH at 20 min after adenoma excision. The accuracy of the latter two assays compared with baseline was compared by ROC curves. In addition, was evaluated the influence on these data of localization diagnostics (ultrasounds and scintigraphy), definitive histology, and type of surgery performed. The ratio of 20-min sampling to baseline in the Rome criterion showed highest diagnostic significance. This finding was not influenced by the type of surgery performed, definitive histologic examination, or intraoperative localization of the adenoma. The Rome criterion has shown its high reliability in detecting persistence. The ratio of sampling at 20 min to baseline is by far the best performing. Further studies are needed to evaluate whether sampling at 10 min after adenoma excision can be considered not mandatory.

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Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience

Cited by 8 publications

References 30 publications

The Diagnostic Value of Contrast‐Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism

The Diagnostic Value of Contrast‐Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism

A roadmap to parathyroidectomy for kidney transplant candidates

Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

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