Endocrinology and Metabolism

Review Articles

Calcium & Bone Metabolism
Update on Preoperative Parathyroid Localization in Primary Hyperparathyroidism: Hye-Sun Park, Namki Hong, Jong Ju Jeong, Mijin Yun, Yumie Rhee; Endocrinol Metab. 2022;37(5):744-755. Published online October 25, 2022; DOI: https://doi.org/10.3803/EnM.2022.1589

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Parathyroidectomy is the treatment of choice for primary hyperparathyroidism when the clinical criteria are met. Although bilateral neck exploration is traditionally the standard method for surgery, minimally invasive parathyroidectomy (MIP), or focused parathyroidectomy, has been widely accepted with comparable curative outcomes. For successful MIP, accurate preoperative localization of parathyroid lesions is essential. However, no consensus exists on the optimal approach for localization. Currently, ultrasonography and technetium-99m-sestamibi–single photon emission computed tomography/computed tomography are widely accepted in most cases. However, exact localization cannot always be achieved, especially in cases with multiglandular disease, ectopic glands, recurrent disease, and normocalcemic primary hyperparathyroidism. Therefore, new modalities for preoperative localization have been developed and evaluated. Positron emission tomography/computed tomography and parathyroid venous sampling have demonstrated improvements in sensitivity and accuracy. Both anatomical and functional information can be obtained by combining these methods. As each approach has its advantages and disadvantages, the localization study should be deliberately chosen based on each patient’s clinical profile, costs, radiation exposure, and the availability of experienced experts. In this review, we summarize various methods for the localization of hyperfunctioning parathyroid tissues in primary hyperparathyroidism.

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Expression of the Calcium-Sensing Receptor on Normal and Abnormal Parathyroid and Thyroid Tissue
Anne L. Worth, Mesrop Ayrapetyan, Susan J. Maygarden, Zibo Li, Zhanhong Wu, Chris B. Agala, Lawrence T. Kim
Journal of Surgical Research.2024; 293: 618. CrossRef
A Rare Case of Hyperfunctioning Lipoadenoma Presenting as a Cystic Pararthyroid Lesion
Jinyoung Kim, Ohjoon Kwon, Tae-Jung Kim, So Lyung Jung, Eun Ji Han, Ki-Ho Song
Journal of Bone Metabolism.2023; 30(2): 201. CrossRef
Role of 18F-Fluorocholine Positron Emission Tomography (PET)/Computed Tomography (CT) in Diagnosis of Elusive Parathyroid Adenoma
Janan R Badier, Pokhraj P Suthar, Jagadeesh S Singh, Miral D Jhaveri
Cureus.2023;[Epub] CrossRef
Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue
Mara Carsote, Mihaela Stanciu, Florina Ligia Popa, Oana-Claudia Sima, Eugenia Petrova, Anca-Pati Cucu, Claudiu Nistor
Medicina.2023; 60(1): 15. CrossRef
Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review
Max H. M. C. Scheepers, Zaid Al-Difaie, Lloyd Brandts, Andrea Peeters, Bjorn Winkens, Mahdi Al-Taher, Sanne M. E. Engelen, Tim Lubbers, Bas Havekes, Nicole D. Bouvy, Alida A. Postma
Diagnostics.2023; 14(1): 25. CrossRef

Miscellaneous
Intraoperative Parathyroid Hormone Monitoring in the Surgical Management of Sporadic Primary Hyperparathyroidism: Zahra F. Khan, John I. Lew; Endocrinol Metab. 2019;34(4):327-339. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.327

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Intraoperative parathyroid hormone monitoring (IPM) has been shown to be a useful adjunct during parathyroidectomy to ensure operative success at many specialized medical centers worldwide. Using the Miami or “>50% intraoperative PTH drop” criterion, IPM confirms the complete excision of all hyperfunctioning parathyroid tissue before the operation is finished, and helps guide the surgeon to identify additional hyperfunctioning parathyroid glands that may necessitate further extensive neck exploration when intraoperative parathyroid hormone (PTH) levels do not drop sufficiently. The intraoperative PTH assay is also used to differentiate parathyroid from non-parathyroid tissues during operations using fine needle aspiration samples and to lateralize the side of the neck harboring the hypersecreting parathyroid through differential jugular venous sampling when preoperative localization studies are negative or equivocal. The use of IPM underscores the recognition and understanding of sporadic primary hyperparathyroidism (SPHPT) as a disease of function rather than form, where the surgeon is better equipped to treat such patients with quantitative instead of qualitative information for durable long-term operative success. There has been a significant paradigm shift over the last 2 decades from conventional to focused parathyroidectomy guided by IPM. This approach has proven to be a safe and rapid operation requiring minimal dissection performed in an ambulatory setting for the treatment of SPHPT.

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Intraoperative parathyroid hormone monitoring in parathyroidectomy for hyperparathyroidism: a protocol for a network meta-analysis of diagnostic test accuracy
Phillip Staibano, Kevin Um, Sheila Yu, Mohit Bhandari, Michael K. Gupta, Michael Au, JEM (Ted) Young, Han Zhang
Frontiers in Surgery.2024;[Epub] CrossRef
Primary Hyperparathyroidism
Saba Kurtom, Sally E. Carty
Surgical Clinics of North America.2024;[Epub] CrossRef
Parathyroidectomy for primary hyperparathyroidism: A retrospective analysis of localization, surgical characteristics, and treatment outcomes
Dongbin Ahn, Ji Hye Kwak, Gil Joon Lee, Jin Ho Sohn
Asian Journal of Surgery.2023; 46(2): 788. CrossRef
Magnitude of parathyroid hormone elevation in primary hyperparathyroidism: Does time of day matter?
C. Corbin Frye, Janessa Sullivan, Sai Anusha Sanka, Jingxia Liu, L. Michael Brunt, William Gillanders, Taylor C. Brown, T.K. Pandian
Surgery.2023; 173(3): 659. CrossRef
Analysis of intraoperative laboratory measurements and imaging techniques such as Tc-99 m-MIBI SPECT/CT, 18F-fluorocholine PET/CT and ultrasound in patients operated with prediagnosis of parathyroid adenoma
Nurullah Bilen, Mehmet Avni Gokalp, Latif Yilmaz, Alper Aytekin, Ilyas Baskonus
Irish Journal of Medical Science (1971 -).2023; 192(4): 1695. CrossRef
Intraoperative Parathyroid Hormone Monitoring Is of Limited Usefulness in Guiding Autotransplantation in Reoperative or Subtotal Parathyroidectomy for Primary Hyperparathyroidism
Bradley A. Richards, Robert A. Vierkant, Benzon M. Dy, Trenton R. Foster, Travis J. McKenzie, Melanie L. Lyden
The American Surgeon™.2023; 89(12): 5421. CrossRef
Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?
Alessio Imperiale, Jacob Bani, Gianluca Bottoni, Adrien Latgé, Céline Heimburger, Ugo Catrambone, Michel Vix, Giorgio Treglia, Arnoldo Piccardo
Frontiers in Medicine.2023;[Epub] CrossRef
Intraoperative Identification of Thyroid and Parathyroid Tissues During Human Endocrine Surgery Using the MasSpec Pen
Rachel J. DeHoog, Mary E. King, Michael F. Keating, Jialing Zhang, Marta Sans, Clara L. Feider, Kyana Y. Garza, Alena Bensussan, Anna Krieger, John Q. Lin, Sunil Badal, Elizabeth Alore, Christopher Pirko, Kirtan Brahmbhatt, Wendong Yu, Raymon Grogan, Livi
JAMA Surgery.2023; 158(10): 1050. CrossRef
A Rare Case of Recurrent Parathyroid Adenomas After Initial Parathyroidectomy
Grant N Schalet, Luke Vincent, Carl Eguez, Gerardo Diaz, Mark S Shachner
Cureus.2023;[Epub] CrossRef
Surgical treatment of tertiary hyperparathyroidism: does one fit for all?
Claudio Casella, Claudio Guarneri, Manuela Campanile, Xavier Adhoute, Pier Paolo Gelera, Riccardo Morandi
Frontiers in Endocrinology.2023;[Epub] CrossRef
A >50% Intraoperative Parathyroid Hormone Decrease Into Normal Reference Range Predicts Complete Excision of Malignancy in Patients With Parathyroid Carcinoma
Valerie L. Armstrong, Tanaz M. Vaghaiwalla, Cima Saghira, Cheng-Bang Chen, Yujie Wang, Johan Anantharaj, Mehmet Ackin, John I. Lew
Journal of Surgical Research.2023;[Epub] CrossRef
Variation in parathyroid adenoma size in patients with sporadic, primary hyperparathyroidism: small gland size does not preclude single gland disease
Sophie Dream, Tina W. F. Yen, Kara Doffek, Douglas B. Evans, Tracy S. Wang
Langenbeck's Archives of Surgery.2022; 407(5): 2067. CrossRef
Role and Recent Trend of Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy in Patients With Primary Hyperparathyroidism
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Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2022; 65(5): 253. CrossRef
Parathyroid Adenoma: Rare Cause of Acute Recurrent Pancreatitis
Shikha Mahajan, Alka Kumar, Vivek Aggarwal, Vikas Jain, Vipul Baweja, Ajay Ajmani, Diplomate CBNC, Fellow EBNM LNU
Annals of Pediatric Gastroenterology and Hepatology.2022; 2(3-4): 9. CrossRef
Long-term outcome of surgical techniques for sporadic primary hyperparathyroidism in a tertiary referral center in Belgium
Klaas Van Den Heede, Amélie Bonheure, Nele Brusselaers, Sam Van Slycke
Langenbeck's Archives of Surgery.2022; 407(7): 3045. CrossRef
Contribution of intraoperative parathyroid hormone monitoring to the surgical success in minimal invasive parathyroidectomy
Ismail Ethem Akgün, Mehmet Taner Ünlü, Nurcihan Aygun, Mehmet Kostek, Mehmet Uludag
Frontiers in Surgery.2022;[Epub] CrossRef
Surgery for primary hyperparathyroidism
Murilo Catafesta das Neves, Rodrigo Oliveira Santos, Monique Nakayama Ohe
Archives of Endocrinology and Metabolism.2022; 66(5): 678. CrossRef
Використання інтраопераційного моніторингу рівня паратиреоїдного гормону в мінімально інвазивній хірургії щитоподібної та паращитоподібних залоз
S.V. Chernyshov, A.V. Tymkiv, A.V. Vovkanych, I.I. Komisarenko
Endokrynologia.2022; 27(4): 311. CrossRef
Diagnostic Values of Intraoperative (1-84) Parathyroid Hormone Levels are Superior to Intact Parathyroid Hormone for Successful Parathyroidectomy in Patients With Chronic Kidney Disease
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Endocrine Practice.2021; 27(11): 1065. CrossRef
Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism
Iván Emilio de la Cruz Rodríguez, Elsy Sarahí García Montesinos, María Fernanda Rodríguez-Delgado, Guadalupe Vargas Ortega, Lourdes Balcázar Hernández, Victoria Mendoza Zubieta, Victor Hernández Avendaño, Baldomero González Virla, Michaï¿½l R. Laurent
Case Reports in Endocrinology.2021; 2021: 1. CrossRef
Parathyroid Surgery
Aditya S. Shirali, Uriel Clemente-Gutierrez, Nancy D. Perrier
Neuroimaging Clinics of North America.2021; 31(3): 397. CrossRef
Focused parathyroidectomy without intraoperative parathyroid hormone measurement in primary hyperparathyroidism: Still a valid approach?
Shelby Holt
Surgery.2021; 170(6): 1860. CrossRef
Response to the Comment on “Risk Factors of Redo Surgery After Unilateral Focused Parathyroidectomy – Conclusions From a Comprehensive Nationwide Database of 13,247 Interventions Over 6 Years”
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Annals of Surgery.2021; 274(6): e861. CrossRef

Original Article

Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism: Eirie Cho, Jung Mi Chang, Seok Young Yoon, Gil Tae Lee, Yun Hyi Ku, Hong Il Kim, Myung-Chul Lee, Guk Haeng Lee, Min Joo Kim; Endocrinol Metab. 2014;29(4):464-469. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.464

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Background

The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT.

Methods

We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and ^99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted.

Results

The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration.

Conclusion

The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Citations

Citations to this article as recorded by

Single-Center Experience of Parathyroidectomy Using Intraoperative Parathyroid Hormone Monitoring
Seong Hoon Kim, Si Yeon Lee, Eun Ah Min, Young Mi Hwang, Yun Suk Choi, Jin Wook Yi
Medicina.2022; 58(10): 1464. CrossRef
The natural history and hip geometric changes of primary hyperparathyroidism without parathyroid surgery
Kyong Yeun Jung, A. Ram Hong, Dong Hwa Lee, Jung Hee Kim, Kyoung Min Kim, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim
Journal of Bone and Mineral Metabolism.2017; 35(3): 278. CrossRef
The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism
MS Lim, M Jinih, CH Ngai, NM Foley, HP Redmond
The Annals of The Royal College of Surgeons of England.2017; 99(5): 369. CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef

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