No abstract available.
Hyperparathyroidism, Primary

No abstract available.
Hyperparathyroidism, Primary*

No abstract available.
Hyperparathyroidism, Primary*

No abstract available.
Hyperparathyroidism, Primary

No abstract available.
Hyperparathyroidism, Primary*

The role of surgery in parathyroid disease has shown a recent decrease with development of calcinomimetics such as cinacalcet. During thyroid surgery, every endocrine surgeon makes every effort to preserve the parathyroid gland. However, postoperative hypoparathyroidism cannot be completely prevented. Knowledge of the precise anatomy of the parathyroid, including embryological movement of parathyroid glands, is needed. Surgical indications of parathyroidectomy include primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism and parathyroid carcinoma. Parathyroidectomy for primary hyperparathyroidism has shown a significant change due to introduction of the sestamibi scan, intraoperative PTH assay, and focused parathyroidectomy. Minimally invasive surgery has now become standard operation for primary hyperparathyroidism. However, focused unilateral parathyroid operation should be done very cautiously because you can lose the chance of cure. Recurrence rate after parathyroidectomy is approximately 5% and experience of a surgeon can only reduce this rate. Surgery for secondary hyperparathyroidismis performed in only 1~2% of CKD patients. Surgical methods include subtotal parathyroidectomy, total parathyroidectomy, and total parathyroidectomy with autotransplantation and the results of the operation are not different. With the introduction of cinacalcet, comparison between surgery and medication showed an effective drop down of serum PTH level and increase of BMD only in surgery. Cincalcet did not show improvement of mortality, vascular calcification, and nephrplithiasis. According to oneJapanese report, PTH more than 500 pg/ml, size larger than 1 cm, and more than two enlarged parathyroid favor parathyroidectomy in renal osteodystrophy. During parathyroid surgery, high suspicion for carcinoma gives the only chance for cure because en bloc resection is important. Parathyroid disease has evolved since introduction of Cinacalcet and endocrine surgeons should join with physicians as a team for development of a treatment plan.
Autografts ; Cinacalcet Hydrochloride ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Hypoparathyroidism ; Minimally Invasive Surgical Procedures ; Mortality ; Parathyroid Diseases ; Parathyroid Glands ; Parathyroid Neoplasms ; Parathyroidectomy ; Recurrence ; Renal Osteodystrophy ; Surgeons ; Thyroid Gland ; Transplantation, Autologous ; Vascular Calcification

The incidence of hyperparathyroidism has slowly increased recently with routine measurement of serum calcium and increasing awareness of the disease by the public. Despite the availability of expert surgeons and preoperative imaging investigations, some patients are re-operated for persistent or recurrent hyperparathyroidism. The main cause of re-operation is the presence of ectopic parathyroid gland or supernumerary parathyroid gland. Supernumerary parathyroid glands are more frequently described in the secondary hyperparathyroidism than in the primary hyperparathyroidism cases, especially in surgery for renal hyperparathytroidism. The intraoperative measurement of intact parathyroid hormone (iPTH) provides the surgeon with a quantitative test that predicts the postoperative serum calcium level and can justify early closure or further exploration for hyperfunctioning parathyroid gland. We present a case of parathyroidectomy of supernumerary parathyroid glands by monitoring intraoperative iPTH in patients with secondary hyperparathyroidism.
Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Incidence ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy

To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.
Axis, Cervical Vertebra ; Bone Remodeling ; Giant Cells ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary ; Incidence ; Osteitis Fibrosa Cystica ; Spine*

Maxillary enlargement is a rare complication of secondary hyperparathyroidism (SHPT). A 35-year-old Korean man undergoing chronic hemodialysis presented with a painless enlargement involving the maxilla and mandible. Plain radiography and CT scan showed bony expansion at the maxilla and mandible with multiple radiolucency. Serum intact parathyroid hormone (iPTH) was >1,600 pg/mL. Tc-99m sestamibi (MIBI) parathyroid scan and neck sonogram were compatible with SHPT. He underwent limited parathyroidectomy and commenced a course of paricalcitol. Fifteen months after surgery, maxillary enlargement and bony resorptions involving both hands markedly improved. Thirty-six months after the surgery, the serum iPTH level was 109.3 pg/mL. This is the first report in Korea documenting a patient with maxillary enlargement in SHPT who was successfully treated with limited parathyroidectomy and paricalcitol.
Adult ; Ergocalciferols ; Hand ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Korea ; Mandible ; Maxilla ; Neck ; Parathyroid Hormone ; Parathyroidectomy ; Renal Dialysis ; Renal Osteodystrophy

PURPOSE: The aim of this retrospective study was to analyze the outcomes of minimally invasive parathyroidectomy without an intraoperative i-PTH test for the patients with primary hyperparathyroidism. METHODS: We analyzed a total of 179 patients with sporadic primary hyperparathyroidism and who underwent parathyroidectomy at ASAN Medical Center between February 1996 and September 2007. Minimally invasive parathyroidectomy without an intraoperative i-PTH test was performed in 75 patients under the guidance of a preoperative localization study that suggested the presence of single gland disease. Bilateral exploration was performed in 70 patients and unilateral exploration was performed in 34 patients. RESULTS: The success rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test was 98.7%. Postoperative persistent hyperparathyroidism developed in only 1 patient among the 75 patients. The frequency of postoperatively confirmed single gland disease and multigland disease was 92.8% (166 patients) and 7.2% (13 patients), respectively. However, for most of the patients with multiglandular disease (11/13 cases, 84.5%), the possibility of multiglandular disease could be predicted by a preoperative localization study and these patients were excluded from the candidates for performing minimally invasive parathyroidectomy without an intraoperative i-PTH test. For cases that the preoperative localization study suggested single lesion, the frequency of multiglandular disease in those patients who underwent bilateral exploration was relatively low (2.7%, 1/38 cases). CONCLUSION: Selected patients with primary hyperparathyroidism can be successfully managed with minimally invasive parathyroidectomy and without an intraoperative i-PTH test when the preoperative localization study suggests the presence of single gland disease. However, careful evaluation of the preoperative localization study is mandatory to minimize the failure rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test.
Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Parathyroidectomy ; Retrospective Studies