Primary hyperparathyroidism due to solitary adenoma. A comparative multicentre study of early and long-term results of different surgical regimens.
Surgical regimens for treatment of solitary parathyroid adenoma were compared in a multicentre study in five departments of surgery in the United States and Europe. Three hundred and twenty-five patients fulfilled the inclusion criteria. Eight years after the operation 272 patients (84%) were available for follow-up investigation. Severe postoperative hypocalcaemia (less than 2.00 mmol) was significantly more common after bilateral than unilateral exploration (p less than 0.001), and in women (p less than 0.01). Neither age nor preoperative serum calcium concentration was related to the severity of postoperative hypocalcaemia. At follow-up, 96% of the patients who had had unilateral, and 89% of those who had had Bilateral exploration had remained normocalcaemic without further treatment. Of the patients who had had incisional biopsies of normal glands 8% had hypercalcaemia and 8% had hypocalcaemia. Of patients operated on without a biopsy being taken or who had had one whole normal gland removed 1% were hypercalcaemic and 4% were hypocalcaemic. Early and late hypocalcaemia are reduced by atraumatic handling of the normal parathyroid gland without increasing the risk of persistent or recurrent hypercalcaemia.
Department of Surgery, University Hospitals, Ann Arbor, Mich.
S
S
Tibblin
J P
JP
Bizard
A G
AG
Bondeson
J
J
Bonjer
H A
HA
Bruining
F
F
Meier
C
C
Proye
J L
JL
Quievreux
M
M
Rothmund
N W
NW
Thompson
D000236:Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery*; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology*; D008297:Male; D008722:Methods; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*
D002118:Calcium