Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

Sitges‐Serra, Antonio; Prieto, Rosa; Valero, M.; Membrilla, Estela; Sancho, José Luis Valero

doi:10.1007/s00423-008-0283-9

Cited by 28 publications

(23 citation statements)

References 51 publications

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“…Specific treatment by PTX seems to be beneficial in decreasing PWV, which may result from improved BP control after surgery. As PTX indications for asymptomatic forms of PH have been discussed, 17,28 our data suggest the potential benefit pursuant to a reduction of subclinical organ damage after surgical treatment in these patients.…”

Section: Discussionmentioning

confidence: 73%

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

et al. 2010

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The study was aimed at investigating the arterial stiffness assessed by aortic pulse wave velocity (PWV) in the presence of primary hyperparathyroidism (PH), with and without concomitant hypertension. Subsequently, we examined the effect of parathyroidectomy (PTX) on arterial stiffness. A total of 28 patients with PH and concomitant hypertension, and 16 with PH without hypertension were investigated in comparison with 28 essential hypertensive patients and 18 healthy controls, respectively. Patients were matched for age, blood pressure (BP), body mass index, lipid profile and fasting glucose. Six months after PTX, 15 patients were examined again (hypertensive as well as normotensive). PWV was obtained using the SphygmoCor applanation tonometer (AtCor Medical, West Ryde, Australia). PWV was significantly higher in patients with PH and hypertension when compared with patients with essential hypertension (10.1 vs. 8.5 m s À1 , P¼0.013). PWV remained significant even after adjustment for age and BP (P¼0.02). Similarly, PWV was significantly higher in PH patients without hypertension in comparison with healthy controls (7.6 vs. 5.8 m s À1 , Po0.001). Six months after surgery, in addition to a normalization of calcium metabolism, a significant decrease in systolic BP (131 vs. 123 mm Hg, P¼0.004) and PWV (9.1 vs. 8.5 m s À1 , P¼0.024) was observed. After adjusting for BP reduction, the decrease in PWV appeared non-significant. Our data indicate that PH increases PWV as a marker of arterial stiffness, in both hypertensive and non-hypertensive patients. However, neither the calcium serum level nor the parathyroid hormone level has been associated with PWV. Specific treatment by PTX significantly decreases PWV, which may be determined primarily by improved BP control after surgery.

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Section: Discussionmentioning

confidence: 73%

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

et al. 2010

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“…It is mandatory to cryopreserve some tissue to avoid the risk of hypocalcemia in total parathyroidectomy. However, the cryopreserved tissue may not function as well as primary autotransplanted parathyroid tissue, particularly after months of cryopreservation [11][12][13].…”

Section: Discussionmentioning

confidence: 98%

“…Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism has become an accepted part of endocrine surgical practice worldwide; however, this technique is not offered to the patients with sHPT [7][8][9][10][11]. There is clinical evidence that demonstrate MIP for sHPT is as safe as a bilateral parathyroid exploration.…”

Section: Introductionmentioning

confidence: 97%

Minimally invasive video-assisted subtotal parathyroidectomy with thymectomy for secondary hyperparathyroidism

Barbaros

Erbil

Yıldırım

et al. 2008

Langenbecks Arch Surg

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“…MGD and smaller glands are inevitable in this group and there is already evidence that this leads to poorer surgical outcomes outside high volume centres. As PHPT is diagnosed earlier the proportion of image-negative patients is set to rise (57).…”

Section: Radiation Exposurementioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

Cited by 28 publications

References 51 publications

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

Minimally invasive video-assisted subtotal parathyroidectomy with thymectomy for secondary hyperparathyroidism

Imaging of the parathyroid glands in primary hyperparathyroidism

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