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Clinical, diagnosis, localization studies and treatment in primary hyperparathyroidism

Year 2018, Volume: 15 Issue: 2, 40 - 44, 14.08.2018

Abstract

Background: Primary hyperparathyroidism is an endocrine hormone disorder disease characterized by hypercalcemia with excessive secretion of parathyroid hormone from the parathyroid glands. The most common cause is parathyroid adenomas. Curative treatment is the surgery. In this study, we aimed to present the results of 47 patients operated for primary hyperparathyroidism

Material and Methods: Data of 47 patients who have been treated surgically with diagnosis of parathyroid adenoma between 2009 and 2017 were analyzed retrospectively.

Results: Forty 0ne patients were female, 6 were male and the mean age was 52.53 (range 21-76 years). The most common symptom patients was bone and joint pain with 21 patients. Preoperative mean PTH values were 381.8 (116-1348) pg / mL, mean Ca values 11.1 (9.7-14.2) mg / dL. The accuracy rate for pathologic parathyroid gland localization study was 75 % in neck USG, 85 % in parathyroid scintigraphy, and 40 % in neck CT. The mean PTH values measured at postoperative 12th hour were 84.1 (4-808.2) pg / ml and mean Ca values were 9.1 (6.7-12.35) mg / dl, whereas 36th hour were 83, 27 (4-435) pg / ml, Ca values 8.8 (7.3-12.19) mg / dl. Parathyroid the PTH values at postoperative Histopathology was parathyroid adenoma in 45 patients and parathyroid hyperplasia was in 2 patients. Thyroid surgery was performed in 18 patients because of accompanying thyroid disease Simultaneous. When thyroid histopathology was evaluated, 14 patients had adenomatous nodular goiter, 3 patients had thyroid papillary carcinoma, and 1 patient had thyroid medullary carcinoma. Complications were hypocalcemia in 3 patients.

Conclusion: Patients with symptomatic PHPT should be treated surgically in order to avoid long-term complications. Risky patients who are thought to develop complications in the future should be operated. In asymptomatic hyperparathyroidism patients. We recommended that parathyroid scintigraphy and neck ultrasonography are used together for preoperative localization. We evaluated that minimally invasive surgery is useful with a successful localization study.

References

  • 1. Kebebew E & Clark O. Parathyroid adenoma, hyperplasia, and carcinoma: localization, technical details of primary neck exploration, and treatment of hypercalcemic crisis. Surgical Oncology Clinics of North America 1998; 7: 721. 2. Rahbari R, Holloway AK, He M, Khanafshar E, Clark OH & Kebebew E. Identification of differentially expressed mi-croRNA in parathyroid tumors. Annals of Surgical Oncology 2011;18:1158–1165. 3. Adami S, Marcocci C & Gatti D. Epidemiology of primary hyperparathyroidism in Europe. Journal of Bone and Mineral Research 2002 17 N18–N23. 4. Thakker R. Genetics of parathyroid tumours. Journal of In-ternal Medicine 2016;280: 574–583. 5. Melton LJ. Epidemiology of primary hyperparathyroidism Journal of Bone and Mineral Research 1991;6:25–30. 6. Robin P, Boushey MD, Thomas RJ, Todd MD. Middlemedias-tinal parathyroid: diagnosis and surgical approach. The An-nals of Thoracic Surgery 2001;71(2):699-701. 7. Horányi J, Szlávik R, Duffek L, et al. Surgery of primary hy-perparathyroidism. Orv Hetil 2006; 147:2347–2351. 8. Wermers RA, Khosla S, Atkinson EJ, etal. The rise and fall of primary hyperparathyrodism: A population based study in Rochester, Minnesota, 1965-1992. Ann Intern Med 1997; 126:433–440. 9. Aydın Y, Akbaba G, Berker D. Asemptomatik Birincil hiperparatiroidi hastalarına endokrinolojik yaklaşım. Düzce Tıp Fak Derg 2009; 11:43–46. 10. Solomon BL, Schaaf M, Smallridge RC. Psychologic symp-toms before and after parathyroid surgery Am J Med 1994; 96:101–106. 11. Silverberg SJ. Non-classical target organs in primary hy-perparathyroidism. J Bone Miner Res 2002; 17:117–125. 12. Dirican A, Yönder H, Karakaş S et al. Paratiroid adenom-larında klinik ve cerrahi deneyimimiz. Endokrinolojide Diyalog 2014, 11(1): 61-65 13. Pallan S, Rahman MO & Khan AA. Diagnosis and manage-ment of primary hyperparathyroidism. BMJ 2012; 344: e1013. 14. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh Q-Y, Doherty GM, Herrera MF, Pasieka JL & Perrier ND. The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JA-MA Surgery 2016;151:959–968. 15. Khan A, Hanley D, Rizzoli R, Bollerslev J, Young J, Rejnmark L, Thakker R, D’Amour P, Paul T & Van Uum S. Primary hy-perparathyroidism: review and recommendations on evalua-tion, diagnosis, and management. A Canadian and Interna-tional Consensus. Osteoporosis International 2017 28:1–19. 16. Norman J, Chedda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 1997;122:998. 17. Miccoli P, Bendinelli Ci, Vignali E, et al. Endoscopic parathy-roidectomy. Report of an initial experience. Surgery 1998;124:1077. 18. Potts JT Jr. Management of asymptomatic hyperparathyroid-ism: a report on the NIH consensus development confer-ence. Trends Endocrinol Metab 1992;10:376-380. 19. Palmer M, Adami HO, Bergstrom R, Jakobsson S, Akerström G, Ljunghall S. Survival and renal function in untreated hy-percalcemia. Population-based cohort study with 14 years of follow- up. Lancet 1987;1:59-62. 20. Lumachi F, Zucchetta P, Marzola MC, Boccagni P, Angelini F, Bui F, D'Amico DF, Favia G. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol. 2000:143:755-60. 21. Cakal E, Cakir E, Dilli A, Colak N, Unsal I, Aslan MS, Karbek B, Ozbek M, Kilic M, Delibasi T, Sahin M. Parathyroid ade-noma screening efficacies of different imaging tools and fac-tors affecting the success rates. Clin Imaging. 2012 ;36:688-94. 22. Hedback G, Tisell LE, Bengtsson BA, Hedman I, Oden A. Premature death in patients operated on for primary hy-perparathyroidism. Ann Chir Gynaecol 1985;74:66-73. 23. Udelsman R, Åkerström G, Biagini C, Duh Q-Y, Miccoli P, Niederle B & Tonelli F. The surgical management of asymp-tomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. Journal of Clinical Endocri-nology and Metabolism 2014 99 3595–3606. 24. Gul K, Ozdemir D, Korukluoglu B, et al. Preoperative and postoperative evaluation of thyroid disease in patients un-dergoing surgical treatment of primary hyperparathyroidism. Endocr Pract 2010;16:7-13. 25. Krause UC, Friedrich JH, Olbricht T, Metz K. Association of primary hyperparathyroidism and non-medullary thyroid can-cer. Eur J Surg 1996;162:685-9. 26. LiVolsi VA, LoGerfo P, Feind CR. Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed? Arch Surg 1978;113:285-6. 27. Lee JK, Obrzut SL, Yi ES, Deftos LJ, Bouvet M. Incidental finding of metastatic papillary thyroid carcinoma in a patient with primary hyperparathyroidism.Endocr. Pract. 2007;13:380-383. 28. Leitha T, Staundenherz A. Concomitant hyperparathyroidism and nonmedullary thyroid cancer, with a review of the litera-ture.Clin Nucl Med 2003;28:113-117.

Primer hiperparatiroidizmde klinik, tanı, lokalizasyon çalışması ve tedavi

Year 2018, Volume: 15 Issue: 2, 40 - 44, 14.08.2018

Abstract

Amaç: Primer hiperparatiroidizm, paratiroid bezlerinin parathormonun aşırı salgılanması sonucu hiperkalsemi ile karakterize bir endokrin hormon bozukluğu hastalığıdır. Ensık sebep paratiroid adenomudur. Küratif tedavisi cerrahidir. Bu çalışmada primer hiperparatiroidizm nedeniyle ameliyat edilen 47 hastanın sonuçlarını literatür eşliğinde sunmayı amaçladık.

Materyal ve Metod: Eylül 2009 - Aralık 2017 yılları arasında Erzurum Bölge Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde Primer hiperparatirodizm nedeniyle ameliyat edilen 47 hastanın arşiv dosyaları retrospektif olarak incelendi.

Bulgular: Hastaların 41’i kadın, 6’sı erkek olup yaş ortalaması 52,53 (21-76) idi. Hastalarda görülen en sık semptom 21 hasta ile kemik ve eklem ağrısı idi. En sık yandaş hastalık 5 hastada görülen ile hipertansiyon idi. Ameliyat öncesi ortalama PTH değerleri 381,8(116-1348) pg/ml, ortalama Ca değerleri 11,1 (9,7-14,2) mg/dl dir. Preoperatif tanı için 37 hastaya USG yapılmış 28 hastada doğru tanı konulmuş, 40 hastaya sintigrafi çekilmiş 34 hastaya doğru tanı konulmuş, 5 hastaya CT çekilmiş 2 hastaya doğru tanı konulmuştur. Postoperatif 12. saatte bakılan ortalama PTH değerleri 84,1(4-808,2) pg/ml, ortalama Ca değerleri 9,1(6,7-12,35) mg/dl iken postoperatif 36. Saatte bakılan PTH değerleri 83,27(4-435) pg/ml, Ca değerleri 8,8 (7,3-12,19) mg/dl idi. Histopatoloji olarak 45 hastada paratiroid adenomu 2 hastada ise paratiroid hiperplazi mevcuttu. Lokalizasyon olarak adenomların 23’ü sol alt, 5’i sol üst, 15’i sağ alt, 4’ü sağ üst tiroid lobu komşuluğunda idi. Hastaların 18’ inde ek yandaş tiroid hastalığı olduğu için eş zamanlı 13 hastaya total tiroidektomi, 5 hastaya da tek taraflı lobektomi yapıldı. Tiroidektomi sonrası histopatoloji değerlendirildiğinde 14 hastada adenomatöz ya da nodüler guatr, 3 hastada tiroid papiller karsinom, 1 hastada ise tiroid medüller karsinom görüldü. Komplikasyon olarak 3 hastada hipokalsemi gelişti.

Sonuç: Uzun dönem komplikasyonlarından korunmak için semptomatik primer paratiroidili hastaların tümü cerrahi olarak tedavi edilmelidir. Asemptomatik hiperparatiroidili hastalarda ise ileri dönemde komplikasyon gelişebileceği düşünülen riskli hastalar ameliyat edilmelidir. Ameliyat öncesi lokalizasyon için paratiroid sintigrafisi ve boyun ultrasonografisinin birlikte kullanılmasını önermekteyiz. Başarılı bir lokalizasyon çalışması ile minimal invaziv cerrahi girişimin faydalı olacağını değerlendirmekteyiz.

References

  • 1. Kebebew E & Clark O. Parathyroid adenoma, hyperplasia, and carcinoma: localization, technical details of primary neck exploration, and treatment of hypercalcemic crisis. Surgical Oncology Clinics of North America 1998; 7: 721. 2. Rahbari R, Holloway AK, He M, Khanafshar E, Clark OH & Kebebew E. Identification of differentially expressed mi-croRNA in parathyroid tumors. Annals of Surgical Oncology 2011;18:1158–1165. 3. Adami S, Marcocci C & Gatti D. Epidemiology of primary hyperparathyroidism in Europe. Journal of Bone and Mineral Research 2002 17 N18–N23. 4. Thakker R. Genetics of parathyroid tumours. Journal of In-ternal Medicine 2016;280: 574–583. 5. Melton LJ. Epidemiology of primary hyperparathyroidism Journal of Bone and Mineral Research 1991;6:25–30. 6. Robin P, Boushey MD, Thomas RJ, Todd MD. Middlemedias-tinal parathyroid: diagnosis and surgical approach. The An-nals of Thoracic Surgery 2001;71(2):699-701. 7. Horányi J, Szlávik R, Duffek L, et al. Surgery of primary hy-perparathyroidism. Orv Hetil 2006; 147:2347–2351. 8. Wermers RA, Khosla S, Atkinson EJ, etal. The rise and fall of primary hyperparathyrodism: A population based study in Rochester, Minnesota, 1965-1992. Ann Intern Med 1997; 126:433–440. 9. Aydın Y, Akbaba G, Berker D. Asemptomatik Birincil hiperparatiroidi hastalarına endokrinolojik yaklaşım. Düzce Tıp Fak Derg 2009; 11:43–46. 10. Solomon BL, Schaaf M, Smallridge RC. Psychologic symp-toms before and after parathyroid surgery Am J Med 1994; 96:101–106. 11. Silverberg SJ. Non-classical target organs in primary hy-perparathyroidism. J Bone Miner Res 2002; 17:117–125. 12. Dirican A, Yönder H, Karakaş S et al. Paratiroid adenom-larında klinik ve cerrahi deneyimimiz. Endokrinolojide Diyalog 2014, 11(1): 61-65 13. Pallan S, Rahman MO & Khan AA. Diagnosis and manage-ment of primary hyperparathyroidism. BMJ 2012; 344: e1013. 14. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh Q-Y, Doherty GM, Herrera MF, Pasieka JL & Perrier ND. The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JA-MA Surgery 2016;151:959–968. 15. Khan A, Hanley D, Rizzoli R, Bollerslev J, Young J, Rejnmark L, Thakker R, D’Amour P, Paul T & Van Uum S. Primary hy-perparathyroidism: review and recommendations on evalua-tion, diagnosis, and management. A Canadian and Interna-tional Consensus. Osteoporosis International 2017 28:1–19. 16. Norman J, Chedda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 1997;122:998. 17. Miccoli P, Bendinelli Ci, Vignali E, et al. Endoscopic parathy-roidectomy. Report of an initial experience. Surgery 1998;124:1077. 18. Potts JT Jr. Management of asymptomatic hyperparathyroid-ism: a report on the NIH consensus development confer-ence. Trends Endocrinol Metab 1992;10:376-380. 19. Palmer M, Adami HO, Bergstrom R, Jakobsson S, Akerström G, Ljunghall S. Survival and renal function in untreated hy-percalcemia. Population-based cohort study with 14 years of follow- up. Lancet 1987;1:59-62. 20. Lumachi F, Zucchetta P, Marzola MC, Boccagni P, Angelini F, Bui F, D'Amico DF, Favia G. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol. 2000:143:755-60. 21. Cakal E, Cakir E, Dilli A, Colak N, Unsal I, Aslan MS, Karbek B, Ozbek M, Kilic M, Delibasi T, Sahin M. Parathyroid ade-noma screening efficacies of different imaging tools and fac-tors affecting the success rates. Clin Imaging. 2012 ;36:688-94. 22. Hedback G, Tisell LE, Bengtsson BA, Hedman I, Oden A. Premature death in patients operated on for primary hy-perparathyroidism. Ann Chir Gynaecol 1985;74:66-73. 23. Udelsman R, Åkerström G, Biagini C, Duh Q-Y, Miccoli P, Niederle B & Tonelli F. The surgical management of asymp-tomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. Journal of Clinical Endocri-nology and Metabolism 2014 99 3595–3606. 24. Gul K, Ozdemir D, Korukluoglu B, et al. Preoperative and postoperative evaluation of thyroid disease in patients un-dergoing surgical treatment of primary hyperparathyroidism. Endocr Pract 2010;16:7-13. 25. Krause UC, Friedrich JH, Olbricht T, Metz K. Association of primary hyperparathyroidism and non-medullary thyroid can-cer. Eur J Surg 1996;162:685-9. 26. LiVolsi VA, LoGerfo P, Feind CR. Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed? Arch Surg 1978;113:285-6. 27. Lee JK, Obrzut SL, Yi ES, Deftos LJ, Bouvet M. Incidental finding of metastatic papillary thyroid carcinoma in a patient with primary hyperparathyroidism.Endocr. Pract. 2007;13:380-383. 28. Leitha T, Staundenherz A. Concomitant hyperparathyroidism and nonmedullary thyroid cancer, with a review of the litera-ture.Clin Nucl Med 2003;28:113-117.
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Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Ayetullah Temiz

Mustafa Suphi Turgut This is me

Publication Date August 14, 2018
Submission Date April 2, 2018
Acceptance Date July 13, 2018
Published in Issue Year 2018 Volume: 15 Issue: 2

Cite

Vancouver Temiz A, Turgut MS. Primer hiperparatiroidizmde klinik, tanı, lokalizasyon çalışması ve tedavi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2018;15(2):40-4.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty