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1.
J Surg Res ; 257: 15-21, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818780

RESUMO

BACKGROUND: The etiology of primary hyperparathyroidism (PHP) is single-gland adenoma in most patients. Imaging localization of single-gland disease allows for a focused operation. We sought to determine the accuracy of imaging for localizing a solitary parathyroid adenoma. METHODS: A single-institution retrospective review was performed of adult patients with PHP undergoing parathyroidectomy from January 2017 through December 2018. Surgeon-performed ultrasound (US), four-dimensional computed tomography (4DCT), and sestamibi were assessed for localization of a parathyroid adenoma yielding a single-gland parathyroidectomy. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each imaging modality. RESULTS: One hundred fifty-four patients underwent parathyroidectomy for PHP during the study period, with 100 patients meeting inclusion criteria with a mean age of 61.1 (SD 10) y and 80% women. Mean calcium was 11.1 mg/dL (SD 0.7) and mean PTH was 116 pg/mL (SD 66). All 100 patients had surgeon-performed US with 17 localized, 51 patients had 4DCT with 41 (80%) localized, and 69 patients had sestamibi with 53 (77%) localized. Eighty-two patients underwent successful unilateral parathyroidectomy, 18 required bilateral neck exploration. US was the most specific imaging modality at 94%. Accuracy of imaging localization was 32% for US, 70% for sestamibi, and 86% for 4DCT. CONCLUSIONS: Surgeon-performed US is a highly specific imaging modality for preoperative localization of solitary parathyroid adenoma in patients with PHP. 4DCT is the most accurate imaging localization study and should be considered for patients with a nonlocalized US.


Assuntos
Tomografia Computadorizada Quadridimensional , Hiperparatireoidismo Primário/diagnóstico por imagem , Paratireoidectomia/métodos , Idoso , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia
2.
Radiol Clin North Am ; 58(6): 1071-1083, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040849

RESUMO

Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. Surgery remains the first-line curative therapy in PHPT. Imaging plays a vital role in presurgical localization of parathyroid adenomas. Ultrasound provides a safe and quick imaging modality free of ionizing radiation, but is operator dependent. Sestamibi scan offers comparable sensitivity to ultrasound, improved with concurrent tomographic imaging. 4DCT remains a problem-solving technique in challenging cases and after failed neck exploration. We present an overview of various parathyroid imaging modalities, including protocols and findings, in addition to relevant pearls and pitfalls.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Imageamento Tridimensional , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Diagnóstico por Imagem/métodos , Feminino , Humanos , Hiperparatireoidismo Primário/etiologia , Masculino , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Prognóstico , Compostos Radiofarmacêuticos , Resultado do Tratamento , Ultrassonografia Doppler/métodos
3.
J Robot Surg ; 14(6): 821-827, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32661866

RESUMO

Minimal invasive techniques in endocrine surgery were lately adopted by surgical teams due to significant complications related to inadequate operative space and high risk of injuring crucial surrounding structures, such as vessels and nerves. Over the last years, technological improvements introduced robotic systems and approaches in endocrine surgery. Several case reports and series have described the safety and efficacy of these procedures such as robotic thyroidectomy and robotic parathyroidectomy. In the current review, we included 15 studies which described robotic-assisted parathyroidectomy for cervical parathyroid adenoma, in patients diagnosed with primary hyperparathyroidism or secondary hyperparathyroidism. No significant negative short-term outcomes were observed, in terms of postoperative complications, such as temporary or permanent injury of RLN, postoperative hypoparathyroidism and blood loss. The cosmetic result was, definitely, superior in comparison to conventional open parathyroidectomy. Despite the fact that RAP is an effective and curative method for patients with PHPT or secondary hyperparathyroidism, there are no available randomized clinical trials to establish this modern procedure as a gold-standard treatment strategy for these patients.


Assuntos
Adenoma/cirurgia , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Secundário/cirurgia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Masculino , Resultado do Tratamento
5.
Clin Nucl Med ; 45(8): e358-e359, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32558723

RESUMO

Ectopic parathyroid adenomas are a common cause of postsurgical persistent primary hyperparathyroidism. Our case highlights a patient with a negative bilateral 4-gland exploration with follow-up parathyroid 4-dimensional CT and Tc-MIBI SPECT/CT, yielding focal uptake in the right piriform sinus. Subsequent direct laryngoscopy revealed a mass in the piriform sinus, which was resected with surgical pathology yielding parathyroid adenoma.


Assuntos
Adenoma/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Neoplasias das Paratireoides/diagnóstico por imagem , Seio Piriforme/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Adenoma/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/cirurgia
6.
J Steroid Biochem Mol Biol ; 201: 105695, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32407867

RESUMO

In patients with primary hyperparathyroidism, the size of the adenoma is a major determinant of biochemical indices, disease severity, and manner of presentation. However, the large variation in adenoma weight, both within and between populations and a steady decline in parathyroid adenoma weights over time remain largely unexplained. Based on the results in a small number of patients almost two decades ago we proposed that vitamin D nutritional status of the patient explains both the disease manifestations and much of the variation in adenoma size. Accordingly, we examined the relationship between vitamin D nutrition, as assessed by serum levels of 25-hydroxyvitamin D, and parathyroid gland weight, the best available index of disease severity, in a large number of patients (n = 440) with primary hyperparathyroidism. A significant inverse relationship was found between serum 25-hydroxyvitamin D level and log adenoma weight (r = -0.361; p < 0.001). Also, the adenoma weight was significantly related directly to serum PTH, calcium, and alkaline phosphatase as dependent variables. In patients with vitamin D deficiency (defined as serum 25-hydroxyvitamin D levels 15 ng/mL or lower), gland weight, PTH, AP, and adjusted calcium were each significantly higher than in patients with 25-hydroxyvitamin D levels of 16 ng/mL or higher, but serum 1,25-dihydroxyvitamin D levels were similar in both groups. We interpret this to mean that suboptimal vitamin D nutrition stimulates parathyroid adenoma growth by a mechanism unrelated to 1,25-dihydroxyvitamin D deficiency. We conclude that variable vitamin D nutritional status in the population may partly explain the differences in disease presentation.


Assuntos
Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Deficiência de Vitamina D , Vitamina D/análogos & derivados , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/patologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Carga Tumoral , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/patologia , Deficiência de Vitamina D/cirurgia
7.
Medicine (Baltimore) ; 99(19): e19989, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384452

RESUMO

This study aimed to establish an optimal protocol for Tc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) Tc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for Tc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.


Assuntos
Hiperparatireoidismo , Hiperplasia , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides , Cintilografia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tecnécio Tc 99m Sestamibi/farmacologia , Feminino , Humanos , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/etiologia , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Cintilografia/métodos , Cintilografia/normas , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
9.
Cancer Treat Rev ; 86: 102012, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32247225

RESUMO

Parathyroid cancer (PC) is a rare malignant tumor which comprises 0.5-5% of patients with primary hyperparathyroidism (PHPT). Most of these cancers are sporadic, although it may also occur as a feature of various genetic syndromes including hyperparathyroidism-jaw tumor syndrome (HPT-JT) and multiple endocrine neoplasia (MEN) types 1 and 2A. Although PC is characterized by high levels of serum ionized calcium (Ca) and parathyroid hormone (PTH), the challenge to the clinician is to distinguish PC from the far more common entities of parathyroid adenoma (PA) or hyperplasia, as there are no specific clinical, biochemical, or radiological characteristic of PC. Complete surgical resection is the only known curative treatment for PC with the surgical approach during initial surgery strongly influencing the outcome. In order to avoid local recurrence, the lesion must be removed en-bloc with clear margins. PC has high recurrence rates of up to 50% but with favorable long-term survival rates (10-year overall survival of 60-70%) due to its slow-growing nature. Most patients die not from tumor burden directly but from uncontrolled severe hypercalcemia. In this article we have updated the information on PC by reviewing the literature over the past 10 years and summarizing the findings of the largest series published in this period.


Assuntos
Neoplasias das Paratireoides/genética , Neoplasias das Paratireoides/cirurgia , Humanos , Hiperparatireoidismo/genética , Hiperparatireoidismo/patologia , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/patologia , Neoplasias das Paratireoides/patologia
10.
Ann R Coll Surg Engl ; 102(6): e111-e114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233855

RESUMO

INTRODUCTION: Bilateral giant parathyroid adenoma in the absence of multiple endocrine neoplasia (MEN) type 1 is extremely rare and literature on this subject is limited. CASE HISTORY: A 79-year-old man presented with acute kidney injury secondary to hypercalcaemia. Blood test results indicated primary hyperparathyroidism. Ultrasonography revealed bilateral parathyroid adenomas measuring 19.4mm x 19.5mm x 18.8mm (left) and 15.2mm x 18.3mm x 19.6mm (left) whereas on computed tomography, the measurements were 31mm x 20mm (left) and 30mm x 14mm (right). Intraoperatively, giant adenomas measuring 50mm x 25mm x 12mm (left, weighing 8.101g) and 48mm x 22mm x 10mm (right, weighing 7.339g) were identified and excised. Parathyroid hormone level dropped from 44.6pmol/l preoperatively to 8.9pmol/l postoperatively (normal range 1.3-7.6pmol/l). The patient was discharged with no complications. CONCLUSIONS: We report a rare phenomenon where bilateral giant parathyroid adenoma occurred in the absence of MEN type 1. It highlights the importance of cross-sectional imaging in delineating the anatomy of adenomas as their size can be grossly underestimated by ultrasonography alone.


Assuntos
Adenoma/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/diagnóstico , Paratireoidectomia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Adenoma/complicações , Adenoma/patologia , Adenoma/cirurgia , Idoso , Cálcio/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Ultrassonografia
11.
BMJ Case Rep ; 13(3)2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32161082

RESUMO

Cystic parathyroid adenomas are one of the rare causes of neck masses. Due to its rarity, it causes misdiagnosis and wrong treatments and has undesirable consequences. The measurement of parathyroid hormone in fine-needle aspiration washout fluid is a minimally invasive, safe method for the diagnosis of parathyroid cysts and seems to be more useful than Tc-99m sestamibi (MIBI) parathyroid single photon emission computed tomography (SPECT)/CT.


Assuntos
Adenoma/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Biópsia por Agulha Fina/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia
13.
BMJ Case Rep ; 13(2)2020 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-32066577

RESUMO

Hyperparathyroidism is a rare disease during pregnancy, which has increased risks, including miscarriage and fetal growth restriction. However, the diagnosis of hyperparathyroidism is frequently not recognised or delayed as symptoms are non-specific and calcium is not routinely measured. With a thorough medical history and clinical suspicion, early diagnosis and treatment can reduce the risk of some pregnancy complications. A 35-year-old woman presented at 13/40 with hyperemesis gravidarum. She had elevated serum calcium and a parathyroid lesion on ultrasound. She underwent a parathyroidectomy with rapid normalisation of her calcium. Histopathology confirmed a parafibromin-deficient parathyroid tumour, suggestive of hyperparathyroidism jaw tumour syndrome. At 30/40, she presented with pre-eclampsia (hypertension, hyper-reflexia, proteinuria and intrauterine growth restriction) and had a caesarean section at 30+1/40, delivering a male infant, 897 g (fifth percentile). She had a prior 12-month history of chronic constipation and nephrolithiasis but was not investigated further despite elevated calcium (2.82 mmol/L).


Assuntos
Cálcio/sangue , Hiperparatireoidismo Primário/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Hiperêmese Gravídica , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Gravidez , Resultado da Gravidez
14.
World Neurosurg ; 137: 384-388, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32105877

RESUMO

BACKGROUND: Brown tumors (BTs) represent the typical nonmalignant lesions of hyperparathyroidism. Mandibles, ribs, and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiologic assessments. Their treatment is essentially based on parathyroidectomy. CASE DESCRIPTION: The present case report describes a patient with primary hyperparathyroidism who developed a cervical BT revealed by slow spinal compression. CONCLUSIONS: The brown tumor, when localized at the level of the spine, can be life-threatening and must be managed as soon as possible.


Assuntos
Adenoma/complicações , Vértebras Cervicais , Hiperparatireoidismo Primário/complicações , Osteíte Fibrosa Cística/complicações , Neoplasias das Paratireoides/complicações , Compressão da Medula Espinal/etiologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Imagem por Ressonância Magnética , Osteíte Fibrosa Cística/diagnóstico por imagem , Osteíte Fibrosa Cística/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Radiografia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Ultrassonografia
16.
Ann R Coll Surg Engl ; 102(4): 294-299, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918555

RESUMO

INTRODUCTION: Accurate localisation of the abnormal hyperfunctioning gland with preoperative imaging has a critical role in parathyroid surgery to obtain a successful outcome. This study aimed to evaluate the diagnostic performance of second-line imaging and their contribution to the treatment success in primary hyperparathyroidism when the first-line methods were negative or discordant. METHODS: Among the patients who underwent parathyroidectomy due to primary hyperparathyroidism, 33 who underwent four-dimensional computed tomography and/or four-dimensional magnetic resonance imaging because of negative or discordant first-line imaging results were included. Persistent and recurrent cases were excluded. RESULTS: The majority of the patients were female (84.8%) and the mean age was 59.2 years. Seventeen patients had four-dimensional computed tomography and 25 had four-dimensional magnetic resonance imaging, respectively. Four-dimensional computed tomography and four-dimensional magnetic resonance imaging localised the culprit gland successfully in 52.9% and 84%, respectively. Twenty-five patients in whom single adenoma was detected underwent focused parathyroidectomy. The culprit gland was solitary in 32 cases and one patient had double adenoma. Normocalcaemia was achieved in all cases. Among the 29 patients who completed their postoperative sixth month success rate was 100%. CONCLUSION: Four-dimensional magnetic resonance imaging had high accuracy with fast dynamic imaging in detecting parathyroid adenomas. When the first-line imaging methods were negative or inconclusive, four-dimensional magnetic resonance imaging should be considered primarily since it is cost effective in Turkey and emits no radiation.


Assuntos
Tomografia Computadorizada Quadridimensional , Hiperparatireoidismo Primário/cirurgia , Imagem por Ressonância Magnética/métodos , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Imagem por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Valor Preditivo dos Testes , Cintilografia/economia , Sensibilidade e Especificidade , Turquia , Ultrassonografia/economia
17.
Endocr J ; 67(2): 161-165, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-31685721

RESUMO

Ectopic parathyroid adenomas (PAs) can occur in numerous locations and are thought to be the cause of a significant portion of failed primary surgery for hyperparathyroidism. PA is a rare cause of hoarseness, which may be harbingers of a malignant process. Here, we describe an unusual case of an ectopic PA in the carotid sheath presenting as unilateral vocal cord paralysis (VCP). A 49-year-old lady presented with a 1-week history of hoarseness, irritating cough and shortness of breath. Fibreoptic laryngoscopy revealed left VCP. Ultrasound and computed tomography of the neck demonstrated a mass in the carotid sheath. Laboratory investigations revealed hypercalcemia (3.10 mmol/L), hypophosphatemia (0.81 mmol/L) and elevated intact parathyroid hormone (iPTH) level (381.6 pg/mL), despite of a negative 99mTc-sestamibi scan. After more rigorous tests, the ectopic tumor adjacent to the left vagus nerve was successfully resected, with subsequent histopathological confirmation of PA. The patient eventually got a normal iPTH level and serum calcium postoperatively, and regular voice function was also regained 4 months after surgery. This case emphasizes the importance of broad differential diagnosis and thorough workup. Although most patients with PA present with hypercalcemia, this disease entity also need to be considered in the differentials of neck masses and VCP.


Assuntos
Adenoma/complicações , Coristoma/complicações , Síndromes de Compressão Nervosa/etiologia , Glândulas Paratireoides , Neoplasias das Paratireoides/complicações , Doenças do Nervo Vago/etiologia , Paralisia das Pregas Vocais/etiologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Tosse/etiologia , Dispneia/etiologia , Feminino , Rouquidão/etiologia , Humanos , Hipercalcemia/etiologia , Hipercalcemia/metabolismo , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/metabolismo , Hiperparatireoidismo Primário/cirurgia , Hipofosfatemia/etiologia , Hipofosfatemia/metabolismo , Laringoscopia , Pessoa de Meia-Idade , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia , Paralisia das Pregas Vocais/diagnóstico
18.
Clin Radiol ; 75(3): 179-184, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31767140

RESUMO

AIM: To identify the differences between ultrasound (US) features of parathyroid carcinoma (PC) and benign parathyroid (BP) lesions in patients with primary hyperparathyroidism (PHPT). MATERIAL AND METHODS: Twenty-one patients with PC and 64 consecutive patients with BP, whose diagnoses were confirmed at surgery, were enrolled from January 2013 to December 2018. The US features, demographic, clinical, and biochemical characteristics of the two groups were compared retrospectively. RESULTS: There are no significant differences between the patients with PC and BP regarding mean age or mean ionized calcium levels but differences were seen in sex distribution and mean parathyroid hormone (PTH) levels. On US imaging, PC significantly exhibited higher incidences of larger size and higher depth/width (D/W) ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, intra-nodular calcifications, indistinct border, cystic change, and the presence of suspicious lymph nodes compared to BP lesions. CONCLUSION: Preoperative ultrasonography is helpful to differentiate PC and BP. Patients with PC are differentiated from BP by their sex distribution, mean PTH levels, and major US characteristics: larger size, higher D/W ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, indistinct border, intra-nodular calcifications, cystic change, and the presence of suspicious lymph nodes.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Carcinoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Paratireoides/diagnóstico por imagem , Doenças das Paratireoides/cirurgia , Neoplasias das Paratireoides/cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos
19.
Intern Med ; 59(3): 389-394, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588082

RESUMO

A 77-year-old man with a history of hypertension, prostate hyperplasia, and urolithiasis was admitted for acute kidney injury caused by hypercalcemia. Neck ultrasonography showed a large cyst adjacent to the right lower thyroid lobe. Although a 99mtechnetium sestamibi scan was negative, an extremely high intracystic intact parathyroid hormone level suggested that the cyst had a parathyroid origin and that a functional parathyroid cyst was present. Immunohistochemical staining for the calcium-sensing receptor (CaSR) after right lower parathyroidectomy revealed CaSR-positive cells lining the cyst, indicating that the functional parathyroid cyst had originated from the hemorrhagic degeneration of a parathyroid adenoma.


Assuntos
Adenoma/fisiopatologia , Cinacalcete/uso terapêutico , Hipercalcemia/complicações , Hiperparatireoidismo/tratamento farmacológico , Glândulas Paratireoides/fisiopatologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/fisiopatologia , Adenoma/etiologia , Adenoma/cirurgia , Idoso , Calcimiméticos/uso terapêutico , Cistos/fisiopatologia , Cistos/cirurgia , Humanos , Masculino , Neoplasias das Paratireoides/etiologia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Resultado do Tratamento
20.
J Surg Res ; 246: 335-341, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635835

RESUMO

BACKGROUND: Persistent/recurrent hyperparathyroidism occurs in 2%-5% of patients with sporadic primary hyperparathyroidism (PHPT). In this study, the incidence and time to recurrence in patients with single-gland disease (SGD), double adenomas (DAs), or four-gland hyperplasia (FGH) at initial parathyroidectomy were compared. METHODS: This retrospective review included adult patients with sporadic PHPT who underwent initial parathyroidectomy with intraoperative parathyroid hormone monitoring (IOPTH) from 1/2000 to 12/2016 with ≥6 mo follow-up. An abnormal parathyroid was defined by a gland weight of ≥50 mg. A concurrent serum calcium >10.2 mg/dL and parathyroid hormone >40 pg/mL was defined as persistent PHPT if present <6 mo and recurrent PHPT if present ≥6 mo postoperatively after initial normocalcemia. RESULTS: Of 1486 patients, 1203 (81%) had SGD, 159 (11%) DA, and 124 (8%) FGH. Among the 3 groups, there was no difference in the percent decrease from the baseline or time of excision to final postexcision IOPTH levels between groups (79% versus 80% versus 80%, respectively; P = 0.954) or in the proportion of patients with a final IOPTH ≥40 (22% versus 18% versus 14%; P = 0.059). Overall, 22 (1.5%) had persistent PHPT and 26 (1.7%) had recurrent PHPT. Persistent PHPT was more frequent with DAs (6; 3.8%) than other groups (SGD: 16, 1.3%; FGH: 0; P = 0.02). At median follow-up of 33 mo (IQR, 18-60), there was no difference in recurrence rate (1.6% versus 2.5% versus 2.4%; P = 0.57) or median time (mo) to recurrence (SGD: 59 [IQR, 21-86], DAs: 36 [IQR, 29-58], FGH: 23 [IQR, 17-40]; P = 0.46). CONCLUSIONS: Recurrent PHPT occurred in 1.7% of patients who underwent curative initial parathyroidectomy, with no difference in incidence or time to recurrence between groups based on the number of glands removed. Patients with DA more commonly had persistent PHPT, raising the possibility of unrecognized FGH.


Assuntos
Adenoma/epidemiologia , Hiperparatireoidismo Primário/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/epidemiologia , Adenoma/complicações , Adenoma/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Hiperplasia/complicações , Hiperplasia/cirurgia , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/cirurgia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
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