Persistent/Recurrent Primary Hyperparathyroidism: Does the Number of Abnormal Glands Play a Role?
| Autor: | Tracy S. Wang, Kara Doffek, Joseph L. Shaker, Azadeh A. Carr, Douglas B. Evans, Tina W.F. Yen, Ioanna G. Mazotas |
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| Rok vydání: | 2019 |
| Předmět: |
Parathyroidectomy
Adenoma Male medicine.medical_specialty Time Factors endocrine system diseases medicine.medical_treatment Parathyroid hormone Gastroenterology Parathyroid Glands 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans In patient Postoperative Period Aged Retrospective Studies Hyperplasia business.industry Incidence (epidemiology) Incidence Middle Aged medicine.disease Hyperparathyroidism Primary Parathyroid Neoplasms Time to recurrence 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Recurrent hyperparathyroidism Female Neoplasm Recurrence Local business Primary hyperparathyroidism Follow-Up Studies |
| Zdroj: | The Journal of surgical research. 246 |
| ISSN: | 1095-8673 |
| Popis: | 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.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 calcium10.2 mg/dL and parathyroid hormone40 pg/mL was defined as persistent PHPT if present6 mo and recurrent PHPT if present ≥6 mo postoperatively after initial normocalcemia.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).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. |
| Databáze: | OpenAIRE |
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