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1.
Langenbecks Arch Surg ; 408(1): 71, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36720758

RESUMO

PURPOSE: This study is aimed at investigating the role of preoperative procollagen type 1 N-terminal peptide (P1NP) and collagen type 1 C-telopeptide (CTx) levels in predicting the development of postoperative hypocalcemia in primary hyperparathyroidism (PHPT). METHODS: In this prospective observational study, preoperative complaints of patients with primary hyperparathyroidism and their urea, creatinine, glomerular filtration rate (GFR), calcium, albumin, urinary calcium, parathyroid hormone, and bone mineral density (BMD) were recorded. P1NP and CTx levels were analyzed in blood samples taken the day before surgery, and their relationship with calcium levels obtained on the first postoperative day was examined. RESULTS: The median age was 53 years for patients who developed hypocalcemia and 62 years for those who did not develop hypocalcemia (p = 0.01). The urea, creatinine, and GFR values were determined as 22 mcg/dl, 0.61 mcg/dl, and 105 ml/min, respectively, for the hypocalcemia group (Group 1) and 30.5 mcg/dl, 0.74 mcg/dl, and 90 ml/min, respectively, for the non-hypocalcemia group (Group 2) (p = 0.02, 0.001, and 0.01, respectively). The BMD femur Z-score was - 0.1 in Group 1 and 0.8 in the Group 2 (p = 0.02). The mean CTx values were 4.14 pg/dl and 1.98 pg/dl (p = 0.036), and the mean P1NP values were 252.84 mcg/dl and 269.04 mcg/dl (p = 0.427) for Groups 1 and 2, respectively. According to multivariate analysis, only CTx was a significant independent predictor of hypocalcemia (odds ratio 1.739). CONCLUSION: CTx level is a significant factor in predicting the risk of developing early postoperative hypocalcemia in patients scheduled for surgery due to primary hyperparathyroidism.


Assuntos
Hiperparatireoidismo Primário , Hipocalcemia , Humanos , Pessoa de Meia-Idade , Cálcio , Paratireoidectomia , Creatinina , Hiperparatireoidismo Primário/cirurgia , Pró-Colágeno , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Colágeno Tipo I
2.
Surg Oncol Clin N Am ; 32(1): 199-220, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36410918

RESUMO

Recent changes in the landscape of endocrine surgery include a shift from total thyroidectomy for almost all patients with papillary thyroid cancer to the incorporation of thyroid lobectomy for well-selected patients with low-risk disease; minimally invasive parathyroidectomy with, and potentially without, intraoperative parathyroid hormone monitoring for patients with well-localized primary hyperparathyroidism; improvement in the management of parathyroid cancer with the incorporation of immune checkpoint blockade and/or targeted therapies; and the incorporation of minimally invasive techniques in the management of patients with benign tumors and selected secondary malignancies of the adrenal gland.


Assuntos
Sistema Endócrino , Hormônio Paratireóideo , Paratireoidectomia , Humanos , Monitorização Intraoperatória/métodos , Paratireoidectomia/métodos
3.
Surgery ; 173(1): 132-137, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36511281

RESUMO

BACKGROUND: The usefulness of incorporating near-infrared autofluorescence into the surgical workflow of endocrine surgeons is unclear. Our aim was to develop a prospective registry and gather expert opinion on appropriate use of this technology. METHODS: This was a prospective multicenter collaborative study of patients undergoing thyroidectomy and parathyroidectomy at 7 academic centers. A questionnaire was disseminated among 24 participating surgeons. RESULTS: Overall, 827 thyroidectomy and parathyroidectomy procedures were entered into registry: 42% of surgeons found near-infrared autofluorescence useful in identifying parathyroid glands before they became apparent; 67% correlated near-infrared autofluorescence pattern to normal and abnormal glands; 38% of surgeons used near-infrared autofluorescence, rather than frozen section, to confirm parathyroid tissue; and 87% and 78% of surgeons reported near-infrared autofluorescence did not improve the success rate after parathyroidectomy or the ability to find ectopic glands, respectively. During thyroidectomy, 66% of surgeons routinely used near-infrared autofluorescence to rule out inadvertent parathyroidectomy. However, only 36% and 45% felt near-infrared autofluorescence decreased inadvertent parathyroidectomy rates and improved ability to preserve parathyroid glands during central neck dissections, respectively. CONCLUSION: This survey study identified areas of greatest potential use for near-infrared autofluorescence, which can form the basis of future objective trials to document the usefulness of this technology.


Assuntos
Glândulas Paratireoides , Glândula Tireoide , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Imagem Óptica/métodos , Paratireoidectomia/métodos , Tireoidectomia/métodos
4.
Ann Surg Oncol ; 30(2): 973-993, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36481865

RESUMO

BACKGROUND: Accurate parathyroid gland (PG) identification is a critical yet challenging component of cervical endocrine procedures. PGs possess strong near-infrared autofluorescence (NIRAF) compared with other tissues in the neck. This property has been harnessed by image- and probe-based near-infrared fluorescence detection systems, which have gained increasing popularity in clinical use for their ability to accurately aid in PG identification in a rapid, noninvasive, and cost-effective manner. All NIRAF technologies, however, cannot differentiate viable from devascularized PGs without the use of contrast enhancement. Here, we aim to provide an overview of the rapid evolution of these technologies and update the surgery community on the most recent advancements in the field. METHODS: A PubMed literature review was performed using the key terms "parathyroid," "near-infrared," and "fluorescence." Recommendations regarding the use of these technologies in clinical practice were developed on the basis of the reviewed literature and in conjunction with expert surgeons' opinions. RESULTS: The use of near-infrared fluorescence detection can be broadly categorized as (1) using parathyroid NIRAF to identify both healthy and diseased PGs, and (2) using contrast-enhanced (i.e., indocyanine green) near-infrared fluorescence to evaluate PG perfusion and viability. Each of these approaches possess unique advantages and disadvantages, and clinical trials are ongoing to better define their utility. CONCLUSIONS: Near-infrared fluorescence detection offers the opportunity to improve our collective ability to identify and preserve PGs intraoperatively. While additional work is needed to propel this technology further, we hope this review will be valuable to the practicing surgeon.


Assuntos
Glândulas Paratireoides , Glândula Tireoide , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Pescoço/cirurgia , Paratireoidectomia/métodos , Imagem Óptica/métodos
5.
Front Endocrinol (Lausanne) ; 13: 1040264, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36531501

RESUMO

Objective: We aimed to construct and validate a predictive model for the risk of hypocalcemia following parathyroidectomy (PTX) for the treatment of secondary(renal) hyperparathyroidism (SHPT). Methods: Information regarding patients with SHPT who underwent PTX between January 2019 and April 2022 was collected retrospectively. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for hypocalcemia following PTX and to construct predictive models. The areas under the receiver operating characteristic curve (AUC), the calibration curve, and the clinical decision curve (decision curve analysis, DCA) were used to assess the discrimination, calibration, and level of clinical benefit obtained using the predictive models. Results: We studied 238 patients who were randomly allocated in a 7:3 ratio to a training group (n=166) and a test group (n=72). Univariate and multivariate logistic regression analyses were performed, in which three variables (the circulating parathyroid hormone (PTH) and Ca concentrations, and alkaline phosphatase (ALP) activity) were interrogated for possible roles as independent risk factors for hypocalcemia in patients with SHPT who undergo PTX, and used to construct predictive models. The AUCs for the constructed models were high for both the training (0.903) and test (0.948) groups. The calibration curve showed good agreement between the incidence of postoperative hypocalcemia estimated using the predictive model and the actual incidence. The DCA curve indicated that the predictive model performed well. Conclusion: A predictive model constructed using a combination of preoperative PTH, Ca, and ALP may represent a useful means of identifying patients with SHPT at high risk of developing hypocalcemia following PTX in clinical practice.


Assuntos
Hiperparatireoidismo Secundário , Hipocalcemia , Humanos , Paratireoidectomia/efeitos adversos , Hipocalcemia/etiologia , Hipocalcemia/epidemiologia , Hipocalcemia/cirurgia , Estudos Retrospectivos , Cálcio , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Hormônio Paratireóideo
6.
BJS Open ; 6(6)2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36515670

RESUMO

BACKGROUND: When applying intraoperative parathyroid hormone monitoring (IOPTH) to patients with primary hyperparathyroidism (PHPT), there are established criteria predicting biochemical cure in patients with basal parathyroid hormone (PTH) levels in the medium range (100-400 pg/ml); however, there is a challenge concerning patients with low (less than 100 pg/ml) or high (more than 400 pg/ml) basal PTH levels. The aim of this study was to investigate the value of the 'Vienna criterion' applied during IOPTH in patients with PHPT and various basal PTH concentrations. METHODS: Consecutive patients between 1999-2009 with a biochemical diagnosis of PHPT who underwent surgical parathyroidectomy were included. Based on preoperative PTH levels they were divided into three groups: group 1 (low) (<100 pg/ml), group 2 (medium) (100-400 pg/ml) and group 3 (high) (>400 pg/ml) basal PTH. PTH was measured at the start of the operation, when the gland was excised and then at 5, 10 and 15 min after. Calcium and PTH levels were measured at 7 days and 12 months postoperatively. Sensitivity, specificity, positive and negative predictive value, as well as accuracy of IOPTH were calculated for the different groups postoperatively. RESULTS: 675 patients with PHPT were analysed. Sensitivity and specificity were 83.7 per cent and 66.7 per cent in group 1 (n = 187), 90.7 per cent and 69.2 per cent in group 2 (n = 433), and 94.4 per cent and 100 per cent in group 3 (n = 55) to predict cure. Preoperative creatinine (p = 0.002) showed significant statistical difference between the groups but was not related to intraoperative PTH decline. At 12 months follow-up normocalcaemia was documented in 98.9 per cent in group 1, 99.0 per cent group 2, and 98.0 per cent of group 3 patients. CONCLUSION: Normocalcaemia was predicted intraoperatively by applying the 'Vienna criterion' in 98 to 100 per cent and was confirmed after 12 months follow-up in up to 99.0 per cent of patients. Low specificity and a high false-negative rate in patients with low basal PTH show that other criteria might be better suited for this group.


Assuntos
Hiperparatireoidismo Primário , Hipoparatireoidismo , Humanos , Hormônio Paratireóideo , Hiperparatireoidismo Primário/cirurgia , Estudos Retrospectivos , Paratireoidectomia , Monitorização Intraoperatória
7.
Cir. mayor ambul ; 27(1): 11-17, oct.- dic. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-212649

RESUMO

En los últimos 20 años la cirugía en régimen ambulatorio se ha impuesto como una realidad cotidiana. Se ha convertido en un estándar para ciertas cirugías en casos seleccionados. La cirugía tiroidea y paratiroidea han sido unos de los procedimientos que se han implantado en muchas unidades de CMA, pero todavía hay reticencias a su realización y no existen muchas publicaciones al respecto en el ámbito nacional. Por ello, revisamos la literatura publicada en revistas indexadas respecto a la cirugía tiroidea y paratiroidea en régimen ambulatorio en España en los últimos 20 años (AU)


In the last 20 years ambulatory surgery has established itself as a daily reality. It has become a standard for certain surgeries in selected cases. Thyroid and parathyroid surgery have been one of the procedures that have been implemented in many units, but there is still reluctance to carry them out and there are not many publications on the matter at the national level. For this reason, we reviewed the literature published in indexed journals regarding thyroid and parathyroid surgery in outpatient settings in Spain in the last 20 years (AU)


Assuntos
Humanos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Tireoidectomia/métodos , Tireoidectomia/estatística & dados numéricos , Paratireoidectomia/métodos , Paratireoidectomia/estatística & dados numéricos , Doenças do Sistema Endócrino/cirurgia , Espanha
8.
BMC Endocr Disord ; 22(1): 322, 2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36529731

RESUMO

BACKGROUND: Juvenile primary hyperparathyroidism (PHPT) is a rare endocrine disease. Its diagnosis might be masked by clinical, biochemical, and radiological features of rickets. CASE PRESENTATION: A 12-year-old Sudanese boy presented with progressive lower limbs deformity and difficulty in walking for six months. It was associated with fatigability, poor appetite, and generalized bone pain. On examination, he was thin, disproportionately short and pubertal, and had bilateral genu valgum deformity. X-rays showed osteopenia and signs of rickets. Biochemical workup revealed mildly elevated serum calcium, low phosphate, high alkaline phosphatase, and high parathyroid hormone with low 25-hydroxy vitamin D3. Celiac screening, liver function test and renal profile were normal. Serum calcium rose dramatically after vitamin D therapy. Genetic testing was negative for CYP2R1 and MEN1 genes. Ultrasound neck showed left inferior parathyroid adenoma which was surgically excised. Histopathology confirmed the diagnosis of parathyroid adenoma. Postoperatively, he had hypocalcemia which was treated with calcium and alfacalcidol. Corrective surgery is planned for the genu valgum deformity which markedly improved after parathyroidectomy. CONCLUSION: Although PHPT is extremely rare in the young population, it should be considered in patients with rickets and elevated serum calcium at baseline or after initiating vitamin D therapy.


Assuntos
Adenoma , Geno Valgo , Hipercalcemia , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Raquitismo , Masculino , Humanos , Adolescente , Criança , Neoplasias das Paratireoides/complicações , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/genética , Cálcio/uso terapêutico , Geno Valgo/complicações , Geno Valgo/cirurgia , Adenoma/patologia , Raquitismo/diagnóstico , Raquitismo/tratamento farmacológico , Raquitismo/cirurgia , Paratireoidectomia , Hormônio Paratireóideo , Vitamina D , Hipercalcemia/complicações
9.
Front Endocrinol (Lausanne) ; 13: 1059828, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36561571

RESUMO

Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are common and complicated clinical endocrine diseases. The parathyroid glands maintain endocrine homeostasis by secreting parathyroid hormone to regulate blood calcium levels. However, structural alterations to multiple organs and systems occur throughout the body due to hyperactivity disorder in SHPT and THPT. This not only decreases the patients' quality of life, but also affects mortality. Since current treatments for these diseases remains unclear, we aimed to develop a comprehensive review of advances in the treatment of SHPT and THPT according to the latest relevant researches.


Assuntos
Hiperparatireoidismo Secundário , Humanos , Hiperparatireoidismo Secundário/tratamento farmacológico , Hiperparatireoidismo Secundário/cirurgia , Hiperparatireoidismo Secundário/terapia , Glândulas Paratireoides/metabolismo , Hormônio Paratireóideo/metabolismo , Paratireoidectomia , Qualidade de Vida
10.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 36(11): 822-826;834, 2022 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-36347573

RESUMO

Objective:To evaluate the clinical effect of reoperation in persistent hyperparathyroidism (PHPT) patients after operation of parathyroidectomy combined with autotransplantation(PTX+AT) on secondary hyperparathyroidism (SHPT) . Methods:18 PHPT patients who treated with reoperation after PTX+AT were enrolled in this study during the period from Aug 2012 to Dec 2021 in the Department of Otolaryngology Head and Neck Surgery of Peking University Civil Aviation School of Clinical Medicine, Civil Aviation General Hospital. The remaining parathyroid glands were located by preoperative colour Doppler ultrasonography, radionuclide imaging, enhanced CT and MR imaging in the neck region . Based on the imaging findings, the remaining parathyroid glands were removed in situ, and the missed ectopic or extra parathyroid glands were resected with an extended surgical scope according to the parathyroid dissection method. The surgical effect was evaluated by the changes of clinical symptoms, the dynamic change of serum intact paramyroidhomone(i-PTH) between preoperative and postoperative periods and the surgical complications. Results:All the 18 patients accepted successful operation. 30 parathyroid glands were resected confirmed by postoperative pathology, including 16 in situ and 14 ectopic glands(5 in superior mediastinum, 4 in thymus, 2 in posterior mediastinum ,2 in thyroid glands, 1 in carotid sheath).Osteoarthropathy and skin itching were significantly relieved or even disappeared at 6 h after surgery. The levels of serum i-PTH, calcium and phosphorus reached the standards and muscle weakness was significantly improved 1 week after surgery. 16 patients presented hypocalcemia and returned to normal after supplement of calcium. Hoarseness due to temporary injury of laryngeal nerve was found in 6 cases. No serious complications or death occurred after the operation.There was no recurrence after 1 year follow-up. Conclusion:Reoperation is the first choice for SHPT patients complicated with persistent hyperparathyroidism. Multiple imaging examinations are used to locate the residual parathyroid, especially the ectopic gland. Expanded surgical scope is applied to resect all the residual parathyroid glands(ectopic, in situ and concealed parathyroid) according to the concept of dissection parathyroidectomy. The surgery is effective and safe. Patients'quality of life and long-term survival rate is improved.


Assuntos
Cálcio , Hiperparatireoidismo Secundário , Humanos , Reoperação/efeitos adversos , Qualidade de Vida , Hiperparatireoidismo Secundário/complicações , Paratireoidectomia/métodos , Glândulas Paratireoides , Período Pós-Operatório , Hormônio Paratireóideo
13.
Arch Endocrinol Metab ; 66(5): 678-688, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36382757

RESUMO

Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at risk for multiglandular disease, especially in those who present with familial forms of PHPT that require bilateral neck exploration. This manuscript also explores other conditions that warrant special consideration during surgical treatment for PHPT: normocalcemic primary hyperparathyroidism, pregnancy, reoperation for persistent or recurrent PHPT, parathyroid carcinoma, and familial and genetic forms of hyperparathyroidism.


Assuntos
Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Humanos , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/efeitos adversos , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Hormônio Paratireóideo , Glândulas Paratireoides/cirurgia
14.
Arch Endocrinol Metab ; 66(5): 689-693, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36382758

RESUMO

Primary hyperparathyroidism (PHPT) is an endocrine disorder resulting from the hyperfunction of one or more parathyroid glands, with hypersecretion of parathyroid hormone (PTH). It can be managed by parathyroidectomy (PTX) or non-surgically. Medical therapy with pharmacological agents is an alternative for those patients with asymptomatic PHPT who meet guidelines for surgery but are unable or unwilling to undergo PTX. In this review, we focus upon these non-surgical aspects of PHPT management. We emphasize the most studied and widely used pharmacological alternatives: bisphosphonates, denosumab, cinacalcet and hormone therapy, in addition to combined therapy. We also address the relevant aspects of perioperative management.


Assuntos
Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia , Cinacalcete/uso terapêutico , Hormônio Paratireóideo/uso terapêutico , Glândulas Paratireoides/cirurgia
15.
J Coll Physicians Surg Pak ; 32(11): 1386-1391, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36377002

RESUMO

OBJECTIVE: To determine the outcomes of unintended limited parathyroidectomy (LPTX; three or less than three glands removed) in patients with secondary hyperparathyroidism (SHPT). STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Jiangmen Central Hospital, China, from January 2012 and December 2019. METHODOLOGY: The operative and biochemical outcomes of LPTX with total parathyroidectomy plus auto-transplantation (PTX+AT) among patients with SHPT were compared. Primary outcomes were persistence and time to recurrence. Secondary outcomes were all-cause death and levels of serum parathyroid hormone (PTH), calcium, alkaline phosphatase (ALP), and phosphate measured pre-surgery, on postoperative day 1 (POD1), and one-year post-PTX in patients cured after the initial surgery. RESULTS: Forty-three patients received LPTX, and 78 underwent PTX-AT. Persistent SHPT was more frequent in the LPTX group (p = 0.001). The area under the receiver operating characteristic curve was 0.89 for POD1 PTH (p <0.001). The frequencies of SHPT recurrence and all-cause mortality were not significantly different. One-year postsurgery, PTH, calcium, ALP, and phosphate levels were significantly decreased in both groups, compared with the respective preoperative values (p <0.001, each). CONCLUSION: LPTX resulted in a higher proportion of persistent SHPT. However, more than half of the patients could be cured and achieved satisfactory outcomes. Cured patients who underwent LPTX can be identified according to PTH levels on POD1. KEY WORDS: Limited parathyroidectomy, Secondary hyperparathyroidism, Recurrence, Persistence, All-cause death.


Assuntos
Hiperparatireoidismo Secundário , Paratireoidectomia , Humanos , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Cálcio , Estudos Retrospectivos , Resultado do Tratamento , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Hormônio Paratireóideo , Fosfatos , Fosfatase Alcalina
16.
Front Endocrinol (Lausanne) ; 13: 975954, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36325457

RESUMO

Objective: Primary hyperparathyroidism is a common disorder of the parathyroid glands. Parathyroid adenoma (PA) in pregnancy is a relatively rare disease, whose diagnosis and treatment is a challenging task. The aim of the present study is to present a new case of parathyroid adenoma during pregnancy and to give a detailed account of all reported cases of parathyroid adenoma during pregnancy in the literature. Study design: A bibliographic research was performed, and characteristics of parathyroid adenomas in pregnancy such as age, gestational week at diagnosis, ionized calcium levels, genetic testing result, symptomatology, radiological method of localization, treatment method, gestational week at operation, and maternal/fetal complications were recorded. Results: A 34-year-old woman at her 25 weeks' gestation was diagnosed with parathyroid adenoma and was referred to our Surgical Department due to contraindication for conservative treatment. A parathyroidectomy was performed, and the maternal and fetal postoperative period was uneventful. Two hundred eleven cases of parathyroid adenoma in pregnancy were recorded in the literature, and statistical analysis was performed. The median gestational week at diagnosis was 21 ± 9.61 weeks. The mean level of ionized calcium was 2.69 mmol/l [SD = 0.75 (2.55-2.84 95% CI)]. Most cases were familiar (72.4%), while surgery was the preferred treatment option (67.3%). The majority of cases were asymptomatic (21.7%), and the main radiological method applied for localization was ultrasound (63.4%). Conclusion: Parathyroid adenoma in pregnancy is a rare condition. The early diagnosis is of great importance as surgical treatment at the second trimester of pregnancy outweighs the maternal and fetal risks.


Assuntos
Adenoma , Neoplasias das Paratireoides , Complicações Neoplásicas na Gravidez , Humanos , Feminino , Gravidez , Adulto , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Cálcio , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/cirurgia , Paratireoidectomia/métodos
17.
Front Endocrinol (Lausanne) ; 13: 1030007, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36325460

RESUMO

Background: Postoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery. Methods: We used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients. Results: In total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism. Conclusion: We concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.


Assuntos
Hipoparatireoidismo , Glândulas Paratireoides , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Tireoidectomia/métodos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Perfusão/efeitos adversos
18.
Cir Cir ; 90(5): 623-626, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36327466

RESUMO

OBJECTIVE: There are few studies evaluating the effect of high body mass index (BMI) on parathyroid surgery. The aim of this study was to examine the relationship between the BMI and post-operative outcome of the patients who were operated for primary hyperparathyroidism (PHP). MATERIAL AND METHODS: Hospital files of patients who were operated for PHP between January 2013 and January 2020 were reviewed retrospectively. Patients operated by surgeons experienced in endocrine surgery (more than 25 cases/year) were included in the study. Patients were divided into two groups according to BMI (Group 1 < and Group 2 ≥ 25). Data were analyzed. RESULTS: Groups were similar in terms of age (p = 0.715) and sex (p = 0.253). There was no significant difference between groups regarding postoperative hospital stay (p = 0.561), rate of transient hypocalcemia (p = 0.748), or permanent hypocalcemia (p = 0.530). The mean operative time was shorter in Group 1 (84 min in Group 1 and 70 min in Group 2, p = 0.045). CONCLUSION: Parathyroid surgery can safely be performed in patients with high BMI by surgeons experienced in endocrine surgery.


OBJETIVOS: Existen pocos estudios evaluando el efecto de un alto índice de masa corporal (IMC) en la cirugía de paratiroides. El objetivo de este estudio fue examinar la relación entre el índice de masa corporal (IMC) y el resultado posoperatorio depacientes que fueron operados por hiperparatiroidismo primario (PHP). MATERIAL Y MÉTODOS: Expedientes de pacientes que fueron operados por PHP entre enero de 2013 y enero de 2020 fueron revisados retrospectivamente. Pacientes operados por ciruganoscon experiencia en cirugía endocrina (más de 25 casos por año) fueron incluidos. Los pacientes fueron divididos en dos grupos de acuerdo a IMC (grupo 1 < 25 y grupo 2 ≥ 25). Los datos fueron analizados. RESULTADOS: Los grupos eran similares en cuanto a edad (p = 0.715) y sexo (p = 0.253). No hubo diferencia significativa entre los grupos en relación con la permanencia hospitalaria posoperatoria (p = 0.561), taza de hipocalcemia transitoria (p = 0.748) ohipocalcemia permanente (p = 0.530). La media de tiempo de operación fue menor en el grupo 1 (84 minutos en el grupo 1 y 70 minutos en el grupo 2, p = 0.045). CONCLUSIÓN: La cirugía de paratiroides puede ser realizada con seguridad en pacientes con alto IMC por ciruganos con experiencia en cirugía endocrina.


Assuntos
Hiperparatireoidismo Primário , Hipocalcemia , Humanos , Paratireoidectomia , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/complicações , Índice de Massa Corporal , Hipocalcemia/etiologia , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
19.
J Bone Miner Res ; 37(11): 2330-2350, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36245249

RESUMO

This narrative review summarizes data on classical and nonclassical manifestations of primary hyperparathyroidism (PHPT). It is based on a rigorous literature search, inclusive of a Medline search for systematic reviews from 1940 to December 2020, coupled with a targeted search for original publications, covering four databases, from January 2013-December 2020, and relevant articles from authors' libraries. We present the most recent information, identify knowledge gaps, and suggest a research agenda. The shift in the presentation of PHPT from a predominantly symptomatic to an asymptomatic disease, with its varied manifestations, has presented several challenges. Subclinical nephrolithiasis and vertebral fractures are common in patients with asymptomatic disease. The natural history of asymptomatic PHPT with no end organ damage at diagnosis is unclear. Some observational and cross-sectional studies continue to show associations between PHPT and cardiovascular and neuropsychological abnormalities, among the different disease phenotypes. Their causal relationship is uncertain. Limited new data are available on the natural history of skeletal, renal, cardiovascular, neuropsychological, and neuromuscular manifestations and quality of life. Normocalcemic PHPT (NPHPT) is often diagnosed without the fulfillment of rigorous criteria. Randomized clinical trials have not demonstrated a consistent long-term benefit of parathyroidectomy (PTX) versus observation on nonclassical manifestations. We propose further refining the definition of asymptomatic disease, into two phenotypes: one without and one with evidence of target organ involvement, upon the standard evaluation detailed in our recommendations. Each of these phenotypes can present with or without non-classical manifestations. We propose multiple albumin-adjusted serum calcium determinations (albumin-adjusted and ionized) and exclusion of all secondary causes of high parathyroid hormone (PTH) when establishing the diagnosis of NPHPT. Refining the definition of asymptomatic disease into the phenotypes proposed will afford insights into their natural history and response to interventions. This would also pave the way for the development of evidence-based guidance and recommendations. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).


Assuntos
Hiperparatireoidismo Primário , Humanos , Hiperparatireoidismo Primário/complicações , Estudos Transversais , Qualidade de Vida , Revisões Sistemáticas como Assunto , Paratireoidectomia , Hormônio Paratireóideo , Cálcio , Doenças Assintomáticas , Albuminas
20.
Sci Rep ; 12(1): 17427, 2022 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261462

RESUMO

The objective of this study was to retrospectively evaluate preoperative imaging modalities for localization of parathyroid adenomas with a view to enable minimally invasive parathyroidectomy and in particular, to consider the contribution of 18F-fluorocholine-PET/CT. 104 patients with primary hyperparathyroidism, who underwent parathyroid surgery in a single centre during a 6-year period were included. Of these, 103 underwent ultrasound, 97 99mTc-Pertechnetate/SestaMIBI-SPECT, 20 MRI and 30 18F-fluorocholine-PET/CT. Based on surgical findings, sensitivities and specificities for correct lateralisation in orthotopic locations were: for ultrasound 0.75 (0.65-0.83) and 0.89 (0.81-0.94), for 99mTc-MIBI-SPECT 0.57 (0.46-0.67) and 0.97 (0.91-0.99), for MRI 0.60 (0.36-0.81) and 0.83 (0.59-0.96) and for 18F-fluorocholine-PET/CT 0.90 (0.73-0.98) and 0.90 (0.73-0.98). Correctly lateralized adenomas were significantly larger than those not found with ultrasound (p = 0.03) and SPECT (p = 0.002). Pre-operative PTH-levels were higher in single adenomas detected by scintigraphy than in those not (p = 0.02). 64 patients could be treated with a minimally invasive procedure. Cure after parathyroidectomy was obtained in 94% of patients. 18F-Fluorocholine-PET/CT could be shown to be a highly accurate modality to localize parathyroid adenomas preoperatively, obviating the need for total exploration in the majority of patients in whom ultrasound and scintigraphic results are discordant or both negative.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Humanos , Paratireoidectomia/métodos , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Estudos Retrospectivos , Glândulas Paratireoides/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Pertecnetato Tc 99m de Sódio , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Compostos Radiofarmacêuticos
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