The management of high‐risk patients with primary hyperparathyroidism – minimally invasive parathyroidectomy <i>vs.</i> medical treatment

Fang, Wen-Liang; Tseng, Ling‐Ming; Chen, Jui-Yu; Chiou, See-Ying; Chou, Yi‐Hong; Wu, Chew-Wun; Lee, Chen‐Hsen

doi:10.1111/j.1365-2265.2007.03076.x

Cited by 23 publications

(17 citation statements)

References 33 publications

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“…Our study finds that patients with crisis have similar incidence of MGD compared with non-crisis patients (6%). Other recent studies found that hypercalcemic crisis is likely to be caused by a single adenoma in 85%-92% of cases [2,4,11]. Furthermore, the current study shows that targeted parathyroidectomy without BNE can achieve excellent initial and long-term success rates with 0% mortality.…”

Section: Discussionsupporting

confidence: 56%

“…Today, once biochemical evaluation confirms the diagnosis of hyperparathyroidism, imaging studies are performed to determine the location of the hypersecreting parathyroid adenoma. Over time, medical therapy followed by expeditious parathyroidectomy has been established as the treatment of choice in the treatment of patients with primary hyperparathyroidism presenting with hypercalcemic crisis [2][3][4][5][6][7][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…This condition is associated with profound disturbances in mental status, cardiac, renal, and gastrointestinal function in the presence of markedly elevated serum calcium and parathyroid hormone (PTH) levels [1]. Early diagnosis, prompt preoperative medical management, and expeditious parathyroidectomy provide the best therapy for hypercalcemic crisis [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

Beck

Lew

Solórzano

2011

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

Beck

Lew

Solórzano

2011

Journal of Surgical Research

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“…The Workshop guidelines state that imaging studies are not appropriate for confirming the diagnosis of PHPT or screening patients for surgical referral and that negative imaging findings should not preclude surgical referral or intervention. However, it is desirable to enforce the use of MIBI scintigraphy whenever possible because the localized diagnosis that can be achieved with this modality decreases the risk of surgical invasiveness, thereby increasing the operative success rate (19). The use of MIBI scintigraphy is advocated for determining whether surgery is indicated, even if the guideline criteria are not met.…”

Section: Discussionmentioning

confidence: 99%

“…Rubin et al (23) performed resection in 50 of 99 patients with asymptomatic PHPT and followed the subjects for a maximum of 15 years, reporting that the disease progressed in 37% of patients not treated surgically. Fang et al (19) performed resection in 19 of 33 PHPT patients with a high risk for surgery and provided medical treatment to 14 who refused surgery. The patients were followed for two to three years, with significant disease exacerbation observed in the non-surgically treated patients.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study to Examine the Management of Asymptomatic Hyperparathyroidism in Japanese Patients in Accordance with the Guidelines for Asymptomatic PHPT Proposed at the Third International Workshop in 2008

et al. 2014

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Objective The treatment for asymptomatic primary hyperparathyroidism (PHPT) remains controversial. In 2008, the Third International Workshop on the Management of Asymptomatic PHPT proposed a set of guidelines for the management of asymptomatic PHPT. We therefore evaluated the application of the Workshop recommendations in Japanese patients with asymptomatic PHPT. Methods We analyzed each parameter of the guidelines in 87 Japanese patients with asymptomatic PHPT who underwent methoxy-isobutyl-isonitrile (MIBI) scintigraphy. Results Fewer than 10% of the patients were less than 50 years of age. The bone mineral density T-score was below -2.5 SD in 20 women (46.5% of all women analyzed) and in none of the men. The eGFR was <60 mL/min/1.73 m 2 in 17 patients. A majority of patients (43) satisfied only one parameter, while 25 patients satisfied none of the parameters. Furthermore, the MIBI-positive and surgically treated patients tended to satisfy a larger number of the parameters. The Workshop criteria and levels of PTH, daily Ca excretion, serum ALP and 1,25(OH)2 Vitamin D were further analyzed in relation to the findings of MIBI scans, and almost all of the parameters were found to be significantly correlated with the results of the MIBI studies. Conclusion Our results suggest the need to reassess the Workshop guidelines for the treatment of hyperparathyroidism in Japanese patients. It is desirable that MIBI scintigraphy be performed whenever possible, as this modality is anticipated to play an important role in determining whether or not surgery is appropriate.

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Diagnosis and Management of Primary Hyperparathyroidism Across the Veterans Affairs Health Care System

et al. 2019

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IMPORTANCE Untreated primary hyperparathyroidism impairs quality of life and incurs substantial costs. Parathyroidectomy is a low-risk, high-success, definitive intervention.OBJECTIVES To determine the appropriateness of diagnostic evaluation for primary hyperparathyroidism in patients with hypercalcemia and the use of parathyroidectomy for the treatment of primary hyperparathyroidism across the Veterans Affairs (VA) health care system. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of veterans with hypercalcemia and primary hyperparathyroidism was conducted from January 1, 2000, through September 30, 2015, using the VA Corporate Data Warehouse, a national electronic health record-based repository. The study included 371 370 veterans with chronic hypercalcemia and 47 158 veterans with biochemical evidence of primary hyperparathyroidism diagnosed by hypercalcemia, elevated serum parathyroid hormone levels, and near-normal serum creatinine levels. Statistical analysis was performed from April 21, 2017, to April 10, 2019. MAIN OUTCOMES AND MEASURESThe proportion of veterans with hypercalcemia who have parathyroid hormone levels evaluated, the proportion of veterans with hyperparathyroidism who are treated surgically, and the factors associated with parathyroidectomy using generalized linear latent and mixed model regression. RESULTSOf 371 370 patients with chronic hypercalcemia, 86 887 (23.4%) received further testing with parathyroid hormone level. Of 47 158 patients meeting diagnostic criteria for primary hyperparathyroidism (42 737 men [90.6%] and 4421 women [9.4%]; mean [SD] age, 67.3 [11.8] years), 6048 (12.8%) underwent parathyroidectomy. Of 5793 patients with primary hyperparathyroidism presenting with a serum calcium level more than 1 mg/dL above the upper limit of normal, 1501 (25.9%) underwent parathyroidectomy. There was a decreasing trend in the use of parathyroidectomy over time. Factors positively associated with parathyroidectomy were nephrolithiasis (odds ratio [OR], 2.23; 95% CI, 1.90-2.61) and non-Hispanic white race/ethnicity (OR, 1.31; 95% CI, 1.17-1.46), while age (OR, 0.95; 95% CI, 0.95-0.96), Elixhauser Comorbidity Index score (OR, 0.76; 95% CI, 0.72-0.80), decreased estimated glomerular filtration rate (OR, 0.52; 95% CI, 0.45-0.60), and diagnosis of osteoporosis (OR, 0.65; 95% CI, 0.52-0.80) were inversely related to surgery.CONCLUSIONS AND RELEVANCE From this study's findings, parathyroid hormone level is infrequently tested in patients with hypercalcemia, suggesting underdiagnosis of primary hyperparathyroidism. Patients meeting diagnostic criteria for primary hyperparathyroidism are undertreated with recommended parathyroidectomy. Similar gaps have previously been observed in non-VA care of primary hyperparathyroidism, suggesting the need for a systematic evaluation of barriers to diagnosis and treatment that informs intervention design.

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The management of high‐risk patients with primary hyperparathyroidism – minimally invasive parathyroidectomy vs. medical treatment

Abstract: MIP can be safely performed under local anaesthesia and it facilitates clinical care in high-risk PHPT patients. It is recommended for those selected by image localization.

Cited by 23 publications

References 33 publications

Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

Hypercalcemic Crisis in the Era of Targeted Parathyroidectomy

A Pilot Study to Examine the Management of Asymptomatic Hyperparathyroidism in Japanese Patients in Accordance with the Guidelines for Asymptomatic PHPT Proposed at the Third International Workshop in 2008

Diagnosis and Management of Primary Hyperparathyroidism Across the Veterans Affairs Health Care System

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