To examine changes over the past three decades in the indications for, and outcomes of, surgery for primary hyperparathyroidism.
Survey of a prospective hospital database.
Royal North Shore Hospital (a tertiary referral and university teaching hospital), Sydney, New South Wales, January 1962 to December 1996.
All 733 patients who underwent neck exploration for primary hyperparathyroidism.
The annual number of parathyroidectomies increased virtually exponentially, from a mean of two in 1962-1969 to 73 in 1996. In the 1960s and 1970s, the most common indication for surgery was the presence of renal calculi (58% and 43%, respectively), but in the 1980s there was a marked increase in presentation of asymptomatic disease after biochemical screening (19%). In the 1990s, low bone mineral density detected by osteodensitometry has become the most common indication for surgery (31%). After initial operation, 11 patients (2%) had persistent hypercalcaemia, with five of these cured by reoperation--an overall failure rate of 1%.
Surgery for primary hyperparathyroidism has become increasingly common, with low bone mineral density replacing renal calculi as the most common indication for surgery. Neck exploration in experienced hands results in an overall cure rate of 99%.
"Primary hyperparathyroidism is among the most common endocrine disorders with a prevalence reaching 0.1% to 0.4%  . Diagnosis of primary hyperparathyroidism is based on biochemical markers, including serum parathyroid hormone (PTH) and serum calcium  . "
[Show abstract][Hide abstract] ABSTRACT: With dual-radiopharmaceutical (DR) parathyroid scintigraphy, imaging with 99m TcO 4-or 123 I-NaI is combined with 99m Tc-sestamibi scintigraphy for localization of parathyroid adenomas. The set images are then either visually compared or digitally subtracted to aid in interpretation. While both EANM and SNMMI guidelines recommend use of digital subtraction over visual interpretation alone, to date, the few formal comparisons performed have not demonstrated superiority. The purpose of this investigation is to rigorously assess the added value of digital subtraction over visual interpretation alone using simultaneously-acquired 123 I-NaI and 99m Tc-sestamibi images. Materials: 90 consecutive patients with DR parathyroid scintigraphy for primary hyperparathy-roidism who underwent successful parathyroidectomy were included. DR planar acquisition was performed 15 minutes post injection using 10% dual energy windows. Digital subtraction was subsequently performed using commercially available software. Images were independently reviewed by 3 nuclear medicine trainees and 2 experienced nuclear medicine physicians with and without digital subtraction. Results were compared with surgical and histopathologic findings, which served as ground truth. Results: 90 patients had a total of 91 confirmed parathyroid lesions. All 5 readers had significantly greater sensitivity with digital subtraction compared with visual interpretation alone while specificity was not significantly diminished. Area under the ROC curve was significantly greater with digital subtraction in 3 of 5 readers. Agreement was greater among trainees and experienced physicians when using digital subtraction. Conclusion: Using an optimized DR planar co-imaging technique, digital subtraction significantly improved inter-observer agreement and confidence of interpretation and increased sensitivity, without diminishing specificity.
Open Journal of Medical Imaging 07/2015; 5(02):42-48. DOI:10.4236/ojmi.2015.52007
"Primary hyperparathyroidism most often is due to a parathyroid adenoma that secretes parathyroid hormone (PTH). The severity of hypercalcemia is correlated with the size and weight of the responsible parathyroid adenoma. In the majority of patients with primary hyperparathyroidism (85%) caused by solitary parathyroid adenoma (single gland disease), whereas 13% have hyperplasia (multiple gland disease), 1-2% have double adenoma and 1% have carcinoma. Due to parathormone hypersecretion, several consequences occur such as excess calcium reabsorption from kidneys, phosphaturia, increased vitamin D synthesis and bone reabsorption. "
"Tc-pertechnetate subtraction scintigraphy; CT, CT scan of the neck and mediastinum; TP, true positive; FN, false negative. overall cure rate greater than 90% (Arnaud 1994, Shen et al. 1997, Roe et al. 1998, Delbridge et al. 1998). However, most studies suggested that preoperative localization of abnormal parathyroid glands may be useful in reducing operative time, morbidity and hospital stay, facilitating parathyroidectomy especially in patients with ectopic parathyroid tumours (Wei & Burke 1995, Sfakianakis et al. 1996, Gupta et al. 1998, Sofferman & Nathan 1998, Vogel et al. 1998, Boggs et al. 1999, Chen et al. 1999, Lumachi et al. 1999, Song et al. 1999). "
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