Objective To summarize the research progress of the treatment of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasm type 1 (MEN1). Method The literature about the treatment of PHPT in MEN1 in recent years was reviewed. Results When the symptoms of MEN1 related PHPT were obvious, surgery was an effective treatment. In addition to conventional total parathyroidectomy with autotransplantation and subtotal parathyroidectomy, less-than subtotal parathyroidectomy, and single gland excision had also been proved to be effective recently. Conclusions Combining the clinical manifestations with the actual involvement of the parathyroid of MEN1 related PHPT patients, personalized selection of appropriate timing and methods of parathyroidectomy can help MEN1 related PHPT patients obtain ideal parathyroid function and ensure the quality of life to the greatest extent.
FromJune1989toMarch1998,11casesofprimaryhyperparathyroidism(PHP)hadbeentreatedsurgicallyin .thishospital.Thepreoperativelocalizationof9caseswereachievedbyoneortwononinvasivetechniquesincludingultrasonography,computedtomography,colorDopplerimagingand99mTcMIBIscintigraphy.Parathyroidectomyweredonesuccessfullyin10of11caseswiththepathologicalresultsofadenomain10casesandonenormalparathyroid.Theauthorsemphasize①earlyrecognitionanddiagnosiswhichcanbehelpedbythenoninvasivetechniquesmentionedaboveforlocalization,②familiaritywiththelocalanatomyespeciallyfortheectopicparathyroidtogetherwithfrozensectionbiopsyduringoperation,and③intensivemedicalcareaftersurgeryandfollowupsoastoheightenthecapacityofdiagnosisandtreatmentofthisdisease.
Objective To investigate the clinical value on application of endoscopic parathyroiddectomy by gasless unilateral axillary approach, and perioperation management of patients. Methods Twenty-four patients with primary hyperparathyroidism were enrolled and were divided into open group (14 patients underwent open parathyroid surgery) and lumpectomy group (10 patients underwent endoscopic thyroidectomy by gasless unilateral axillary approach) according to the surgical method. All patients received the “5A” model management. The indexes related with perioperative conditions, postoperative incisional pain, and anterior cervical function were compared between the two groups. Results In the open group, 1 patient suffered from transient hoarseness after operation, 5 patients suffered from hypocalcemia on the first day after operation, and 6 patients suffered from temporary hypoparathyroidism. In the lumpectomy group, hypocalcemia occurred in 3 cases and temporary hypoparathyroidism occurred in 3 cases. There were no incision hematoma and infection cases occurred. There was no significant difference between the two groups in the incidence of hypocalcemia and the incidence of temporary hypoparathyroidism after operation (P>0.05). There was no case of incisional hematoma and infection, incisional pain, coughing and sputum excretion or painful swallowing with pain ≥3 in either group. The swallowing disorder index on postoperative day 3 and at 6 months, the scar assessment score and cosmetic satisfaction score at 6 months were higher in the open group than those in the lumpectomy group (P<0.05). Conclusion Patients underwent parathyroidectomy by gasless unilateral axillary approach have the advantages of good cosmetic results and preservation of the function of the anterior cervical region while safely removing the lesion.
ObjectiveTo analyze the factors influencing the hungry bone syndrome (HBS) in patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy. MethodsThe clinical data of patients who underwent parathyroidectomy for SHPT in the 900th Hospital of the Joint Logistics Support Force from January 2016 to May 2021 were retrospectively analyzed. The risk factors for HBS were analyzed by binary logistic regression analysis. The cut-off value of risk factors for predicting postoperative HBS was analyzed by using recieve operating characteristic (ROC) curve. ResultsA total of 89 patients were included in this study, including 44 males and 45 females, with (47±11) years old. There were 42 (47.2%) patients with HBS. Compared with the patients without HBS, the patients with HBS was younger and had higher levels of preoperative parathyroid hormone, potassium, and alkaline phosphatase (ALP), the differences were statistically different (P<0.05). The multivariate binary logistic regression analysis showed that the higher preoperative ALP level was a risk factor for the HBS [OR (95%CI) = 1.014 (1.007, 1.020), P<0.001]. The area under the ROC curve (95%CI) of the preoperative ALP level in distinguishing the patients with HBS from without HBS was 0.957 (0.919, 0.996), and the optimal cut-off value of ALP for predicting postoperative HBS was 278.90 U/L. ConclusionsFrom the preliminary results of this study, it can be concluded that bone conversion status can be differentiated according to preoperative ALP level in patients with SHPT. When preoperative ALP level is higher than cut-off value, it is recommended that calcium supplementation should be given as soon as possible and blood calcium level should be closely monitored.
ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT). MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0. ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05). ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.
ObjectiveTo evaluate the diagnostic value of 99Tcm-methoxy isobutyl isonitrile (MIBI) dual-time imaging for parathyroid adenoma (PA) and parathyroid hyperplasia (PH).MethodsClinical data of 187 patients with pathologically confirmed hyperparathyroidism (HPT) who admitted to the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine from July 2011 to December 2018 were retrospectively collected. Taking postoperative pathology as the standard, the diagnostic value of preoperative 99Tcm-MIBI dual-time imaging was analyzed.ResultsThe serum PTH level of PH patients was higher than that of PA patients (Z=–3.23, P<0.01). Te/N (T: focal area radioactive count, N: the normal tissue radioactivity count of the corresponding thyroid gland on the opposite side of the lesion) in PA and PH patients were lower than Td/N (Z=–3.61, P<0.01; Z=–3.47, P<0.01). The positive rates of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH lesions were 67.9% (36/53) and 20.6% (86/418), respectively, and the positive rate of PA were higher (χ2=52.51, P<0.01). The positive rate of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH single lesions was higher than that of multiple lesions (χ2=15.79, P<0.01; χ2=64.73, P<0.01). Conclusions99Tcm-MIBI dual-time imaging shows a higher positive rate for PA and a lower positive rate for PH. When HPT is clinically suspected, but 99Tcm-MIBI dual-time imaging is negative and serum PTH is positive, PH should be considered, and B ultrasound and other examinations should be performed to determine the lesion site.
ObjectiveTo compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT). MethodsClinical data of 76 cases of uremia SHPT who underwent sPTX(n=19) and tPTX+AT(n=57) in Xinjiang Armed Police Corps Command Military Hospital and The Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed(from Feb. 2005 to Sep. 2012). ResultsOf the 76 cases, 68 cases(89.5%) got successful surgery and 8 cases (10.5%) suffered non-complete resection, all cases had relief on bone pain, and 14 cases had relief on pruritus(26.9%, 14/52). The values of serum calcium on 1 day, 7 days, and 6 months after operation were lower in tPTX+AT group (P<0.05), and value of iPTH in 6 months after operation was lower too(P<0.05). The operation time, blood loss, hospital stay, and hospital cost in tPTX+AT group were all higher or longer(P<0.05). All of the 76 cases were followed up for 6-18 months(the median time was 8.7 months). During the followed-up, 2 cases died and 2 cases recurred in tPTX+AT group, 1 case died and 7 cases recurred in sPTX group, that the recurrence rate was higher in sPTX group (P<0.05). ConclusiontPTX+AT has lower recurrence rate, but with longer operation time and hospital stay, more blood loss, and expensive cost, so the choice of surgery for SHPT should be based on the comprehensive situation.
Objective To summarize the changes of serum vitamin D level in patients with primary hyperparathyroidism (pHPT), the correlation between vitamin D and clinical manifestations, and feasible pathogenesis of pHPT. Method The literatures related to vitamin D and pHPT in recent years were reviewed. Results The level of vitamin D was decreased in patients with pHPT. Vitamin D level was negatively correlated with the weight of parathyroid adenoma, parathyroid hormone and blood calcium level, and positively correlated with bone mineral density. Conclusions Vitamin D nutritional status affects the severity of symptoms, main biochemical indexes and main clinical complications of patients with pHPT. There are various reasons accounted for the decline of vitamin D level, and the specific pathogenesis needs to be further explored. For patients with pHPT, vitamin D should be supplemented carefully and appropriately before surgical operation.
ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.
Objective To evaluate the diagnostic significance and to analyze reasons of false negative cases forpreoperative ultrasonography， 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）， and CT in primary hyperparathyroidism（PHPT）. Methods Clinical data of 69 patients with PHPT， who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed. Results There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology， including 58 cases of parathyroid adenoma with 60 lesions， 7 cases of parathyroid hyperplasia with 11 lesions， and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity of ultrasonography， CT， and 99Tcm-MIBI scintigraphy were 81.94% （59/72）， 61.76% （21/34）， and 69.57% （16/23）， the accuracy of 3 kinds of tests were 78.67% （59/75）， 61.76% （21/34）， and 66.67% （16/24）， the positive predictive value were 95.16% （59/62）， 100% （21/21）， and 94.12% （16/17） respectively. There was significant differ-ence only between ultrasonography and CT in sensitivity （P=0.03）， no other significant difference was found （P＞0.05）.Conclusions Ultrasonography is complementary to 99Tcm-MIBI scintigraphy， but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.