Paradigm Shift in the Surgical Management of Multigland Parathyroid Hyperplasia

Lebastchi, Amir H.; Donovan, Patricia; Udelsman, Robert

doi:10.1001/jamasurg.2014.1296

Cited by 11 publications

(4 citation statements)

References 11 publications

(12 reference statements)

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“…Fourth, in the absence of bone biopsies, it may be difficult to ascertain bone turnover in patients with renal transplants. 34 Nevertheless, taking into account that our results in the cinacalcet arm are similar to those previously reported 20 and that extended minimally invasive subtotal parathyroidectomy is a feasible approach, 35 our results could reasonably be reproduced in a big clinical trial.…”

Section: Discussionsupporting

confidence: 86%

A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism

Cruzado

Moreno²,

Torregrosa

et al. 2015

JASN

139

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Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant. We designed this 12-month, prospective, multicenter, open-label, randomized study to evaluate whether subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia caused by persistent hyperparathyroidism after kidney transplant. Kidney allograft recipients with hypercalcemia and elevated intact parathyroid hormone (iPTH) concentration were eligible if they had received a transplant $6 months before the study and had an eGFR.30 ml/min per 1.73 m 2 . The primary end point was the proportion of patients with normocalcemia at 12 months. Secondary end points were serum iPTH concentration, serum phosphate concentration, bone mineral density, vascular calcification, renal function, patient and graft survival, and economic cost. In total, 30 patients were randomized to receive cinacalcet (n=15) or subtotal parathyroidectomy (n=15). At 12 months, ten of 15 patients in the cinacalcet group and 15 of 15 patients in the parathyroidectomy group (P=0.04) achieved normocalcemia. Normalization of serum phosphate concentration occurred in almost all patients. Subtotal parathyroidectomy induced greater reduction of iPTH and associated with a significant increase in femoral neck bone mineral density; vascular calcification remained unchanged in both groups. The most frequent adverse events were digestive intolerance in the cinacalcet group and hypocalcemia in the parathyroidectomy group. Surgery would be more cost effective than cinacalcet if cinacalcet duration reached 14 months. All patients were alive with a functioning graft at the end of follow-up. In conclusion, subtotal parathyroidectomy was superior to cinacalcet in controlling hypercalcemia in these patients with kidney transplants and persistent hyperparathyroidism.

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Section: Discussionsupporting

confidence: 86%

A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism

Cruzado

Moreno²,

Torregrosa

et al. 2015

JASN

139

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“…Primary hyperparathyroidism is caused by excessive secretion of parathyroid hormone (PTH) by single or double adenomas, multigland hyperplasia, or rarely, parathyroid carcinoma . Regardless of the disease etiology, complete surgical removal of the hyperfunctional parathyroid tissue is the only hope for cure …”

Section: Introductionmentioning

confidence: 99%

“…P rimary hyperparathyroidism (PHPT) is a common endocrine disorder with approximately 100 000 new cases diagnosed each year in the United States. 1,2 Primary hyperparathyroidism is caused by excessive secretion of parathyroid hormone (PTH) by single or double adenomas, multigland hyperplasia, or rarely, parathyroid carcinoma. 1,3 Regardless of the disease etiology, complete surgical removal of the hyperfunctional parathyroid tissue is the only hope for cure.…”

mentioning

confidence: 99%

“…1,3 Regardless of the disease etiology, complete surgical removal of the hyperfunctional parathyroid tissue is the only hope for cure. 2 This traditionally involves bilateral neck exploration (BNE), inspection of all 4 parathyroid glands, and removal of any grossly enlarged lesions. 4,5 However, over the past 2 decades there has been a growing trend toward more focused and less invasive techniques.…”

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confidence: 99%

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Association of Parathyroid Gland Biopsy Excision Technique With Ex Vivo Radiation Counts During Radioguided Parathyroid Surgery

Hinson

Lawson

Franco

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Unless half of a parathyroid gland is biopsied during radioguided parathyroidectomy, the 20% rule cannot reliably rule out the presence of a hyperfunctional parathyroid lesion. Pie-shaped biopsies originating from the center of the gland are associated with a lower rate of false-negative results compared with peripheral biopsies of similar size. Pie-shaped biopsies and biopsy of half or more of each nonexcised parathyroid gland for ex vivo counts may increase the risk of remnant devascularization and resultant hypoparathyroidism.

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Intraoperative PTH Monitoring for Parathyroid Surgery

Maxwell

Ferris

2016

Medical and Surgical Treatment of Parathyroid Diseases

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Paradigm Shift in the Surgical Management of Multigland Parathyroid Hyperplasia

Cited by 11 publications

References 11 publications

A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism

A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism

Association of Parathyroid Gland Biopsy Excision Technique With Ex Vivo Radiation Counts During Radioguided Parathyroid Surgery

Intraoperative PTH Monitoring for Parathyroid Surgery

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