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Parathyroid Glands (parathyroid + gland)

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Medical Sciences	100%

Selected Abstracts

Fluorescent Detection of Rat Parathyroid Glands via 5-Aminolevulinic Acid,

THE LARYNGOSCOPE, Issue 6 2008
Scott A. Asher BS
Abstract Objective: Anatomic identification of parathyroid glands during surgery is challenging and time consuming. We sought to determine whether 5-aminolevulinic acid (5-ALA) could produce parathyroid gland fluorescence to improve their detection in a preclinical model. Methods: Thirty-two rats were administered 0 to 700 mg/kg of 5-ALA by intraperitoneal injection prior to neck exploration under the illumination of a blue light (380,440 nm). Tissue fluorescence was assessed at 1, 2, or 4 hours postinjection and then removed for histologic confirmation of parathyroid tissue. Results: Rat parathyroid glands could not be visualized under ambient light. At dosages of 300 mg/kg or greater, bilateral parathyroid glands were visualized in 18 of 19 rats using blue light illumination. At dosages less than 300 mg/kg, parathyroid gland fluorescence was detected in only 1 of 13 rats. At 2 hours after 5-ALA administration, the net mean intensity of parathyroid gland fluorescence was optimal with a dose of 500 mg/kg. At both 1 and 4 hours after 5-ALA injection, the net mean intensity of parathyroid gland fluorescence was optimal at the highest dose (700 mg/kg) and positively correlated with dosage increases. Conclusion: 5-ALA can be used to selectively detect parathyroid tissue from surrounding tissue in a preclinical model. Our data support the use of this technique in the clinical setting. [source]

Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia?

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2008
Bassam Abboud MD
Abstract Background Routine calcium and vitamin D administration and routine autotransplantation of parathyroid glands can prevent hypocalcemia after total thyroidectomy. Methods Routine autotransplantation of 1 or more parathyroid glands and oral calcium and vitamin D supplementation was used in 252 patients. Results One, 2, or 3 parathyroid glands were autotransplanted in 223, 27, and 2 patients, respectively. Routine oral calcium and vitamin D was administered in postoperative period in all patients. Postoperative hypocalcemia occurred in 17%, of whom 1.6% had minor symptoms related to hypocalcemia. No patient developed permanent hypocalcemia during the follow-up period. The postoperative stay was 1 day in 93.6% of the cases. The incidence of postoperative hypocalcemia and hospital stay was higher in patients who underwent autotransplantation of more than 1 parathyroid gland. Conclusions Routine oral calcium and vitamin D supplementation and autotransplantation of at least 1 parathyroid gland effectively reduced symptomatic hypocalcemia and permanent hypoparathyroidism in total thyroidectomy. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003
Magdy I. El-Sharaky MD
Abstract Background. Hypoparathyroidism with permanent hypocalcemia is a well-recognized complication after thyroid surgery. Aim. This study was conducted to assess the role of immediate parathyroid autotransplantation in the preservation of parathyroid function after total thyroidectomy. Patients and Methods. Twenty-eight patients had autotransplantation of parathyroid glands resected or devascularized during total thyroidectomy. Data were collected prospectively regarding demographics, indication for surgery, operative procedure, pathologic diagnosis, number of glands transplanted, and subsequent course. Thyroid nodules were evaluated by ultrasonography, radionuclide scanning, and/or fine-needle aspiration cytology. All patients had serum ionized calcium, phosphorus, and intact parathyroid hormone (PTH) levels measured preoperatively and monitored regularly postoperatively for a period of 14 weeks and again at 6 months after operation. Patients were categorized into three groups according to the number of glands transplanted: one (group 1, n = 6), two (group 2, n = 14), or three glands (group 3, n = 8). In three other volunteers, one parathyroid gland was transplanted in the brachioradialis and subjected to electron microscopy 1, 2, and 4 weeks after transplantation. Results. Total thyroidectomy was performed for malignant disease in 16 patients (57.1%) and for benign disease in 12 (42.9%) patients. All patients reverted to asymptomatic normocalcemia without the need for any medications within 4 to 14 weeks. Normal levels of serum markers were regained slower when one gland was transplanted compared with two or three glands (P < .01). Electron microscopic examination showed evidence of ischemic degeneration in the transplanted tissues 1 week postoperatively. Regeneration started by the second week and coincided with normalization of PTH levels. Optimum resting and nearly normal status of parathyroid tissue was achieved by the fourth week. Conclusions. This study showed that active PTH production coincides with regeneration of parathyroid cells and that autotransplantation of at least two resected or devascularized glands during total thyroidectomy nearly eliminates permanent postoperative hypoparathyroidism, thus improving the safety of total thyroidectomy performed for malignant or benign disease. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 799,807, 2003 [source]

Preoperative evaluation of patients with parathyroid adenoma: Role of high-resolution ultrasonography,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2002
David Ulanovski MD
Abstract Background Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. Methods One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. Results The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p = .2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4,55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p = .01) and parathyroid hormone level (p = .0001). Conclusions In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach. © 2002 John Wiley & Sons, Inc. Head Neck 24: 1,5, 2002. [source]

Usefulness of diagnostic imaging in primary hyperparathyroidism

INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2003
KAZUYA SEKIYAMA
Abstract Background : In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. Methods : We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. Results : The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. Conclusion : In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy. [source]

Familial Hypocalciuric Hypercalcemia Caused by an R648stop Mutation in the Calcium-Sensing Receptor Gene ,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2002
Mika Yamauchi
Abstract In this study, we report an 84-year-old female proband in a Japanese family with familial hypocalciuric hypercalcemia (FHH) caused by an R648stop mutation in the extracellular calcium-sensing receptor (CaR) gene. At the age of 71 years, she presented with hypercalcemia (11.4 mg/dl), hypocalciuria (Cca/Ccr = 0.003), hypermagnesemia (2.9 mg/dl), and a high-serum parathyroid hormone (PTH) level (midregion PTH, 3225 [160,520] pg/ml). At the age of 74 years, a family screening was carried out and revealed a total of 9 hypercalcemic individuals (all intact PTH values <62 pg/dl) among 17 family members tested, thus, being diagnosed as FHH. Two and one-half of three clearly enlarged parathyroid glands were resected, because persistently high PTH levels (intact PTH, 292 pg/ml; midregion PTH, 5225 pg/ml) and the presence of a markedly enlarged parathyroid gland by several imaging modalities (ultrasonography, computed tomography [CT], magnetic resonance imaging [MRI], and subtraction scintigraphy) suggested coexistent primary hyperparathyroidism (pHPT); however, hypercalcemia persisted postoperatively. Histological and immunohistochemical examination revealed that the resected parathyroid glands showed lipohyperplasia as well as normally expressed Ki67, vitamin D receptor (VDR), and the CaR. Sequence analysis disclosed that the proband and all affected family members had a heterozygous nonsense (R648stop) mutation in the CaR gene. This mutation is located in the first intracellular loop; thus, it would be predicted to produce a truncated CaR having only one transmembrane domain (TMD) and lacking its remaining TMDs, intracellular loops, and C-terminal tail. Western analysis of biotinylated HEK293 cells transiently transfected with this mutant receptor showed cell surface expression of the truncated protein at a level comparable with that of the wild-type CaR. The mutant receptor, however, exhibited no increase in intracellular free calcium concentration (Ca2+i) when exposed to high extracellular calcium concentrations (Ca2+o). The proband's clinical course was complicated because of associated renal tubular acidosis (RTA) and nephrotic syndrome. However, it was unclear whether their association affected the development of elevated serum PTH and parathyroid gland enlargement. This report is the first to show that an R648stop CaR mutation yields a truncated receptor that is expressed on the cell surface but is devoid of biological activity, resulting in FHH. [source]

Primary hyperparathyroidism in 29 dogs: diagnosis, treatment, outcome and associated renal failure

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 1 2005
R. N. A. Gear
Objectives: To review the records of 29 dogs diagnosed with primary hyperparathyroidism and see if any factors correlate with renal failure. Methods: Dogs were selected retrospectively from case files from the QVSH and the QMH. Results: The majority of dogs were middle-aged and four were keeshonds. The primary presenting complaints were polyuria and polydipsia. All dogs had an elevated total and ionised plasma calcium concentration. Plasma phosphate concentrations were variable. Ultrasonography of the parathyroid gland revealed nodular enlargement which was found to correlate well with surgical findings. The majority of dogs underwent surgical parathyroidectomy. Five cases were treated by ultrasound-guided chemical ablation of the parathyroid gland, of which only two cases showed a partial response. Three dogs were euthanased within a week of presentation. Seven other dogs had renal failure diagnosed either at presentation or up to six months after parathyroidectomy. The development of renal failure was correlated with total calcium concentration but did not correlate with any other factor, including the calcium phosphate product. Thirteen treated dogs were known to be alive at the time of writing, which was six months to 3.5 years after parathyroidectomy. Clinical Significance: Primary hyperparathyroidism cases with high total calcium were more likely to develop renal failure in this group of dogs; however, the calcium phosphate product did not seem to be a useful predictor. Ultrasound-guided chemical ablation seemed to have limited advantage over surgery. [source]

Hypocalcemia in a critically ill patient

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2005
Tamara B. Wills DVM
Abstract Objective: To present a case of clinical hypocalcemia in a critically ill septic dog. Case summary: A 12-year old, female spayed English sheepdog presented in septic shock 5 days following hemilaminectomy surgery. Streptococcus canis was cultured from the incision site. Seven days after surgery, muscle tremors were noted and a subsequent low serum ionized calcium level was measured and treated. Intensive monitoring, fluid therapy, and antibiotic treatment were continued because of the sepsis and hypocalcemia, but the dog was euthanized 2 weeks after surgery. New or unique information provided: Low serum ionized calcium levels are a common finding in critically ill human patients, especially in cases of sepsis, pancreatitis, and rhabdomyolysis. In veterinary patients, sepsis or streptococcal infections are not commonly thought of as a contributing factor for hypocalcemia. Potential mechanisms of low serum ionized calcium levels in critically ill patients include intracellular accumulation of calcium ions, altered sensitivity and function of the parathyroid gland, alterations in Vitamin D levels or activity, renal loss of calcium, and severe hypomagnesemia. Pro-inflammatory cytokines and calcitonin have also been proposed to contribute to low ionized calcium in the critically ill. Many veterinarians rely on total calcium levels instead of serum ionized calcium levels to assess critical patients and may be missing the development of hypocalcemia. Serum ionized calcium levels are recommended over total calcium levels to evaluate critically ill veterinary patients. [source]

Management of secondary hyperparathyroidism of dialysis patients

NEPHROLOGY, Issue 2003
Tadao AKIZAWA
SUMMARY: Hyperphosphatemia, vitamin D deficiency, and resulted hypocalcemia have been regarded as classical pathogeneses of secondary hyperparathyroidism. These factors have been treated by the administration of phosphorus binder and vitamin D derivatives. However, these therapies have not brought about a successful result for the prevention and treatment of secondary hyperparathyroidism. The reason could be mainly attributed to the hypercalcemia that results from the administration of calcium salts as a phosphorus binder and the calcemic action of vitamin D. To prevent hypercalcemia, non-calcium containing phosphorus binder (sevelamer hydrochloride) and vitamin D analogues, which suppress PTH secretion with minimum calcemic action, have been developed. These new vitamin D analogues include 19-nor-1-alpha, 25-dihydroxyvitamin D2 (paricalcitol), 1-alpha-hydroxyvitamin D2 (doxercalciferol), 22oxa-calcitriol (maxacalcitol) and F6-calcitriol (falecalcitriol). Furthermore, calcimimetics that stimulate calcium-sensing receptor of parathyroid cells as calcium and suppress PTH secretion are now under clinical trial. Percutaneous direct injection therapy of vitamin D, vitamin D analogue or calcimimetics into parathyroid gland has also been reported. The combination of these new strategies is expected to effectively and safely suppresses secondary hyperparathyroidism that has been resistant to conventional medical treatments. [source]

Ultrasonography: Highly Accuracy Technique for Preoperative Localization of Parathyroid Adenoma,

THE LARYNGOSCOPE, Issue 9 2008
Bassam Abboud MD
Abstract Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism. Study Design: Retrospective study. Methods: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings. Results: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gland adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up. Conclusions: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia. [source]

Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidism

ANZ JOURNAL OF SURGERY, Issue 5 2009
Tsu-Hui (Hubert) Low
Abstract Background:, A small group of patients with renal disease-related secondary or tertiary hyperparathyroidism require surgical parathyroidectomy. Among them, 5,20% require further re-exploration and excision of parathyroid tissue because of recurrent disease. The aims of the present study were to review the characteristics and outcomes of patients undergoing parathyroidectomy for renal disease related hyperparathyroidism and to identify the risk factors for recurrent hyperparathyroidism. Methods:, Review of data from a dedicated head and neck database at Royal Prince Alfred Hospital between 1988 and 2004. Results:, There were 115 patients of whom 68 (59%) patients were treated with subtotal parathyroidectomy (STP), 43 (37%) were treated with total parathyroidectomy (TP) and 4 (3%) were treated with TP with autotransplant. Of those, 11 (9.6%) patients developed recurrent hyperparathyroidism (9 had STP, 1 had TP and 1 had TP with autotransplant). On re-exploration, persistent hyperplastic parathyroid tissue was located at the site of partially excised parathyroid gland (64%), autotransplanted parathyroid tissue (9%), anterior mediastinum (18%) and intrathyroidal parathyroid (9%). Predictors for recurrent hyperparathyroidism are STP (P= 0.049), preoperative symptom of calciphylaxis or calcinosis (P= 0.024), elevated preoperative calcium level (P= 0.007) and elevated post-operative PTH levels (P= 0.014). Post-operative PTH levels less than 10 pmol/L has a positive predictive value of 97.5% for cure (P= 0.02). Conclusion:, More aggressive surgical approach could be indicated in patients with preoperative hypercalcaemia and calcinosis/calciphylaxis. Post-operative PTH can be utilized as a marker for cure after parathyroidectomy in hyperparathyroidism of renal disease. [source]

Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?

ANZ JOURNAL OF SURGERY, Issue 5 2009
Houman Ebrahimi
Abstract Background:, While the increased risk to parathyroid gland preservation has long been recognized during surgery for thyroid cancer, the effect of different benign pathological conditions on parathyroid preservation has not previously been reported. The aim of this study was to examine parathyroid viability in relation to autoimmune thyroid disease. Methods:, This is a retrospective cohort study including all patients having an initial total thyroidectomy (TT) performed by this unit during the period 2004,2005. Results:, A total of 628 patients underwent TT in the study period. For the Graves' disease cases, 45 (62.5%) required the autotransplantation of one or less parathyroid gland, whereas 27 (37.5%) required two or more glands to be autotransplanted. This was significantly higher than for the benign thyroid disease group in which the respective figures were 242 (77.6%) and 70 (22.4%) (P= 0.01). Of the lymphocytic thyroiditis cases, 61 (65.5%) required the autotransplantation of one or less gland, whereas 32 (34.4%) required the autotransplantation of two or more glands. This was also significantly higher (P= 0.03). Temporary hypocalcaemia was significantly higher when two or more glands were autotransplanted (23 out of 177, 13.2%) than one or less gland autotransplanted (18 out of 451, 4.0%, P < 0.01). However, the overall incidence of permanent hypoparathyroidism was 1.0%, and there was no significant difference between the groups. Conclusion:, TT performed for Graves' disease and lymphocytic thyroiditis results in the autotransplantation of more parathyroid glands, leading to a higher incidence of temporary hypocalcaemia post-operatively. Despite this, the incidence of permanent hypoparathyroidism remains low at 1%. [source]

RISKS AND CONSEQUENCES OF INCIDENTAL PARATHYROIDECTOMY DURING THYROID RESECTION

ANZ JOURNAL OF SURGERY, Issue 1-2 2007
Rebecca S. Sippel
Background: Inadvertent removal of the parathyroid glands during elective thyroid surgery occurs more frequently in certain high-risk patients and can lead to symptomatic hypocalcaemia. Methods: A case,control study was carried out at a tertiary referral, academic medical centre between May 1994 and August 2001. Five hundred and thirteen patients underwent thyroid resection. Pathology reports were reviewed to identify patients who had the inadvertent removal of a parathyroid gland during their thyroid surgery. Thirty-three (6.4%) patients had inadvertent resection of a parathyroid gland. The outcomes of these 33 patients (INCIDENTAL) were compared with the other 480 patients who did not have resection of parathyroid tissue (NO INCIDENTAL). Results: Risk factors for inadvertent parathyroid resection included younger age (P = 0.003), bilateral thyroid resection (P = 0.001) and malignant pathology (P = 0.002). Factors that did not increase the risk of incidental parathyroidectomy included gland weight, sex, presence of a goitre, previous neck exploration and concurrent lymph node dissection. In the INCIDENTAL group 24% had a postoperative calcium levels less than 7.0 mg/dL (P = 0.001). Symptomatic hypocalcaemia developed in 12% of INCIDENTAL patients, compared to 4% in the NO INCIDENTAL group (P = 0.06). Conclusion: Incidental removal of parathyroid tissue occurred in 6.4% of thyroid resections. Younger patients undergoing a total or subtotal thyroidectomy for malignancy were at the highest risk. These patients had lower postoperative calcium levels, but the majority (88%) experienced no clinical consequences. [source]

What steps should be considered in the patient who has had a negative cervical exploration for primary hyperparathyroidism?

CLINICAL ENDOCRINOLOGY, Issue 5 2009
Barney Harrison
Summary The key to cure of the patient with persistent primary hyperparathyroidism is a clear understanding of the investigations, operative procedure and pathology related to the initial procedure. Reinvestigation and subsequent surgery should be performed in a specialist unit. A logical pathway of increasingly sophisticated localization studies (MIBI, ultrasound, CT/MRI, selective venous catheterization for PTH) will usually guide the surgeon to the missing parathyroid gland/s. Improved preoperative localization can facilitate the use of a minimally invasive small incision approach. The surgeon must have a detailed knowledge of the nuances of parathyroid embryology and a meticulous surgical technique, not only to identify and safely remove the retained gland/s but also do so without causing unnecessary morbidity. Results of re-operation (84,98% cure) from centres of excellence are highly commendable, yet the use of ,new' technology (that includes intra-operative PTH) has not translated into improved outcomes in all cases. Some parathyroid glands are extremely difficult to find! Re-operative parathyroid surgery is a challenge, sometimes easy, and on other occasions extremely difficult. [source]

Decreased expression and promoter methylation of the menin tumor suppressor in pancreatic ductal adenocarcinoma

GENES, CHROMOSOMES AND CANCER, Issue 5 2009
Ilaria Cavallari
Loss of menin, a tumor suppressor coded by the MEN1 gene, is a key factor in the pathogenesis of multiple endocrine neoplasia type I and in a percentage of sporadic endocrine tumors of the pancreas and parathyroid glands. This study investigated expression of the menin protein in the normal exocrine pancreas and in pancreatic ductal adenocarcinoma (PDAC), the most common pancreatic tumor. Immunofluorescence (IF) analyses showed that menin is expressed at high levels in normal acinar and duct cells. Examination of 24 clinical samples of PDAC revealed a pronounced decrease in menin expression in all tumors examined. To identify alterations underlying this defect, we searched for disruption and epigenetic silencing of the MEN1 gene. Analysis of nine laser-microdissected tumors revealed loss of heterozygosity of intragenic (one tumor) or adjacent (three tumors) MEN1 microsatellite markers. Methylation of CpG sites in the MEN1 promoter was documented in five of 24 tumors. IF analyses also revealed low to undetectable menin expression in the PDAC cell lines MiaPaCa-2 and Panc-1. Ectopic expression of menin in these cells resulted in a marked alteration of the cell cycle, with an increase in the G1/S+G2 ratio. These findings represent the first evidence that the MEN1 gene is a target of mutation and methylation in PDAC and that menin influences the cell cycle profile of duct cells. © 2009 Wiley-Liss,Inc. [source]

Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2010
Carlo Vulpio MD
Abstract Background. The usefulness of the combination of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) parathyroid scintigraphy and ultrasonography to detect parathyroid glands (PTGs) in secondary hyperparathyroidism (SHPT) is still controversial. Methods. In all, 21 patients with SHPT underwent parathyroidectomy. The sensitivity and specificity of ultrasonography and scintigraphy related to site, size, hyperplasia type of PTG, concomitant thyroid disease, and the frequency of intraoperative frozen sections were determined. Results. The sensitivities of scintigraphy and ultrasonography were 62% and 55%, and the specificity was 95% for both procedures. The sensitivity of combined techniques was 73%. The scintigraphy detected 7/9 (78%) ectopic PTGs, whereas ultrasonography was always negative. A PTG maximum longitudinal diameter <8 mm, the presence of diffuse hyperplasia, the upper localization of glands, and the presence of concomitant thyroid disease reduced the sensitivity and specificity of imaging techniques. In cases of positive imaging, the rate of intraoperative frozen sections was significantly lower. Conclusions. The ultrasonography and sestamibi scintigraphy, which showed a higher sensitivity than that of either ultrasonography or scintigraphy alone, led to a reduction of intraoperative frozen sections and to preoperative diagnosis of ectopic (29%) or supernumerary PTGs (10%) and concomitant nodular thyroid disease (24%). © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia?

Spontaneous remission of primary hyperparathyroidism: A case report and meta-analysis of the literature

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2006
Christopher T. Wootten MD
Abstract Background. In a minority of patients, primary hyperparathyroidism spontaneously remits either by autoinfarction or by hemorrhage into or around the adenoma. We describe a case of autoparathyroidectomy occurring in a 63-year-old man 9 years after three parathyroid glands were removed during a total thyroidectomy. This case is compared with 50 previously reported cases of autoparathyriodectomy, and a meta-analysis is performed. Methods. Case report, literature review, and meta-analysis were done using statistical software (SigmaStat 2.0, SPSS, Chicago). Results. Fifty cases of autoparathyroidectomy were summarized according to the three etiologies. The greatest biochemical aberration was found in the acute intracapsular hemorrhage group, with [Ca++] falling from a mean 15.1 mg/dL to 8.9 mg/dL. The average drop in parathyroid hormone was 69% across all groups, comparing favorably to surgical resection. Conclusions. Autoparathyroidectomy is a rare but described outcome of unoperated primary hyperparathyroidism that may delay or supplant operative management. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy

Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2000
Masayuki Nakagawa
Abstract Background: Prediction of the extent of calcium supplement will facilitate safe and efficient management of hypocalcemia in the early postoperative stage of total parathyroidectomy with autotransplantation (PTXa) in patients with renal osteodystrophy. Methods: The correlation between the extent of calcium deficiency, estimated by the amount of calcium supplement over 48 h after PTXa and using various parameters such as carboxy terminal parathyroid hormone (c-PTH), intact PTH (i-PTH), alkaline phosphatase (ALP), serum calcium, serum phosphorus, duration of hemodialysis, total weight of resected parathyroid glands and degree of subperiosteal resorption of the middle phalanx was examined in 49 patients who underwent PTX with subcutaneous autotransplantation. Bone mineral density (BMD) was also determined before, 3 months and 1 year after PTXa with dual energy X-ray absorptiometry (DEXA) in 13 patients. Results: There was a positive correlation between pre-operative i-PTH level (r = 0.56, P < 0.0005) or ALP level (r = 0.50, P < 0.0005) and the amount of calcium supplement over 48 h after PTXa in these patients. Furthermore, the degree of subperiosteal resorption, determined by Jensen's classification, was significantly correlated with the amount of calcium supplement after PTX (P < 0.05). Bone mineral density 3 months after (P < 0.0005) and 1 year after PTXa (P < 0.001) significantly increased compared with BMD before PTXa in all patients examined. Conclusion: These findings suggest that the pre-operative determination of i-PTH, ALP levels and degree of subperiosteal resorption allow the management of hypocalcemia safely and efficiently in renal osteodystrophy patients after PTXa. [source]

Identification of a Parathyroid Hormone in the Fish Fugu rubripes,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2003
Janine A Danks
Abstract A PTH gene has been isolated from the fish Fugu rubripes. The encoded protein of 80 amino acid has the lowest homology with any of the PTH family members. Fugu PTH(1,34) had 5-fold lower potency than human PTH(1,34) in a mammalian cell system. Introduction: Parathyroid hormone (PTH) is the major hypercalcemic hormone in higher vertebrates. Fish lack parathyroid glands, but there have numerous attempts to identify and isolate PTH from fish. Materials and Methods: Polymerase chain reaction (PCR) was performed with primers based on preliminary data from the Joint Genome Institute database. PCR amplification was performed on genomic DNA isolated from Fugu rubripes. PCR products were purified and DNA was sequenced. All sequence was confirmed from more than one independently amplified PCR product. Multiple sequence alignments were carried out, and the percentage of identities and similarities were calculated. An unrooted phylogenetic tree, using all the known PTH and PTH-related protein (PTHrP) amino acid sequences, was determined. Synthetic peptides were tested in a biological assay that measured cyclic adenosine 3,,5,-monophosphate formation in UMR106.1 cells. Rabbit polyclonal antisera specific for N-terminal human PTHrP and one rabbit polyclonal antiserum specific for N terminus hPTH were used to test the cross-reactivity with fPTH(1,34) in immunoblots. [source]

Familial Hypocalciuric Hypercalcemia Caused by an R648stop Mutation in the Calcium-Sensing Receptor Gene ,

Influence of calcitonin administration on ultimobranchial and parathyroid glands of pigeon, Columba livia

MICROSCOPY RESEARCH AND TECHNIQUE, Issue 5 2009
Seema Yadav
Abstract Pigeons were divided into two numerically equal groups (A and B) containing 30 specimens each. Birds from group A were intraperitoneally injected daily with 0.1 mL/100 g body wt of vehicle (0.1 M acetate buffer, pH 4.3 containing 0.1% gelatin). Specimens from group B were intraperitoneally injected daily with 1 ,g/100 g body wt of salmon calcitonin. Six birds were sacrificed from each group 2 h after the last injection on 1st, 3rd, 5th, 10th, and 15th day of the experiment. After collection of blood samples, ultimobranchial and parathyroid glands were fixed for histological studies. In calcitonin-treated C. livia, the plasma calcium levels exhibit a progressive decline from day 1 till day 5. On day 15, the levels become more or less similar to the control value. No change has been noticed on day 1 in the plasma phosphate levels of calcitonin-treated C. livia. The levels decrease progressively from day 3 to day 5; thereafter, it exhibits an elevation so that on day 15, normal plasma phosphate levels is achieved. The ultimobranchial gland of C. livia exhibits no change up to day 5 following calcitonin treatment. The nuclear volume of ultimobranchial cells exhibits a decrease on day 10. This response progresses up to day 15. Few degenerating cells are also discerned following 15 days calcitonin treatment. The parathyroid gland of calcitonin-treated C. livia exhibits no histological alteration up to day 3. The nuclear volume of parathyroidal cells exhibits a progressive increase from day 3 till the close of the experiment (day 15). Moreover, the gland exhibits more compactness on day 10 and day 15. Few degenerating cells are encountered after day 15 following calcitonin treatment. Microsc. Res. Tech. 2009. © 2008 Wiley-Liss, Inc. [source]

Fluorescent Detection of Rat Parathyroid Glands via 5-Aminolevulinic Acid,

Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?

RISKS AND CONSEQUENCES OF INCIDENTAL PARATHYROIDECTOMY DURING THYROID RESECTION

Primary hyperparathyroidism: Referral patterns and outcomes of surgery

ANZ JOURNAL OF SURGERY, Issue 3 2002
Richard S. Flint
Background: Parathyroidectomy has long been established as an effective treatment for primary hyperparathyroidism (HPT). Methods: A 15-year retrospective audit was made by surgeons at North Shore Hospital, Auckland, of 33 patients with primary HPT who had parathyroidectomy. Results: There were 22 females and 11 males, ranging in age from 18 to 77 years (median 63 years). Initial diagnosis was predominantly by a general practitioner (72%), who invariably referred to a physician. Referral to surgery was made by general physicians (55%), endocrinologists (33%) and geriatricians (6%). Delay between diagnosis and referral for surgery ranged from 8 days to 10 years (median 7 months), and exceeded 2 years in 24% of patients. Twenty-eight (85%) were symptomatic: 13 (39%) had renal symptoms, 13 (39%) had bone disease, 10 (31%) had gastrointestinal complaints, seven (21%) had psychiatric illnesses and six (18%) had fatigue. The high incidence of symptoms was matched by high biochemical values (mean serum cal- cium level 2.97 mmol/L), and large parathyroid glands (mean weight 2001 mg). Twenty-nine patients (88%) had single adenomas, two (6%) had chief cell hyperplasia and two (6%) had carcinoma. Thirty-one (94%) were cured of their primary HPT. Conclusions: Parathyroidectomy is a safe and effective treatment for primary HPT but depends upon referral from non-surgical clinicians. A large proportion of patients have long delays before their surgery, and the group selected for surgery is referred with severe disease. [source]

Resection of ectopic mediastinal parathyroid glands with the da Vinci® robotic system

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010
M. Ismail
Background: Mediastinal ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism, traditionally treated by open surgery. Thoracoscopic access is associated with reduced morbidity in mediastinal surgery. The aim of this study was to evaluate the feasibility and effectiveness of robot-assisted dissection for mediastinal ectopic parathyroid glands. Methods: Two patients with recurrent secondary hyperparathyroidism and three with complicated primary hyperparathyroidism were operated on between July 2004 and August 2008 for ectopic mediastinal parathyroid glands. Fusion of single-photon emission computed tomography and computed tomography led to an exact identification of the culprit glands. Surgery was performed thoracoscopically with the da Vinci® robotic system using a three-trocar approach. Results: All procedures were completed successfully with the robotic system. No perioperative morbidity or mortality was noted. Median operating time was 58 (range 42,125) min. Intraoperative parathyroid hormone reduction indicated complete resection. Median hospital stay was 3 (range 2,4) days. Conclusion: Robot-assisted dissection is a promising approach for resection of ectopic parathyroid glands in remote narrow anatomical locations such as the mediastinum. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Characterization of the insulin-like growth factor axis and Wilms' tumour suppressor gene in hyperparathyroidism ,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2007
C. K. M. Wong
Background: Genetic mutations and upregulation of growth factors are implicated in the pathogenesis of hyperparathyroidism. The aim of this study was to evaluate the role of Wilms' tumour suppressor gene (WT-1) and the insulin-like growth factor (IGF) axis in hyperparathyroidism. Methods: The expression of WT-1 and IGF components was examined by immunohistochemistry, reverse transcriptase,polymerase chain reaction and western immunoblotting in a panel of parathyroid specimens from both primary and secondary hyperparathyroidism. A human parathyroid cell culture model was established to examine the parathyroid response to IGF stimulation. Results: There was a significantly lower level of WT-1 expression in parathyroid tumours than in normal parathyroid glands. Most tumours expressed IGF-I and IGF-II receptors and responded to IGF stimulation. Only IGF-I was present in normal parathyroid glands, whereas IGF-II was expressed exclusively in parathyroid tumours. Conclusion: Abnormal expression of WT-1 and the IGF axis may play a role in the pathogenesis of hyperparathyroidism. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Minimally invasive surgery of the thyroid and parathyroid glands

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2006
J.-F. Henry
Complements the conventional approach [source]