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George L Irvin - One of the best experts on this subject based on the ideXlab platform.
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focused Parathyroidectomy guided by intra operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism a 10 year outcome
Surgery, 2009Co-Authors: John I Lew, George L IrvinAbstract:Background There remains concern that focused Parathyroidectomy guided by intra-operative parathormone monitoring (IPM) will miss multiglandular disease (MGD) leading to a higher recurrence rate. This study reports the 10-year outcome of patients with sporadic primary hyperparathyroidism treated by focused Parathyroidectomy guided by IPM. Methods From 1993 to 1998, 173 consecutive patients with sporadic primary hyperparathyroidism underwent focused Parathyroidectomy guided by IPM. When IPM showed >50% decrease 10 minutes after abnormal gland excision, the operation was completed. Recurrent hyperparathyroidism was defined as elevated serum calcium and parathormone (PTH) levels >6 months after successful Parathyroidectomy. Results There were 164 patients with a mean follow-up of 83 months. In this group, 96% patients had single gland disease (SGD) and 4% had MGD. Five (3%) patients developed recurrent hyperparathyroidism at 2, 4, 9, 10, and 12 years. In 43 eucalcemic patients followed for >10 years, PTH levels remained normal in 54%, were constantly above normal range in 2%, or varied between normal and above normal range in 44%. Conclusion In patients 10 years after treatment, IPM-guided Parathyroidectomy does not fail to identify MGD, allows for limited dissection in SGD, and shows that various sized parathyroid glands left in situ do not cause higher recurrence rates.
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long term outcome of patients with elevated parathyroid hormone levels after successful Parathyroidectomy for sporadic primary hyperparathyroidism
Archives of Surgery, 2008Co-Authors: Carmen C. Solorzano, John I Lew, William Mendez, Steven E Rodgers, Raquel E Montano, Denise Carneiropla, George L IrvinAbstract:Hypothesis Untreated long-term elevated parathyroid hormone (PTH) levels after successful Parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after Parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear. Design Retrospective case series. Setting Tertiary referral center. Patients Five hundred seventy-six consecutive patients with HPT. Intervention Parathyroidectomy guided by intraoperative monitoring of PTH levels. Main Outcome Measures Overall incidence of elevated PTH levels (measurements of ≥ 70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after Parathyroidectomy). Results Of the 505 patients who underwent successful Parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency. Conclusion Although one-third of the patients had elevated PTH levels after successful Parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.
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"Limited" Parathyroidectomy in geriatric patients.
Annals of surgery, 2001Co-Authors: George L Irvin, Denise M. CarneiroAbstract:In the geriatric age group, patients with the diagnosis of primary hyperparathyroidism often go untreated, with most therapeutic emphasis being placed on their more serious comorbid diseases. This is unfortunate, because many of these patients have symptoms related to hyperparathyroidism that could be improved with Parathyroidectomy. It is a frequently neglected problem, as shown in large survey studies reporting that 2% of all elderly patients and 3% of women 75 years of age or older have primary hyperparathyroidism. 1 Few investigators report the outcome of Parathyroidectomy in many of these patients, and when this procedure is reported, it is usually performed for advanced disease, suggesting that physicians are hesitant to offer surgical referral to their older patients. 2 Some of the reluctance to recommend Parathyroidectomy in this age group centers around the risks of anesthesia and the extensive bilateral neck exploration used in a conventional Parathyroidectomy. Since 1993, we have used two surgical adjuncts in patients undergoing Parathyroidectomy: Tc-99m-sestamibi nuclear scans for preoperative localization and intraoperative parathyroid hormone assay (QPTH) for rapid confirmation of excision of all hypersecreting glands. These modalities allowed a change in our surgical approach to primary hyperparathyroidism by not only improving the success rate, as measured by a return to normocalcemia, 3 but also by substantially simplifying the surgical procedure from a bilateral neck exploration under general anesthesia to a simpler outpatient procedure. 4 The procedure can be done under light general or local anesthesia with conscious sedation. The purpose of this article is to report the outcome of “limited” Parathyroidectomy in geriatric patients.
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Ambulatory Parathyroidectomy for Primary Hyperparathyroidism
Archives of surgery (Chicago Ill. : 1960), 1996Co-Authors: George L Irvin, George Sfakianakis, Luke Yeung, George T. Deriso, Lawrence M. Fishman, Alberto S. Molinari, Joseph N. FossAbstract:Objective: To evaluate whether the combined application of preoperative localization and intraoperative monitoring of intact parathyroid hormone (iPTH) levels could facilitate safe outpatient Parathyroidectomy. Design: Consecutive patients, who had no antecedent social or medical conditions mandating hospitalization, were prospectively offered ambulatory Parathyroidectomy with a mean follow-up of 7 months (range, 1-25 months). Setting: Tertiary care referral center. Patients: From 85 patients who had primary hyperparathyroidism with hypercalcemia and elevated iPTH levels, 57 were offered outpatient Parathyroidectomy. Nineteen patients were asymptomatic, 3 had hypercalcemic crisis, and the others gave a history of renal stones or had complaints consistent with bone disease. Interventions: Technetium Tc 99m sestamibi scintiscans were used for preoperative localization. Monitoring iPTH levels during Parathyroidectomy quantitatively assured the surgeon (G.L.I. only) when all hyperfunctioning glands were excised. Main Outcome Measure: The number of patients without complications and with short operative times who were discharged without hospital admission or overnight stay. Results: The combination of preoperative localization of abnormal parathyroid glands and a decline in circulating iPTH levels predicting postoperative normocalcemia after excision of all hyperfunctioning glands resulted in successful Parathyroidectomy in 84 of 85 patients. A decreased operative time (average, 52 minutes) with minimal neck dissection permitted outpatient Parathyroidectomy in 42 of 57 eligible patients. Conclusions: The combination of preoperative parathyroid scintiscan localization and iPTH level monitoring during surgery permitted successful Parathyroidectomy in an ambulatory setting in half of a consecutive series of patients with primary hyperparathyroidism. The safety, success, and likely cost savings of this approach suggest wider application. Arch Surg. 1996;131:1074-1078
Carmen C. Solorzano - One of the best experts on this subject based on the ideXlab platform.
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Does concomitant thyroidectomy increase risks of Parathyroidectomy
The Journal of surgical research, 2016Co-Authors: Colleen M. Kiernan, Cameron Schlegel, Sandra L. Kavalukas, Chelsea A. Isom, Mary F. Peters, Carmen C. SolorzanoAbstract:Abstract Background Concomitant thyroid pathology in patients with primary hyperparathyroidism is common. This study compares complications of patients who underwent Parathyroidectomy to those who underwent Parathyroidectomy with a concomitant thyroidectomy. Methods A retrospective review of prospectively collected data on 709 patients who underwent Parathyroidectomy was performed. Patients who had prior thyroid or parathyroid procedures were excluded. Chi-square, Fisher's exact, Student's t-test, and Wilcoxon rank-sum tests were used to compare cohorts. Results Of the 641 patients included, 90% underwent Parathyroidectomy alone and 10% underwent Parathyroidectomy with a concomitant thyroidectomy. Overall, 49% had preoperative thyroid disease and 22% of patients with thyroid disease had a thyroid procedure. When compared with Parathyroidectomy alone, Parathyroidectomy with a concomitant thyroidectomy was associated with longer operative times (91 min versus 57 min, P Conclusions Parathyroidectomy with a concomitant thyroidectomy is associated with longer operative times, increased rate of overnight stay, and increased transient hypocalcemia.
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Hypercalcemic crisis in the era of targeted Parathyroidectomy.
The Journal of surgical research, 2011Co-Authors: William C. Beck, John I Lew, Carmen C. SolorzanoAbstract:Background Hypercalcemic crisis patients are appropriately treated by expeditious Parathyroidectomy. Previous studies have suggested that crisis patients may have lower operative success rates compared to non-crisis patients. This study reviews the outcomes for hypercalcemic crisis in the era of targeted parathyroid surgery. Methods The records of 839 patients with primary hyperparathyroidism who underwent Parathyroidectomy at a single institution from 1993 to 2009 were reviewed. From this group, 34 patients were surgically treated for hypercalcemic crisis, defined as having signs and symptoms of acute calcium intoxication and serum calcium levels ≥14 mg/dL. All patients underwent Parathyroidectomy guided by preoperative localization studies and intra-operative PTH hormone monitoring (IPM). Pre- and postoperative symptoms and laboratory values and rates of operative failure and recurrence were compared to 805 patients without crisis. Results Mean preoperative serum calcium (15.8 versus 11.6 mg/dL) and parathyroid hormone (PTH) (719 versus 175 pg/mL) levels were significantly higher among patients presenting with hypercalcemic crisis (P Conclusion Despite presenting with more ectopic glands and parathyroid cancer, crisis patients have similar Parathyroidectomy success rates compared with non-crisis patients. The high rate of success in the era of targeted Parathyroidectomy may be due to the widespread use of localization studies and IPM.
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long term outcome of patients with elevated parathyroid hormone levels after successful Parathyroidectomy for sporadic primary hyperparathyroidism
Archives of Surgery, 2008Co-Authors: Carmen C. Solorzano, John I Lew, William Mendez, Steven E Rodgers, Raquel E Montano, Denise Carneiropla, George L IrvinAbstract:Hypothesis Untreated long-term elevated parathyroid hormone (PTH) levels after successful Parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after Parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear. Design Retrospective case series. Setting Tertiary referral center. Patients Five hundred seventy-six consecutive patients with HPT. Intervention Parathyroidectomy guided by intraoperative monitoring of PTH levels. Main Outcome Measures Overall incidence of elevated PTH levels (measurements of ≥ 70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after Parathyroidectomy). Results Of the 505 patients who underwent successful Parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency. Conclusion Although one-third of the patients had elevated PTH levels after successful Parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.
John I Lew - One of the best experts on this subject based on the ideXlab platform.
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intraoperative parathormone spikes during Parathyroidectomy may be associated with multiglandular disease
Surgery, 2017Co-Authors: Richard Teo, Josefina C Farra, Zahra F Khan, Andrea R Marcadis, John I LewAbstract:Abstract Background The importance of intraoperative parathormone “spikes” during Parathyroidectomy remains unclear. This study compared patients with and without intraoperative parathormone spikes during Parathyroidectomy using the criterion of a > 50% parathormone and determined the effect of intraoperative parathormone spikes on operative outcome. Methods We performed a retrospective review of prospectively collected data on 683 patients who underwent Parathyroidectomy guided by intraoperative parathormone monitoring. An intraoperative parathormone “spike value” was calculated by subtracting the preincision intraoperative parathormone value from the pre-excision intraoperative parathormone value (SV = PE − PI). An intraoperative parathormone spike was defined as having a positive spike value ≥9 pg/mL (≥10th percentile of all spike values). Results Of 683 patients, 224 (33%) had intraoperative parathormone spikes and a greater rate of multiglandular disease (8% vs. 3%, P Conclusions Although the presence of intraoperative parathormone spikes may increase suspicion for multiglandular disease, the ability of intraoperative parathormone monitoring to predict operative success after Parathyroidectomy is not affected by spikes.
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Hypercalcemic crisis in the era of targeted Parathyroidectomy.
The Journal of surgical research, 2011Co-Authors: William C. Beck, John I Lew, Carmen C. SolorzanoAbstract:Background Hypercalcemic crisis patients are appropriately treated by expeditious Parathyroidectomy. Previous studies have suggested that crisis patients may have lower operative success rates compared to non-crisis patients. This study reviews the outcomes for hypercalcemic crisis in the era of targeted parathyroid surgery. Methods The records of 839 patients with primary hyperparathyroidism who underwent Parathyroidectomy at a single institution from 1993 to 2009 were reviewed. From this group, 34 patients were surgically treated for hypercalcemic crisis, defined as having signs and symptoms of acute calcium intoxication and serum calcium levels ≥14 mg/dL. All patients underwent Parathyroidectomy guided by preoperative localization studies and intra-operative PTH hormone monitoring (IPM). Pre- and postoperative symptoms and laboratory values and rates of operative failure and recurrence were compared to 805 patients without crisis. Results Mean preoperative serum calcium (15.8 versus 11.6 mg/dL) and parathyroid hormone (PTH) (719 versus 175 pg/mL) levels were significantly higher among patients presenting with hypercalcemic crisis (P Conclusion Despite presenting with more ectopic glands and parathyroid cancer, crisis patients have similar Parathyroidectomy success rates compared with non-crisis patients. The high rate of success in the era of targeted Parathyroidectomy may be due to the widespread use of localization studies and IPM.
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focused Parathyroidectomy guided by intra operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism a 10 year outcome
Surgery, 2009Co-Authors: John I Lew, George L IrvinAbstract:Background There remains concern that focused Parathyroidectomy guided by intra-operative parathormone monitoring (IPM) will miss multiglandular disease (MGD) leading to a higher recurrence rate. This study reports the 10-year outcome of patients with sporadic primary hyperparathyroidism treated by focused Parathyroidectomy guided by IPM. Methods From 1993 to 1998, 173 consecutive patients with sporadic primary hyperparathyroidism underwent focused Parathyroidectomy guided by IPM. When IPM showed >50% decrease 10 minutes after abnormal gland excision, the operation was completed. Recurrent hyperparathyroidism was defined as elevated serum calcium and parathormone (PTH) levels >6 months after successful Parathyroidectomy. Results There were 164 patients with a mean follow-up of 83 months. In this group, 96% patients had single gland disease (SGD) and 4% had MGD. Five (3%) patients developed recurrent hyperparathyroidism at 2, 4, 9, 10, and 12 years. In 43 eucalcemic patients followed for >10 years, PTH levels remained normal in 54%, were constantly above normal range in 2%, or varied between normal and above normal range in 44%. Conclusion In patients 10 years after treatment, IPM-guided Parathyroidectomy does not fail to identify MGD, allows for limited dissection in SGD, and shows that various sized parathyroid glands left in situ do not cause higher recurrence rates.
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long term outcome of patients with elevated parathyroid hormone levels after successful Parathyroidectomy for sporadic primary hyperparathyroidism
Archives of Surgery, 2008Co-Authors: Carmen C. Solorzano, John I Lew, William Mendez, Steven E Rodgers, Raquel E Montano, Denise Carneiropla, George L IrvinAbstract:Hypothesis Untreated long-term elevated parathyroid hormone (PTH) levels after successful Parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after Parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear. Design Retrospective case series. Setting Tertiary referral center. Patients Five hundred seventy-six consecutive patients with HPT. Intervention Parathyroidectomy guided by intraoperative monitoring of PTH levels. Main Outcome Measures Overall incidence of elevated PTH levels (measurements of ≥ 70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after Parathyroidectomy). Results Of the 505 patients who underwent successful Parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency. Conclusion Although one-third of the patients had elevated PTH levels after successful Parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.
Martin Almquist - One of the best experts on this subject based on the ideXlab platform.
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Total versus subtotal Parathyroidectomy for secondary hyperparathyroidism.
Surgery, 2018Co-Authors: Elin Isaksson, Kerstin Ivarsson, Shahriar Akaberi, Andreas Muth, Karl Göran Prütz, Naomi Clyne, Gunnar Sterner, Martin AlmquistAbstract:Background It remains unclear whether total or subtotal Parathyroidectomy for secondary hyperparathyroidism yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture, and recurrent Parathyroidectomy after total versus subtotal Parathyroidectomy in patients on renal replacement therapy. Methods Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid surgery, and the National Inpatient Registry, we identified patients who underwent Parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total versus subtotal Parathyroidectomy using COX's regression, adjusting for age, sex, cause of renal disease, time with a functioning graft before and after Parathyroidectomy, Charlson comorbidity index, year of surgery, prevalent cardiovascular disease, time on dialysis, renal transplantation at Parathyroidectomy, and treatment with calcimimetics before Parathyroidectomy. Results There were 824 patients who underwent Parathyroidectomy, 388 total and 436 subtotal. There was no difference in mortality or risk of incident hip fracture between groups. Comparing the subtotal with the total Parathyroidectomy, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 0.43 (0.25–0.72) and for recurrent Parathyroidectomy 3.33 (1.33–8.32). Conclusion There was a higher risk of cardiovascular events in patients after total Parathyroidectomy compared with subtotal Parathyroidectomy, but a lower risk of recurrent Parathyroidectomy.
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The Effect of Parathyroidectomy on Risk of Hip Fracture in Secondary Hyperparathyroidism
World journal of surgery, 2017Co-Authors: Elin Isaksson, Kerstin Ivarsson, Shahriar Akaberi, Andreas Muth, Naomi Clyne, Gunnar Sterner, Prütz Karl-göran, Martin AlmquistAbstract:Background Secondary hyperparathyroidism increases the risk for fractures. Despite improvement in medical therapy, surgical Parathyroidectomy (PTX) often becomes necessary, but its effect on risk of fractures is not clear. Our aim was to study the effect of Parathyroidectomy on the risk of hip fractures in patients on dialysis or with a functioning renal graft at time of Parathyroidectomy.
Electron Kebebew - One of the best experts on this subject based on the ideXlab platform.
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patient factors associated with Parathyroidectomy in older adults with primary hyperparathyroidism
JAMA Surgery, 2021Co-Authors: Carolyn D Seib, Tong Meng, Insoo Suh, Amber W Trickey, Alexander K Smith, Emily Finlayson, Kenneth E Covinsky, Manjula Kurella Tamura, Electron KebebewAbstract:Importance Parathyroidectomy provides definitive management for primary hyperparathyroidism (PHPT), reducing the risk of subsequent fracture, nephrolithiasis, and chronic kidney disease (CKD), but its use among older adults in the US is unknown. Objective To identify patient characteristics associated with the use of Parathyroidectomy for the management of PHPT in older adults. Design, Setting, and Participants This population-based, retrospective cohort study used 100% Medicare claims from beneficiaries with an initial diagnosis of PHPT from January 1, 2006, to December 31, 2016. Patients were considered to meet consensus guideline criteria for Parathyroidectomy based on diagnosis codes indicating osteoporosis, nephrolithiasis, or stage 3 CKD. Multivariable logistic regression was used to identify patient characteristics associated with Parathyroidectomy. Data were analyzed from February 11, 2020, to October 8, 2020. Main Outcomes and Measures The primary outcome was Parathyroidectomy within 1 year of diagnosis. Results Among 210 206 beneficiaries with an incident diagnosis of PHPT (78.8% women; mean [SD] age, 75.3 [6.8] years), 63 136 (30.0%) underwent Parathyroidectomy within 1 year of diagnosis. Among the subset of patients who met consensus guideline criteria for operative management (n = 131 723), 38 983 (29.6%) were treated with Parathyroidectomy. Patients treated operatively were younger (mean [SD] age, 73.5 [5.7] vs 76.0 [7.1] years) and more likely to be White (90.1% vs 86.0%), to be robust or prefrail (92.1% vs 85.7%), and to have fewer comorbidities (Charlson Comorbidity Index score of 0 or 1, 54.6% vs 44.1%), in addition to being more likely to live in socioeconomically disadvantaged (46.9% vs 40.3%) and rural (18.1% vs 13.6%) areas (all P < .001). On multivariable analysis, increasing age had a strong inverse association with Parathyroidectomy among patients aged 76 to 85 years (unadjusted rate, 25.9%; odds ratio [OR], 0.68 [95% CI, 0.67-0.70]) and older than 85 years (unadjusted rate, 11.2%; OR, 0.27 [95% CI, 0.26-0.29]) compared with those aged 66 to 75 years (unadjusted rate, 35.6%), as did patients with moderate to severe frailty (unadjusted rate, 18.9%; OR, 0.60 [95% CI, 0.56-0.64]) compared with robust patients (unadjusted rate, 36.1%) and those with a Charlson Comorbidity Index score of 2 or greater (unadjusted rate, 25.9%; OR, 0.77 [95% CI, 0.75-0.79]) compared with a Charlson Comorbidity Index score of 0 (unadjusted rate, 37.0%). With regard to operative guidelines, a history of nephrolithiasis increased the odds of Parathyroidectomy (OR, 1.43 [95% CI, 1.39-1.47]); stage 3 CKD decreased the odds of Parathyroidectomy (OR, 0.71 [95% CI, 0.68-0.74]); and osteoporosis showed no association (OR, 1.01 [95% CI, 0.99-1.03]). Conclusions and Relevance In this cohort study, most older adults with PHPT did not receive definitive treatment with Parathyroidectomy. Older age, frailty, and multimorbidity were associated with nonoperative management, and guideline recommendations had minimal effect on treatment decisions. Further research is needed to identify barriers to surgical care and develop tools to target Parathyroidectomy to older adults most likely to benefit.
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undertreatment of primary hyperparathyroidism in a privately insured us population decreasing utilization of Parathyroidectomy despite expanding surgical guidelines
Surgery, 2021Co-Authors: Carolyn D Seib, Tong Meng, Insoo Suh, Robin M Cisco, Dana T Lin, Arden M Morris, Amber W Trickey, Electron KebebewAbstract:Abstract Background Primary hyperparathyroidism is associated with substantial morbidity, including osteoporosis, nephrolithiasis, and chronic kidney disease. Parathyroidectomy can prevent these sequelae but is poorly utilized in many practice settings. Methods We performed a retrospective cohort study using the national Optum de-identified Clinformatics Data Mart Database. We identified patients aged ≥35 with a first observed primary hyperparathyroidism diagnosis from 2004 to 2016. Multivariable logistic regression was used to determine patient/provider characteristics associated with Parathyroidectomy. Results Of 26,522 patients with primary hyperparathyroidism, 10,101 (38.1%) underwent Parathyroidectomy. Of the 14,896 patients with any operative indication, 5,791 (38.9%) underwent Parathyroidectomy. Over time, there was a decreasing trend in the rate of Parathyroidectomy overall (2004: 54.4% to 2016: 32.4%, P Conclusion The majority of US privately insured patients with primary hyperparathyroidism are not treated with Parathyroidectomy. Having an operative indication only modestly increases the likelihood of Parathyroidectomy. Further research is needed to address barriers to treatment and the gap between guidelines and clinical care in primary hyperparathyroidism.
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limited Parathyroidectomy in multiple endocrine neoplasia type 1 associated primary hyperparathyroidism a setup for failure
Annals of Surgical Oncology, 2016Co-Authors: Naris Nilubol, Lee S Weinstein, William F Simonds, Robert T Jensen, Stephen J Marx, Electron KebebewAbstract:Background Recently, some surgeons have suggested that minimally invasive Parathyroidectomy guided by preoperative localizing studies of patients with multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) provides an acceptable outcome while minimizing the risk of hypoparathyroidism. This study aimed to evaluate the outcome for MEN1 patients who underwent limited Parathyroidectomy compared with subtotal Parathyroidectomy.
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Less-than-subtotal Parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after Parathyroidectomy in tertiary hyperparathyroidism after renal transplantation
Surgery, 2006Co-Authors: Frédéric Triponez, Electron Kebebew, Glenn M. Chertow, David Dosseh, Quan-yang Duh, Marc Hazzan, Christian Noel, François Wambergue, Dominique Fleury, Vincent LemaitreAbstract:Background The optimal surgical approach for tertiary hyperparathyroidism (HPT) after kidney transplantation is unknown. Existing studies are limited by small sample size, lack of adjustment for kidney function, and no long-term follow-up. Methods We retrospectively analyzed 74 patients with tertiary HPT who underwent Parathyroidectomy at two centers since 1978. Persistent HPT was defined as parathyroid hormone (PTH) concentrations in excess of the K/DOQI target range for the corresponding estimated creatinine clearance (eCrCl). Results Seventy-four patients had 83 operations (72 subtotal and 11 less-than-subtotal parathyroidectomies). Mean follow-up time was 5.4 ± 4.7 years. Calcium concentrations decreased significantly after Parathyroidectomy (2.83 vs 2.28 mmol/L, P Conclusions The use of limited Parathyroidectomy for tertiary HPT after kidney transplantation has a higher risk of persistent/recurrent HPT. Subtotal Parathyroidectomy is recommended for patients with tertiary HPT.
