[A diagnostic strategy in persistent hyperparathyroidism]

Primary operations for hyperparathyroidism performed by experienced surgeons has a success rate of about 95% without any preoperative localization. After unsuccessful cervicotomy, localization studies must be performed in order to define the surgical approach. The objective of our retrospective studies was to determine the accuracy of non invasive and invasive localization studies in patients with persistent hyperparathyroidism.

The present reoperative series involved 7 patients with persistent hyperparathyroidism. Six patients came from a series of 140 operated on at the department of Prof. J. Marescaux from 1991 to 1993 (success rate of 95.7% in cervical exploration). Patient n. 7 came from another department.

After negative initial cervicotomy, non invasive localization procedure are undertaken, but with a high incidence of false-positive results (9% to 75%). Among available invasive techniques, it has been chosen to sample blood from large veins in the neck and mediastinum for Parathyroid Hormone (1-84 PTH) determination and to realise angiography for locating parathyroid adenomas as well as for vein mapping. Their combination permitted to localize all lesions.

The specificity of serum concentration of 1-84 PTH determination by catheterization of cervical and mediastinal veins (100%) combined to the sensitivity of angiography (82%) allowed to obtain good result in parathyroid localization in persistent hyperparathyroidism.