Surgical Aspects of Primary Hyperparathyroidism

Perrier, Nancy D.; Lang, Brian Hung‐Hin; Farias, Leonardo C. B.; Lorente-Poch, Leyre; Sywak, Mark; Almquist, Martin; Vriens, Menno R.; Yeh, Michael W.; Shariq, Omair A.; Duh, Quan‐Yang; Yeh, Randy; Vu, Thinh; LiVolsi, Virginia A.; Sitges‐Serra, Antonio

doi:10.1002/jbmr.4689

Cited by 19 publications

(22 citation statements)

References 213 publications

(416 reference statements)

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“…However, recPTH is related to parathyroid gland which is not resected in first surgery and has a potential pathological nature. [ 23 - 25 ] The incidence of perHPT is more common than recHPT; in several studies the rate of perHPT varies 60-85% and the rate of recHPT is 15–40%. [ 5 , 6 , 20 ]…”

Section: Etiologymentioning

confidence: 99%

“…In the literature review discussed at the 5 th international multidisciplinary workshop on primary HPT, the discussion about the 6-month time periods in the definitions of persistent and recurrent disease is increasing, and it is recommended to update these periods and definitions. [ 23 ] Although the definition of recHPT is development of hypercalcemia after 6 months normocalcemic period, the main question is whether occurring of a new disease as recHPT after this period or is this period a transient period which masks the perHPT.…”

Section: Long-term Follow-up and Follow-up For Recurrencementioning

confidence: 99%

“…In the light of a better understanding of asymmetric hyperplasia and the information obtained from more sensitive third and fourth generation PTH tests and ioPTH monitoring; dormant disease needs to be better understood. [ 7 , 23 , 61 , 63 ]…”

Section: Long-term Follow-up and Follow-up For Recurrencementioning

confidence: 99%

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Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the pre-operative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography (4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fine-needle aspiration biopsy, and parathormone washout are invasive methods.

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Section: Etiologymentioning

confidence: 99%

Section: Long-term Follow-up and Follow-up For Recurrencementioning

confidence: 99%

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Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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“…Preoperative localization is now used routinely to guide the parathyroid surgeon [ 118 ]. Successful localization appears to be less likely in NPHPT compared to HPHPT.…”

Section: Biochemical Course In Apparent Nphptmentioning

confidence: 99%

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Shaker

Wermers

2023

Journal of the Endocrine Society

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Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.

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“…In patients with asymptomatic PHPT, we recommend surgery to cure the disease (strong recommendation/high quality evidence). 5. For which patients is parathyroidectomy an option?…”

Section: Summary Of Recommendationsmentioning

confidence: 99%

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

Bilezikian

Khan

Silverberg

et al. 2020

Journal of Bone and Mineral Research

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159

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The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non‐surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence‐based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in‐depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Surgical Aspects of Primary Hyperparathyroidism

Cited by 19 publications

References 213 publications

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

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