Kristin E Goodsell1, Jae P Ermer2, Salman Zaheer2, Rachel R Kelz3, Douglas L Fraker3, Heather Wachtel4. 1. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA. 2. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. 3. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA; Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. 4. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA; Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. Electronic address: Heather.Wachtel@pennmedicine.upenn.edu.
Abstract
BACKGROUND: Primary hyperparathyroidism (PHPT) caused by double adenoma may carry a higher risk of failure to cure. We compared outcomes in single adenoma (SA), double adenoma (DA) and four-gland hyperplasia (HP). METHODS: Patients undergoing initial parathyroidectomy for PHPT were categorized by diagnosis. The primary outcome was persistent/recurrent disease postoperatively. RESULTS: Of 3408 patients, 81.3% had SA, 9.5% had DA, and 9.3% had HP. Rates of persistence/recurrence were 2.9%, 5.3%, and 4.5% in SA, DA, and HP, respectively (p = 0.281). Patients with persistence/recurrence had higher preoperative calcium (11.0 vs 10.7 mg/dl, p = 0.028) and PTH (96 vs 77 pg/ml, p = 0.015), and lower rates of IOPTH normalization (77% vs 96%, p < 0.001). On multivariable analysis, DA was associated with increased risk of persistent/recurrent disease (OR 3.0, p = 0.017). CONCLUSIONS: Most patients with DA are cured with removal of two glands, but approximately 5% experience disease persistence/recurrence. Low-normal final IOPTH was associated with lower risk of persistent/recurrent disease.
BACKGROUND: Primary hyperparathyroidism (PHPT) caused by double adenoma may carry a higher risk of failure to cure. We compared outcomes in single adenoma (SA), double adenoma (DA) and four-gland hyperplasia (HP). METHODS: Patients undergoing initial parathyroidectomy for PHPT were categorized by diagnosis. The primary outcome was persistent/recurrent disease postoperatively. RESULTS: Of 3408 patients, 81.3% had SA, 9.5% had DA, and 9.3% had HP. Rates of persistence/recurrence were 2.9%, 5.3%, and 4.5% in SA, DA, and HP, respectively (p = 0.281). Patients with persistence/recurrence had higher preoperative calcium (11.0 vs 10.7 mg/dl, p = 0.028) and PTH (96 vs 77 pg/ml, p = 0.015), and lower rates of IOPTH normalization (77% vs 96%, p < 0.001). On multivariable analysis, DA was associated with increased risk of persistent/recurrent disease (OR 3.0, p = 0.017). CONCLUSIONS: Most patients with DA are cured with removal of two glands, but approximately 5% experience disease persistence/recurrence. Low-normal final IOPTH was associated with lower risk of persistent/recurrent disease.
Authors: Michael W Yeh; James E Wiseman; Stephanie D Chu; Philip H G Ituarte; In-Lu Amy Liu; Kraig L Young; Steven J Kang; Avital Harari; Philip I Haigh Journal: Surgery Date: 2011-12 Impact factor: 3.982
Authors: Scott M Wilhelm; Tracy S Wang; Daniel T Ruan; James A Lee; Sylvia L Asa; Quan-Yang Duh; Gerard M Doherty; Miguel F Herrera; Janice L Pasieka; Nancy D Perrier; Shonni J Silverberg; Carmen C Solórzano; Cord Sturgeon; Mitchell E Tublin; Robert Udelsman; Sally E Carty Journal: JAMA Surg Date: 2016-10-01 Impact factor: 14.766
Authors: Heather Wachtel; Isadora Cerullo; Edmund K Bartlett; Rachel R Kelz; Giorgos C Karakousis; Douglas L Fraker Journal: Ann Surg Oncol Date: 2014-10-30 Impact factor: 5.344