Patient-based Surgical Outcome Tool Demonstrating Alleviation of Symptoms following Parathyroidectomy in Patients with Primary Hyperparathyroidism

ArticleinWorld Journal of Surgery 26(8):942-9 · August 2002with25 Reads
DOI: 10.1007/s00268-002-6623-y · Source: PubMed
Abstract
This study assessed the impact of parathyroidectomy on the preoperative symptoms of patients with primary hyperparathyroidism (1 degrees HPT) using a surgical outcome tool designed specifically for HPT. The multicenter nature of this study allowed us to validate further this disease-specific outcome tool. 1 degrees HPT patients from Canada, the United States, and Australia filled out the questionnaire preoperatively and postoperatively on day 7 and at 3 and 12 months. The symptoms recorded by the patients were expressed as parathyroidectomy assessment of symptoms (PAS) scores: the higher the score, the more symptomatic is the patient. Quality of Life (QOL) and self-rated health uni-scales were included. Altogether, 203 patients with 1 degrees HPT were enrolled; 27 from center A, 54 from center B, and 122 from center C; 58 nontoxic thyroid patients were enrolled for comparison. The comparison group had no significant change in their PAS scores throughout the study (scores 184, 215, 156, 186). All three centers demonstrated a significant reduction in symptoms following surgery. The median preoperative PAS score from center B patients was 282. Following surgery, PAS scores decreased significantly: 136, 58, 0 (p <0.05). Center C patients had a median preoperative PAS score of 344, decreasing postoperatively to 228 (p <0.05) and continuing to decrease to 190, then 180. Center A also demonstrated a significant reduction in symptoms at 3 months, from 510 preoperatively to 209 (p <0.001). Both QOL and self-rated health improved in the HPT patients, whereas no change was found in the comparison group following surgery. PAS scores are a reliable, disease-specific measure of symptoms seen with HPT. Parathyroidectomy significantly reduces these preoperative symptoms, and this change translated into an improved health-related QOL for the patients.
    • "The vertical axis defined a normophosphatemia, a hyperphosphatemia, the absence or presence of phosphorus binders, high or low level of alkaline phosphatases, the presence or absence of vitamin D supplementation, the presence or absence of calcium suplementation. Each patient is identified by a number and a color according to the following code: black for group 1 ( " intermediate " ), green for group 2 (younger with severe cardiovascular comorbidities), blue for group 3 (elderly patients with few cardiovascular comorbidities), pink for group 4 ( " cinacalcet prescription " ).Table 3 Characteristics of dialysis subgroups identified at time of secondary hyperparathyroidism (SHPT) diagnosis: variables used to cluster dialysis patients at time of SHPT diagnosis by Pasieka et al. was used in several studies on primary and secondary hyperparathyroidism to quantify severity of symptoms using median values181920. In the EPHEYL study, one out of two patients suffered from at least one symptom. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Recommendations for secondary hyperparathyroidism (SHPT) consider that a “one-size-fits-all” target enables efficacy of care. In routine clinical practice, SHPT continues to pose diagnosis and treatment challenges. One hypothesis that could explain these difficulties is that dialysis population with SHPT is not homogeneous. Methods EPHEYL is a prospective, multicenter, pharmacoepidemiological study including chronic dialysis patients (≥3 months) with newly SHPT diagnosis, i.e. parathyroid hormone (PTH) ≥500 ng/L for the first time, or initiation of cinacalcet, or parathyroidectomy. Multiple correspondence analysis and ascendant hierarchical clustering on clinico-biological (symptoms, PTH, plasma phosphorus and alkaline phosphatase) and treatment of SHPT (cinacalcet, vitamin D, calcium, or calcium-free calcic phosphate binder) were performed to identify distinct phenotypes. Results 305 patients (261 with incident PTH ≥ 500 ng/L; 44 with cinacalcet initiation) were included. Their mean age was 67 ± 15 years, and 60% were men, 92% on hemodialysis and 8% on peritoneal dialysis. Four subgroups of SHPT patients were identified: 1/ “intermediate” phenotype with hyperphosphatemia without hypocalcemia (n = 113); 2/ younger patients with severe comorbidities, hyperphosphatemia and hypocalcemia, despite SHPT multiple medical treatments, suggesting poor adherence (n = 73); 3/ elderly patients with few cardiovascular comorbidities, controlled phospho-calcium balance, higher PTH, and few treatments (n = 75); 4/ patients who initiated cinacalcet (n = 43). The quality criterion of the model had a cut-off of 14 (>2), suggesting a relevant classification. Conclusion In real life, dialysis patients with newly diagnosed SHPT constitute a very heterogeneous population. A “one-size-fits-all” target approach is probably not appropriate. Therapeutic management needs to be adjusted to the 4 different phenotypes.
    Full-text · Article · Aug 2014
    • "Eine schottische Studie beschrieb bei 2097 Patienten mit unbehandeltem pHPT das erhöhte Parathormon als wichtigsten Risikofaktor für das Auftreten und die Mortalität kardiovaskulärer Erkrankun- gen [6]. Häufig berichten die Betroffenen auch über neurokognitive und psychische Symp tome wie Müdigkeit, Konzentrationsstörungen , Stimmungsschwankungen und Depressivität [7, 8] . In einer deutschen Multicenterstudie konnte unsere eigene Arbeitsgruppe [9] bei Patienten mit einem pHPT im Vergleich zu einer Kontrollgruppe von Patienten mit euthy reoten Knotenstrumen eine deutlich reduzierte Lebensqualität und vermehrt depressive Symptome nachweisen, die sich postoperativ signifikant zurückbil- deten. "
    [Show abstract] [Hide abstract] ABSTRACT: In primary hyperparathyroidism (pHPT) preoperative localization of parathyroid adenomas enables focussed unilateral parathyroidectomy. Ultrasound and sestamibi scintigraphy are the recommended standard procedures for primary diagnostics of pHPT and C-11 methionine positron emission tomography computed tomography (Met-PET/CT) is the latest technique for localization of hyperfunctioning parathyroid glands. This review presents the results of Met-PET/CT on the basis of a selective literature search using the keywords "primary hyperparathyroidism and methionine", "primary hyperparathyroidism and PET", "parathyroid adenomas and methionine" and "parathyroid adenomas and PET". Localization of single gland adenomas can be achieved with Met-PET/CT in 79-91 % of cases. The advantages of this procedure are a high sensitivity even in operations for recurrencies or concomitant thyroid nodules and an accurate detection even with atypical localizations. In multiglandular disease a localization of more than one hyperfunctioning gland remains difficult. Potential limitations of the method include the restricted availability and the relatively high costs of Met-PET/CT. Using Met-PET/CT hyperfunctioning parathyroid glands can be exactly localized in most patients with pHPT. Indications for this procedure are mostly when preoperative standard tests are negative and in parathyroid surgery for recurrencies.
    Full-text · Article · Mar 2014
    • "This questionnaire has not been validated as a research tool and was not tested on the normal population. However, the Wve questions related to " tiring easily, " forgetfulness, " " depression, " " irritability, " and " general health " are identical to those used by Pasieka et al. [6, 14], and the other three questions dealing with " decreased concentration, " " uneasiness, " and " sleeplessness " are all easily understandable neuropsychological symptoms. To ensure that all patients understood the questions, the meaning of each question was thoroughly explained to the patient prior to surgery; however, 1 year postoperatively, the questionnaires were simply sent by mail to the patients with no further explanations. "
    [Show abstract] [Hide abstract] ABSTRACT: Primary hyperparathyroidism (PHPT) is known to cause diverse subjective symptoms, in addition to those related to osteitis fibrosa cystica and kidney stones. The treatment of the disease ameliorates the subjective symptoms and improves the patients' quality of life. In this prospective study, patients undergoing surgery for incidentally detected, mild, asymptomatic PHPT were assessed to determine whether subjective neuropsychological symptoms are improved even in patients with "asymptomatic" PHPT. From October 1995 to March 2004, 25 patients who had one or more neuropsychological symptoms preoperatively and were followed up 1 year after parathyroidectomy were enrolled. The subjective symptoms were identified using questionnaires distributed to patients; eight questions were used to determine the presence or absence of psychoneurological symptoms. Compared to their preoperative status, patients responded that their general health perceptions 1 year after surgery were improved (13 cases, 52%), unchanged (11 cases, 44%), or aggravated (1 case, 4%). There were no statistically significant differences in the patients' responses before and after surgery with respect to individual neuropsychological symptoms, such as "tiring easily, "forgetfulness," "decreased concentration," "depression," "irritability," "uneasiness," and "sleeplessness." Therefore, subjective neuropsychological symptoms did not improve in otherwise asymptomatic PHPT patients following parathyroidectomy. However, patients' questionnaire responses may not reflect their actual status as accurately as laboratory examination results. Overall, 52% of patients were subjectively satisfied with surgery; this may result from patients' expectations of treatment.
    Full-text · Article · Jun 2008
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