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Ultima Vez Modificado: 1 de febrero del 2002
UI - 11774396
AU - Ulanovski D; Feinmesser R; Cohen M; Sulkes J; Dudkiewicz M; Shpitzer T
TI - Preoperative evaluation of patients with parathyroid adenoma: role of high-resolution ultrasonography.
SO - Head Neck 2002 Jan;24(1):1-5
AD - Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel. Ulanovski@yahoo.com
BACKGROUND: Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. METHODS: One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. RESULTS: The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p =.2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4-55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p =.01) and parathyroid hormone level (p =.0001). CONCLUSIONS: In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach. Copyright 2002 John Wiley & Sons, Inc.
UI - 11796876
AU - Alfaro JJ; Lamas C; Estrada J; Lucas T
TI - MEN-2A syndrome and pulmonary metastasis.
SO - Postgrad Med J 2002 Jan;78(915):51-2
AD - Division of Endocrinology and Nutrition, Clinica Puerta de Hierro, Madrid, Spain. firstname.lastname@example.org
A case of multiple endocrine neoplasia syndrome type-2A (MEN-2A) with primary hyperparathyroidism and medullary carcinoma of thyroid initially treated by surgery is reported. The presence of pulmonary nodules six years after the initial treatment was thought to be related to metastasis of medullary carcinoma, and the increase in serum calcium concentrations was assumed to be caused by persistence of parathyroid adenomatous or hyperplastic tissue. The patient underwent surgery again and the pulmonary nodules were confirmed to be metastases of a parathyroid carcinoma, a very rare entity in MEN-2A syndrome.
UI - 11603567
AU - Yamashita K; Suzuki S; Yumita W; Ikeo Y; Uehara Y; Minemura K; Sakurai
TI - A; Hashizume K A case of familial isolated hyperparathyroidism with ectopic parathyroid cancer.
SO - Endocr J 2001 Aug;48(4):453-8
AD - Department of Aging Medicine and Geriatrics, Shinshu University School of Medicine, Matsumoto, Japan.
We report the kindred with familial isolated hyperparathyroidism with parathyroid cancer. The proband was diagnosed as having primary hyperparathyroidism at age 43. The same disorder was also found in his daughter who had low bone mass. His son was found to have primary hyperparathyroidism by family screening. The pathological diagnosis of the resected parathyroid in both father and daughter was parathyroid cancer, and that in son was parathyroid adenoma. The right lower gland of the proband and the left lower gland of the son were present in thymus. No mutations were found in the sequences of MEN1 gene, hence gene(s) other than MEN1 gene may have contributed to the malignant potency in our cases.
UI - 11711312
AU - Sun SS; Shiau YC; Lin CC; Kao A; Lee CC
TI - Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m MIBI parathyroid image findings.
SO - Nucl Med Biol 2001 Nov;28(8):929-33
AD - Department of Nuclear Medicine, China Medicine College Hospital, Taichung, Taiwan.
The major factor to influence localization of parathyroid adenomas is tumor size. P-glycoprotein (P-gp) expression in parathyroid adenomas has been considered to be an another possible factor to influence localization of parathyroid adenomas because false-negative studies have been reported with large tumors and true-positives reported with very small tumors in previous studies. The aim of this study was to characterize Tc-99m MIBI uptake and retention by parathyroid adenomas and to correlate this with cell surface expression of P-gp. Sixteen patients with parathyroid adenoma (larger than 1.5 gm) underwent dual-phase (10min and 2hr) Tc-99m MIBI parathyroid image immediately before parathyroid exploration. Tissues were obtained from normal and abnormal parathyroid glands and from the thyroid gland. Immunohistochemistry (IHC) was obtained with monoclonal antibodies to identify P-gp expression in all tissues. All of the 16 parathyroid adenomas and 32 normal control specimens (16 normal parathyroid and 16 normal thyroid specimens) were submitted for P-gp detection by IHC. The dual-phase Tc-99m MIBI parathyroid image accurately localized 14 parathyroid adenomas, but not the remaining 2 adenomas. The 14 parathyroid adenomas with significant Tc-99m MIBI uptake in delayed 2hr images revealed negative P-gp expression, but the 2 adenomas without significant Tc-99m MIBI uptake, as well as normal parathyroid and normal thyroid specimens, revealed positive P-gp expression when evaluated by IHC. Not only the size of parathyroid adenomas, but also significant P-gp expression limited the sensitivity of dual-phase Tc-99m MIBI parathyroid image to localize parathyroid adenomas before operation.
UI - 11795928
AU - Scheiner JD; Dupuy DE; Monchik JM; Noto RB; Cronan JJ
TI - Pre-operative localization of parathyroid adenomas: a comparison of power and colour Doppler ultrasonography with nuclear medicine scintigraphy.
SO - Clin Radiol 2001 Dec;56(12):984-8
AD - Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA. email@example.com
AIM: To compare power and colour Doppler ultrasonography (US) with nuclear medicine scintigraphy (NM) in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: Thirty-one patients with biochemical evidence of PHPT underwent pre-operative US and NM for parathyroid adenoma localization. Both studies were interpreted independently without prior knowledge of the other study's findings. All patients had surgical removal of the parathyroid adenoma utilizing standard neck exploration or minimally invasive unilateral surgical techniques with rapid serum assay of circulating parathyroid hormone levels. RESULTS: All patients had single parathyroid adenomas at surgery. Prospective sensitivities for US, NM and both studies combined were 65%, 68%, and 74%, respectively, with a positive predictive value of 100% each. The adenoma was localized by only one imaging modality in 16% of cases. CONCLUSIONS: US and NM provide complementary roles in the pre-operative localization of parathyroid adenomas in patients with PHPT.
UI - 11842966
AU - Lucas DG Jr; Lockett MA; Cole DJ
TI - Spontaneous infarction of a parathyroid adenoma: two case reports and review of the literature.
SO - Am Surg 2002 Feb;68(2):173-6
AD - Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
The spontaneous infarction of a parathyroid adenoma is an uncommon event, although it has been previously described. Patients may present symptomatically or experience resolution of their hyperparathyroidism. As such the appropriate clinical management of these patients remains unclear. We present two cases of spontaneous infarction of parathyroid adenomas. The first presented with neck pain and dysphagia and experienced at least temporary resolution of her hyperparathyroidism. The second patient experienced a fall in his parathyroid hormone and calcium levels before neck exploration. Infarcted parathyroid adenoma was diagnosed on pathologic evaluation of the surgical specimen. Inflammation surrounding the infarcted adenoma provided for a technically difficult operation. Although resolution of hyperparathyroidism has been described postinfarction, a regeneration of the parathyroid adenoma may occur. Therefore neck exploration and parathyroidectomy should still be considered. We propose a period of observation after diagnosis of spontaneous parathyroid adenoma infarction to avoid these acute inflammatory changes that have been described.
UI - 11585294
AU - Casara D; Rubello D; Pelizzo MR; Shapiro B
TI - Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism.
SO - Eur J Nucl Med 2001 Sep;28(9):1351-9
AD - Department of Radiotherapy, Regional Hospital of Padova, Italy. firstname.lastname@example.org
The main purposes of this study were: (a) to investigate the efficacy of an imaging protocol based on the combination of 99mTcO4/MIBI scintigraphy and neck ultrasound (US) in selecting patients with primary hyperparathyroidism (HPT) for unilateral neck exploration, and (b) to help define the role of the intraoperative MIBI gamma probe (IMGP) technique in the performance of minimally invasive radio-guided surgery (MIRS). One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified 99mTcO4/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid 99mTcO4 washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46 patients (93.5%) who were candidates for MIRS, the IMGP technique allowed parathyroidectomy to be performed through a small, 2- to 2.5-cm skin incision with a short duration of intervention (mean 34 min). We conclude that: (a) The integrated scan/US imaging protocol that we used appears to be accurate in selecting patients with primary HPT for unilateral neck exploration. (b) In our series the most prevalent cause of bilateral neck exploration was the co-existence of a nodular goitre; thus accurate preoperative evaluation of the thyroid gland by dual-tracer scintigraphy and US imaging is strongly recommended in all patients with HPT. (c) SPET can provide the surgeon with useful information when an EPG is located deep in the neck or mediastinum. (d) IMGP appears to be a useful intraoperative device in HPT patients with solitary parathyroid adenomas and a normal thyroid gland, since it permits minimally invasive and time-saving surgery.
UI - 11759885
AU - Ito Y; Iwase H; Tanaka H; Yuasa H; Kureyama Y; Yamashita H; Toyama T;
TI - Kimura M; Kobayashi S Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case.
SO - Surg Today 2001;31(10):895-8
AD - Department of Surgery, Toyokawa City Hospital, Toyokawa, Japan.
An extremely rare case of metachronous primary hyperparathyroidism (PHP) due to a parathyroid adenoma and subsequent carcinoma with local lymphatic spread is presented herein. A 55-year-old woman was operated on for a parathyroid adenoma in the right inferior gland. Thirteen years after the first operation, she was again hospitalized for hypercalcemia and the presence of a hard mass in the right anterior neck region. Exploratory surgery and a histological examination of the resected tumor provided evidence of a parathyroid neoplasm in the right superior gland but the malignancy was equivocal. Postoperatively, her serum parathyroid hormone (PTH) level remained at 1.5-fold the upper limit of the normal range, and hypercalcemia again gradually developed. The results of higher positive rates by Ki-67 immunohistochemical staining and an aneuploid pattern by a flow cytometric analysis of the second neoplasm were consistent with a histological diagnosis of carcinoma, and she therefore underwent further surgery. A radical neck dissection revealed two lymph node metastases which were both successfully removed. The postoperative serum PTH and calcium levels then returned to within the normal ranges. These findings indicate the usefulness of Ki-67 immunohistochemical staining and a flow cytometric analysis for differentiating malignant lesions from benign parathyroid lesions, and the importance of surgically treating cases limited to local regions without distant metastasis.
UI - 11766088
AU - Marchesi M; Biffoni M; Benedetti RN; Campana FP
TI - Incidental parathyroid adenomas with normocalcemia discovered during thyroid operations: report of three cases.
SO - Surg Today 2001;31(11):996-8
AD - Third Department of Surgery, University La Sapienza, Rome, Italy.
We report three cases of parathyroid adenoma incidentally discovered during a total thyroidectomy. No patients showed any clinical or chemical features that led us to suspect a hyperparathyroidism condition before operation, but a macroscopically enlarged parathyroid was discovered during the dissection and it was removed in all three cases. All patients had a single adenoma confirmed by a histological analysis. Calcemia decreased after operation in every case but only one patient needed temporary adjunctive therapy. No permanent hypoparathyroidism or recurrent hyperparathyroidism was observed. We recommend that any enlarged parathyroid discovered during neck surgery should thus be removed in order to avoid the risks of future surgical procedures due to successive bouts of clinical hyperparathyroidism.
UI - 11846729
AU - Gulkesen KH; Kilicarslan B; Altunbas HA; Karpuzoglu G
TI - EGFR and p53 expression and proliferative activity in parathyroid adenomas; an immunohistochemical study.
SO - APMIS 2001 Dec;109(12):870-4
AD - Akdeniz University, Pathology Department, Antalya, Turkey. email@example.com
EGFR (epidermal growth factor receptor), p53, and proliferative markers provide some clues as to the formation of several tumours. In this study the mechanism of the genesis of parathyroid adenomas was investigated using immunohistochemistry. Sections of parathyroid adenomas from 12 cases were stained using PCNA (proliferating cell nuclear antigen), EGFR, and p53 immunohistochemistry. Correlations between PCNA LI (labelling index), EGFR expression, p53 expression, age, serum parathormone, Ca and P levels, and tumour diameter were investigated. PCNA LI was 45.8+/-33.1 (mean+/-standard deviation) and all the cases were somewhat positive. Five cases (41.67 %) were EGFR positive. Maximum 10 % of the cells were positive in these cases. All the cases were p53 negative. There was a correlation between PCNA LI and serum parathormone level (r=0.607, p=0.036). According to these results, parathormone synthesis is high when the proliferative activity of parathyroid adenoma is high. Four of the five EGFR-positive patients were below 35 years of age. These data may indicate that formation of parathyroid adenoma in young patients is related to a mechanism involving EGFR. Absence of p53 expression suggests that p53 mutation is not a common component of parathyroid adenomas.
UI - 11848628
AU - Mozes G; Curlee KJ; Rowland CM; van H; Thompson GB; Grant CS; Farley DR
TI - The predictive value of laboratory findings in patients with primary hyperparathyroidism.
SO - J Am Coll Surg 2002 Feb;194(2):126-30
AD - Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
BACKGROUND: Despite extensive preoperative imaging and intraoperative "gadgetry" to facilitate localization of abnormal parathyroid glands, the onus of identification and resection remains with the surgeon in the operating room. We pondered the relative usefulness of routine laboratory studies to the surgeon as predictive guides to the intraoperative findings in patients with primary hyperparathyroidism (HPT). STUDY DESIGN: Pre- and postoperative laboratory data were analyzed in 166 consecutive patients (1998 to 1999) undergoing successful cervical exploration for sporadic primary HPT and were correlated with the pathologic findings. Patients with secondary HPT, multiple endocrine neoplasia, familial HPT, and parathyroid carcinoma were not included in this study. RESULTS: One hundred eighteen women and 48 men (mean age = 63 years) with parathyroid adenoma (n = 155) and sporadic hyperplasia (n = 11) were evaluated. Mean parathormone (PTH) levels varied little with the pathology: adenoma = 9.6 pmol/L and hyperplasia = 10.2 pmol/L (p > 0.05). In patients with parathyroid adenoma, analysis of preoperative measures showed a positive correlation (r = 0.48, p < 0.0001) with PTH and gland weight. The correlation appeared to be the strongest in the tails of the distribution; in 22 of 23 (96%) cases with PTH levels lower than 6 pmol/L, the offending lesion or lesions were less than 400 mg; in all six cases with PTH levels higher than 18.0 pmol/L, the abnormal gland or glands weighed more than 800 mg. PTH levels between 6 and 18 pmol/L revealed mean adenoma weight of 757 mg (median = 420 mg; range = 50 to 5,500 mg). CONCLUSIONS: Extreme values of PTH in patients with single-gland parathyroid disease alert the surgeon to the likelihood of small or large parathyroid adenomas. Laboratory studies do not differentiate adenoma from hyperplasia, nor do they pinpoint the size of abnormal glands with moderate-range PTH values.
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