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Predictors of multiglandular disease in primary hyperparathyroidism
Mark Thier1,2, Sébastien Daudi3, Anders Bergenfelz3
1Department of Clinical Sciences, Lund University, Lund, Sweden. mark.thier@skane.se.
Langenbeck'S Archives of Surgery
|January 3, 2018
Summary
Predicting multiglandular disease (MGD) in primary hyperparathyroidism (pHPT) is crucial. Negative sestamibi scans, diabetes, and high osteocalcin levels can indicate MGD in pHPT patients.
Area of Science:
- Endocrinology
- Surgical Oncology
- Medical Diagnostics
Background:
- Primary hyperparathyroidism (pHPT) can stem from single or multiglandular disease (MGD).
- MGD poses higher surgical risks and recurrence rates compared to single-gland disease.
- Identifying MGD preoperatively is essential for surgical planning and patient management.
Purpose of the Study:
- To determine if preoperative clinical and biochemical factors can predict multiglandular disease (MGD) in patients with primary hyperparathyroidism (pHPT).
- To identify key indicators that may suggest the presence of MGD before surgery.
Main Methods:
- Retrospective analysis of 707 patients undergoing surgery for first-time, non-hereditary pHPT between 1989 and 2013.
- MGD defined by >1 pathological gland or persistent hypercalcemia post-single gland excision.
- Logistic regression analysis to identify predictors of MGD, calculating odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- 11% of patients (79/707) had MGD.
- MGD patients showed higher rates of negative sestamibi scintigraphy (31% vs. 17%), diabetes (16% vs. 7.2%), and lower urinary calcium levels.
- Multivariable analysis revealed negative scintigraphy (OR 2.42), diabetes (OR 2.75), and elevated osteocalcin (OR 3.79) as significant predictors of MGD.
Conclusions:
- Negative sestamibi scintigraphy is associated with a higher likelihood of MGD.
- The presence of diabetes in pHPT patients may indicate multiglandular disease.
- Elevated preoperative osteocalcin levels are a significant predictor of MGD in primary hyperparathyroidism.
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