The Normohormonal Primary Hyperparathyroidism; a surgical dilemma pre and intra-operatively - 06/04/22
Abstract |
Introduction |
Normohormonal Primary Hyperparathyroidism (NPHPT), poses a dilemma for surgeons; first in deciding when to operate where the PTH is normal and second at what level should the drop in intra-operative PTH (ioPTH) be considered a successful operation.
Materials & methods |
A retrospective evaluation of all parathyroidectomies performed by a single surgeon from 2009 to 2019 was conducted.
Results |
In 33 of 349 (9%) parathyroidectomies the indication was NPHPT. Negative pre-operative nuclear localization was found in 17(52%) patients. Intra-operative findings were: 27(82%) single-adenoma, 3(9%) double-adenomas and 3(9%) hyperplasia. In patients with single-adenomas the ioPTH dropped from 57 ± 8 to 23 ± 10 pg./ml. The average size of the adenomas was 403 ± 360 mg.
Conclusion |
NPHPT is uncommon where the disease is diagnosed in its early stages. Over 50% has negative pre-operative nuclear localization test requiring 4-gland surgical exploration. The intra-operative drop in PTH below 30 pg./ml can be utilized as an indicator of a successful operation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | In patients with Normohormonal primary hyperparathyroidism presentations, ioPTH levels on average have been found to be lower |
• | Decrease of ioPTH to below 30 pg/ml was associated with lower rates of recurrence |
• | Normohormonal primary hyperparathyroidism is more challenging to diagnose due less detectability of pathologic glands on pre-operative imaging |
• | Normohormonal PHPT glands are usually single adenomas and small |
Mots-clés : PTH:, PHPT:, cPHPT:, NPHPT:, ioPTH:, Ca:
Keywords : Hyperparathyroidism, Normohormonal primary hyperparathyroidism, Intra-operative PTH, Parathyroidectomy
Plan
Vol 223 - N° 3
P. 589-591 - mars 2022 Retour au numéro
Article précédent
- Treatment differences at high volume centers and low volume centers IN NON -metastatic and metastatic adrenocortical carcinoma
- The non-classical primary hyperparathyroidism; a surgical dilemma pre and intra-operatively
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