Long-term management and outcome of parathyroidectomy for sporadic primary multiple-gland disease
| Autor: | Pejman Cohan, Armando E. Giuliano, Andre J. Van Herle, Frederick R. Singer, D. Michael Rose, Thomas F. Wood |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Parathyroidectomy
Adult Male medicine.medical_specialty medicine.medical_treatment Aftercare Preoperative care Subtotal Parathyroidectomy Recurrence Risk Factors Medicine Humans Parathyroid disease Aged Retrospective Studies Hyperparathyroidism business.industry Patient Selection Retrospective cohort study Middle Aged medicine.disease Long-Term Care Surgery Treatment Outcome Hypoparathyroidism Parathyroid Hormone Calcium Female business Primary hyperparathyroidism |
| Zdroj: | Archives of surgery (Chicago, Ill. : 1960). 136(6) |
| ISSN: | 0004-0010 |
| Popis: | Hypothesis For a specific subset of patients with sporadic primary multiple-gland parathyroid disease, subtotal parathyroidectomy results in long-term normocalcemia in the majority of patients, with a minimal complication rate. Design Retrospective analysis of outcomes in patients undergoing parathyroidectomy performed by a single surgeon (A.E.G.) between 1984 and 1999. Setting A multidisciplinary endocrine service based at a tertiary referral center. Patients Patients undergoing subtotal parathyroidectomy for primary hyperparathyroidism due to sporadic multiple-gland disease identified from a single surgeon's operative records (A.E.G.). Main Outcome Measures Data analyzed included demographic factors, operative and pathologic findings, and postoperative and long-term clinical and laboratory results, including calcium and intact parathyroid hormone levels. Results Of 379 patients undergoing parathyroidectomy for hyperparathyroidism between 1984 and 1999, 49 (13%) had sporadic multiple-gland disease. Median preoperative calcium and intact parathyroid hormone (iPTH) levels were 2.7 mmol/L (10.8 mg/dL) and 11.79 pmol/L, respectively. Postoperative calcium and iPTH levels were available in 39 patients, and median values were 2.28 mmol/L (9.1 mg/dL) and 2.84 pmol/L, respectively. Long-term follow-up was available for 36 patients (73%), and duration ranged from 6 to 180 months (median, 44 months). Median calcium and iPTH levels at follow-up were 2.3 mmol/L (9.2 mg/dL) and 3.26 pmol/L, respectively, with 3 (8%) of 36 patients having evidence of persistent or recurrent hyperparathyroidism. No patient had biochemical evidence of hypoparathyroidism at long-term follow-up. Five patients (14%) had persistent elevated iPTH levels (range, 8.11-10.95 pmol/L) and normal calcium levels. Conclusions Subtotal parathyroidectomy for sporadic primary multiple-gland disease resulted in a long-term normocalcemia rate of 92%, with minimal complications. Selective subtotal parathyroidectomy can yield excellent long-term results in patients with multiple-gland disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|