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17-10-2022 | Hyperparathyroidism | Research

Persistence of primary hyperparathyroidism: a single-center experience

Authors: Dmitrii M. Buzanakov, Ilya V. Sleptsov, Arseny A. Semenov, Roman A. Chernikov, Konstantin Y. Novokshonov, Yulia V. Karelina, Natalya I. Timofeeva, Anna A. Uspenskaya, Viktor A. Makarin, Igor K. Chinchuk, Elisey A. Fedorov, Natalya A. Gorskaya, Ilya V. Sablin, Yuriy N. Malugov, Svetlana A. Alekseeva, Ksenya A. Gerasimova, Alexander A. Pushkaruk, Mikhail V. Lyubimov, Dina V. Rebrova, Shamil S. Shikhmagomedov, Timur A. Dzhumatov, Anna V. Zolotoukho, Alexander N. Bubnov

Published in: Langenbeck's Archives of Surgery | Issue 8/2022

Abstract

Background

Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism (PHPT). Precise localization of abnormal glands is a key to a successful surgery. Most patients are expected to be successfully treated with focused parathyroidectomy. However, this approach is associated with a risk of existing multiglandular disease which may lead to the postoperative persistence of PHPT.

Methods

Eight hundred ten patients who underwent an initial surgery for PHPT at SPBU Hospital in 2017–2018 were included in the study. Preoperative imaging results were evaluated. Multivariate logistic regressions were calculated to estimate predictive values of preoperative data for the risk of postoperative persistence and risk of MGD.

Results

Multiglandular disease was found to be a leading cause of persistent hyperparathyroidism. An anamnesis of thyroid surgery was found to be a significant risk factor for the persistence of hyperparathyroidism. The rate of persistence did not differ significantly between groups with bilateral neck exploration and focused parathyroidectomy. Age, sex, body mass index as well as negative results of preoperative US, MIBI, and 4D CT were not independently associated with a higher risk of MGD. All preoperative imaging modalities showed from low to moderate sensitivity for the detection of MGD. The frequency of cases of a missed second adenoma did not differ significantly between patients with concordant and discordant preoperative data. There were 7 cases with previously unsuspected second adenomas found solely due to bilateral neck exploration.

Conclusions

None of the combination of preoperative visualization modalities was able to rule out the MGD and reliably identify patients for focused parathyroidectomy. Additional preoperative visualization failed to improve overall results. Bilateral neck exploration appeared to have a slight benefit for the patients with concordant preoperative imaging results.

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Title: Persistence of primary hyperparathyroidism: a single-center experience
Authors: Dmitrii M. Buzanakov
Ilya V. Sleptsov
Arseny A. Semenov
Roman A. Chernikov
Konstantin Y. Novokshonov
Yulia V. Karelina
Natalya I. Timofeeva
Anna A. Uspenskaya
Viktor A. Makarin
Igor K. Chinchuk
Elisey A. Fedorov
Natalya A. Gorskaya
Ilya V. Sablin
Yuriy N. Malugov
Svetlana A. Alekseeva
Ksenya A. Gerasimova
Alexander A. Pushkaruk
Mikhail V. Lyubimov
Dina V. Rebrova
Shamil S. Shikhmagomedov
Timur A. Dzhumatov
Anna V. Zolotoukho
Alexander N. Bubnov
Publication date: 17-10-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hyperparathyroidism
Parathyroidectomy
Parathyroidectomy
Published in: Langenbeck's Archives of Surgery / Issue 8/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02711-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Persistence of primary hyperparathyroidism: a single-center experience

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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