2003, Number 5
<< Back Next >>
Cir Cir 2003; 71 (5)
Primary hyperparathyroidism: A report of 67 cases.The experience of 5 years at the IMSS Centro Médico Nacional Siglo XXI Specialties Hospital
Mendoza-Zubieta V, Zamudio-Villarreal JF, Peña-García JF, Marín-Méndez A, Martínez-Martínez L, Mercado-Atri M
Language: Spanish
References: 25
Page: 363-368
PDF size: 60.23 Kb.
ABSTRACT
Introduction: Primary hyperparathyroidism (PHPT) is a frequent disease.
It is characterized by hypercalcemia and elevation of parathyroid hormone
(PTH) levels. The incidence is variable, being more frequent in women
(3:1) in the perimenopauseal period. In the last decades, diagnosis of
asymptomatic PHPT has increased due to automatized calcium determinations.
Duration of the disease and serum concentrations of calcium and PTH
determine symptomatology.
Surgery is the definitive treatment. It is important to assess surgical
criteria in asymptomatic patients. Successful treatment of this disease
depends on a highly specialized team of parathyroid surgeons.
Material and methods: We reviewed the clinical and biochemical background
of patients subjected to parathyroidectomy from January 1998 to August
2003 in our medical center. We then analyzed clinical and laboratory data,
final histopathologic diagnosis, and surgery outcome.
Results: Sixty seven patients were included, with an average age of 50 years
(± 11.9), 15 men and 52 women. Greatest frequency of PHPT was observed in
patients between 40 and 60 years of age. Average calcium value was 11.7
mg/dl (± 1.23) and that of PTH was 194.5 pg/ml (± 93). Histopathologic
diagnosis was adenoma in 56 (83.58%), hyperplasia in 9 (13.43%), and
carcinoma in 2 (2.9%) patients. Cure of the disease was achieved in 65
patients (97%).
PHPT is a surgically curable disease; it is necessary to confirm diagnosis
and decide on surgical treatment in accordance with established criteria
even if the disease is asymptomatic.
REFERENCES
Bilezikian JP, Potts JT, Fuleihan EH, et al. Summary statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: a Perspective for the 21st Century. J Clin Endocrinol Metab 2002;87:5353-61.
Heath H III, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: Incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980;302:189-93.
Heath H. Primary hyperparathyroidism: recent advances in pathogenesis, diagnosis, and management. Ann Intern Med 1991;37:275-293.
Sosa JA, Powe NR, Levine MA, Undelsman R, Zeiger MA. Thresholds for Surgery and Surgical Outcomes for Patients with Primary Hyperparathyrodism: A National Survey of Endocrine Surgeons. J Clin Endocrinol Metab 1998;83:2658-65.
Eigelberger MS, Clark OH. Surgical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am 2000;29:479-503.
Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999;341:1249-55.
Potts JT Jr, Fradkin JE, Aurbach GD, Bilezikian JP, Raisz LG, editors. Proceedings of the NIH Consensus Development Conference on Diagnosis and Management of Asymptomatic Primary Hyperparathyroidism, Bethesda, MD, USA, October 29-31, 1990. J Bone Miner Res 1991;6(Suppl 2):S1-166.
Chan AK, Duh QY, Katz MH, Siperstein AE, Clark OH. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy: a case-control study. Ann Surg 1995;222:402-414.
Silverberg S. Natural history of primary hyperparathyroidism. Endocrinol Metab Clin North Am 2000;29:451-64.
Borley NR, Collins REC, O’Doherty M, et al. Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration. Br J Surg 1996;83:989.
Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism in dependent solely upon the surgeons choice of operative procedure. J Am Coll Surg 1998;186:293-305.
Marx SJ. Hyperparathyroidism and hypoparathyroidism disorders. N Engl J Med 2000;343:1863-75.
Reeve TS, Babidge WJ, Parkyn RF, Edis AJ, et al. Minimally invasive surgery for primary hyperparathyroidism: a systematic review. Aust NZ J Surg 2000;70:244-50.
Irvin GL III, Sfakianakis G, Yeung L, et al. Ambulatory parathyroidectomy for primary hyperparathyroidismp. Arch Surg 1996;131:1074-78.
Halabe JC, Lifshitz AG. Valoración perioperatoria integral en el adulto. 3rd ed. Uteha Noriega Eds. Limusa SA de CV. 2002.pp.77-86.
Carrol MF, Schade DS. A practical approach to hypercalcemia.
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359:1929.
Stewart AF. Nonparathyroid hypercalcemia. In: Becker KL, editor Principles and practice of endocrinology and metabolism. 3rd ed. Philadelphia, PA, USA: Lippincott Williams & Wilkins, 2001.pp.574-86.
Silverberg SJ, Bilesikian JP. Primary hyperparathyroidism. In: Becker KL, editor. Principles and practice of endocrinology and metabolism. 3rd ed. Philadelphia, Lippincott Williams & Wilkins, 2001.pp.564-74.
Parks J, Coer F, Favus M. Hyperparathyroidism in nephrolithiasis. Arch Intern Med 1980;140:1479.
Mendoza V, Hernández A, Márquez ML, Delgadillo M, Peña J, Mercado M. Primary hyperparathyroidism due to parathyroid carcinoma. Arch Med Res 1997;28:303-306.
Schantz A, Castleman B. Parathyroid carcinoma: a study of 70 cases. Cancer 1973;31:600-5.
Bergenfelz A, Lndblom P, Tibblin S, et al. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 2002;236:543-51.
Lafferty FW, Hubay CA. Hyperparathyroidism: a review of the long-term surgical and nonsurgical morbidity as a basis for rational approach to treatment. Arch Intern Med 1989;149:789.
Van Heerden JA, Grand CS. Surgical treatment of primary hyperparathyroidism: an institutional perspective. World J Surg 1991;15:688.