The Analysis of Diagnosis and Managements for Primary Hyperparathyroidism in 73 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Quan , CUI Aimin , BAI Nan ,  ZHANG Ziqin

Department of General Surgery， Beijing Jishuitan Hospital， Beijing 100035， China;

Corresponding author：

ZHANG Ziqin, Email: zq.Zhang2009@gmail.com

Keywords：

Primary hyperparathyroidism; Diagnosis; Parathyroidectomy; Tumor; Multi-endocrine neoplasm

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）.
Methods 　The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively.
Results 　There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperative
serum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）
within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case of
adenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 months
prior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up.
Conclusions 　The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.

Citation： WU Quan,CUI Aimin,BAI Nan,ZHANG Ziqin. The Analysis of Diagnosis and Managements for Primary Hyperparathyroidism in 73 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 776-781. doi: Copy

1.	Wermers RA， Khosla S， Atkinson EJ， et al. Incidence of primaryhyperparathyroidism in Rochester， Minnesota， 1993-2001：an update on the changing epidemiology of the disease[J]. J Bone Miner Res， 2006， 21(1)：171-177.
2.	Richert L， Trombetti A， Herrmann FR， et al. Age and gender distribution of primary hyperparathyroidism and incidence of surgicaltreatment in a European country with a particularly high life expec-tancy[J]. Swiss Med Wkly， 2009， 139(27-28)：400-404.
3.	王深明，李晓曦，常光其，等. 原发性甲状旁腺功能亢进症的外科治疗[J]. 中华外科杂志， 2004， 42(9)：532-535.
4.	付利军，闫红印，董汉华，等. 原发性甲状旁腺功能亢进的诊治分析[J]. 中华内分泌外科杂志， 2010， 4(6)：396-399.
5.	董建宇，管珩，朱预. 368例甲状旁腺功能亢进症的外科治疗[J]. 中华普通外科杂志， 2011， 26(4)：289-291.
6.	苏磊，王雪晨，姚永忠，等. 原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J]. 中国普外基础与临床杂志， 2010， 17(12)：1290-1293.
7.	王鸥，邢小平，孟迅吾，等. MEN患者甲状旁腺功能亢进症的临床表现[J]. 中华内分泌代谢杂志， 2004， 20(4)：296-299.
8.	Pepe J， Cipriani C， Pilotto R， et al. Sporadic and hereditary primaryhyperparathyroidism[J]. J Endocrinol Invest， 2011， 34(7 Suppl)：.
9.	Kirkby-Bott J， Lewis P， Harmer CL， et al. One stage treatment of parathyroid cancer[J]. Eur J Surg Oncol， 2005， 31(1)：.
10.	Schantz A， Castleman B. Parathyroid carcinoma. A study of 70 cases[J]. Cancer， 1973， 31(3)：600-605.
11.	Lee PK， Jarosek SL， Virnig BA， et al. Trends in the incidence and treatment of parathyroid cancer in the United States[J]. Cancer， 2007， 109(9)：1736-1741.
12.	Hundahl SA， Fleming ID， Fremgen AM， et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U. S. between 1985-1995：a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society[J]. Cancer， 1999， 86(3)：538-544.
13.	Schulte KM， Talat N， Miell J， et al. Lymph node involvement and surgical approach in parathyroid cancer[J]. World J Surg， 2010， 34(11)：2611-2620.
14.	Hanif F， Coffey JC， Romics L Jr， et al. Rapid intraoperative parathyroid hormone assay—more than just a comfort measure[J]. World J Surg， 2006， 30(2)：156-161.
15.	Alhefdhi A， Pinchot SN， Davis R， et al. The necessity and relia-bility of intraoperative parathyroid hormone (PTH) testing inpatients with mild hyperparathyroidism and PTH levels in the normalrange[J]. World J Surg， 2011， 35(9)：2006-2009.
16.	Halevy A， Stepansky A， Halpern Z， et al. Quick parathormone assay in the surgical management of hyperparathyroidism[J]. Isr Med Assoc J， 2003， 5(11)：775-777.
17.	Bieglmayer C， Prager G， Niederle B. Kinetic analyses of parathyroid hormone clearance as measured by three rapid immunoassays during parathyroidectomy[J]. Clin Chem， 2002， 48(10)：1731-1738.
18.	Khoo TK， Vege SS， Abu-Lebdeh HS， et al. Acute pancreatitis in primary hyperparathyroidism：a population-based study[J]. J Clin Endocrinol Metab， 2009， 94(6)：2115-2118.
19.	Bai HX， Giefer M， Patel M， et al. The association of primary hyperparathyroidism with pancreatitis[J]. J Clin Gastroenterol， 2012， 46(8)：656-661.
20.	Abboud B， Daher R， Boujaoude J. Digestive manifestations of parathyroid disorders[J]. World J Gastroenterol， 2011， 17(36)：4063-4066.
21.	Anderson JL， Vanwoerkom RC， Horne BD， et al. Parathyroid hormone， vitamin D， renal dysfunction， and cardiovascular disease：dependent or independent risk factors？ [J]. Am Heart J， 2011， 162(2)：331-339.
22.	Altay H， Zorlu A， Binici S， et al. Relation of serum parathyroid hormone level to severity of heart failure[J]. Am J Cardiol， 2012， 109(2)：252-256.
23.	Ozbey N， Erbil Y， Ademoğlu E， et al. Correlations between vitamin D status and biochemical/clinical and pathological parameters in primary hyperparathyroidism[J]. World J Surg， 2006， 30(3)：321-326.
24.	Pradeep PV， Mishra A， Agarwal G， et al. Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency[J]. World J Surg， 2008， 32(5)：829-835.
25.	Brown EM. Calcium receptor and regulation of parathyroid hormone secretion[J]. Rev Endocr Metab Disord， 2000， 1(4)：307-315.
26.	-44.
27.	-83.

1. Wermers RA， Khosla S， Atkinson EJ， et al. Incidence of primaryhyperparathyroidism in Rochester， Minnesota， 1993-2001：an update on the changing epidemiology of the disease[J]. J Bone Miner Res， 2006， 21(1)：171-177.
2. Richert L， Trombetti A， Herrmann FR， et al. Age and gender distribution of primary hyperparathyroidism and incidence of surgicaltreatment in a European country with a particularly high life expec-tancy[J]. Swiss Med Wkly， 2009， 139(27-28)：400-404.
3. 王深明，李晓曦，常光其，等. 原发性甲状旁腺功能亢进症的外科治疗[J]. 中华外科杂志， 2004， 42(9)：532-535.
4. 付利军，闫红印，董汉华，等. 原发性甲状旁腺功能亢进的诊治分析[J]. 中华内分泌外科杂志， 2010， 4(6)：396-399.
5. 董建宇，管珩，朱预. 368例甲状旁腺功能亢进症的外科治疗[J]. 中华普通外科杂志， 2011， 26(4)：289-291.
6. 苏磊，王雪晨，姚永忠，等. 原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J]. 中国普外基础与临床杂志， 2010， 17(12)：1290-1293.
7. 王鸥，邢小平，孟迅吾，等. MEN患者甲状旁腺功能亢进症的临床表现[J]. 中华内分泌代谢杂志， 2004， 20(4)：296-299.
8. Pepe J， Cipriani C， Pilotto R， et al. Sporadic and hereditary primaryhyperparathyroidism[J]. J Endocrinol Invest， 2011， 34(7 Suppl)：.
9. Kirkby-Bott J， Lewis P， Harmer CL， et al. One stage treatment of parathyroid cancer[J]. Eur J Surg Oncol， 2005， 31(1)：.
10. Schantz A， Castleman B. Parathyroid carcinoma. A study of 70 cases[J]. Cancer， 1973， 31(3)：600-605.
11. Lee PK， Jarosek SL， Virnig BA， et al. Trends in the incidence and treatment of parathyroid cancer in the United States[J]. Cancer， 2007， 109(9)：1736-1741.
12. Hundahl SA， Fleming ID， Fremgen AM， et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U. S. between 1985-1995：a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society[J]. Cancer， 1999， 86(3)：538-544.
13. Schulte KM， Talat N， Miell J， et al. Lymph node involvement and surgical approach in parathyroid cancer[J]. World J Surg， 2010， 34(11)：2611-2620.
14. Hanif F， Coffey JC， Romics L Jr， et al. Rapid intraoperative parathyroid hormone assay—more than just a comfort measure[J]. World J Surg， 2006， 30(2)：156-161.
15. Alhefdhi A， Pinchot SN， Davis R， et al. The necessity and relia-bility of intraoperative parathyroid hormone (PTH) testing inpatients with mild hyperparathyroidism and PTH levels in the normalrange[J]. World J Surg， 2011， 35(9)：2006-2009.
16. Halevy A， Stepansky A， Halpern Z， et al. Quick parathormone assay in the surgical management of hyperparathyroidism[J]. Isr Med Assoc J， 2003， 5(11)：775-777.
17. Bieglmayer C， Prager G， Niederle B. Kinetic analyses of parathyroid hormone clearance as measured by three rapid immunoassays during parathyroidectomy[J]. Clin Chem， 2002， 48(10)：1731-1738.
18. Khoo TK， Vege SS， Abu-Lebdeh HS， et al. Acute pancreatitis in primary hyperparathyroidism：a population-based study[J]. J Clin Endocrinol Metab， 2009， 94(6)：2115-2118.
19. Bai HX， Giefer M， Patel M， et al. The association of primary hyperparathyroidism with pancreatitis[J]. J Clin Gastroenterol， 2012， 46(8)：656-661.
20. Abboud B， Daher R， Boujaoude J. Digestive manifestations of parathyroid disorders[J]. World J Gastroenterol， 2011， 17(36)：4063-4066.
21. Anderson JL， Vanwoerkom RC， Horne BD， et al. Parathyroid hormone， vitamin D， renal dysfunction， and cardiovascular disease：dependent or independent risk factors？ [J]. Am Heart J， 2011， 162(2)：331-339.
22. Altay H， Zorlu A， Binici S， et al. Relation of serum parathyroid hormone level to severity of heart failure[J]. Am J Cardiol， 2012， 109(2)：252-256.
23. Ozbey N， Erbil Y， Ademoğlu E， et al. Correlations between vitamin D status and biochemical/clinical and pathological parameters in primary hyperparathyroidism[J]. World J Surg， 2006， 30(3)：321-326.
24. Pradeep PV， Mishra A， Agarwal G， et al. Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency[J]. World J Surg， 2008， 32(5)：829-835.
25. Brown EM. Calcium receptor and regulation of parathyroid hormone secretion[J]. Rev Endocr Metab Disord， 2000， 1(4)：307-315.
26. -44.
27. -83.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Analysis of Diagnosis and Managements for Primary Hyperparathyroidism in 73 Cases

Abstract Full text Figures/Tables Video References Cited by

Format

Content