RESUMO
OBJECTIVE: Vitamin D deficiency (VDD) was previously associated with larger adenoma size in primary hyperparathyroidism (PHPT), but this topic was not addressed in patients with the mild/asymptomatic form of the disease (aPHPT). METHODS: We retrospectively retrieved from our series of patients affected by PHPT, 96 consecutive subjects with aPHPT in whom 25-hydroxyvitamin D (25OHD) levels had been assayed and compared those results with localizing imaging studies. RESULTS: Twenty-five of 96 patients had VDD (25OHD <20 ng/mL), but positive ultrasound and scintigraphic studies were not different between patients with and without VDD (52.3% versus 55.7% and 42.9% versus 52.4%, respectively). Upon logistic regression analysis, after adjusting for different variables, including the presence of goiter, VDD was not an independent predictor of localization by imaging studies. CONCLUSION: VDD does not affect the likelihood of positive pre-operative imaging in aPHPT and the consequent surgical decisions.
Assuntos
Adenoma/complicações , Adenoma/diagnóstico , Diagnóstico por Imagem , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Deficiência de Vitamina D/complicações , Adenoma/sangue , Adenoma/cirurgia , Idoso , Doenças Assintomáticas , Calcifediol/sangue , Diagnóstico por Imagem/métodos , Feminino , Humanos , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/epidemiologia , Neoplasias das Paratireoides/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Tecnécio Tc 99m Sestamibi , Ultrassonografia , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/cirurgiaAssuntos
Hiperparatireoidismo Primário/diagnóstico , Conservadores da Densidade Óssea/uso terapêutico , Doenças Ósseas/etiologia , Calcimiméticos/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/cirurgia , Nefropatias/etiologia , Masculino , Hormônio Paratireóideo/sangue , Paratireoidectomia , Índice de Gravidade de DoençaRESUMO
Rapid intraoperative parathyroid hormone (RIOPTH) monitoring predicts complete removal of all hypersecreting tissue by means of a significant parathyroid hormone (PTH) decrease. In this study we have tried to provide an explanation for some unexpected results of RIOPTH monitoring observed during a series of 125 conventional parathyroidectomies for primary hyperthyroidism, discussing the possible consequences on the surgical strategy. Three main groups can be recognized: (1) spikes: a PTH increase 10 minutes after removal of the diseased gland was observed in three patients; (2) false-negative results: six patients showed an inadequate PTH decreases at 10 minutes, three of them resulting in cure at 20 minutes (all six patients were cured at follow-up); (3) false-positive results: five patients with multiglandular disease showed a PTH decrease to a cure level despite excision of one adenoma only (in two of these patients a 20-minute sample showed a PTH increase soon after manipulation of the second adenoma). We concluded that the spike, almost certainly a consequence of manipulating the adenoma, when detected should be considered the "true" baseline value. False-negative results are to some extent related to undetected spikes. The assay used for RIOPTH determination and PTH half-life variability may also play a role. A false-negative result usually prolongs the surgical time. False-positive results are usually related to a double adenoma, one functionally prevailing over the other. Because in our experience manipulation of the second adenoma brought a PTH increase detected with RIOPTH monitoring, we believe that the second adenoma should be excised.