Risk factors for surgical failure in patients undergoing surgery for primary hyperparathyroidism

Joseau, Santiago Olguín; Arias, Ariel; Garzón, A.E. Crespo; Peretti, Emiliano; Guzmán, Luis; Ruggieri, Marcelo

doi:10.1016/j.cireng.2022.04.008

Cited by 1 publication

(5 citation statements)

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“…Primary hyperparathyroidism (pHPT) is the third most common endocrine disease[ 3 ], with ongoing incidence and 100000 new cases annually in the United States[ 4 ]. It is sporadic (90%-95%) and hereditary (5%-10%) and is associated with multiple endocrine neoplasia (MEN) syndromes.…”

Section: Introductionmentioning

confidence: 99%

“…Its causes include mainly single parathyroid adenoma (PA) (80%-85%), double adenoma (4%-5%), diffuse hyperplasia (10%-15%) and parathyroid cancer (< 1%), as shown schematically in Figure 1 [ 5 ]. Cure has been defined as the restoration of calcium levels (normal homeostasis) lasting six months at a minimum[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cure rates currently range between 95% and 99%[ 3 , 6 , 7 ]. However, normocalcemia before the initial operation exists in 10% of pHPT[ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recurrent hyperparathyroidism (R-HPT) occurs when calcium increases beyond normal limits after at least 6 mo of normal values after the initial parathyroidectomy for pHPT. It is due to untreated parathyroid hyperplasia, parathyroid carcinoma (PC) or metastasis, autograft hyperplasia or parathyromatosis[ 3 , 6 , 12 ]. The latter (benign diffused multiple nodules of hyperfunctioning parathyroid tissue in the neck and superior mediastinum) is a very rare cause of R-HPT[ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Risk for persistence constitutes hyperplasia and normal parathyroid tissue on the histopathological report[ 3 ]. Additionally, measuring parathyroid hormone and calcium in the early postoperative period (after two weeks) may better predict later recurrent pHPT[ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Pavlidis¹,

Pavlidis²

2023

World J Clin Cases

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Primary hyperparathyroidism (pHPT) is the third most common endocrine disease. The surgical procedure aims for permanent cure, but recurrence has been reported in 4%-10% of pHPT patients. Preoperative localization imaging is highly valuable. It includes ultrasound, computed tomography (CT), single-photon-emission CT, sestamibi scintigraphy and magnetic resonance imaging. The operation has been defined as successful when postoperative continuous eucalcemia exists for more than the first six months. Ongoing hypercalcemia during this period is defined as persistence, and recurrence is defined as hypercalcemia after six months of normocalcemia. Vitamin D is a crucial factor for a good outcome. Intraoperative parathyroid hormone (PTH) monitoring can safely predict the outcomes and should be suggested. PTH ≤ 40 pg/mL or the traditional decrease ≥ 50% from baseline minimizes the likelihood of persistence. Risk factors for persistence are hyperplasia and normal parathyroid tissue on histopathology. Risk factors for recurrence are cardiac history, obesity, endoscopic approach and low-volume center (at least 31 cases/year). Cases with double adenomas or four-gland hyperplasia have a greater likelihood of persistence/ recurrence. A 6-mo calcium > 9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 mo may be associated with recurrence necessitating long-term follow-up. 18F-fluorocholine positron emission tomography and 4-dimensional CT in persistent and recurrent cases can be valuable before reoperation. With these novel advances in preoperative imaging and localization as well as intraoperative PTH measurement, the recurrence rate has dropped to 2.5%-5%. Six-month serum calcium ≥ 9.8 mg/dL and parathyroid hormone ≥ 80 pg/mL indicate a risk of recurrence. Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels are predictors of multiglandular disease, which brings an increased risk of persistence and recurrence. Bilateral neck exploration was considered the gold-standard diagnostic method. Minimally invasive parathyroidectomy and neck exploration are both effective surgical techniques. Multidisciplinary diagnostic and surgical management is required to prevent persistence and recurrence. Long-term follow-up, even up to 10 years, is necessary.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Cure rates currently range between 95% and 99%[ 3 , 6 , 7 ]. However, normocalcemia before the initial operation exists in 10% of pHPT[ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%