Endocrinol Metab.  2011 Jun;26(2):109-117. 10.3803/EnM.2011.26.2.109.

Current Understanding and Treatment of Primary Hyperparathyroidism

• Lew JI

• KMID: 1497716
• DOI: http://doi.org/10.3803/EnM.2011.26.2.109

Abstract

No abstract available.

MeSH Terms

Hyperparathyroidism, Primary

Figure

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  Fig. 1 Coronal tomogram from a delayed phase Sestamibi scan in a patient with a left inferior parathyroid adenoma.

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  Fig. 2 Delayed phase coronal fused SPECT/CT tomogram showing a left superior parathyroid adenoma (arrow) with a posterior location at the upper pole of the left thyroid lobe.

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  Fig. 3 A. Transverse view of SUS showing a right inferior parathyroid adenoma (arrow). B. Longitudinal view of same right inferior parathyroid adenoma (arrow) with typical ultrasound features including hypoechogenicity and elliptical shape.

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  Fig. 4 Intraoperative parathyroid hormone monitoring in a patient with a solitary hyperfunctioning parathyroid gland. The 71% intraoperative parathyroid hormone (PTH) drop from 139 pg/mL to 41 pg/mL confirms all abnormal parathyroid tissue has been surgically removed.

Reference

1. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery. 1984. 95:14–21.

2. Uden P, Chan A, Duh QY, Siperstein A, Clark OH. Primary hyperparathyroidism in younger and older patients: symptoms and outcome of surgery. World J Surg. 1992. 16:791–797.

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

4. Bilezikian JP, Potts JT Jr. Asymptomatic primary hyperparathyroidism: new issues and new questions--bridging the past with the future. J Bone Miner Res. 2002. 17:Suppl 2. N57–N67.

5. Monchik JM, Gorgun E. Normocalcemic hyperparathyroidism in patients with osteoporosis. Surgery. 2004. 136:1242–1246.

6. Tordjman KM, Greenman Y, Osher E, Shenkerman G, Stern N. Characterization of normocalcemic primary hyperparathyroidism. Am J Med. 2004. 117:861–863.

7. Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008. 93:3462–3470.

8. Bilezikian JP, Potts JT Jr, Fuleihan Gel H, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg SJ, Udelsman R, Wells SA Jr. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Bone Miner Res. 2002. 17:Suppl 2. N2–N11.

9. Bilezikian JP, Khan AA, Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009. 94:335–339.

10. Pasieka JL, Parsons LL. Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg. 1998. 22:513–518.

11. VanderWalde LH, Liu IL, O'Connell TX, Haigh PI. The effect of parathyroidectomy on bone fracture risk in patients with primary hyperparathyroidism. Arch Surg. 2006. 141:885–889.

12. Chiu B, Sturgeon C, Angelos P. What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy. Surgery. 2006. 140:418–422.

13. Carneiro-Pla DM, Solorzano CC, Irvin GL 3rd. Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg. 2006. 202:715–722.

14. Yip L, Pryma DA, Yim JH, Virji MA, Carty SE, Ogilvie JB. Can a light-bulb sestamibi SPECT accurately predict single-gland disease in sporadic primary hyperparathyroidism? World J Surg. 2008. 32:784–792.

15. Casas AT, Burke GJ, Sathyanarayana , Mansberger AR Jr, Wei JP. Prospective comparison of technetium-99m-sestamibi/iodine-123 radionuclide scan versus high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with previously unoperated primary hyperparathyroidism. Am J Surg. 1993. 166:369–373.

16. Caixas A, Berna L, Hernandez A, Tebar FJ, Madariaga P, Vegazo O, Bittini AL, Moreno B, Faure E, Abos D, Piera J, Rodriguez JM, Farrerons J, Puig-Domingo M. Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism. Surgery. 1997. 121:535–541.

17. Sharma J, Mazzaglia P, Milas M, Berber E, Schuster DM, Halkar R, Siperstein A, Weber CJ. Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality? Surgery. 2006. 140:856–863.

18. Anderson SR, Vaughn A, Karakla D, Wadsworth JT. Effectiveness of surgeon interpretation of technetium tc 99m sestamibi scans in localizing parathyroid adenomas. Arch Otolaryngol Head Neck Surg. 2008. 134:953–957.

19. Melton GB, Somervell H, Friedman KP, Zeiger MA, Cahid Civelek A. Interpretation of 99mTc sestamibi parathyroid SPECT scan is improved when read by the surgeon and nuclear medicine physician together. Nucl Med Commun. 2005. 26:633–638.

20. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics. 2008. 28:1461–1476.

21. Solorzano CC, Carneiro-Pla DM, Irvin GL 3rd. Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg. 2006. 202:18–24.

22. Jabiev AA, Lew JI, Solorzano CC. Surgeon-performed ultrasound: a single institution experience in parathyroid localization. Surgery. 2009. 146:569–575.

23. Solorzano CC, Lee TM, Ramirez MC, Carneiro DM, Irvin GL. Surgeon-performed ultrasound improves localization of abnormal parathyroid glands. Am Surg. 2005. 71:557–562.

24. Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005. 132:359–372.

25. Arici C, Cheah WK, Ituarte PH, Morita E, Lynch TC, Siperstein AE, Duh QY, Clark OH. Can localization studies be used to direct focused parathyroid operations? Surgery. 2001. 129:720–729.

26. Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. Clin Endocrinol (Oxf). 2002. 57:241–249.

27. Gawande AA, Monchik JM, Abbruzzese TA, Iannuccilli JD, Ibrahim SI, Moore FD Jr. Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg. 2006. 141:381–384.

28. Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg. 2007. 94:42–47.

29. Lew JI, Solorzano CC, Montano RE, Carneiro-Pla DM, Irvin GL 3rd. Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies. Surgery. 2008. 144:299–306.

30. Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD, Shapiro SE, Edeiken BS, Truong MT, Evans DB, Lee JE, Perrier ND. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006. 140:932–940.

31. Irvin GL 3rd, Prudhomme DL, Deriso GT, Sfakianakis G, Chandarlapaty SK. A new approach to parathyroidectomy. Ann Surg. 1994. 219:574–579.

32. Irvin GL 3rd, Sfakianakis G, Yeung L, Deriso GT, Fishman LM, Molinari AS, Foss JN. Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg. 1996. 131:1074–1078.

33. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL 3rd. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003. 134:973–979.

34. Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG. Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg. 2004. 28:187–192.

35. Chiu B, Sturgeon C, Angelos P. Which intraoperative parathyroid hormone assay criterion best predicts operative success? A study of 352 consecutive patients. Arch Surg. 2006. 141:483–487.

36. Carneiro-Pla DM, Solorzano CC, Lew JI, Irvin GL 3rd. Long-term outcome of patients with intraoperative parathyroid level remaining above the normal range during parathyroidectomy. Surgery. 2008. 144:989–993.

37. Taylor J, Fraser W, Banaszkiewicz P, Drury P, Atkins P. Lateralization of parathyroid adenomas by intra-operative parathormone estimation. J R Coll Surg Edinb. 1996. 41:174–177.

38. Ito F, Sippel R, Lederman J, Chen H. The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing. Ann Surg. 2007. 245:959–963.

39. Boggs JE, Irvin GL 3rd, Carneiro DM, Molinari AS. The evolution of parathyroidectomy failures. Surgery. 1999. 126:998–1002.

40. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005. 138:583–587.

41. Irvin GL 3rd, Molinari AS, Figueroa C, Carneiro DM. Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg. 1999. 229:874–878.

42. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002. 235:665–670.

43. Westerdahl J, Lindblom P, Bergenfelz A. Measurement of intraoperative parathyroid hormone predicts long-term operative success. Arch Surg. 2002. 137:186–190.

44. Irvin GL 3rd, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg. 2004. 239:704–708.

45. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005. 140:472–478.

46. Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg. 2007. 246:976–980.

47. Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, Milas M. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008. 248:420–428.

48. Sidhu S, Neill AK, Russell CF. Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma. World J Surg. 2003. 27:339–342.

49. Lew JI, Irvin GL 3rd. Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: a 10-year outcome. Surgery. 2009. 146:1021–1027.

50. Mun HC, Conigrave A, Wilkinson M, Delbridge L. Surgery for hyperparathyroidism: does morphology or function matter most? Surgery. 2005. 138:1111–1120.

51. Elliott DD, Monroe DP, Perrier ND. Parathyroid histopathology: is it of any value today? J Am Coll Surg. 2006. 203:758–765.

52. Carneiro-Pla DM, Romaguera R, Nadji M, Lew JI, Solorzano CC, Irvin GL 3rd. Does histopathology predict parathyroid hypersecretion and influence correctly the extent of parathyroidectomy in patients with sporadic primary hyperparathyroidism? Surgery. 2007. 142:930–935.

53. Kaplan EL, Yashiro T, Salti G. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg. 1992. 215:300–317.

54. Allendorf J, DiGorgi M, Spanknebel K, Inabnet W, Chabot J, Logerfo P. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg. 2007. 31:2075–2080.

55. Duh QY. Presidential Address: Minimally invasive endocrine surgery--standard of treatment or hype? Surgery. 2003. 134:849–857.

56. Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg. 2003. 238:332–337.

57. Chen H, Mack E, Starling JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg. 2005. 242:375–380.

58. Inabnet WB 3rd, Dakin GF, Haber RS, Rubino F, Diamond EJ, Gagner M. Targeted parathyroidectomy in the era of intraoperative parathormone monitoring. World J Surg. 2002. 26:921–925.

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