Kostek M, Aygun N, Unlu M T, Uludag M
University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of General Surgery, Sisli, Istanbul, Turkey.
Acta Endocrinol (Buchar). 2023 Apr-Jun;19(2):208-214. doi: 10.4183/aeb.2023.208. Epub 2023 Oct 27.
Primary hyperparathyroidism is one of the most common endocrinological disorder and surgery of parathyroid glands is the main therapy of this disease. Minimally invasive surgery is getting more prominent in these days and its success in parathyroid surgery mostly depends on accuracy of the localization studies.
The aim of this study is to understand the relationship between preoperative biochemical tests, intraoperative findings and Technetium-99m-methoxyisobutylisonitrile (MIBI) scan results.
Retrospective clinical study.
A total of 185 patients, who have been diagnosed with primary hyperparathyroidism (PHPT) and operated between January, 2010 and October, 2018, were included to the study. Patients with less than 6 months of follow up are excluded from the study.
Patients were divided into two groups according to their scintigraphy results; with positive scintigraphy findings as group 1 (n:135) and negative scintigraphy findings as group 2 (n:50). Mean preoperative serum parathyroid hormone (PTH) values were significantly different between the two groups (p<0.02). Mean preoperative serum calcium, creatinine, magnesium, phosphorus, alkaline phosphatase, 25-OH Vitamin D3 levels of both groups were analyzed and there were no statistical differences between the two groups considering these parameters. Also, mean diameter and mean volume of parathyroid adenomas were significantly higher in group 1 (2.1±1.0 cm . 1.55±0.72 cm, respectively, p<0.0001; 2.66±5.35 cm . 1±1.9 cm, respectively, p<0.0001). Optimal cut-off values of parathyroid adenoma diameter for MIBI scan positivity were 1.55 cm, parathyroid volume for MIBI scan positivity were 0.48 cm, preoperative serum PTH for MIBI scan positivity were 124.5 ng/L.
Preoperative serum PTH levels, diameter and volume of adenomas might be helpful for the prediction of MIBI scan accuracy and possible need of another localization studies.
原发性甲状旁腺功能亢进是最常见的内分泌疾病之一，甲状旁腺手术是该疾病的主要治疗方法。近年来，微创手术越来越突出，其在甲状旁腺手术中的成功主要取决于定位研究的准确性。
本研究的目的是了解术前生化检查、术中发现与锝-99m-甲氧基异丁基异腈（MIBI）扫描结果之间的关系。
回顾性临床研究。
本研究纳入了2010年1月至2018年10月期间诊断为原发性甲状旁腺功能亢进（PHPT）并接受手术的185例患者。随访时间少于6个月的患者被排除在研究之外。
根据闪烁扫描结果将患者分为两组；闪烁扫描结果阳性的为第1组（n = 135），闪烁扫描结果阴性的为第2组（n = 50）。两组术前血清甲状旁腺激素（PTH）的平均水平有显著差异（p < 0.02）。分析了两组术前血清钙、肌酐、镁、磷、碱性磷酸酶、25-羟基维生素D3水平，考虑这些参数，两组之间无统计学差异。此外，第1组甲状旁腺腺瘤的平均直径和平均体积显著更高（分别为2.1±1.0 cm和1.55±0.72 cm，p < 0.0001；分别为2.66±5.35 cm和1±1.9 cm，p < 0.0001）。MIBI扫描阳性的甲状旁腺腺瘤直径的最佳截断值为1.55 cm，MIBI扫描阳性的甲状旁腺体积为0.48 cm，MIBI扫描阳性的术前血清PTH为124.5 ng/L。
术前血清PTH水平、腺瘤直径和体积可能有助于预测MIBI扫描的准确性以及是否可能需要进行其他定位研究。
