Persistent or recurrent primary hyperparathyroidism.
نویسندگان
چکیده
More than 95% of patients with Primary Hyperparathyroidism (PHPT) are treated successfully at the initial operation when the operation is done by an experienced surgeon, but the success rate is considerably lower when done by an unexperienced surgeon. The approach to patients with persistent and recurrent PHPT is to confirm the diagnosis and to use precise localization procedures done by expert radiologists. Reexploration after one or more previously failed parathyroid operations is unfortunately associated with a higher morbidity and a lower success rate. Improved pre- and intraoperative testing during the last decade has improved the results of reoperation and allowed more focused approaches. Preoperatively, we recommend a combination of sestamibi scanning, ultrasound, and MRI scanning. Highly selective venous sampling for iPTH is recommended for patients with recurrent or persistent PHPT when the non-invasive studies are negative, equivocal, or discordant. Several factors such as age of the patient, severity of symptoms, comorbidity, and the results of localization studies, should all be considered in the management of these patients although we believe that reoperation is indicated for most of these patients. Today successful reoperations can be done in more than 90% of patients with a relatively low morbidity rate.
منابع مشابه
Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy
Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1) correct hypercalcemia, thus preventing persistent or recurrent hyperparathyr...
متن کاملMediastinal parathyroid adenoma causing primary hyperparathyroidism.
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first explor...
متن کاملCase Report Mediastinal Parathyroid Adenoma causing primary Hyperparathyroidism
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first explor...
متن کامل[Amyloid goiter secondary to rheumatoid arthritis. a case report].
4. Doherty GM, Weber B, Norton JA. Cost of unsuccessful surgery for primary hyperparathyroidism. Surgery. 1994;116:954--7. 5. Fayet P, Hoeffel C, Fulla Y, Legmann P, Hazebroucq V, Luton J, et al. Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism. Br J Radiol. 1997;70:459--64. 6. Jaskowiak N, Norton JA, Ale...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Annali italiani di chirurgia
دوره 74 4 شماره
صفحات -
تاریخ انتشار 2003