Preoperative Thoracic Muscle Mass Predicts Bone Density Change After Parathyroidectomy in Primary Hyperparathyroidism.

CONTEXT: Predicting bone mineral density (BMD) gain after parathyroidectomy may influence individualized therapeutic approaches for treating patients with primary hyperparathyroidism (PHPT). OBJECTIVE: This study aimed to assess whether skeletal muscle mass data could predict BMD change after parathyroidectomy in patients with PHPT. METHODS: This retrospective study collected data from 2012 to 2021 at Severance Hospital, Seoul, Korea. A total of 130 patients (mean age, 64.7 years; 81.5% women) with PHPT who underwent parathyroidectomy were analyzed. Thoracic muscle volume (T6-T7 level) was estimated using noncontrast parathyroid single photon emission computed tomography/computed tomography (SPECT/CT) scans and an automated deep-learning-based software. The primary outcome assessed was the change in femoral neck BMD (FNBMD, %) 1 year after parathyroidectomy. RESULTS: The median degree of FNBMD change after parathyroidectomy was + 2.7% (interquartile range: -0.9 to + 7.6%). Elevated preoperative PTH level was associated with lower thoracic muscle mass (adjusted ß: -8.51 cm3 per one log-unit PTH increment, P = .045) after adjusting for age, sex, body mass index (BMI), and baseline FNBMD. One SD decrement in thoracic muscle mass was associated with lesser FNBMD (adjusted ß: -2.35%, P = .034) gain and lumbar spine BMD gain (adjusted ß: -2.51%, P = .044) post surgery after adjusting for covariates. CONCLUSION: Lower thoracic skeletal muscle mass was associated with elevated preoperative PTH levels in patients with PHPT. Lower skeletal muscle mass was associated with lesser BMD gain after parathyroidectomy, independent of age, sex, BMI, preoperative BMD, and PTH level.

Circulating miR-122-5p and miR-375 as Potential Biomarkers for Bone Mass Recovery after Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Proof-of-Concept Study.

Primary hyperparathyroidism (PHPT) is the leading cause of secondary osteoporosis. Although bone mineral density (BMD) tends to recover after parathyroidectomy in PHPT patients, the degree of recovery varies. Circulating microRNAs (miRNAs) profiles are known to be correlated with osteoporosis and fracture. We aimed to investigate whether osteoporotic fracture-related miRNAs are associated with postoperative BMD recovery in PHPT. Here, 16 previously identified osteoporotic fracture-related miRNAs were selected. We analyzed the association between the preoperative level of each miRNA and total hip (TH) BMD change. All 12 patients (among the 18 patients enrolled) were cured of PHPT after parathyroidectomy as parathyroid hormone (PTH) and calcium levels were restored to the normal range. Preoperative miR-19b-3p, miR-122-5p, and miR-375 showed a negative association with the percent changes in TH BMD from baseline. The association remained robust for miR-122-5p and miR-375 even after adjusting for sex, age, PTH, and procollagen type 1 N-terminal propeptide levels in a multivariable model. In conclusion, preoperative circulating miR-122-5p and miR-375 levels were negatively associated with TH BMD changes after parathyroidectomy in PHPT patients. miRNAs have the potential to serve as predictive biomarkers of treatment response in PHPT patients, which merits further investigation.

Robot-assisted posterior retroperitoneoscopic adrenalectomy: single port access.

Laparoscopic adrenalectomy has become a gold standard in adrenal gland surgery. More recently, some minimally invasive trials have been conducted on single access surgery on the adrenal gland. In this study, we introduce our first experiences of robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access and the da Vinci system.