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Primer hiperparatiroidizm için cerrahi tedavi sonuçlarının değerlendirilmesi: Tek merkez deneyimi

Year 2021, Volume: 54 Issue: 1, 123 - 128, 27.04.2021

Hakan Ataş Yunus Yuksek Cengiz Ceylan Ebru Menekşe Buket Altun Özdemir Bülent Çomçalı Tanju Tütüncü Birol Korukluoğlu

https://doi.org/10.20492/aeahtd.869562

Abstract

AMAÇ: Primer hiperparatiroidizm (PHPT), dört paratiroid bezinin bir veya daha fazlasından aşırı paratiroid hormonu (PTH) salgılanmasıyla karakterize bir hastalıktır. Anormal paratiroid bezlerinin cerrahi olarak çıkarılması, hastalığın en etkili tedavi yötemidir. Bu çalışma, PHPT nedeniyle ameliyat edilen hastaların klinik ve cerrahi deneyimlerimizi sunmayı amaçlamaktadır.
GEREÇ VE YÖNTEM: Ocak 2014 - Mart 2019 tarihleri arasında hastanemiz meme ve endokrin cerrahisi bölümünde PHPT tanısı ile ameliyat edilen hastaların verileri geriye dönük olarak incelendi.
BULGULAR: Bu çalışmaya medyan yaşı 54 olan toplam 334 hasta (dağılım 16-86) dahil edildi. Bunlardan 165'i (% 81,7) kadın, 37'si (% 18,3) erkekti. Preoperatif lokalizasyon çalışmalarında, en yüksek doğru tespit oranı, anormal paratiroid bezlerinin % 85.7'sini tanımlayan sestamibili tek foton emisyonlu bilgisayarlı tomografi ve ultrasonografi ile elde edildi. Hastaların % 22.16'sında minimal invaziv yöntem, %76,94'ünde bilateral boyun eksplorasyonu tercih edildi. 3 hastada sternotomi gerekti. Patolojik bezlerin ektopik lokalizasyonu 26 (% 7.788) hastada mevcuttu. Eş zamanlı tiroidektomi 124 (% 37.12) hastaya uygulandı. 14 (% 11.29) hastada rastlantısal tiroid maligniteleri teşhis edildi. Persitent ve rekürren hastalık görülme sıklıkları sırasıyla 6.88% ve 4.19% olarak tespit edildi.
SONUÇ: PHPT, multidisipliner bir yaklaşım gerektirir. Cerrahi tedavi, düşük komplikasyon oranları ile% 95'in üzerinde iyileşme sağlayabilir. Anormal bezler için dikkatli lokalizasyon çalışmaları ve eşlik eden tiroid patolojileri için ayrıntılı incelemelerin ameliyat başarısını daha da artıracağına inanıyoruz.

Keywords

Pimer hiperparatiroidizm paratiroid lokalizasyonu paratiroidektomi cerrahi

References

  • 1. Bilezikian JP, Bandeira L, Khan A, et al. Hyperparathyroidism. Lancet. 2018; 13; 391(10116): 168-178. doi: 10.1016/S0140-6736(17)31430-7.
  • 2. Bilezikian JP. Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2018 ;103(11): 3993-4004. doi: 10.1210/jc.2018-01225.
  • 3. Machado NN, Wilhelm SM. Diagnosis and Evaluation of Primary Hyperparathyroidism. Surg Clin North Am. 2019 ;99(4): 649-666. doi: 10.1016/j.suc.2019.04.006. 4. Augustine MM, Bravo PE, Zeiger MA. Surgical treatment of primary hyperparathyroidism. Endocr Pract. 2011 ;17 Suppl 1: 75-82. doi: 10.4158/EP10359.RA.
  • 5. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016; 151(10): 959-968. doi: 10.1001/jamasurg.2016.2310.
  • 6. Bilezikian JP, Cusano NE, Khan AA, et al. Primary hyperparathyroidism. Nat Rev Dis Primers. 2016; 2: 16033. doi: 10.1038/nrdp.2016.33.
  • 7. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011; 253(3): 585-91. doi: 10.1097/SLA.0b013e318208fed9.
  • 8. Mazotas IG, Yen TWF, Doffek K, et al. Persistent/Recurrent Primary Hyperparathyroidism: Does the Number of Abnormal Glands Play a Role? J Surg Res. 2020; 246: 335-341. doi: 10.1016/j.jss.2019.08.007.
  • 9. Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012; 344:e1013. doi: 10.1136/bmj.e1013.
  • 10. Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008; 93(9): 3462-70. doi: 10.1210/jc.2007-1215. 11. Yadav SK, Johri G, Bichoo RA, et al. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. Arch Endocrinol Metab. 2020; 64(2): 105-110. doi: 10.20945/2359-3997000000211.
  • 12.Oberger Marques JV, Moreira CA. Primary hyperparathyroidism. Best Pract Res Clin Rheumatol. 2020; 34(3): 101514. doi: 10.1016/j.berh.2020.101514.
  • 13. Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007 ;48(7): 1084-9. doi: 10.2967/jnumed.107.040428.
  • 14. Berri RN, Lloyd LR. Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization. Am J Surg. 2006;191(3): 311-4. doi: 10.1016/j.amjsurg.2005.10.027.
  • 15. Ryan S, Courtney D, Moriariu J, et al. Surgical management of primary hyperparathyroidism. Eur Arch Otorhinolaryngol. 2017;274(12): 4225-4232. doi: 10.1007/s00405-017-4776-4.
  • 16. Kartal A, Çitgez B, Öden S, et al. Risk factors in the occurance of persistent primary hyperparathyroidism. Sisli Etfal Hastan Tip Bul. 2014; 48(3): 213-226.
  • 17. Bagul A, Patel HP, Chadwick D, et al. Primary hyperparathyroidism: an analysis of failure of parathyroidectomy. World J Surg. 2014; 38(3): 534-41. doi: 10.1007/s00268-013-2434-6.
  • 18. Lou I, Balentine C, Clarkson S, et al. How long should we follow patients after apparently curative parathyroidectomy? Surgery. 2017; 161(1): 54-61. doi: 10.1016/j.surg.2016.05.049.
  • 19. Zhu CY, Sturgeon C, Yeh MW. Diagnosis and Management of Primary Hyperparathyroidism. JAMA. 2020; 323(12): 1186-1187. doi: 10.1001/jama.2020.0538.

Evaluation of surgical treatment outcomes for primary hyperthyroidism: A single center experience

Year 2021, Volume: 54 Issue: 1, 123 - 128, 27.04.2021

Hakan Ataş Yunus Yuksek Cengiz Ceylan Ebru Menekşe Buket Altun Özdemir Bülent Çomçalı Tanju Tütüncü Birol Korukluoğlu

https://doi.org/10.20492/aeahtd.869562

Abstract

AIM: Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH) secretion from one or more of the four parathyroid glands. Surgical removal of abnormal parathyroid glands is the most effective treatment method for the disease. This study aims to present our clinical and surgical experience of patients operated on for PHPT.
MATERIAL AND METHOD: The data of patients who were operated with a diagnosis of PHPT in the breast and endocrine surgery department of our hospital between January 2014 and March 2019 were retrospectively analyzed.
RESULTS: A total of 334 patients (range 16 to 86) with a median age of 54 were included in this study. Of these, 165 (81.7%) were female and 37 (18.3%) were male. In preoperative localization studies, the highest accurate detection rate was obtained sestamibi with single-photon emission computed tomography and ultrasonography, which defined 85.7% of abnormal parathyroid glands. Minimally invasive method was preferred in 22.16% of the patients, and bilateral neck exploration was preferred in 76.94% of the patients. Sternotomy was required in 3 patients. Ectopic localization of pathological glands was present in 26 (7.788%) patients. Concomitant thyroidectomy was performed in 124 (37.12%) patients. Incidental thyroid malignancies were diagnosed in 14 (11.29%) patients. The prevalence of persistent and recurrent disease was determined as 6.88% and 4.19%, respectively.
CONCLUSION: PHPT requires a multidisciplinary approach. Surgical treatment can provide over 95% improvement with low complication rates. We believe that careful localization studies for abnormal glands and detailed examinations for accompanying thyroid pathologies will further incress the the surgery success.

Keywords

primary hyperparathyroidism parathyroid localization parathyroidectomy surgery

References

  • 1. Bilezikian JP, Bandeira L, Khan A, et al. Hyperparathyroidism. Lancet. 2018; 13; 391(10116): 168-178. doi: 10.1016/S0140-6736(17)31430-7.
  • 2. Bilezikian JP. Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2018 ;103(11): 3993-4004. doi: 10.1210/jc.2018-01225.
  • 3. Machado NN, Wilhelm SM. Diagnosis and Evaluation of Primary Hyperparathyroidism. Surg Clin North Am. 2019 ;99(4): 649-666. doi: 10.1016/j.suc.2019.04.006. 4. Augustine MM, Bravo PE, Zeiger MA. Surgical treatment of primary hyperparathyroidism. Endocr Pract. 2011 ;17 Suppl 1: 75-82. doi: 10.4158/EP10359.RA.
  • 5. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016; 151(10): 959-968. doi: 10.1001/jamasurg.2016.2310.
  • 6. Bilezikian JP, Cusano NE, Khan AA, et al. Primary hyperparathyroidism. Nat Rev Dis Primers. 2016; 2: 16033. doi: 10.1038/nrdp.2016.33.
  • 7. Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011; 253(3): 585-91. doi: 10.1097/SLA.0b013e318208fed9.
  • 8. Mazotas IG, Yen TWF, Doffek K, et al. Persistent/Recurrent Primary Hyperparathyroidism: Does the Number of Abnormal Glands Play a Role? J Surg Res. 2020; 246: 335-341. doi: 10.1016/j.jss.2019.08.007.
  • 9. Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012; 344:e1013. doi: 10.1136/bmj.e1013.
  • 10. Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008; 93(9): 3462-70. doi: 10.1210/jc.2007-1215. 11. Yadav SK, Johri G, Bichoo RA, et al. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. Arch Endocrinol Metab. 2020; 64(2): 105-110. doi: 10.20945/2359-3997000000211.
  • 12.Oberger Marques JV, Moreira CA. Primary hyperparathyroidism. Best Pract Res Clin Rheumatol. 2020; 34(3): 101514. doi: 10.1016/j.berh.2020.101514.
  • 13. Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007 ;48(7): 1084-9. doi: 10.2967/jnumed.107.040428.
  • 14. Berri RN, Lloyd LR. Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization. Am J Surg. 2006;191(3): 311-4. doi: 10.1016/j.amjsurg.2005.10.027.
  • 15. Ryan S, Courtney D, Moriariu J, et al. Surgical management of primary hyperparathyroidism. Eur Arch Otorhinolaryngol. 2017;274(12): 4225-4232. doi: 10.1007/s00405-017-4776-4.
  • 16. Kartal A, Çitgez B, Öden S, et al. Risk factors in the occurance of persistent primary hyperparathyroidism. Sisli Etfal Hastan Tip Bul. 2014; 48(3): 213-226.
  • 17. Bagul A, Patel HP, Chadwick D, et al. Primary hyperparathyroidism: an analysis of failure of parathyroidectomy. World J Surg. 2014; 38(3): 534-41. doi: 10.1007/s00268-013-2434-6.
  • 18. Lou I, Balentine C, Clarkson S, et al. How long should we follow patients after apparently curative parathyroidectomy? Surgery. 2017; 161(1): 54-61. doi: 10.1016/j.surg.2016.05.049.
  • 19. Zhu CY, Sturgeon C, Yeh MW. Diagnosis and Management of Primary Hyperparathyroidism. JAMA. 2020; 323(12): 1186-1187. doi: 10.1001/jama.2020.0538.
There are 17 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original research article
Authors

Hakan Ataş 0000-0003-4144-417X

Yunus Yuksek 0000-0003-0442-8410

Cengiz Ceylan 0000-0003-3471-8726

Ebru Menekşe 0000-0003-2867-6128

Buket Altun Özdemir 0000-0002-1043-8108

Bülent Çomçalı 0000-0002-2111-1477

Tanju Tütüncü 0000-0001-9058-465X

Birol Korukluoğlu 0000-0003-4164-6898

Publication Date April 27, 2021
Submission Date January 27, 2021
Published in Issue Year 2021 Volume: 54 Issue: 1

Cite

AMA Ataş H, Yuksek Y, Ceylan C, Menekşe E, Altun Özdemir B, Çomçalı B, Tütüncü T, Korukluoğlu B. Primer hiperparatiroidizm için cerrahi tedavi sonuçlarının değerlendirilmesi: Tek merkez deneyimi. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. April 2021;54(1):123-128. doi:10.20492/aeahtd.869562
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