Indications for operative intervention in patients with asymptomatic primary hyperparathyroidism: Practice patterns of endocrine surgery

Kouvaraki, Maria A.; Greer, Marilyn; Sharma, Sheena; Beery, David; Armand, Robert; Lee, Jeffrey E.; Evans, Douglas B.; Perrier, Nancy D.

doi:10.1016/j.surg.2005.09.006

Cited by 44 publications

(26 citation statements)

References 33 publications

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“…Another possible explanation for the findings could be broader indications for surgery. This has also been reported in other institutions: indeed despite rather conservative guidelines [14], surveys suggest that many endocrine surgeons consider the operation indicated in all patients with pHPT [15].…”

Section: Discussionsupporting

confidence: 56%

Changing biochemical presentation of primary hyperparathyroidism

Almquist

Bergenfelz

Mårtensson

et al. 2010

Langenbecks Arch Surg

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Section: Discussionsupporting

confidence: 56%

Changing biochemical presentation of primary hyperparathyroidism

Almquist

Bergenfelz

Mårtensson

et al. 2010

Langenbecks Arch Surg

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“…Asymptomatic patients with mild to moderate hypercalcemia may be monitored at regular intervals. The National Institute of Health (NIH) guidelines for the treatment of PHPT are also useful in LAH patients in regards to patient selection for parathyroidectomy [37]. (Figure 1) When medically feasible lithium should be discontinued or alternative therapy substituted (valproate, carbamazepine or atypical antipsychotics) in selected LAH patients.…”

Section: An Evidence Based Algorithm For the Management Of Lahmentioning

confidence: 99%

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

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Background: Long-term lithium use in psychiatric patients may lead to lithium associated hyperparathyroidism (LAH). Although anecdotal case reports have appeared, an evidence based algorithm for management of LAH is lacking. Methods: A comprehensive literature search was performed using PubMed with keywords; "lithium" "hypercalcemia" "hyperparathyroidism" "sestamibi" "intra-operative parathyroid hormone (IOPTH) monitoring" "parathyroidectomy" and "medical management". All English language publications addressing etiology and clinical management issues concerning LAH were critically analyzed. Results: Lithium associated hyperparathyroidism occurs in 4.3% -6.3% of chronic lithium users compared to the general population which has an incidence of 0.5% -1%. 194 cases of LAH have been reported which includes 10 patients (5%) treated medically and 170 patients (88%) who underwent parathyroidectomy. No details were available for 14 patients (7%). Among parathyroidectomy patients, 104 (59%) had adenomatous disease and 66 (39%) had multiglandular hyperplasia. Preoperative localization studies were utilized in only 22 patients (13%) and IOPTH monitoring was reported in only 3 studies (32 patients, 19%). Among surgical patients, bilateral neck exploration (BNE) was the most common approach performed in 162 patients (95%); focused neck exploration was utilized in only 8 patients (5%). Parathyroidectomy normalized LAH biochemical changes in nearly all patients (90% -97%) in the early post-operative period, but recurrent hyperparathyroidism occurred in 8% -42% of patients. Conclusion: LAH is an under appreciated and poorly understood endocrine disorder. LAH has a higher incidence of multiglandular disease and bilateral neck exploration is mandatory in majority for disease control. Nonsurgical approaches may be useful in select patients on short-term lithium therapy.

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“…While surgical resection of the visible tumors fails to cure the patient, prophylactic surgery aims to remove these lesions before malignancy develops. However, while recent data show that early diagnosis and surgery improve survival [92], others suggest a more conservative approach, as their data indicate, that only tumors larger than 2 cm are associated with an increased risk of malignancy [79]. Therapeutic strategies thus range from follow-up, to enucleation of visible lesions [86] or aggressive interventions with enucleation of tumors in the head of the pancreas combined with distal, subtotal (80%) pancreatic resection as prophylaxis against tumor recurrence [78, 93, 94].…”

Section: Surgical Therapymentioning

confidence: 99%