Clinical Experience in the Surgical Treatment of Primary Hyperparathyroidism: 94 Cases

Year 2013, Volume: 15 Issue: 3, 12 - 14, 01.12.2013

Abdullah Kısaoglu Müfide Nuran Akçay Sabri Selcuk Atamanalp Mehmet İlhan Yıldırgan Gürkan Öztürk Bünyami Özoğul

Abstract

Purpose:Hyperparathyroidism, which is often seen in the elderly, is the most common cause ofhypercalcemia.Primary Hyperparathyroidism is a rare endocrine disease. PrimaryMethods: In the present study we have studied patients who admitted to Erzurum AtaturkUniversity, Faculty of Medicine, Department of General Surgery and who underwent surgeryfor parathyroid adenoma within a period of 7 years.Results: In our study, male / female ratio was 4.8 / 1, mean age was 51.98, the most commoncomplaint was joint pain with general body pain. 6% of the patients had bilateral adenomas.Parathyroid adenoma was detected in all patients with neck ultrasound and parathyroidscintigraphy. The most common complication after surgery was transient hypocalcemia whichresponses to medical treatment. One third of patients underwent only adenoma excision and anadditional thyroid surgery was performed to the remaining patients. Pathological diagnoses ofthe patients were mostly reported as adenoma.Conclusion: In asymptomatic elderly patients, diagnosis of parathyroid adenoma can be madewith routine laboratory tests

Keywords

Primary Hyperparathyroidism, parathyroid adenoma, hypercalcemia

Primer Hiperparatiroidizm’in Cerrahi Tedavisinde Klinik Deneyimlerimiz: 94 Olgu

Abstract

Amaç: Primer Hiperparatiroidi nadir görülen endokrin hastalıklardan biridir. Sıklıkla ileriyaşlarda görülen Primer Hiperparatiroidi hiperkalseminin en sık nedenidir.Yöntem: Biz bu çalışmada Erzurum Atatürk Üniversitesi Tıp Fakültesi Genel Cerrahi AnabilimDalı’nda 7 yıllık süre içerisinde paratiroid adenomu nedeniyle ameliyat edilen hastalarıinceledik.Bulgular: Çalışmamızda kadın/erkek 4.8/1, ortalama yaş 51.98, en sık görülen şikayet ise genelvücut ağrısı ile birlikte eklem ağrısı idi. Bilateral adenom hastalarımızın % 6’sında vardı. BoyunUltrasonografi ve paratiroid sintigrafisin birlikte kullanıldığı hastaların tamamında adenomtespit edildi. Ameliyat sonrası en sık görülen komplikasyon medikal tedaviye cevap veren geçicihipokalsemi idi. Hastaların üçte birine sadece adenom eksizyonu yapılırken geriye kalanhastalara tiroid cerrahisi de yapıldı. Hastaların patolojik tanıları büyük oranda adenom olarakrapor edildi.Sonuç: Paratiroid adenom tanısı asemptomatik ileri yaştaki hastalarda rutin laboratuar tetkiklerile tespit edilebilir

Keywords

Primer Hiperparatiroidizm, paratiroid adenom, hiperkalsemi

References

• Adami S, Marcocci C, Gatti D. “Epidemiology of primaryhyperparathyroidism in Europe,” Journal of Bone and Mineral Research.2002;17:18–23.
• Melton LJ. Epidemiology of primary hyperparathyroidism. Journal of Bone and Mineral Research 1991;6:25–30.
• Bilezikian JP, PottsJr JT., El-HajjFuleihan G. et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspectiveforthe 21st century. Journal of Clinical Endocrinology&Metabolism. 2002; 87: 5353–61.
• Silverberg SJ. Non-classic altargetorgans in primary hyperparathyroidism. J Bone MinerRes 2002:17:117-25.
• Wermers RA, Khosla S, Atkinson EJ. et al. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993– 2001: an update on the changing epidemiology of the disease J Bone Miner Res, 2006;21: 171–77.
• Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000;343:1863–75.
• Mollerup CL, Vestergaard P, Frİkjaer VG, Mosekilde L, Christiansen P, Blichert-Toft M. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ,2002;305:807.
• Pyram R, Mahajan G, Gliwa A. Primary hyperparathyroidism: Skeletal and non-skeletal effects, diagnosis and management. Maturitas 2011:70;246-55.
• Mozes MF, Soper WD, Jonasson O, Lang GR. Total parathyroidectomy and autotransplantation in secondary hyperparathyroidism. Arch Surg. 1980;115:378.
• Ritz E, Matthias S, Siedel A. Distributed calcium metabolism in renal failure-pathogenesis and therapeutic strategies. Kidney İnternational 1994;37-42.
• Lumachi F, Zucchetta P, Marzola MC, Boccagni P, Angelini F, Bui F, D'Amico DF, Favia G. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol. 2000:143:755-60.
• Cakal E, Cakir E, Dilli A, Colak N, Unsal I, Aslan MS, Karbek B, Ozbek M, Kilic M, Delibasi T, Sahin M. Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates. Clin Imaging. 2012 ;36:688-94.
• Yetkin E, Çöker A, Kılıç M ve ark.Paratiroid adenomları 36 olguluk tek merkez deneyimi. Ulusal Cerrahi Dergisi 1996:12;201-5.
• Erbil Y, Barbaros U, Tükenmez M ve ark. Impact of adenoma weight and ectopic lozation of parathyroid adenoma on localization study results. World J Surg 2008:32;566-71.