Journal article
Detection of multiple gland primary hyperparathyroidism in the era of minimally invasive parathyroidectomy
Surgery, Vol.136(6), pp.1303-1309
12/2004
DOI: 10.1016/j.surg.2004.06.062
PMID: 15657591
Abstract
A focused surgical approach for primary hyperparathyroidism relies on the ability of preoperative imaging and intraoperative parathyroid hormone monitoring (IOPTH) to detect multiple gland disease (MGD). The study objective was to determine the best predictor for MGD.
First time parathyroidectomy was performed on 233 patients with primary hyperparathyroidism who underwent preoperative sestamibi imaging, ultrasound, and IOPTH between December 1999 and January 2004.
Single gland disease (SGD) was found in 204 (88%) and MGD in 23 (10%) patients. Hyperparathyroidism persisted in 6 of 233 patients (2.6%). For patients with MGD, sestamibi imaging correctly predicted MGD in 2 of 23 (9%) patients, incorrectly showed SGD in 9 of 23 (39%), and was negative in 12 of 23 (52%). Ultrasound correctly predicted MGD in 6 of 23 (26%) patients, incorrectly predicted SGD in 6 of 23 (39%), and was negative in 8 of 23 (35%). Together sestamibi imaging and ultrasound predicted MGD in 7 of 23 (30%) patients, incorrectly predicted SGD in 7 of 23 (30%), was negative in 7 of 23 (30%), and was discordant in 10 of 23 (5%). IOPTH indicated MGD in 15 of 18 (83%) patients but falsely predicted cure after single gland excision in 3 of 18 (17%). The combination of sestamibi imaging, ultrasound, and IOPTH detected MGD in 16 of 18 (89%) patients.
Ultrasound was more sensitive for detecting MGD than sestamibi imaging. Ultrasound and sestamibi imaging together provided information warranting a bilateral approach in 70% of patients with MGD. IOPTH was the most sensitive for MGD, but combining all 3 tests was the best predictor, identifying the majority of patients with MGD.
Details
- Title: Subtitle
- Detection of multiple gland primary hyperparathyroidism in the era of minimally invasive parathyroidectomy
- Creators
- Sonia L Sugg - Division of Pancreatobiliary/Endocrine Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USAElizabeth A KrzywdaMichael J DemeureStuart D Wilson
- Resource Type
- Journal article
- Publication Details
- Surgery, Vol.136(6), pp.1303-1309
- Publisher
- United States
- DOI
- 10.1016/j.surg.2004.06.062
- PMID
- 15657591
- ISSN
- 0039-6060
- eISSN
- 1532-7361
- Language
- English
- Date published
- 12/2004
- Academic Unit
- Surgery
- Record Identifier
- 9984051897702771
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