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Langenbeck's Archives of Surgery

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Open Access 01-02-2018 | ORIGINAL ARTICLE

Predictors of multiglandular disease in primary hyperparathyroidism

Authors: Mark Thier, Sébastien Daudi, Anders Bergenfelz, Martin Almquist

Published in: Langenbeck's Archives of Surgery | Issue 1/2018

Abstract

Background

Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT.

Methods

We retrospectively evaluated patients operated 1989–2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and multiglandular disease. Logistic regression was used to identify variables predicting MGD, yielding odds ratios (OR) with 95% confidence intervals (CI).

Results

There were 707 patients, of which 79 (11%) had MGD. Patients with MGD were more likely to have negative sestamibi scintigraphy than patients with single-gland disease, 15 of 49 (31%) vs. 70 of 402 (17%; p = 0.03), to suffer from diabetes (12 of 74, 16%) vs. 45 out of 626 patients (7.2%; p < 0.01) and had lower preoperative levels of urinary calcium (3.80 vs. 4.44 mmol/L; p = 0.04). Multivariable analysis identified negative scintigraphy (OR 2.42; 95% CI 1.18 to 4.79), diabetes (OR 2.75; 95% CI 1.31 to 4.97) and elevated levels of osteocalcin (OR 3.79, 95% CI: 1.75 to 8.21) as predictors of MGD.

Conclusion

Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels were predictors of MGD.

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Title: Predictors of multiglandular disease in primary hyperparathyroidism
Authors: Mark Thier
Sébastien Daudi
Anders Bergenfelz
Martin Almquist
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1647-9

At a glance: The STEP trials

Springer Medicine

Predictors of multiglandular disease in primary hyperparathyroidism

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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