Management and outcomes of hyperparathyroidism: a case series from a single institution over two decades

Abstract

BackgroundHyperparathyroidism is a frequent endocrine disorder with variable clinical manifestations and outcomes. We aimed to evaluate clinical presentations, management and outcomes of hyperparathyroidism.MethodsA retrospective study was conducted to include all patients presented with hyperparathyroidism between 1995 and 2014 at a single tertiary hospital with an average follow-up period of 46 months. Data were reviewed for clinical presentations, diagnostic work-up, intraoperative findings, management, and outcomes.ResultWe identified 161 patients with hyperparathyroidism; 69% were females and the mean age was 49.4±15 years. Patients presented mainly with musculoskeletal (65.8%), renal (37.3%), gastrointestinal tract (53.8%) and neuropsychiatric (8.8%) manifestations. At presentation, mean serum calcium and parathyroid hormone levels were elevated while mean vitamin D level was lower. Sestamibi-99mTc (MIBI) scintigraphy was done for 134 patients (83.2%) and was positive in 94 (70%). Primary hyperparathyroidism (67.7%) was the most frequent diagnosis followed by secondary (29.8%) and tertiary hyperparathyroidism (2.5%). The frequent indication for surgery was hypercalcemia (67.3%), bone disease (35.6%) and renal calculi (28.9%). The main postoperative pathology was parathyroid adenoma (63.1%) followed by hyperplasia (37.3%). Fourteen (8.9%) and 18 (11.4%) patients had persistent and recurrent hyperparathyroidism, respectively. Autotransplantation of parathyroid tissue was done in 36 cases.ConclusionPrimary hyperparathyroidism is the most frequent cause of the parathyroid disease. Parathyroidectomy is the effective surgical approach in symptomatic patients. Further studies are needed to establish the association between vitamin D levels, renal disorders and persistent or recurrent hyperparathyroidism.

Role of routine frozen sections for parathyroid exploration in a resource poor setting

“…Hypocalcaemia results in compensatory stimulation of the gland in secondary hyperparathyroidism. Tertiary hyperparathyroidism is a complication of secondary hyperparathyroidism where the gland remains to be hyperactivity independent of the e t i o l o g i c a l f a c t o r. B o t h s e c o n d a r y a n d t e r t i a r y hyperparathyroidism are less common than primary hyperparathyroidism (13).…”

“…Mishaps in communication occur at different points in the surgical care. This is broadly divided into inaccuracies that occur in preoperative assessment and optimization phase, pre procedure/procedural phase, post-operative phase and daily ward care (13). These miscommunications among team members could lead to devastating outcomes resulting in high morbidity and mortality (14).…”

“…Several systematic reviews and studies conducted in intrahospital patient handover (15)(16)(17)(18)(19), information transfer among healthcare workers (13,20,21) and effectiveness of surgical checklists (22, 23) concluded that communication errors are a shared the issue throughout the world. However, presently there are no reviews evaluating communication.…”

Parathyroidectomy under Local Anesthesia: A Case Report

“…Parathyroidectomy is the curative treatment 2,5,6 . Postoperative hypocalcaemia after parathyroidectomy is expected and usually resolved after 4 th postoperative day 6,7 . The aim of presentation is to increase awareness of this common disease and to present the value of parathyroidectomy under local anesthesia.…”

“…Musculoskeletal system remains the most common system affected due to primary hyperparathyroidism followed by renal and gastrointestinal system . Indication for surgical treatment of hyperparathyroidism, are marked unremitting hypercalcaemia, recurrent renal stones, nephrocalcinosis and sever bone changes 1,6,8 . Excision of adenoma containing parathyroid is good option in treatment of primary hyperparathyroidism, but this diagnosis can be misleading in patients with history of chronic renal disease 6,8 .…”