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Surgical Treatment of Primary Hyperparathyroidism: Description of Techniques and Advances in the Field

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Abstract

Primary hyperparathyroidism is a disease commonly seen in patients above 60 years of age. It is the most common cause of asymptomatic or symptomatic hypercalcemia, usually found incidentally on routine check-ups. Surgical treatment is the only definitive treatment of choice in the symptomatic patient; however, it can also be employed in asymptomatic patients. First described in 1925, bilateral neck exploration is the gold standard of treatment for primary hyperparathyroidism. The recent interest in minimally invasive surgeries has led to better and improved techniques of neck exploration with improved cosmetic results and lesser chances of transient or permanent hypoparathyroidism due to inadvertent removal of normally functioning parathyroid tissue. These include unilateral neck explorations, minimally invasive parathyroidectomies and minimally invasive radio-guided parathyroidectomy. The intact parathyroid hormone assays have greatly added to the detection of normal and abnormal functioning glands, hence better surgical outcomes.

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Abbreviations

iPTH:

Intact parathyroid hormone

MIRP:

Minimally invasive radio-guided parathyroidectomy

PTH:

Parathyroid hormone

MEN:

Multiple endocrine neoplasia

CT:

Computed tomography

MRI:

Magnetic resonance imaging

U/S:

Ultrasonography

IRMA:

Immunoradiometric assay

IOPTH:

Intraoperative parathyroid hormone assay

ICMA:

Immunochemiluminometric assay

BMD:

Bone mineral density

References

  1. Ahuja AT, Wong KT, Ching AS, Fung MK, Lau JY, Yuen EH et al (2004) Imaging for primary hyperparathyroidism—what beginners should know. Clin Radiol 59(11):967–976

    Article  PubMed  CAS  Google Scholar 

  2. Eigelberger MS, Cheah WK, Ituarte PH, Streja L, Duh QY, Clark OH (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 239(4):528–535

    Article  PubMed  PubMed Central  Google Scholar 

  3. Diaz-Aguirregoitia FJ, Emparan C, Gaztambide S, Aniel-Quiroga MA, Busturia MA, Vazquez JA et al (2004) Intraoperative monitoring of kinetic total serum calcium levels in primary hyperparathyroidism surgery. J Am Coll Surg 198(4):519–524

    Article  PubMed  Google Scholar 

  4. Allendorf J, Kim L, Chabot J, DiGiorgi M, Spanknebel K, LoGerfo P (2003) The impact of sestamibi scanning on the outcome of parathyroid surgery. J Clin Endocrinol Metab 88(7):3015–3018

    Article  PubMed  CAS  Google Scholar 

  5. Brasier AR (1994) Hyperparathyroidism and the metabolic responses to parathyroidectomy. In: Morris PJ, Malt RA (eds) Oxford textbook of surgery, 1st edn. Oxford Medical Publications, Oxford, pp 755–760

    Google Scholar 

  6. Norman J, Chheda H (1997) Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 122:998–1004

    Article  PubMed  CAS  Google Scholar 

  7. Nilsson IL, Wadsten C, Brandt L, Rastad J, Ekbom A (2004) Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease. Surgery 136(5):981–987

    Article  PubMed  Google Scholar 

  8. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J (2002) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 236(5):543–551

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen H, Zeiger MA, Gordon TA et al (1996) Parathyroidectomy in Maryland: effects of an endocrine center. Surgery 120:948–952

    Article  PubMed  CAS  Google Scholar 

  10. Russell CF, Edis AJ (1982) Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br J Surg 69:244–247

    Article  PubMed  CAS  Google Scholar 

  11. Inabet WB, Dakin GF, Haber RS, Rubino F, Diamond EJ, Gagner M (2002) Targeted parathyroidectomy in the era of intraoperative parathormone monitoring. World J Surg 26:921–925

    Article  Google Scholar 

  12. Wang CA (1985) Surgical management of primary hyperparathyroidism. Curr Prob Surg 22:1–50

    Article  CAS  Google Scholar 

  13. Dillavou ED, Cohn HE (2003) Minimally invasive parathyroidectomy: 101 consecutive cases from a single surgeon. J Am Coll Surg 197(1):1–7

    Article  PubMed  Google Scholar 

  14. Mandell DL, Genden EM, Mechanick JI, Bergman DA, Diamond EJ, Urken ML (2001) The influence of intraoperative parathyroid hormone monitoring on the surgical management of hyperparathyroidism. Arch Otolaryngol Head Neck Surg 127(7):821–827

    PubMed  CAS  Google Scholar 

  15. Sadler GP, Dudley N (2000) Surgery for the parathyroid glands. In: Moriris PJ, Wood WC (eds) Oxford textbook of surgery, 2nd edn. Oxford University Press, Oxford, pp 1129–1141

    Google Scholar 

  16. Ryan JA Jr, Lee FT (2004) Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization tests. Arch Surg 139(8):838–842, discussion 842–3

    Article  PubMed  Google Scholar 

  17. Goldstein RE, Billheimer D, Martin WH, Richards K (2003) Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement. Ann Surg 237(5):722–730, discussion 730–1

    PubMed  PubMed Central  Google Scholar 

  18. Utelsman R (2002) Six -hundret fifty six consecutive explorations for primary hyperparatyroidism. Ann Surg 235(5):665–670, discussion 670–2

    Article  Google Scholar 

  19. Wineland A, Siegel E, Stack BC Jr (2008) Reexamining normative radiation data for radioguided parathyroid surgery. Arch Otolaryngol Head Neck Surg 134(11):1209–1213

    Article  PubMed  Google Scholar 

  20. Bekis R, Celik P, Uysal B et al (2008) Exposure of surgical staff in surgical probe applications in radioguided parathyroidectomy. Eur Arch Otorhinolaryngol 265(12):1545–1548

    Article  PubMed  Google Scholar 

  21. Goasguen N, Chirica M, Roger N et al (2010) Primary hyperparathyroidism from parathyroid microadenoma: specific features and implications for a surgical strategy in the era of minimally invasive parathyroidectomy. J Am Coll Surg 210(4):456–462

    Article  PubMed  Google Scholar 

  22. Pitt SC, Sippel RS, Chen H (2009) Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am 89(5):1227–1239

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jaskowiak NT, Sugg SL, Helke J, Koka MR, Kaplan EL (2002) Pitfalls of intraoperative quick parathyroid hormone monitoring and gamma probe localization in surgery for primary hyperparathyroidism. Arch Surg 137(6):659–668, discussion 668–9

    Article  PubMed  Google Scholar 

  24. Elaraj DM, Remaley AT, Simonds WF, Skarulis MC, Libutti SK, Bartlett DL et al (2002) Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. Surgery 132(6):1028–1033, discussion 1033–4

    Article  PubMed  Google Scholar 

  25. Harman CR, Grant CS, Hay ID et al (1998) Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery 124(6):1011–1019, Discussion 1019–20

    Article  PubMed  CAS  Google Scholar 

  26. Adler JT, Sippel RS, Chen H (2010) New trends in parathyroid surgery. Curr Probl Surg 47(12):958–1017

    Article  PubMed  Google Scholar 

  27. Quiros RM, Alef MJ, Wilhelm SM, Djuricin G, Loviscek K, Prinz RA (2003) Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy. Surgery 134(4):675–681, discussion 681–3

    Article  PubMed  CAS  Google Scholar 

  28. Genc H, Morita E, Perrier ND, Miura D, Ituarte P, Duh QY et al (2003) Differing histologic findings after bilateral and focused parathyroidectomy. J Am Coll Surg 196(4):535–540

    Article  PubMed  Google Scholar 

  29. Abbas G, Dubner S, Heller KS (2001) Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck 23(7):544–546

    Article  PubMed  CAS  Google Scholar 

  30. Elaraj DM, Remaley AT, Simonds WF, Skarulis MC, Libutti SK, Bartlett DL et al (2002) Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. Surgery 132(6):1028–1033, discussion 1033–4

    Article  PubMed  Google Scholar 

  31. Hasse C, Sitter H, Brune M, Wollenteit I, Nies C, Rothmund M (2002) Quality of life and patient satisfaction after reoperation for primary hyperparathyroidism: analysis of long-term results. World J Surg 26(8):1029–1036

    Article  PubMed  Google Scholar 

  32. Silverberg SJ, Lewiecki EM, Mosekilde L et al (2009) Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94(2):351–365

    Article  PubMed  CAS  Google Scholar 

  33. Dudley N (1994) Surgery of the parathyroid Glands. In: Morris PJ, Malt RA (eds) Oxford textbook of surgery, 1st edn. Oxford Medical Publications, Oxford, pp 761–772

    Google Scholar 

  34. Hedback G, Oden A (2004) Persistent disease after surgery for primary hyperparathyroidism: the long-term outcome. Eur J Endocrinol 150(1):19–25

    Article  PubMed  Google Scholar 

  35. Boonen S, Vanderschueren D, Pelemans W, Bouillon R (2004) Primary hyperparathyroidism: diagnosis and management in the older individual. Eur J Endocrinol 151(3):297–304

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. St. Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK

    Muhammad Adil Abbas Khan, Sadia Rafiq, Sophocles Lanitis, Farhan Arshad Mirza, Lukasz Gwozdziewicz, Ragheed Al-Mufti & Dimitri J. Hadjiminas

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  1. Muhammad Adil Abbas Khan
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  2. Sadia Rafiq
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  3. Sophocles Lanitis
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Correspondence to Muhammad Adil Abbas Khan.

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Khan, M.A.A., Rafiq, S., Lanitis, S. et al. Surgical Treatment of Primary Hyperparathyroidism: Description of Techniques and Advances in the Field. Indian J Surg 76, 308–315 (2014). https://doi.org/10.1007/s12262-013-0898-0

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  • DOI: https://doi.org/10.1007/s12262-013-0898-0

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