Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism.
BACKGROUND
The development of localization studies and quick parathyroid hormone assay (QPTH) has allowed the development of focused surgery in sporadic primary hyperparathyroidism. The aim of this investigation was to determine whether localization studies select a specific population of patients.


METHODS
From 1999 to 2001, 213 patients underwent surgery for sporadic primary hyperparathyroidism. All were investigated with sestamibi scanning and ultrasonography. When at least 1 study showed a positive result (n=175), the patient underwent a video-assisted approach with QPTH. When results were negative (n=38), the patient underwent cervicotomy and exploratory procedures of all 4 parathyroid glands.


RESULTS
All patients are cured (mean follow-up, 17.8+/-10.3 months [SD]). Patients with negative preoperative study results had a high risk of multiglandular disease (12/38 patients; 31,6%), compared with patients with 1 positive study result (3/83 patients; 3.6%; P<.0001) and those with 2 concordant positive study results (0/92 patients; P<.0001).


CONCLUSIONS
When preoperative localization study results are negative, the patient has a high risk of multiglandular disease, and a conventional cervicotomy with identification of the 4 glands is recommended strongly. When only 1 localization study is positive, the risk of multiglandular disease justifies the use of QPTH during a focused approach. When positive localization study results are concordant, the use of QPTH is questionable during a focused approach.
Sebag
Frederic
F
Department of Endocrine Surgery, La Timone Hospital, 264 Rue Saint Pierre, 13005 Marseilles, France.
Hubbard
Johnathan G H
JG
Maweja
Sylvie
S
Misso
Claudia
C
Tardivet
Laurent
L
Henry
Jean-Francois
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000378:metabolism / Q000503:physiopathology*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
D010281:Parathyroid Hormone