Berber Eren, Akbulut Serkan, Avci Seyma, Isiktas Gizem
Departments of Endocrine, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
General Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
World J Surg. 2022 Apr;46(4):807-812. doi: 10.1007/s00268-021-06422-8. Epub 2022 Jan 10.
There are scant data in the literature regarding whether parathyroid autofluorescence (AF) signal patterns vary based on the etiology of hyperparathyroidism. The aim of this study was to compare AF signals of parathyroid glands across different etiologies of hyperparathyroidism.
As a prospective institutional review board-approved study between 2016 and 2019, AF intensities and heterogeneity indexes (HIs) of parathyroid glands in patients who underwent parathyroidectomy using AF were calculated and compared using Chi-square, Kruskal Wallis, Mann Whitney U, and logistic regression tests.
Of the total of 183 patients, 127 patients had sporadic classic primary hyperparathyroidism, 30 patients had sporadic normohormonal primary hyperparathyroidism, 10 patients had sporadic normocalcemic primary hyperparathyroidism, 12 patients had tertiary hyperparathyroidism, and 4 patients had familial primary hyperparathyroidism related to multiple endocrine neoplasia (MEN) 2A. There were no statistical differences in AF signals of abnormal parathyroid glands in classic, normohormonal or normocalcemic sporadic hyperparathyroidism. Parathyroid glands in patients with tertiary hyperparathyroidism were similar in intensity, but more homogenous compared to those in sporadic primary hyperparathyroidism.
The pattern of AF exhibited by abnormal parathyroid glands was similar across different spectrums of primary hyperparathyroidism, in accordance with observations in the literature. However, parathyroid glands in tertiary hyperparathyroidism were more homogeneous, despite exhibiting a similar intensity of AF compared to those in sporadic primary hyperparathyroidism. These differences should be kept in mind when using the AF pattern as an adjunct to visual assessment in parathyroid exploration.
关于甲状旁腺自发荧光（AF）信号模式是否因甲状旁腺功能亢进的病因不同而有所差异，文献中的数据很少。本研究的目的是比较不同病因的甲状旁腺功能亢进患者甲状旁腺的AF信号。
作为一项2016年至2019年经机构审查委员会批准的前瞻性研究，对使用AF进行甲状旁腺切除术的患者甲状旁腺的AF强度和异质性指数（HI）进行计算，并使用卡方检验、Kruskal Wallis检验、Mann Whitney U检验和逻辑回归检验进行比较。
在总共183例患者中，127例患有散发性经典原发性甲状旁腺功能亢进，30例患有散发性正常激素水平原发性甲状旁腺功能亢进，10例患有散发性血钙正常原发性甲状旁腺功能亢进，12例患有三发性甲状旁腺功能亢进，4例患有与多发性内分泌腺瘤病（MEN）2A相关的家族性原发性甲状旁腺功能亢进。经典型、正常激素水平型或血钙正常型散发性甲状旁腺功能亢进患者异常甲状旁腺的AF信号无统计学差异。三发性甲状旁腺功能亢进患者的甲状旁腺在强度上相似，但与散发性原发性甲状旁腺功能亢进患者的甲状旁腺相比，其同质性更高。
根据文献中的观察结果，不同类型的原发性甲状旁腺功能亢进患者异常甲状旁腺呈现的AF模式相似。然而，三发性甲状旁腺功能亢进患者的甲状旁腺同质性更高，尽管与散发性原发性甲状旁腺功能亢进患者的甲状旁腺相比，其AF强度相似。在甲状旁腺探查中使用AF模式作为视觉评估的辅助手段时，应牢记这些差异。
