True recurrence of hyperparathyroidism: Proposed criteria of recurrence

Abstract

Although recurrent hyperparathyroidism should not be rare on theoretical grounds, only a few cases of proved recurrence have been reported in the literature. In the present author's series only 4 patients (1 per cent) had true recurrence. Criteria for recurrence were: 1. Histological identification by biopsy and frozen section of all the parathyroid glands at the first operation. 2. Complete removal of the enlarged gland(s). 3. A normocalcaemic period of at least 1 year. 4. The finding of a tumour at the site of a previously normal-sized gland. The low incidence of recurrent hyperparathyroidism might be explained by the long period of time needed for the recurrence to develop. However, since diagnosis of hyperparathyroidism is now more easily made and patients are treated surgically earlier in the course of the disease, the incidence of true recurrence might be expected to rise. A meticulous exploration during operation and careful follow-up of the patients are therefore required.

Parathyroidectomy: Extent of resection and late results

“…True recurrence of hypercalcaemia after parathyroidectomy, with new disease in glands originally found normal on biopsy, is rare and its estimated incidence is 1 per cent (Fulmer et al, 1969;Muller, 1975). In the 70 patients with adenoma in the present series there has been no instance of recurrent hypercalcaemia.…”

Strategy in Reoperative Surgery for Hyperparathyroidism

“…The median size of the missed glands was 2 cm, with a range of 0.5 to 7 cm in the longest diameter. Among these 32 missed adenomas, 2 were fifthgland adenomas, found after 4 …”

Prophylaktische oder therapeutische parathyreoidektomie beim prim�ren hyperparathyreoidismus

“…Durch eine komplikationslose Reoperation wurden 8 Adenome beseitigt. Bei 3 Patienten dfirfte es sich um echte Rezidive gehandelt haben (5%), obwohl nicht alle von Muller [11] aufgestellten Kriterien erffillt waren (keine histologische Sicherung normaler Epithelk6rperchen bei der Erstoperation). In einem Fall waren 4 Eingriffe n6tig, wobei 4 normal gelegene und 2 ektope akzessorische Nebenschilddrfisen entfernt werden konnten.…”

“…Die verbleibenden Drfisen k6nnen sich aber im sp/iteren Verlauf adenomat6s ver/indern und zu Rezidiven fiihren, was sich bei 3 Patienten (5%) w/ihrend einer Zweitoperation best/itigte. Ob diese im Vergleich mit gr6Beren Studien (1% Rezidive [11]) hohe Rezidivquote auf unsere geringe Fallzahl zuriickzufiihren ist oder ob eine falsche Beurteilung bei der ersten Operation vorlag, ist schwer zu sagen. Besonders aufwendig kann die Suche nach ektop gelegenen Adenomen werden (10%).…”