Background
We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma
to evaluate and compare our current results and outcomes to our previous experience.
Methods
From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after
failed operation underwent reoperation. Patients were re-explored with the assistance
of non-invasive and sometimes invasive imaging.
Results
A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted
in long-term resolution of hypercalcemia in 92%. Adenomas were in entopic locations
in 32%; the most frequent ectopic location was the thymus (20%). Sestamibi scanning
and ultrasonography were the most successful non-invasive imaging studies (96% positive
predictive value (PPV) and 84% PPV respectively). Forty-four percent of patients had
a reoperation based solely on non-invasive imaging. Of the invasive procedures performed,
arteriography resulted in the best localization (92% PPV). Permanent recurrent laryngeal
nerve injury occurred in 1.8%.
Conclusion
Compared to our prior experience (1982–1995), outcomes remained similar (92% resolution
of hypercalcemia and 1.8% recurrent nerve injury currently versus 96% and 1.3% previously).
Fewer patients received invasive studies for pre-operative localization (56% vs 73%,
respectively). The decreased use of invasive imaging is due to technical improvements
and greater confidence in the combination of ultrasonography and sestamibi scanning.
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Article info
Publication history
Accepted:
September 17,
2009
Footnotes
Supported by the intramural NIH programs of NCI and NIDDK.
Identification
Copyright
Published by Elsevier Inc.
