ABSTRACT
Objective To explore the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods Clinical data of 35 cases of PHPT were retrospectively analyzed. Results 23 out of 26 cases (88.5%) undergoing preoperative ultrasonography with a positive result were verified by intraoperative (findings). For ECT, the positive rate was 21 out of 23 cases (95.5%). Unilateral neck explorations (UNE) was performed in 27 cases of parathyroidoma. Two cases of parathyroid hyperplasia were treated by UNE and the other two cases by bilateral neck exploration (BNE). The procedure for 3 cases of parathyroid carcinoma was the same as that for papillary thyroid carcinoma. Unilateral resection of thyroid and parathyroid was done in a case of parathyroidoma with malignant change. Emergency excision of parathyroidoma, after (emergency) medical management, was performed in a patient with parathyroid storm, and the symptoms (subsided) postoperatively. All cases developed hypocalcemia in various degrees after surgery, but the symptoms were relieved with the use of calcium gluconate. Conclusions PHPT could be diagnosed according to (co-elevated) calcemia and PTH. Ultrasonography and ECT should be considered as the methods of first choice for preoperative localization. UNE of parathyroidoma could be feasible if accurate image localizations are (available). Radionuclear guided parathyroid resection could be performed in the patients with ectopic parathyroid disease or lesions without accurate localization. Aggressive surgical exploration after medical control of (symptoms) is the first choice of treatment when parathyroid storm is diagnosed.
ABSTRACT
Objective To investigate the different clinical behavior and the diagnosis and trearment of primary hyperparathyroidism(PHPT). Methods Clinical data of 53 patients with PHPT treated in Beijing Jishuitan Hospital from May 1977 to April 2004 were collected and analyzed. Results 53 patients with PHPT were confirmed by operation and pathology. The majority of the patients were aged 20~50 years. There were more female than male patients. There were various clinical manifestations, and the duration of illness was (protracted). Many cases were misdiagnosed. There were bone pathologic changes of varying extent in all (patients), stones in urinary system plus bone pathology in 11 cases, serum level of calcium was raised in 51 patients(96.2%) and (parathyroid) hormone (PTH) was elevated in all examined 48 cases. Ultrasound, MIBI and CT were done before operation after 1991, and accurate preoperative localization diagnosis was (obtained). Minimally invasive (parathyroidectomy) (MIP) was successfully completed in 39 of 45 cases, and the primary operation cure rate was 97.4%. At postoperative follow-up of 10 months to 10 years, with the (exception) of 15 cases of severe bone deformity that had no obvious improvement, the other symptoms and signs were all relieved to varying (extents), the laboratory markers returned to normal, and there was no permanent hypoparathyroidism or (recurrent) nerve injury or other complications.Conclusions Early diagnosis of PHPT and effective early (treatment) by surgical removal of the pathologic lesion can alleviate the occurrence of severe bone changes and deformity. The preoperative combined use of imaging localization technique and overall assessment can improve the accuracy of diagnostic localization of the lesion.