Normocalcemic hyperparathyroidism: preoperatively a disease, postoperatively cured?

作者：Stuart Heather C; Harvey Adrian; Pasieka Janice L^*

来源：American Journal of Surgery, 2014, 207(5): 673-680.

DOI：10.1016/j.amjsurg.2014.01.005

• Parathyroidectomy
• Minimally invasive
• Postoperative hyperparathyroidism
• Normocalcemia

BACKGROUND: Up to 44% of primary hyperparathyroidism patients have elevated parathyroid hormone (ePTH) with normal calcium postparathyroidectomy (PTx). The question is whether the surgical approach affects the incidence of this phenomenon. %26lt;br%26gt;METHODS: Patients with hyperparathyroidism and presumed single-gland disease on preoperative imaging who underwent PTx between 1994 and 2008 were identified and contacted for long-term follow-up. PTx was either a focused approach (minimally invasive approach [MIP]) or a bilateral neck exploration (BNE). %26lt;br%26gt;RESULTS: In total, 171 patients had PTH measured postoperatively (95 MIP and 76 BNE); 30 of 171 (17%) had ePTH with normal calcium (MIP 21 [22%] and BNE 9 [12%], P 5.08). This occurred within 2 years in 48% and 67% and after 2 years in 52% and 33%, MIP vs BNE, respectively. Four patients recurred, 2 MIP and 2 BNE. %26lt;br%26gt;CONCLUSIONS: There is a trend toward a higher incidence of ePTH in patients having undergone an MIP. The etiology of ePTH is multifactorial but may represent an early recurrence.

• 出版日期2014-5