title: Reoperation for missed parathyroid adenoma.
abstract: These results in difficult patients with previously missed parathyroid adenomas demonstrate that a prospective strategy to treat these patients surgically can be used with a high degree of success. This strategy required collaboration among endocrinologists, radiologists, and surgeons. Prospectively, only patients with symptomatic persistent or recurrent primary hyperparathyroidism were included. Operative reports and pathology results from the initial operation and all previous operations were reviewed in detail. Patients with FHH or hypercalcemia from other causes were excluded. State-of-the-art radiologic localization procedures were used to localize the abnormal parathyroid gland. Most patients had only noninvasive procedures, such as the sestamibi scan, but some whose results were equivocal underwent invasive localization, including selective angiography and venous sampling. All patients underwent surgery even if the localization procedures were negative. The operative approach and strategy were dependent on the previous operative result and results of the imaging studies. Operative techniques like IOUS and urinary cAMP determination helped facilitate a more rapid successful outcome. However, in some patients, operative success was only achieved by complete dissection and removal of all tissue that might harbor the adenoma such as a lobe of the thyroid or the thymus. Abnormal parathyroid tissue was cryopreserved for possible subsequent autotransplantation in the event of hypoparathyroidism. The reoperative success rate for missed adenoma was 97%, the highest ever reported with a very acceptable complication rate and no deaths. Postoperative hypoparathyroidism, which was really a complication of the initial previous operations during which normal parathyroid tissue was removed, was treated by autotransplantation of cryopreserved tissue in 12 patients, and 8 functioned perfectly. With attention to details and possible pitfalls, reoperations for missed parathyroid adenomas can be performed safely and effectively.
authors.affiliation: University of California, San Francisco, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Norton
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D007669:Kidney Calculi / Q000209:etiology; D008482:Mediastinum / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019275:Radiopharmaceuticals; D012086:Reoperation; D017256:Technetium Tc 99m Sestamibi; D017211:Treatment Failure
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi