When is surgery indicated for asymptomatic primary hyperparathyroidism?

Morris, Luc G.T.; Myssiorek, David

doi:10.1002/lary.20740

Cited by 11 publications

(2 citation statements)

References 5 publications

(17 reference statements)

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“…However, these symptoms cannot be attributed with certainty to hypercalcemia given the patient's mental status. Her laboratory levels of serum calcium and the concern for carcinoma in this patient were the two main factors that led to surgical excision [14].…”

Section: Discussionmentioning

confidence: 89%

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

Muelleman¹,

Rosenberger²,

Humphrey³

et al. 2016

IJOHNS

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We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.

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Section: Discussionmentioning

confidence: 89%

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

Muelleman¹,

Rosenberger²,

Humphrey³

et al. 2016

IJOHNS

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“…Patients deemed surgical candidates with symptomatic disease or qualifying by National Institutes of Health criteria in asymptomatic disease were subjected to localisation studies consisting of a neck ultrasound scan and a sestamibi scan. 2,3 The parathyroidectomy was tailored to the localisation studies into focused surgery or small incision fourgland visualisation. Concordant preoperatively localised disease was approached via a focused unilateral approach with a central or lateral incision and the removal of the abnormal gland and identification of the normal ipsilateral gland when feasible.…”

Section: Protocol Of Interventionsmentioning

confidence: 99%

Morbidity in parathyroid surgery for renal disease is under reported: a comparison of outcomes with primary hyperparathyroidism

Nastos

Constantinides

Mizamtsidi

et al. 2018

annals

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Introduction Parathyroidectomy is considered to be a safe procedure with low morbidity. However, while this is true for primary hyperparathyroidism, whether it applies to tertiary disease is not so well documented. The aim of this study was to assess the morbidity of surgery for tertiary hyperparathyroidism compared with primary disease and to establish whether there are predictive factors for poor outcomes. Methods Data for patients subjected to parathyroidectomy during the period 2007-2015 were retrospectively analysed from a prospectively collected database. Patient age, sex, American Society of Anesthesiologists (ASA) score, renal status, extent of operation and indications for surgery were examined. The complication and mortality rate were compared and independent predictors of outcome were examined. Results A total of 1079 patients were scheduled for a parathyroidectomy during the study period of whom 158 for renal related hyperparathyroidism (renal group) and 921 for primary disease (non-renal group). There was a significantly higher complication rate in the renal parathyroid group, including a higher mortality (1.3% vs 0.1%, P = 0.011), overall complication rate (7.0% vs 2.3%, P = 0.001), surgery related complication rate (4.4% vs 1.7%, P = 0.03) and systemic complication rate (2.5% vs 0.4%, P = 0.005). In patients with ASA score ≤ 2 reoperative surgery (OR 9.25, 95% confidence interval, CI 1.41-60.75), male sex (OR 4.12, 95% CI 1.46-11.63) and renal impairment were (OR 5.86, 95% CI 1.65-20.78) were predictors of worse outcomes. In patients with ASA score ≥3 renal impairment, in addition to other variables, were not predictors of complications. Conclusions Parathyroidectomy in renal-related disease is associated with a significantly higher risk of morbidity and mortality compared with primary hyperparathyroidism.

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Parathyroidectomy

Sakr

2022

Parathyroid Gland Disorders

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When is surgery indicated for asymptomatic primary hyperparathyroidism?

Cited by 11 publications

References 5 publications

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

Morbidity in parathyroid surgery for renal disease is under reported: a comparison of outcomes with primary hyperparathyroidism

Parathyroidectomy

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