Clinical analysis of primary hyperparathyroidism: a report of 138 cases

doi:10.16139/j.1007-9610.2018.02.009

Abstract

Abstract: Objective To summarize the experience in the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods The clinical data of 138 patients with PHPT who underwent parathyroidectomy in our hospital from January 2015 to November 2017 were analyzed retrospectively. Results The patients including 30 males and 108 females were all treated with surgical treatment. Five cases had parathyroid crisis and 1 case underwent emergent surgery. A total of 150 parathyroid glands were resected. Postoperative pathology confirmed that 123 (82.0%) lesions were parathyroid adenoma, 9 (6.0%) lesions parathyroid hyperplasia, 4 (2.7%) lesions parathyroid carcinoma, 10 (6.6%) lesions parathyroid cysts and 4(2.7%) lesions parathyroid atypical adenoma. Parathyroid hormone decreased to normal and the blood calcium decreased in all cases after parathyroidectomy. The symptoms of hypocalcemia were found in 48 cases whose blood calcium restored to normal after supplementation of active vitamin D and calcium gluconate. There were no recurrent laryngeal nerve injury and other complications. Conclusions Blood calcium and parathyroid hormone can be used in the diagnosis of PHPT in early stage. Parathyroidectomy is an effective treatment for PHPT. Preoperation precise localization is helpful for the exploration of pathological lesion. Management with hydration diuresis and bisphosphonates and early parathyroidectomy have good effect on parathyroid crisis.

Key words: Primary hyperparathyroidism, Parathyroid crisis, Parathyroidectomy

CLC Number:

R653

LI Fuxin, JIANG Ruoyu, LI Dongyang, CHEN Zuoyu, WEI Mingze, ZHANG Bai, HE Xianghui. Clinical analysis of primary hyperparathyroidism: a report of 138 cases[J]. Journal of Surgery Concepts & Practice, 2018, 23(02): 125-129.

References

[1] Coker LH, Rorie K, Cantley L, et al.Primary hyperparathyroidism, cognition, and health-related quality of life[J]. Ann Surg,2005,242(5):642-650.
[2] Ahmad S, Kuraganti G, Steenkamp D.Hypercalcemic crisis: a clinical review[J]. Am J Med,2015,128(3):239-245.
[3] AACE/AAES Task Force on Primary Hyperparathyroidism. The American association of clinical endocrino-logists and the American association of endocrine surgeons position statement on the diagnosis and management of primary hyperparathyroidism[J]. Endocr Pract,2005,11(1):49-54.
[4] Bilezikian JP, Silverberg SJ.Normocalcemic primary hyperparathyroidism[J]. Arq Bras Endocrinol Metabol,2010, 54(2):106-109.
[5] Walker MD, Rubin M, Silverberg SJ.Nontraditional manifestations of primary hyperparathyroidism[J]. J Clin Densitom,2013,16(1):40-47.
[6] Cusano NE, Silverberg SJ, Bilezikian JP.Normocalcemic primary hyperparathyroidism[J]. J Clin Densitom,2013, 16(1):33-39.
[7] 邓先兆, 伍波, 樊友本, 等. 原发性甲状旁腺功能亢进的多学科联合诊治120例[J]. 上海医学,2012,35(11):931-934.
[8] 苏磊, 王雪晨, 桑剑锋, 等. 原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J]. 中国普外基础与临床杂志,2010,17(12):1290-1293.
[9] 朱信心, 魏涛, 龚日祥, 等. 136例原发性甲状旁腺功能亢进的诊治体会[J]. 中国普外基础与临床杂志,2014, 21(4):452-457.
[10] Pallauf A, Schopohl J, Makeschin M, et al.Lethal gene-ralized calcinosis and hypercalcemic crisis in primary hyperparathyroidism[J]. J Clin Endocrinol Metab,2015,100(1):17-18.
[11] Zanocco K, Angelos P, Sturgeon C.Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism[J]. Surgery,2006,140(6):874-881.
[12] Sheldon DG, Lee FT, Neil NJ.Surgical treatment of hyperparathyroidism improves health-related quality of life[J]. Arch Surg,2002,137(9):1022-1026.
[13] Ambrogini E, Cetani F, Cianferotti L, et al.Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial[J]. J Clin Endocrinol Metab,2007,92(8):3114-3121.
[14] Kaur P, Gattani R, Singhal AA, et al.Impact of preoperative imaging on surgical approach for primary hyperparathyroidism: Data from single institution in India[J]. Indian J Endocrinol Metab,2016,20(5):625-630.
[15] Karipineni F, Sahli Z, Somervell H, et al.Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease?[J]. Surgery,2018 ,163(1):35-41.
[16] Libutti SK, Alexander HR, Bartlett DL, et al.Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism[J]. Surgery,1999,126(6):1145-1150.
[17] Ito F, Sippel R, Lederman J, et al.The utility of intrao-perative bilateral internal jugular venous sampling with rapid parathyroid hormone testing[J]. Ann Surg,2007,245(6):959-963.
[18] Dobrinja C, Santandrea G, Giacca M, et al.Effectiveness of Intraoperative Parathyroid Monitoring(ioPTH) in predicting a multiglandular or malignant parathyroid disease[J]. Int J Surg,2017,41(Suppl 1):S26-S33.
[19] Javid M, Callender G, Quinn C, et al.Primary hyperparathyroidism with normal baseline intraoperative parathyroid hormone: A challenging population[J]. Surgery,2017,161(2):493-498.
[20] Norman J, Lopez J, Politz D.Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations[J]. J Am Coll Surg,2012, 214(3):260-269
[21] Cron DC, Kapeles SR, Andraska EA, et al.Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism[J]. Am J Surg,2017,214(3):509-514.
[22] Yu HH, Lou SY, Chou YH, et al.Hyperparathyroid crisis: the timing of surgery[J]. Asian J Surg,2011,34(4):147-152.
[23] Yu R.Hypercalcemic crisis associated with anastrozole use in a patient with breast cancer and primary hyperparathyroidism[J]. Endocrine,2016,53(3):868-869.
[24] Lowell AJ, Bushman NM, Wang X, et al.Assessing the risk of hypercalcemic crisis in patients with primary hyperparathyroidism[J]. J Surg Res,2017,217:252-257.
[25] Kuan YC, Tan F.Hypercalcemic crisis - a fatal case of primary hyperparathyroidism[J]. Med J Malaysia,2014, 69(6):231-233.
[26] Ameerudden S, He X.Management and surgical treatment of parathyroid crisis secondary to parathyroid tumors: report of four cases[J]. Int Med Case Rep J,2011,4:59-66.
[27] Singh DN, Gupta SK, Kumari N, et al.Primary hyperparathyroidism presenting as hypercalcemic crisis: Twenty-year experience[J]. Indian J Endocrinol Metab,2015, 19(1):100-105.