Granados CE, Servín TE, Piscil SMA, Velázquez GJA, Serrano GI, Granados CR, Benítez TFP

Language: Spanish
References: 21
Page: 249-253
PDF size: 71.13 Kb.

ABSTRACT

Objective: To present the surgical experience in the treatment of primary hyperparathyroidism.
Setting: Third level health care center (Specialty Hospital of the National Medical Center “La Raza”).
Design: Ambispective, observational, longitudinal, descriptive study.
Statistical analysis: Percentages as summary measure for qualitative variables.
Patients and Methods: The study was performed from January 2006 to December 2010 in the General Surgery Service of the Specialty Hospital of the Centro Médico Nacional “La Raza”, with a minimum follow up of one year. The clinical records were revised as well as evolution along time, assessing morbidity, mortality, recurrence or surgical success.
Results: A total of 119 patients were included with an average age of 51.8 years; 22 men and 97 women. The highest frequency of primary hyperparathyroidism was observed among patients aged from 40 to 69 years. Average serum calcium was 11.6 mg/dl at the time of diagnosis, and the mean parathyroid hormone value was of 274 pg/ml. Histopathological findings included 106 adenomas (89%) and 13 hyperplasias (10.9%). Cure was obtained with the first surgery in 113 (95%) patients with two acute complications (1.6%) and three chronic ones (2.5%); no mortality was recorded.
Conclusions: When determining recurrence of primary hyperparathyroidism according to surgical experience in this third level healthy care center and comparing with that reported in the worldwide literature, our result lie within the average. Determining recurrence is useful to detect its conditioning factors, aside from performing adequate preoperative study and patient selection.

REFERENCES

1. Body JJ. Primary hyperparathyroidism: diagnosis and management. Rev Med Brux 2012; 33: 263-267.

2. Odivina CV, Sackhaee K, Heller HJ, Peterson RD, Poindexter JR, Padalino PK, et al. Biochemical characterization of primary hyperparathyroidism with and without kidney stones. Urol Res 2007; 35: 123-128.

3. Miller BS, Dimick J, Wainess R, Burney RE. Age-and sex-related incidence of surgically treated primary hyperparathyroidism. World J Surg 2008; 32: 795-799.

4. Doria AS, Huang C, Makitie O, Thorner P, Kooh SW, Sochet E, et al. Neonatal, severe primary hyperparathyroidism: a 7-year clinical and radiological follow-up of one patient. Pediatr Radiol 2002; 32: 684-689.

5. Hsieh YY, Chang CC, Tsai HD, Yang TC, Chiu TH, Tsai CH. Primary hyperparathyroidism in pregnancy. Report of 3 cases. Arch Gynecol Obstet 1998; 261: 209-214.

6. Levy MT, Braun JT, Pennant M, Thompson LD. Primary paraganglioma of the parathyroid: a case report and clinicopathologic review. Head Neck Pathol 2010; 4: 37-43.

7. Mendoza Zubieta V, Ramírez Renteria C, González Villaseñor GA, Espinosa Barrones AE, Peña García JF, Hernández García I, et al. Hiperparatiroidismo primario. Experiencia en el Hospital de Especialidades Centro Médico Nacional Siglo XXI. Rev Endocrinol Nutr 2009; 17: 13-20.

8. Fernández del Castillo C, Villareal Villareal A, Dib Kuri A, Chávez-Peón F, de la Rosa Laris C. Tratamiento quirúrgico del hiperparatiroidismo primario. Experiencia en el Instituto Nacional de la Nutrición Salvador Zubirán. Rev Invest Clin 1986; 38: 279-286.

9. Delgadillo Teyer GH, Fenig Rodríguez J, González Romero F, Velázquez García JA, Serrano Galeana I, et al. Experiencia de 15 años en el tratamiento quirúrgico del hiperparatiroidismo. Cir Gen 2005; 27: 149-152.

10. Quesada Gómez JM. Diagnostic evaluation and differential diagnosis of primary hyperparathyroidism. Endocrinol Nutr 2009; 56: 14-19.

11. Cordellat IM. Hyperparathyroidism: primary or secondary disease? Reumatol Clin 2012; 8: 287-291.

12. Roka R, Pramhas M, Roka S. Primary hyperparathyroidism: is there a role for imaging? Eur J Nucl Med Mol Imaging 2004; 31: 1322-1324.

13. Rubello D, Massaro A, Cittadin S, Rampin L, Al-Nahhas A, Boni G, et al. Role of 99mTc sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery. Eur J Nucl Med Mol Imaging 2006; 33: 1091-1092.

14. Witteveen JE, Kievit J, Stokkel MP, Morreau H, Romijn JA, Hamdy NA. Limitations of Tc99m-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism. World J Surg 2011; 35: 128-139.

15. Harari A, Mitmaker E, Grogan R, Lee J, Shen W, Gosnell J, et al. Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs). Ann Surg Oncol 2011; 18: 1717-1722.

16. Hughes DT, Miller BS, Doherty GM, Gauger PG. Intraoperative parathyroid hormone monitoring in patients with recognized multiglandular primary hyperparathyroidism. Word J Surg 2011; 35: 336-341.

17. Morris LF, Zanocco K, Ituarte PH, Ro K, Duh QY, Sturgeon C, et al. The value of intraoperative parathyroid hormone monitoring in localized primary hyperparathyroidism: a cost analysis. Ann Surg Oncol 2010; 17: 679-685.

18. Alvarado R, Meyer-Rochow G, Sywak M, Delbridge L, Sidhu S. Bilateral internal jugular venous sampling for parathyroid hormone determination in patients with nonlocalizing primary hyperparathyroidism. World J Surg 2010; 34: 1299-1303.

19. Quiros RM, Pesce CE, Djuricin G, Prinz RA. Do intraoperative total serum and ionized calcium levels, like intraoperative intact PTH levels, correlate with cure of hyperparathyroidism. World J Surg 2005; 29: 486-490.

20. Prescott JD, Udelsman R. Remedial operation for primary hyperparathyroidism. Word J Surg 2009; 33: 2324-2334.

21. Aspinall SR, Boase S, Malycha P. Long-term symptom relief from primary hyperparathyroidism following minimally invasive parathyroidectomy. World J Surg 2010; 34: 2223-2227.