Clinical Review of Primary Hyperparathyroidism / 대한내분비외과학회지

ABSTRACT

PURPOSE: The increased detection of hypercalcemia during health screening has been increased the diagnosis of hyperparathyroidism. The surgical treatment of primary hyperparathyroidism has been changing from standard exploration for all 4 parathyroid glands to minimally invasive surgery focused to abnormal gland. For the latter, exact preoperative localization is necessary. The aims of this study were to evaluate clinical features of patients with primary hyperparathyroidism and the preoperative localization methods. METHODS: A retrospective study was performed for 61 patients with primary hyperparathyroidism in Samsung Medical Center. RESULTS: There were 19 males and 42 females whose ages ranged from 12 to 76 years. Among 61 patients with primary hyperparathyroidism, there were 51 adenomas, 7 hyperplasias and 3 adenocarcinomas. Preoperative parathyroid hormone (PTH) level was increased in all patients except in a MEN IIA associated patient. Among the methods for preoperative localization, ultrasonography detected 47 of 55 cases (85.5%), (99m)Tc-sestamibi scan 40 of 49 cases (81.6%), MRI 3 of 5 cases (60.0%), CT 9 of 18 cases (50.0%) and Tl-Tc subtraction scan 6 of 9 cases (66.7%). In 26 patients who have been diagnosed as single nodular lesion in the same area by the parathyroid scan and ultrasonography, we could find a single parathyroid adenoma in that area during exploration. Postoperative PTH level of all patients but one were normalized. CONCLUSION: Single gland disease detected by both parathyroid scan and ultrasonography was mostly due to adenoma which can be treated safely by unilateral exploration or minimally invasive surgery.