Emmanuelle Trébouet1, Sahar Bannani2, Matthieu Wargny1, Christophe Leux3, Cécile Caillard2, Françoise Kraeber-Bodéré4,5, Karine Renaudin6, Lucy Chaillous1, Éric Mirallié2, Catherine Ansquer7,8. 1. Service d'Endocrinologie, CHU de Nantes, Boulevard Jacques Monod, 44093, Nantes Cedex 1, France. 2. Clinique de Chirurgie Digestive et Endocrinienne, CHU de Nantes, Hôtel Dieu, Place Ricordeau, 44093, Nantes Cedex 1, France. 3. Service d'Information Médicale, CHU de Nantes, 5 allée de l'île Gloriette, 44093, Nantes Cedex 1, France. 4. Service de Médecine Nucléaire, CHU de Nantes, Hôtel Dieu, Paris, France. 5. CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France. 6. Service d'Anatomie Cytologie Pathologique, CHU de Nantes, Hôtel Dieu, Place Ricordeau, 44093, Nantes Cedex 1, France. 7. Service de Médecine Nucléaire, CHU de Nantes, Hôtel Dieu, Paris, France. catherine.ansquer@chu-nantes.fr. 8. CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France. catherine.ansquer@chu-nantes.fr.
Abstract
BACKGROUND: Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate. METHODS: We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland. RESULTS: We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%. The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1-96.2%). CONCLUSIONS: MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.
BACKGROUND: Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate. METHODS: We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland. RESULTS: We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%. The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1-96.2%). CONCLUSIONS: MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.
Authors: C Camenzuli; A N DiMarco; K E Isaacs; Y Grant; J Jackson; A Alsafi; C Harvey; T D Barwick; N Tolley; F F Palazzo Journal: Ann R Coll Surg Engl Date: 2020-08-24 Impact factor: 1.891