Kaur Parjeet, Gattani Raghav, Singhal Alka Ashmita, Sarin Deepak, Arora Sowrabh Kumar, Mithal Ambrish
Division of Endocrinology and Diabetes, Medanta the Medicity, Gurgaon, Haryana, India.
Department of Radiodiagnostics, Medanta the Medicity, Gurgaon, Haryana, India.
Indian J Endocrinol Metab. 2016 Sep-Oct;20(5):625-630. doi: 10.4103/2230-8210.190540.
Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy.
To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT).
This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study.
A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH.
We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT.
甲状旁腺腺瘤的术前定位对于决定甲状旁腺切除术的手术方式至关重要。
描述原发性甲状旁腺功能亢进症（PHPT）患者的临床和生化特征，评估术前成像方式及手术方法。
这是一项在单一机构进行的回顾性研究。纳入了2011年至2015年期间接受PHPT评估和手术的所有患者。
共有100例患者接受了PHPT手术。平均（标准差）年龄为51.6（15.9）岁，女性与男性比例为1.7:1。40例患者有严重症状，60例有轻度至中度症状。锝-99m六甲基丙烯胺肟（MIBI）扫描和颈部超声检查（USG）识别异常甲状旁腺的敏感性分别为93%（93/100）和98%（98/100）。90/93（96.7%）例患者的MIBI扫描结果与手术结果相符，而96/98例患者（98%）的术前USG检查结果与手术结果相关。对40例患者（微创甲状旁腺切除术=38例，双侧颈部探查=1例，单侧颈部探查=1例）在切除后10分钟测量术中完整甲状旁腺激素（IOPTH）水平。除2例患者外，所有患者的IOPTH下降均<50%。腺瘤重量与术前完整PTH呈正相关。
我们发现，在定位异常甲状旁腺方面，USG的敏感性（98%）高于MIBI扫描（93%）。此外，USG的术前定位准确性（93%）高于MIBI扫描（90%），有助于选择合适的手术方式。较高比例的患者（60%）患有轻度/无症状形式的PHPT。
