Reoperation for Persistent or Recurrent Primary Hyperparathyroidism

Shen, Wen T.; Düren, Mete; Morita, Eugene; Higgins, Charles B.; Duh, Quan‐Yang; Siperstein, Allan; Clark, Orlo H.

doi:10.1001/archsurg.1996.01430200071013

Cited by 230 publications

(177 citation statements)

References 12 publications

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“…23 Patients with multinodular thyroid disease, a short and thick neck or an adenoma in the retroesophageal, mediastinal or tracheoesophageal groove are more likely to yield a false-negative result. 24 Ultrasound is a sensitive investigation for intrathyroid glands, which account for 10% of ectopic glands, 13 and accurately identified one intrathyroid lesion prior to redo surgery in our series. Parathyroid glands are more readily identified when there is concordance between the sestamibi and US scans.…”

Section: Discussionmentioning

confidence: 57%

“…Ectopic glands have been found at redo surgery in the thymus, thyroid gland, tracheoesophageal groove or paraesophagus, mediastinum, carotid sheath, base of skull and lateral to the carotid artery. 13 The tracheoesophageal groove is the most common location of missed glands 14 and it has been suggested that a reluctance to dissect near the recurrent laryngeal nerve may be a key factor in the failure to appreciate abnormal parathyroid glands in this position. 3 In our series, there were five cases of ectopic glands; two of these were within the mediastinum and were accessed via a cervical incision in keeping with other published studies.…”

Section: Discussionmentioning

confidence: 99%

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Re-explorative Parathyroid Surgery for Persistent and Recurrent Primary Hyperparathyroidism

Afors¹,

O’Connell²,

Thomas³

2011

World Journal of Endocrine Surgery

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Primary hyperparathyroidism (HPT) is treated by parathyroidectomy. Excision of abnormal parathyroid tissue is curative in the majority of cases. Postoperative persistent or recurrent HPT has been reported up to 30%. The purpose of this study was to evaluate the role of imaging techniques and determine the efficacy of reexplorative surgery. A total of 306 patients underwent parathyroidectomy between 2000 and 2009. Twelve patients (3.9%) were not cured. Two patients declined further treatment, the other 10 patients underwent further investigation and surgery. Imaging and results of redo surgery together with associated complications were evaluated. All 10 patients were investigated with sestamibi, which accurately localized aberrant parathyroid tissue in three cases and ultrasound scans which also localized three cases. CT was useful in one of the three cases for which it was used. PET and MRI were not helpful. Twelve glands were resected, six adenomas, five hyperplastic and one normal gland. Nine of the 10 reoperated patients became normocalcemic. Complications included a bilateral recurrent laryngeal paresis. In total, 317 operations were performed and 303 of 306 (99%) patients were cured. Redo surgery for HPT is challenging and carries higher risks than primary surgery. Sestamibi and ultrasound scans are the most helpful imaging modalities. When there is concordance a targeted approach may be considered, otherwise a more extensive dissection is required. Redo parathyroid surgery should be considered, even if scans are unhelpful, for patients who are symptomatic or young or have a persistently high calcium level.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Re-explorative Parathyroid Surgery for Persistent and Recurrent Primary Hyperparathyroidism

Afors¹,

O’Connell²,

Thomas³

2011

World Journal of Endocrine Surgery

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“…Patients undergoing reoperation were distributed between SGD and MGD in a proportion similar to that of patients undergoing initial exploration, and a missed single adenoma was the leading cause of recurrent/persistent hyperparathyroidism in our group, which was in keeping with findings in the existing literature. 15,16 Given the importance of determining the probability of MGD in the setting of a potential reoperation, it is essential to include these patients in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers

Sepahdari¹,

Bahl

Harari

et al. 2015

AJNR Am J Neuroradiol

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“…When carried out by an experienced surgeon (at least 10 parathyroid interventions every year), success rate is nearly 95% (1,8,16). Surgery is recommended for symptomatic patients, with renal or skeletal involvement (1,11,17).…”

Section: Treatmentmentioning

confidence: 99%

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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Reoperation for Persistent or Recurrent Primary Hyperparathyroidism

Cited by 230 publications

References 12 publications

Re-explorative Parathyroid Surgery for Persistent and Recurrent Primary Hyperparathyroidism

Re-explorative Parathyroid Surgery for Persistent and Recurrent Primary Hyperparathyroidism

Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers

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

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