Advertisement
Surgery
Advanced searchSave search
Research Article| Volume 116, ISSUE 6, P991-998, December 1994

Persistent and recurrent sporadic primary hyperparathyroidism: Histopathology, complications, and results of reoperation

DOI:https://doi.org/10.5555/uri:pii:0039606094902941
Persistent and recurrent sporadic primary hyperparathyroidism: Histopathology, complications, and results of reoperation
Previous ArticleLocalization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism
Next ArticleThoracoscopic excision of enlarged mediastinal parathyroid glands
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Background. Our purpose was to analyze the causes of persistent and recurrent sporadic primary hyperparathyroidism (PD and RD).
      Methods. The histopathology, complications, and results of reoperation were studied. Five hundred sixty-eight patients with primary hyperparathyroidism were operated on initially by one surgeon and underwent follow-up examination for 3.7 ± 3.8 years. During the operation, all parathyroids were sought and confirmed by biopsy. Enlarged glands were resected, and subtotal parathyroidectomy was done for multiglandular disease (hyperplasia).
      Results. The cure rate after the initial surgical procedure was 96.4%, PD = 2.8% (16 of 568). At reoperation (10 of 16), nine of 10 were cured (90%) (two adenomas, six hyperplasias, one lung carcinoma). RD was documented (at 4, 4, 10, 15, 16) in five (0.9%) patients, one with parathyroid carcinoma and four with hyperplasia. Thirty-five patients with PD and two patients with RD were referred for reoperation: 17 with adenomas (eight mediastinal) and 18 with hyperplasias (one mediastinal gland). Preoperative calcium level was higher for PD (12.57 mg/dl) and RD (13.89 mg/dl) versus all cases (12.19 mg/dl) (p < 0.03 and p < 0.0005, respectively). After reoperation, normocalcemia was achieved in 47 (92.%) of 51 patients with PD or RD. Transient hypocalcemia occurred in 22% of patients (permanent, 2.0%) and transient hoarseness in 2.0% of patients (no permanent nerve damage). Permanent hypocalcemia and nerve damage after 568 initial operations were 0% and 0%, respectively. Two perioperative deaths occurred.
      Conclusions. We conclude that inadequate neck exploration or resection of hyperplastic tissue accounts for most cases of PD and RD. Optimal results necessitate intraoperative identification of all parathyroids whenever possible, with minimal morbidity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • McGarity W.C.
        • Mathews W.H.
        • Fulenwider T.
        • Isaacs J.W.
        • Miller D.A.
        The surgical management of primary hyperparathyroidism.
        Ann Surg. 1981; 193: 794-804
        • Van Heerden J.
        • Grant C.
        Surgical treatment of primary hyperparathyroidism: an institutional perspective.
        World J Surg. 1991; 15: 688-692
        • Kaplan E.L.
        • Yashiro T.
        • Salti G.
        Primary hyperparathyroidism in the 1990s.
        Ann Surg. 1991; 215: 300-317
        • Rudberg C.
        • Akerstrom G.
        • Palmer M.
        • Ljunghall S.
        • Adami H.O.
        • Johansson H.
        • Grimelius L.
        • Thoren L.
        • Bergstrom R.
        Late results of operation for primary hyperparathyroidism in 441 patients.
        Surgery. 1986; 99: 643-651
        • Bonjer H.J.
        • Bruining H.A.
        • Birkenhager J.C.
        • Nishiyama R.H.
        • Jones M.A.
        • Bagwell C.B.
        Single and multigland disease in primary hyperparathyroidism: clinical follow-up, histopathology, and flow cytometric DNA analysis.
        World J Surg. 1992; 16: 737-744
        • Russell C.F.
        • Edis A.J.
        Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient.
        Br J Surg. 1982; 69: 244-247
        • Uden P.
        • Chan A.
        • Duh Q.
        • Siperstein A.
        • Clark O.
        Primary hyperparathyroidism in younger and older patients: symptoms and outcome of surgery.
        World J Surg. 1992; 16: 791-798
        • Clark O.H.
        • Wilkes W.
        • Siperstein A.E.
        • Duh Q.Y.
        Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy, and deficiencies in our knowledge.
        J Bone Miner Res. 1991; 6: 135-142
        • McGarity W.C.
        • Goldman A.L.
        Reoperation for primary hyperparathyroidism.
        Ann Surg. 1981; 194: 134-139
        • Levin K.E.
        • Clark O.H.
        The reasons for failure in parathyroid operations.
        Arch Surg. 1989; 124: 911-915
        • Cheung P.
        • Borgstom A.
        • Thompson N.
        Strategy in reoperative surgery for hyperparathyroidism.
        Arch Surg. 1989; 124: 676-680
        • Wang C.A.
        Parathyroid re-exploration.
        Ann Surg. 1977; 186: 140-145
        • Grant C.S.
        • van Heerden J.A.
        • Charboneau W.
        • James E.M.
        • Reading C.C.
        Clinical management of persistent and/or recurrent primary hyperparathyroidism.
        World J Surg. 1986; 10: 555-565
        • McGarity W.C.
        • McKeown P.P.
        • Sewell C.W.
        The role of routine biopsy of all parathyroid glands in primary hyperparathyroidism.
        Am Surg. 1985; 51: 8-14
        • Weber C.J.
        • Vansant J.
        • Alazraki N.
        • Christy J.
        • Watts N.
        • Phillips L.
        • Mansour K.
        • Sewell C.W.
        • McGarity W.C.
        Value of technetium 99m sestamibi iodine 123 imaging in reoperative parathyroid surgery.
        Surgery. 1993; 114: 1011-1018
        • McGarity W.C.
        • Bostwick J.
        Technique of parathyroidectomy.
        Am Surg. 1976; 42: 657-663
        • Carty S.E.
        • Norton J.A.
        Management of patients with persistent or recurrent primary hyperparathyroidism.
        World J Surg. 1991; 15: 716-723
        • Block M.A.
        • Frame B.
        • Kleerekoper M.
        • Rao D.S.
        Surgical management of persistence or recurrence after subtotal parathyroidectomy for primary hyperparathyroidism.
        Am J Surg. 1979; 138: 561-566
        • Goretzki P.E.
        • Dotzenrath C.
        • Roeher H.D.
        Management of primary hyperparathyroidism caused by multiple gland disease.
        World J Surg. 1991; 15: 693-697
        • Brennan M.
        • Doppman J.
        • Marx S.
        • Spiegel A.
        • Brown E.
        • Aurbach G.
        Reoperative parathyroid surgery for persistent hyperparathyroidism.
        Surgery. 1978; 83: 669-676
        • Wallfelt C.
        • Ljunghall S.
        • Bergstrom R.
        • Rastad J.
        • Akerstrom G.
        Clinical characteristics and surgical treatment of sporadic primary hyperparathyroidism with emphasis on chief cell hyperplasia.
        Surgery. 1990; 107: 13-19
        • Lafferty F.W.
        • Hubay C.A.
        Primary hyperparathyroidism: a review of the long-term surgical and nonsurgical morbidities as a basis for a rational approach to treatment.
        Arch Intern Med. 1989; 149: 789-796

      Article info

      Footnotes

      ☆Presented at the Fifteenth Annual Meeting of the American Association of Endocrine Surgeons, Dearborn, Mich., April 17–19, 1994.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:0039606094902941

      Copyright

      © 1994 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX