| Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. | |
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MedLine Citation:
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PMID: 21061130 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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PURPOSE: The purpose of this study is to investigate the results of first-time surgery for sporadic primary hyperparathyroidism (pHPT) in patients with preoperatively negative sestamibi scintigraphy and ultrasound. METHODS: Data were gathered prospectively in a multicenter database for quality control in parathyroid surgery. Between 2004 and 2008, 3,158 patients underwent first-time surgery for sporadic pHPT. A total of 984 patients were subjected to preoperative localization with ultrasound and sestamibi scintigraphy, and in 173 patients, both investigations were negative. Intraoperative findings and early outcome are reported. RESULTS: One hundred and fifty-five of 173 patients underwent bilateral neck exploration. The median weight of excised parathyroid tissue was 350 mg. In 23 patients (13.3%), the exploration was negative. A total of 112 patients (64.7%) had a histological diagnosis of parathyroid adenoma and 38 patients (22%) had multiglandular disease. Six weeks after operation, 164 patients were available for analysis, and 30 patients (18%) had persistent pHPT. The risk for persistent pHPT increased for patients with few intraoperatively identified (p = 0.001) and excised (p = 0.024) parathyroid glands. Patients operated with intraoperative parathyroid hormone (iOPTH) had lower risk for persistent pHPT 7/79 (9%) compared with 23/85 patients (27%) operated without iOPTH (p = 0.003). CONCLUSIONS: Negative localization with sestamibi and ultrasound in pHPT infers a highly selected patient population with small parathyroid adenomas, an alarmingly high rate of negative exploration, and an increased risk for persistent disease. The use of iOPTH influences cure rate favorably. |
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Authors:
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Anders O J Bergenfelz; Göran Wallin; Svante Jansson; Håkan Eriksson; Hans Mårtensson; Peer Christiansen; Eva Reihnér |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie Volume: 396 ISSN: 1435-2451 ISO Abbreviation: Langenbecks Arch Surg Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-01-05 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9808285 Medline TA: Langenbecks Arch Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 83-90 Citation Subset: IM |
Affiliation:
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Department of Surgery, Skåne University Hospital-Lund, 221 85 Lund, Sweden. anders.bergenfelz@med.lu.se |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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