Management of Primary Hyperparathyroidism

Rose, John; Guerrero, Marlon A.

doi:10.5772/30842

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…Needle aspiration with parathyroid hormone assay allows for accurate identification of the parathyroid gland, but the false-negative rate is as high as 13%. 15,16 Alternatively, NIR fluorescence spectroscopy is capable of identifying the parathyroid in 30–40 seconds without damage to the tissue. The briefcase-sized spectroscopy system is associated with a one-time cost of approximately $8,000.…”

Section: Discussionmentioning

confidence: 99%

A novel optical approach to intraoperative detection of parathyroid glands

McWade¹,

Paras²,

White³

et al. 2013

Surgery

147

137

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Background Inadvertent removal of parathyroid glands is a challenge in endocrine operations. There is a critical need for a diagnostic tool that provides sensitive, real-time parathyroid detection during procedures. We have developed an intraoperative technique using near-infrared (NIR) fluorescence for in vivo, real-time detection of the parathyroid regardless of its pathologic state. Methods NIR fluorescence was measured intraoperatively from 45 patients undergoing parathyroidectomy and thyroidectomy. Spectra were measured from the parathyroid and surrounding neck tissues during the operation with the use of a portable, probe-based fluorescence system at 785-nm excitation. Accuracy was evaluated by comparison with histology or visual recognition by the surgeon. Results NIR fluorescence detected the parathyroid in 100% of patients. Parathyroid fluorescence was stronger (1.2–18 times) than that of the thyroid with peak fluorescence at 822 nm. Surrounding tissues showed no auto-fluorescence. Disease state did not affect the ability to discriminate parathyroid glands but may account for signal variability. Conclusions NIR fluorescence spectroscopy can detect intraoperatively the parathyroid regardless of tissue pathology. The signal may be caused by calcium-sensing receptors present in the parathyroid. The signal strength and consistency indicates the simplicity and effectiveness of this method. Its implementation may limit operative time, decrease costs, and improve operative success rates.

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Section: Discussionmentioning

confidence: 99%

A novel optical approach to intraoperative detection of parathyroid glands

McWade¹,

Paras²,

White³

et al. 2013

Surgery

147

137

View full text Add to dashboard Cite

show abstract

Use of cinacalcet in nephrolithiasis associated with normocalcemic or hypercalcemic primary hyperparathyroidism: results of a prospective randomized pilot study

Brardi

Cevenini

Verdacchi

et al. 2015

Arch Ital Urol Androl

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.Objectives: To evaluate, by means of a prospective randomized study, the efficacy of cinacalcet in the forms of nephrolithiasis associated with primary hyperparathyroidism in both the hypercalcemic and normocalcemic variant. Materials and Methods: Ten patients suffering from active nephrolithiasis associated with primary hyperparathyroidism (4 hypercalcemics and 6 normocalcemics), equally divided between males and females, were randomly but not blindly addressed to treatment with potassium citrate and allopurinol, or to the same therapeutic regimen in combination with cinacalcet. The dosage of cinacalcet was optimized for each patient in order to obtain a reduction of parathyroid hormone (PTH) within normal limits while enabling the maintenance of adequate calcemic values. All study participants were given the same diet based on a reduction in sodium intake, oxalate-rich foods and animal protein with standardized intake of calcium and an increase in hydration. After a follow up period of 10 months , cinacalcet was associated to standard therapy and diet in patients who were not taken it, conversely cinacalcet was withdrawn in the remaining patients who remained on standard therapeutic regimen and diet. SummaryNo conflict of interest declared.

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Management of Primary Hyperparathyroidism

Cited by 2 publications

References 47 publications

A novel optical approach to intraoperative detection of parathyroid glands

A novel optical approach to intraoperative detection of parathyroid glands

Use of cinacalcet in nephrolithiasis associated with normocalcemic or hypercalcemic primary hyperparathyroidism: results of a prospective randomized pilot study

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