To determine whether a symptomatic presentation was associated with parathyroid hyperplasia, we retrospectively examined pre-operative symptom profiles of patients who underwent parathyroidectomy.
From October 2007 to July 2008, 111 patients with primary hyperparathyroidism completed a preoperative symptom questionnaire prior to parathyroidectomy. The symptom profiles of patients with and without hyperplasia were compared.
Neurocognitive symptoms occurred in 51.4% of patients. Patients with 1 neurocognitive symptom had a 25% risk of parathyroid hyperplasia. Additional neurocognitive symptoms increased the risk of hyperplasia linearly, with hyperplasia occurring in 38% of patients reporting 2 neurocognitive symptoms (P < .001) and 61% of patients reporting 3 or more of these symptoms (P < .001). A negative sestamibi scan was associated with a 33% risk of hyperplasia. Coupled with at least 1 neurocognitive symptom, the risk of hyperplasia was 53.3% (P < .001). Of patients with 3 or more neurocognitive symptoms and a negative localizing scan, 100% were found to have parathyroid hyperplasia (P < .001).
The presence of neurocognitive dysfunction in a patient with hyperparathyroidism may be used as a predictor of hyperplastic disease. Three or more of these symptoms, coupled with a negative sestamibi scan, was 100% predictive of parathyroid hyperplasia in our cohort.
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
- Primary hyperparathyroidism.Oncologist. 2007; 12: 644-653
- A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable?.Ann Surg. 2005; 242: 375-383
- A prospective evaluation of preoperative localization by technetium-99 m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism.Am J Surg. 2007; 193: 155-159
- What is the link between nonlocalizing sestamibi scans, multigland disease, and persistent hypercalcemia? A study of 401 consecutive patients undergoing parathyroidectomy.Surgery. 2006; 140: 418-422
- Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: A simple and accurate scoring model.Arch Surg. 2006; 141 (777,82)
- Dual-phase 99mTc-sestamibi imaging: its utility in parathyroid hyperplasia and use of immediate/delayed image ratios to improve diagnosis of hyperparathyroidism.J Nucl Med Technol. 2002; 30: 179-184
- Mandarim de Lacerda CA, Boasquevisque E. Parathyroid glands: combination of sestamibi-(99 m)tc scintigraphy and ultrasonography for demonstration of hyperplasic parathyroid glands.Rev Esp Med Nucl. 2008; 27: 8-12
- The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible?.Ann Surg Oncol. 2007; 14: 2363-2366
- Psychiatric and cognitive aspects of primary hyperparathyroidism.Curr Opin Oncol. 2007; 19: 1-5
- Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism.Surgery. 2005; 138: 1121-1129
- Improvement of sleep disturbance and neurocognitive function after parathyroidectomy in patients with primary hyperparathyroidism.Endocr Pract. 2007; 13: 338-344
- Effect of parathyroidectomy on quality of life and neuropsychological symptoms in primary hyperparathyroidism.World J Surg. 2007; 31: 1202-1209
- Surgery for hyperparathyroidism in image-negative patients.Arch Surg. 2008; 143: 335-337
- Factors contributing to negative parathyroid localization: an analysis of 1000 patients.Surgery. 2008; 144: 74-79
- Neuropsychiatric and cognitive changes after surgery for primary hyperparathyroidism.World J Surg. 2006; 30: 680-685
- Intraoperative PTH monitoring in parathyroid hyperplasia requires stricter criteria for success.Surgery. 2004; 136: 1154-1159
- The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing.Ann Surg. 2007; 245: 959-963
- Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies.Surgery. 2008; 144: 299-306
Accepted: September 17, 2009
Presented at the American Association of Endocrine Surgeons Meeting.
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.