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Surgical treatment for primary hyperparathyroidism
1Department of Surgery, University of Hong Kong, Queen Mary Hospital, China.
Insights
Surgical treatment for primary hyperparathyroidism (HPT) is safe and effective. Routine preoperative localization studies are not cost-effective for HPT surgery.
Area of Science:
- Endocrinology
- Surgical Oncology
Background:
- Primary hyperparathyroidism (HPT) is a common endocrine disorder.
- Surgical intervention is the definitive treatment for symptomatic HPT.
Purpose of the Study:
- To evaluate the surgical outcomes for primary HPT at Queen Mary Hospital.
- To assess the cost-effectiveness of preoperative localization studies.
Main Methods:
- A prospective study of 30 patients (11 men, 19 women) undergoing 31 operations for primary HPT between 1995 and 1996.
- Data collected included patient demographics, preoperative localization results, surgical findings, and postoperative outcomes.
- Preoperative localization studies included ultrasonography, CT scans, and scintigraphy.
Main Results:
- Hypercalcemia symptoms were present in 67% of patients.
- Localization accuracy varied: ultrasonography (52%), CT scans (42%), and scintigraphy (59%).
- Twenty-nine patients achieved immediate normocalcemia; one required a second surgery for persistent hypercalcemia. High success rate with low complication rate.
Conclusions:
- Surgical treatment for primary HPT offers a safe and highly successful therapeutic option.
- Routine preoperative localization studies were found to be not cost-effective in this series.
Objective:
To document the recent surgical results in the treatment of primary hyperparathyroidism (HPT) at Queen Mary Hospital.
Methods:
From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. The data of 11 men and 19 women with ages ranging from 19 to 86 years (median: 57 years) were prospectively recorded with emphasis on the need of preoperative localization.
Results:
Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respectively. Seventy-seven localization studies were performed in 28 patients (average: 2.6 tests/patient). Localization was accurate in 12 of 23 (52%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scintigraphies. Twenty-six patients had a single adenoma excised while 3 patients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical exploration. Immediate normocalcemia was achieved in 29 patients. One patient had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second operation. One patient had a unilateral vocal cord paralysis and 4 patients needed calcium supplement on discharge. During a median follow-up of 5 months, all patients were normocalcemic with one requiring calcium supplements.
Conclusion:
Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experience routine preoperative localization study is not cost-effective.