Experience of Diagnosis and Treatment of 136 Patients with Primary Hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHUXin-xin , WEITao , GONGRi-xiang , LIZhi-hui , HUANGQiu-shi , ZOUXiu-he , WANGXun-li , DUZhen-hong , SUNYing-he , LIUFeng , WENLe-bin ,  ZHUJing-qiang

Department of Thyroid and Breast Surgy, West China Hosptial, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

ZHUJing-qiang, Email: zjq-wkys@163.com

Keywords：

Primary hyperparathyroidism; Parathyroid adenoma; Parathyroid carcinoma; Surgical treatment

DOI：

10.7507/1007-9424.20140110

Video：

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Objective To analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroidism (PHPT). Methods A retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital. Results The 136 cases were composed of 52 cases (38.23%) bone types, 17 cases (12.50%) nephrocalcinosis, 7 cases (5.15%) skeletal and renal involvements, 24 cases (17.65%) asymptomatic primary hyperparathyroidism, and 36 cases (26.47%) combined with other clinical symptoms. The preoperative parathyroid hormone (PTH) levels were (106.20±88.88) pmol/L (6.91-390 pmol/L) and serum calcium were (3.12±0.66) mmol/L (2.15-5.77 mmol/L). The coincidence rate between the examinations preoperation and pathology:B type ultrasound was 75.00%, ⁹⁹Tc^m-MIBI scan was 85.29%, ultrasound and ⁹⁹Tc^m-MIBI combined with computerized tomography (CT) scan was 86.76%. Pathology presentation:129 patients (94.85%) were benign lesions, 7 cases (5.15%) were parathyroid carcinoma. Of the 129 patients, 114 cases (95.80%) were single parathyroid adenoma, 5 cases (4.20%) were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases (7.75%) were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases (91.18%). One hundred and twenty-four cases (91.18%) were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients (8.82%) were lost to follow-up, 2 patients (1.47%) with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients (2.20%) with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery. Conclusion Surgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.

Citation： ZHUXin-xin, WEITao, GONGRi-xiang, LIZhi-hui, HUANGQiu-shi, ZOUXiu-he, WANGXun-li, DUZhen-hong, SUNYing-he, LIUFeng, WENLe-bin, ZHUJing-qiang. Experience of Diagnosis and Treatment of 136 Patients with Primary Hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(4): 452-457. doi: 10.7507/1007-9424.20140110 Copy

1.	Khan A, Bilezikian J. Primary hyperparathyroidism:pathophysiology and impact on bone[J]. CMAJ, 2000, 163(2):184-187.
2.	Turken SA, Cafferty M, Silverberg SJ, et al. Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism[J]. Am J Med, 1989, 87(5):553-557.
3.	Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years[J]. J Clin Endocrinol Metab, 2008, 93(9):3462-3470.
4.	Bilezikian JP, Khan AA, Potts JT Jr, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism:summary statement from the third international workshop[J]. J Clin Endocrinol Metab, 2009, 94(2):335-339.
5.	邢小平, 孔晶, 王鸥.高钙危象的诊治[J].临床内科杂志, 2012, 29(9):590-592.
6.	Calò PG, Pisano G, Tatti A, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism:is it really mandatory?[J]. Minerva Chir, 2012, 67(4):337-342.
7.	邓先兆, 伍波, 樊友本, 等.原发性甲状旁腺功能亢进的多学科联合诊治120例[J].上海医学, 2012, 35(11):931-934.
8.	苏磊, 王雪晨, 桑剑锋, 等.原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J].中国普外基础与临床杂志, 2010, 17(12):1290-1293.
9.	贺晓燕, 韩晴, 宁光, 等. 160例原发性甲状旁腺功能亢进症患者临床资料初步分析[J].诊断学理论与实践, 2007, 6(3):243-247.
10.	Kassahun WT, Jonas S. Focus on parathyroid carcinoma[J]. Int J Surg, 2011, 9(1):13-19.
11.	Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States[J]. Cancer, 2007, 109(9):1736-1741.
12.	Haghighi P, Astariata R, Wepsic T, et al. Concurrent primary parathyroid hyperplasia and parathyroid carcinoma[J]. Arch Pathol Lab Med, 1983, 107(7):349-350.
13.	Boyle NH, Ogg CS, Hartley RB, et al. Parathyroid carcinoma secondary to prolonged hyperplasia in chronic renal failure and in coeliac disease[J]. Eur J SurgOncol, 1999, 25(1):100-103.
14.	Schoretsanitis G, Daskalakis M, Melissas J, et al. Parathyroid carcinoma:clinical presentation and management[J]. Am J Otolaryngol, 2009, 30(4):277-280.
15.	Abdelgadir Adam M, Untch BR, Olson JA Jr. Parathyroid carcin-oma:current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics[J]. Oncologist, 2010, 15(1):61-72.
16.	Marcocci C, Cetani F, Rubin MR, et al. Parathyroid carcinoma[J]. Bone Miner Res, 2008, 23(12):1869-1880.
17.	Uruno T, Kebebew E. How to localize parathyroid tumors in primary thyperparathyroidism?[J]. Endocrinol Invest, 2006, 29(9):840-847.
18.	Hara H, Igarashi A, Yano Y, et al. Ultrasonographic features of parathyroid carcinoma[J]. Endocr J, 2001, 48(2):213-217.
19.	Koea JB, Shaw JH. Parathyroid cancer:biology and management[J]. Surg Oncol, 1999, 8(3):155-165.
20.	Zerizer I, Parsaï A, Win Z, et al. Anatomical and functional localization of ectopic parathyroid adenomas:6-year institutional experience[J]. Nucl Med Commun, 2011, 32(6):496-502.
21.	Hojaij F, Vanderlei F, Plopper C, et al. Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters:a cadaveric study[J]. Anat Sci Int, 2011, 86(4):204-212.
22.	Bahar G, Feinmesser R, Joshua BZ. et al. Hyperfunctioning intrathyroid parathyroidgland:a potential cause of failure in parath-yroidectomy[J]. Surgery, 2006, 139(6):821-826.
23.	Goodman A, Politz D, Lopez J, et al. Intrathyroid parathyroid adenoma:incidence and location-the case against thyroid lobec tomy[J]. Otolaryngol Head Neck Surg, 2011, 144(6):867-871.
24.	Abboud B, Sleilaty G, Ayoub S, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism:can it be predicted preo-peratively[J]. World J Surg, 2007, 31(4):817-823.
25.	Haggi M, Guennadi K, David F, et al. Intrathyroidal parathyroid glands:Small, but mighty (a Napoleonphenomenon)[J]. Surgery, 2012, 152(6):1193-200.
26.	Mazzaglia PJ, Milas M, Berber E, et al. Normalization of 2-week postoperative parathyroid hormone values in patients with primary hyperparathyroidism:four-gland exploration compared to focused-approach surgery[J]. World J Surg, 2010, 34(6):1318-1324.
27.	Stewart ZA, Blackford A, Somervell H, et al. 25-Hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypoc-alcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy[J]. Surgery, 2005, 138(6):1018-1026.
28.	Yen TW, Wilson SD, Krzywda EA, et al. The role of parathyroid hormone measurements after surgery for primary hyperparathyroi-dism[J]. Surgery, 2006, 140(4):665-674.
29.	Beyer TD, Solorzano CC, Prinz RA, et al. Oral vitamin D supp-lementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism[J]. Surgery, 2007, 141(6):777-783.
30.	Robert JH, Trombetti A, Garcia A, et al. Primary hyperparathyroidism:can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature[J]. Ann Surg Oncol, 2005, 12(7):526-532.
31.	朱精强, 刘嘉林, 李霞, 等.原发性甲状旁腺功能亢进症的诊断与治疗(附11例报告)[J].中国普外基础与临床杂志, 1998, 5(5):277-279.
32.	Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone synd-rome:still a challenge in the postoperative management of primary hyperparathyroidism:a systematic review of the literature[J]. Eur J Endocrinol, 2013, 168(3):R45-R53.
33.	Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years[J]. Clin Endocrinol Metab, 2008, 93(9):3462-3470.

1. Khan A, Bilezikian J. Primary hyperparathyroidism:pathophysiology and impact on bone[J]. CMAJ, 2000, 163(2):184-187.
2. Turken SA, Cafferty M, Silverberg SJ, et al. Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism[J]. Am J Med, 1989, 87(5):553-557.
3. Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years[J]. J Clin Endocrinol Metab, 2008, 93(9):3462-3470.
4. Bilezikian JP, Khan AA, Potts JT Jr, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism:summary statement from the third international workshop[J]. J Clin Endocrinol Metab, 2009, 94(2):335-339.
5. 邢小平, 孔晶, 王鸥.高钙危象的诊治[J].临床内科杂志, 2012, 29(9):590-592.
6. Calò PG, Pisano G, Tatti A, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism:is it really mandatory?[J]. Minerva Chir, 2012, 67(4):337-342.
7. 邓先兆, 伍波, 樊友本, 等.原发性甲状旁腺功能亢进的多学科联合诊治120例[J].上海医学, 2012, 35(11):931-934.
8. 苏磊, 王雪晨, 桑剑锋, 等.原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J].中国普外基础与临床杂志, 2010, 17(12):1290-1293.
9. 贺晓燕, 韩晴, 宁光, 等. 160例原发性甲状旁腺功能亢进症患者临床资料初步分析[J].诊断学理论与实践, 2007, 6(3):243-247.
10. Kassahun WT, Jonas S. Focus on parathyroid carcinoma[J]. Int J Surg, 2011, 9(1):13-19.
11. Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States[J]. Cancer, 2007, 109(9):1736-1741.
12. Haghighi P, Astariata R, Wepsic T, et al. Concurrent primary parathyroid hyperplasia and parathyroid carcinoma[J]. Arch Pathol Lab Med, 1983, 107(7):349-350.
13. Boyle NH, Ogg CS, Hartley RB, et al. Parathyroid carcinoma secondary to prolonged hyperplasia in chronic renal failure and in coeliac disease[J]. Eur J SurgOncol, 1999, 25(1):100-103.
14. Schoretsanitis G, Daskalakis M, Melissas J, et al. Parathyroid carcinoma:clinical presentation and management[J]. Am J Otolaryngol, 2009, 30(4):277-280.
15. Abdelgadir Adam M, Untch BR, Olson JA Jr. Parathyroid carcin-oma:current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics[J]. Oncologist, 2010, 15(1):61-72.
16. Marcocci C, Cetani F, Rubin MR, et al. Parathyroid carcinoma[J]. Bone Miner Res, 2008, 23(12):1869-1880.
17. Uruno T, Kebebew E. How to localize parathyroid tumors in primary thyperparathyroidism?[J]. Endocrinol Invest, 2006, 29(9):840-847.
18. Hara H, Igarashi A, Yano Y, et al. Ultrasonographic features of parathyroid carcinoma[J]. Endocr J, 2001, 48(2):213-217.
19. Koea JB, Shaw JH. Parathyroid cancer:biology and management[J]. Surg Oncol, 1999, 8(3):155-165.
20. Zerizer I, Parsaï A, Win Z, et al. Anatomical and functional localization of ectopic parathyroid adenomas:6-year institutional experience[J]. Nucl Med Commun, 2011, 32(6):496-502.
21. Hojaij F, Vanderlei F, Plopper C, et al. Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters:a cadaveric study[J]. Anat Sci Int, 2011, 86(4):204-212.
22. Bahar G, Feinmesser R, Joshua BZ. et al. Hyperfunctioning intrathyroid parathyroidgland:a potential cause of failure in parath-yroidectomy[J]. Surgery, 2006, 139(6):821-826.
23. Goodman A, Politz D, Lopez J, et al. Intrathyroid parathyroid adenoma:incidence and location-the case against thyroid lobec tomy[J]. Otolaryngol Head Neck Surg, 2011, 144(6):867-871.
24. Abboud B, Sleilaty G, Ayoub S, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism:can it be predicted preo-peratively[J]. World J Surg, 2007, 31(4):817-823.
25. Haggi M, Guennadi K, David F, et al. Intrathyroidal parathyroid glands:Small, but mighty (a Napoleonphenomenon)[J]. Surgery, 2012, 152(6):1193-200.
26. Mazzaglia PJ, Milas M, Berber E, et al. Normalization of 2-week postoperative parathyroid hormone values in patients with primary hyperparathyroidism:four-gland exploration compared to focused-approach surgery[J]. World J Surg, 2010, 34(6):1318-1324.
27. Stewart ZA, Blackford A, Somervell H, et al. 25-Hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypoc-alcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy[J]. Surgery, 2005, 138(6):1018-1026.
28. Yen TW, Wilson SD, Krzywda EA, et al. The role of parathyroid hormone measurements after surgery for primary hyperparathyroi-dism[J]. Surgery, 2006, 140(4):665-674.
29. Beyer TD, Solorzano CC, Prinz RA, et al. Oral vitamin D supp-lementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism[J]. Surgery, 2007, 141(6):777-783.
30. Robert JH, Trombetti A, Garcia A, et al. Primary hyperparathyroidism:can parathyroid carcinoma be anticipated on clinical and biochemical grounds? Report of nine cases and review of the literature[J]. Ann Surg Oncol, 2005, 12(7):526-532.
31. 朱精强, 刘嘉林, 李霞, 等.原发性甲状旁腺功能亢进症的诊断与治疗(附11例报告)[J].中国普外基础与临床杂志, 1998, 5(5):277-279.
32. Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone synd-rome:still a challenge in the postoperative management of primary hyperparathyroidism:a systematic review of the literature[J]. Eur J Endocrinol, 2013, 168(3):R45-R53.
33. Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years[J]. Clin Endocrinol Metab, 2008, 93(9):3462-3470.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of Diagnosis and Treatment of 136 Patients with Primary Hyperparathyroidism

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