Article Sidebar
Views PDF: 225
CLINICAL AND PARACLINICAL CHARACTERISTICS AND RESULTS OF SURGERY OF ADENOMA PARATHYROID
Main Article Content
Abstract
Objective:To study the clinical and paraclinical characteristics, evaluate the results of surgery of adenoma parathyroid. Methods: Case series. Materials: 15 patients were diagnosed and operated on for adenoma parathyroid at Hanoi Medical University Hospital. Results: Female / male ratio = 1,14/1, average age is 52 ± 11.21. The main reason for medical examination is periodic health examination. Common symptoms are fatigue (10/15 patients), manifestations of bone and kidneywith high rate, including bone pain (7/15 patients), low back pain (2/15 patients), and other non-specific symptoms such as anorexia, thirst and insomnia. 9/15 of patients have history of urinary stones. The mean concentration of PTH is31.69 ± 16.39 pmol/l, total calciemiaconcentration is 3,05 ± 0,43 mmol/l and ionized calciemia concentration is 1,62 ± 0,22 mmol/l. 10/15 patients were detected tumors by ultrasound. Scintigraphy detected 7/11 patients. CT was conducted in 1 patient and a parathyroid tumor was found. MRI performed in a patient but the result was negative. Selective venous sampling tests for PTH in 3 patients were performed and helped to identify tumors. All 15 patients underwent minimally invasive parathyroidectomy. Each patient had a tumor, mainly in the inferior parathyroid gland. Intraoperative PTH concentrationdecreased more than 50% with a averagedrop 86,04 ±5,52% . The average operative time was 61,33 ± 8,12 minute. Common tumor size were 1-2 cm. No patient had complications during or after surgery. Follow-up after 6 months,all patients hasionized calciemia concentration, total calciemia concentration, PTH within normal ranges. Conclusion: The research showed that clinical symptoms of adenoma parathyroid were non-specific and in many different organs. Diagnosis primary hyperparathyroidism is base on an increase in calcium and parathyroid hormone levels. The 99m-Tc-Sestamibi scintigraphy and ultrasound have high sensitivity. When non-invasive imaging methods arenegative, selective venous sampling is performed. Especially minimally invasive parathyroidectomy has a high success rate, short operative time, and few complications.
Article Details
Keywords
Primary hyperparathyroidism, adenoma parathyroid
References
2. Liu JM., Natalie E., Barbara C. et al (2013), Primary Hyperparathyroidism: A Tale of Two Cities Revisited — New York and Shanghai. Bone Research, 2, 162-169
3. Yadav SK., Johri G., Bichoo RA. et al (2020). Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. Arch Endocrinol Metab, 64, 105-110.
4. Malabu UH. (2007), Primary Hyperparathyroidism in Saudi Arabia: A Review of 46 Cases. Med J Malasia, 62(5), 4.
5. Paruk IM., Esterhuizen TM., Maharaj S. et al (2013). Characteristics, management and outcome of primary hyperparathyroidism in South Africa: a single-centre experience. Postgrad Med J, 89(1057), 626-631.
6. Pradeep PV., Jayashree B., Mishra A. (2011). Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends. Int J Endocrinol, 2011, e921814.
7. Ikuno M., Yamada T., Shinjo. (2018), Selective venous sampling supports localization of adenoma in primary hyperparathyroidism. Acta Radiol Open, 7(2).
8. Yazici P., Mihmanli M., Aygun N. et al (2015). Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look? World J Endocr Surg, 7, 1-5.
9. Jinih M., O’Connell E., O’Leary DP. ( 2017). Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol, 24(7), 1924-1934.