EFFECTS OF PREOPERATIVE FINDINGS ON POSTOPERATIVE RESULTS IN PATIENTS UNDERGOING SURGERY FOR PRIMARY HYPERPARATHYROIDISM

Year 2023, Volume: 30 Issue: 1, 97 - 105, 14.03.2023

İsmail Hasırcı , Çetin Kotan

https://doi.org/10.17343/sdutfd.1229962

Abstract

Objective
To investigate the success of imaging methods and
the effect of preoperative findings on postoperative
results in patients who underwent surgery for primary
hyperparathyroidism (p-HPT).
Material and Method
In this study, the data of 50 consecutive patients who
underwent p-HPT surgery at the General Surgery
Clinic of Yuzuncu Yil University Faculty of Medicine
between January 2008 and December 2010 were
prospectively analyzed. During the study period,
the patients’ demographic data, clinical findings,
preoperative and postoperative laboratory results,
findings of ultrasonography, scintigraphy, and
computed tomography performed for localization in
the preoperative period, and surgery and pathology
reports were evaluated and recorded. The obtained
data were statistically analyzed.
Results
Musculoskeletal pain was the most common (80%)
reason for the patients’ presentation to the hospital.
In the operated patients, the serum parathormone
and calcium levels significantly decreased compared
to the preoperative period (p<0.05). The rate of
patients who underwent bilateral neck dissection
was 30%. In the histopathological examination of the
glands, adenoma lesions were detected in 88% of the
patients, and the rate of those with a pathology result
of parathyroid hyperplasia was 12%. In addition,
4% of the patients had ectopic pathological glands
(retroesophageal, anterior mediastinum), and 4% had
double adenomas. The sensitivity of ultrasonography
in detecting pathological glands was calculated as
72%. However, ultrasonography did not accurately
localize all ectopic (4%) and double adenoma (4%)
lesions. The postoperative calcium values were similar
between the patients that underwent simultaneous
thyroidectomy and those that did not undergo this
operation, but the parathormone values measured on
the second postoperative day were significantly lower
in the former.
Conclusion
Although ultrasonography has a high diagnostic
value, it can cause mislocalization in the presence
of multiple lesions with atypical localization. The risk
of postoperative hypocalcemia increases as surgical
exploration increases.

Keywords

Endocrine surgery, Parathyroid adenoma, Hyperparathyroidism

PRİMER HİPERPARATİROİDİ CERRAHİSİ GEÇİREN HASTALARDA PREOPERATİF VE PEROPERATİF PARAMETRELERİN KARŞILAŞTIRILMASI, PREOPERATİF PARAMETRELERİN POSTOPERATİF SEYRİ ÜZERİNE ETKİSİ

Abstract

Amaç
Çalışmamızda, primer hiperparatiroidi (p-HPT) nedeni
ile opere edilen hastalarda görüntüleme yöntemlerinin
başarısı ve preoperatif bulguların postoperatif
sonuçlara etkisi araştırıldı.
Gereç ve Yöntem
Bu çalışmada Ocak 2008 ile Aralık 2010 tarihleri arasında
Yüzüncü Yıl Üniversitesi Tıp Fakültesi Genel
Cerrahi kliniği tarafından p-HPT nedeni ile opere edilen
50 ardışık olgunun verileri prospektif olarak incelendi.
Çalışma süresi boyunca hastaların demografik
verileri, klinik bulguları, ameliyat öncesi ve sonrası
laboratuvar sonuçları, ameliyat öncesi dönemde lokalizasyon
amacıyla yapılan ultrasonografi (USG),
sintigrafi ve bilgisayarlı tomografi (BT) bulguları, ameliyat
ve patoloji raporları incelendi ve kaydedildi. Elde
edilen veriler istatistiksel olarak analiz edildi.
Bulgular
Kas iskelet sistemi ağrılarının en sık (%80) hastaneye
başvuru nedeni olduğu görüldü. Opere edilen hastalarda
ameliyat sonrası serum parathormon (PTH) ve
kalsiyum seviyelerinin ameliyat öncesi döneme göre
anlamlı oranda düştüğü tespit edildi (p<0.05). İki taraflı
boyun diseksiyonu yapılan hastaların oranı %30
idi. Bezlerin histopatolojik incelemesinde hastaların %
88’inde adenom tespit edilirken paratiroid hiperplazisi
olarak rapor edilenlerin oranı ise % 12 idi. Ayrıca
hastaların % 4’ünde patolojik bezler ektopik yerleşimli
(retroözofagial, ön mediasten) iken, % 4 hastada ise
çift adenom mevcut idi. USG’nin patolojik bezleri tespit
etmedeki sensitivitesi %72 olarak hesaplandı. Bununla
birlikte USG’nin ektopik yerleşimli (%4) ve çift
adenom (%4) olan lezyonların tamamında doğru lokalizasyon
yapamadığı görüldü. Eş zamanlı tiroidektomi
yapılan hastalarda, ameliyat sonrası kalsiyum değerleri
tiroidektomi yapılmayanlara benzerken 2. gün
PTH değeri daha düşük bulunmuştur.
Sonuç
Ultrasonografi yüksek tanısal değere sahip olmakla
birlikte atipik yerleşimli, multipl lezyonlarda yanlış lokalizasyona
sebep olabilmektedir. Cerrahi eksplorasyon
arttıkça postop hipokalsemi riski artmaktadır.

Keywords

Endokrin cerrahi, Paratiroid adenomu, Hiperparatiroidi.

References

• 1. Silverberg SJ BJ. The Parathyroids: Basic and Clinical Concepts. Orlando, ABD; 2001. 349–60.
• 2. Uruno T, Kebebew E. How to localize parathyroid tumors in primary hyperparathyroidism? J Endocrinol Invest. 2006; 29(9):840-7.
• 3. Wells SA, Debendetti MK DG. Recurrent or persistent hyperparathyroidism. J Bone Min Res. 2002;158–62.
• 4. Rodriquez JM, Tezelman S, Siperstein AE, Duh QY, Higgins C, Morita E, Dowd CF CO. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg. 1994, 129(8):870-5.
• 5. Mitchell BK, Kinder BK, Merrell RC. Localization Studies in Patients with Hyperparathyroidism. Surg Clin North Am. 1995; 75(3):483–98.
• 6. Mariani G1, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, Manca G, Casara D, Sotti G, Erba P, Volterrani D GA. Preoperative localization and radioguided parathyroid surgery. J Nucl Med. 1995;1443–58.
• 7. Frasoldati A, Valcavi R. Challenges in neck ultrasonography: Lymphadenopathy and parathyroid glands. Endocrine Practice. 2004, 10(3):261-8.
• 8. Scheiner JD, Dupuy DE, Monchik JM, Noto RB, Cronan JJ. Pre-operative localization of parathyroid adenomas: A comparison of power and colour Doppler ultrasonography with nuclear medicine scintigraphy. Clin Radiol. 2001; 56(12):984-8.
• 9. Ohe MN, Santos RO, Barros ER, Lage A, Kunii IS, Abrahão M, et al. Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002. Brazilian J Med Biol Res. 2005; 38(9):1383–7.
• 10. Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ. Primary hyperparathyroidism: New concepts in clinical, densitometric and biochemical features. Journal of Internal Medicine. 2005, 257(1):6-17.
• 11. Sywak MS, Knowlton ST, Pasieka JL, Parsons LL, Jones J. Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism? Surgery, 2002; 132(6): 1013–20.
• 12. Suliburk JW, Perrier ND. Primary hyperparathyroidism. Oncologist. 2007 Jun;12(6):644-53.
• 13. Silverberg SJ BJ. Principles and Practice of Endocrinology and Metabolism Primary hyperparathyroidism. Philadelphia: Lippincott Willliams & Wilkins; 2001. 564–573 p.
• 14. Bussey AD, Bruder JM. Urinary calcium excretion in primary hyperparathyroidism: Relationship to 25-hydroxyvitamin d status. Endocr Pract. 2005 Jan;11(1):37–42.
• 15. Livolsi VA. Parathyroids IN: Bilezikian JP, Marcus R LM (Eds). The Parathyroids Basic and Clinical Concepts Orlando: Acad Press; 2001;4–10.
• 16. Denham DW, Norman J. Cost-effectiveness of preoperative sestamibi scan for primary hyperparathyroidism is dependent solely upon the surgeon’s choice of operative procedure. J Am Coll Surg. 1998; 186(3):293-305.
• 17. Tziakouri C, Eracleous E, Skannavis S, Pierides A, Symeonides P, Gourtsoyiannis N. Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism. Acta radiol. 1996 May;37(3P2):720–6.
• 18. Gofrit ON, Lebensart PD, Pikarsky A, Lackstein D, Gross DJ, Shiloni E. High-resolution ultrasonography: Highly sensitive, specific technique for preoperative localization of parathyroid adenoma in the absence of multinodular thyroid disease. World J Surg. 1997; 21(3):287-91
• 19. Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, et al. Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism. World Journal of Surgery. 1996. 20(7):835-40
• 20. Mazzeo S, Caramella D, Lencioni R, Molea N, De Liperi A, Marcocci C, et al. Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. Am J Roentgenol. 1996; 166(6):1465-70.
• 21. De Feo ML, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, et al. Parathyroid glands: Combination of 99mTc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology. 2000; 214(2):393-402.
• 22. Brennan MF, Doppman JL, Kurdy AG, Marx SJ, Spiegel AM, Aurbach GD. Assessment of techniques for preoperative parathyroid gland localization in patients undergoing reoperation for hyperparathyroidism. Surgery. 1982; 91(1):6-11.
• 23. Lo CY, van Heerden JA P reoperations. Textbook of Endocrine Surgery. Philadelphia: Saunders; 2005. 418–525
• 24. Gaz RD. Surgery of the Thyroid and Parathyroid Glands. Philadelphia: Saunders; 2003. 564–570
• 25. De Beur SMJ, Streeten EA LM. Principles and Practice of Endocrinology and Metabolism. Philadelphia: Lippincott Williams&Wilkins; 2001. 586–602 p.
• 26. Pavlov A V. Regeneration of the parathyroid glands after partial resection. Arkh Anat Gistol Embriol. 1986; 77-80.
• 27. Parfitt AM. Parathyroid growth: The Parathyroids: Basic and Clinical Concepts. NewYork: Raven Press; 1994. 373–405 p.
• 28. Mallette LE, Bilezikian JP, Heath DA AG. Manual of Endocrine Surgery. 1974. 127–146 p.
• 29. Rao SD, Honasoge MD, Divine GW, Phillips ER, Lee MW, Ansari MR, Talpos GB PA. Effect of vitamin D nutrition on parathyroid adenoma weight: Pathogenetic and clinical implications. J Clin Endocrinol Metab. 2000; 85(3), 1054–8.
• 30. Kösem M, Algün E, Kotan Ç, Harman M, Öztürk M. Coexistent thyroid pathologies and high rate of papillary cancer in patients with primary hyperparathyroidism: Controversies about minimal invasive parathyroid surgery. Acta Chir Belg. 2004; 104(5):568-71
• 31. Gul K, Ozdemir D, Korukluoglu B, Ersoy PE, Aydin R, Ugras SN, et al. Preoperative and postoperative evaluation of thyroid disease in patients undergoing surgical treatment of primary hyperparathyroidism. Endocr Pract. 2010; 16(1):7-13.
• 32. Monroe DP, Edeiken-Monroe BS, Lee JE, Evans DB, Perrier ND. Impact of preoperative thyroid ultrasonography on the surgical management of primary hyperparathyroidism. Br J Surg. 2008; 95(8):957-60.