1991
DOI: 10.1007/bf01675660
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Secondary hyperparathyroidism: Diagnosis of site of recurrence

Abstract: Persistent or recurrent hyperparathyroidism after total parathyroidectomy with forearm implant may be caused by hyperplastic grafted tissue, residual parathyroid tissue left in the neck or the presence of a supernumerary gland not found during surgery. A correct assessment of graft function is needed to localize the source of hormone excess and to avoid an unnecessary neck reoperation in cases of graft dependent hyperparathyroidism. In 12 patients with relapsing hyperparathyroidism after total parathyroidectom… Show more

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Cited by 80 publications
(43 citation statements)
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“…Reimplantation into the forearm may obviate the need for surgical reexploration of the neck in the event of recurrent HPT due to graft hyperplasia. Another advantage is that the site of recurrence can be assessed by a Casanova autograftectomy test [37] or its simplified modification [38]. The only prospective randomized trial comparing the outcome of 40 patients with either subtotal PTX or TPTX+AT showed significantly decreased rates of recurrence, significantly more often normalization of serum calcium and alkaline phosphatase as well as significant improvement of clinical signs like pruritus and muscle weakness after TPTX+AT compared to subtotal PTX [39] (EL IB).…”
Section: Surgical Concepts In Renal Hyperparathyroidismmentioning
confidence: 99%
See 1 more Smart Citation
“…Reimplantation into the forearm may obviate the need for surgical reexploration of the neck in the event of recurrent HPT due to graft hyperplasia. Another advantage is that the site of recurrence can be assessed by a Casanova autograftectomy test [37] or its simplified modification [38]. The only prospective randomized trial comparing the outcome of 40 patients with either subtotal PTX or TPTX+AT showed significantly decreased rates of recurrence, significantly more often normalization of serum calcium and alkaline phosphatase as well as significant improvement of clinical signs like pruritus and muscle weakness after TPTX+AT compared to subtotal PTX [39] (EL IB).…”
Section: Surgical Concepts In Renal Hyperparathyroidismmentioning
confidence: 99%
“…Therefore, in contrast to primary surgery, imaging studies to localize the enlarged parathyroid gland(s) are mandatory. In case of previous autograft into the forearm, an autograft-related PTH excess can be determined by the Casanova test [37] or its modification [38]. In case of a neck recurrence, imaging modalities should at minimum include neck ultrasound and 99 Tc sestamibi-SPECT scintigraphy, possibly supplemented by magnetic resonance imaging (MRI) of the neck and mediastinum, methionine-positron emission tomography (PET) CT or selective venous sampling (SVS), depending on the outcome of the respective studies [31].…”
Section: Surgical Approach For Persistent and Recurrent Renal Hyperpamentioning
confidence: 99%
“…A modified Casanova test demonstrating a reduction in serum PTH following application of a tourniquet under general anaesthetic immediately prior to surgery may help confirm the diagnosis. 5 Sestamibi scintigraphy has been described to detect forearm graft hyperplasia 2 but we could find only one report of radioguided forearm parathyroidectomy. 3 In that report, possibly due to high background counts within forearm muscle, the intra-operative radioguided 99 mTcSestamibi (707 MBq) was injected intravenously into the right antecubital fossa.…”
Section: Discussionmentioning
confidence: 88%
“…Casanova y cols 13 , describen una nueva e interesante forma de solucionar este problema, realizando isquemia completa en la extremidad en donde se realizó el autotrasplante; esto generaría un rápido cambio en la concentración de PTH si es que el hiperparatiroidismo es dependiente de la zona de autotrasplante. Pero en caso, en que el autotrasplante se realice en el músculo esternocleidomastoídeo, como acontece en nuestra casuística, este método carece de aplicación.…”
Section: Figuraunclassified