Background
To determine whether a symptomatic presentation was associated with parathyroid hyperplasia,
we retrospectively examined pre-operative symptom profiles of patients who underwent
parathyroidectomy.
Methods
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.
Results
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).
Conclusion
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.
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Article info
Publication history
Accepted:
September 17,
2009
Footnotes
Presented at the American Association of Endocrine Surgeons Meeting.
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
