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Inicio Cirugía Española (English Edition) Surgical results and the location of pathological glands in the treatment of pri...
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Vol. 100. Issue 1.
Pages 18-24 (January 2022)
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Vol. 100. Issue 1.
Pages 18-24 (January 2022)
Original article
Surgical results and the location of pathological glands in the treatment of primary sporadic hyperparathyroidism with negative preoperative 99mTc-sestamibi scintigraphy
Resultados quirúrgicos y localización de las glándulas patológicas en el tratamiento del hiperparatiroidismo primario esporádico con gammagrafía 99mTc-sestamibi negativa
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Leire Agirre
Corresponding author
, Aitor de la Quintana, Gloria Martínez, Ainhoa Arana, María José Servide, Jasone Larrea
Unidad de Cirugía Endocrina, Hospital Universitario de Cruces, Barakaldo, Spain
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Tables (4)
Table 1. Cases of PHPT with concomitant thyroid pathology.
Table 2. Thyroid surgery performed and corresponding pathology result.
Table 3. Criteria for surgical indication in asymptomatic patients.
Table 4. Cure rates and multiglandular disease rates according by publications.
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Abstract
Introduction

The primary hyperparathyroidism is a frequent disease whom the surgery is the only curative treatment. The preoperative location imaging techniques could help in the surgical management. Our objective was to analyze surgical results regarding the cure rate, etiology and location of the glands responsible for the primary hyperparathyroidism in patients with negative preoperative 99mTc-sestamibi scintigraphy.

Methods

Observational study in patients with the diagnosis of primary sporadic hyperparathyroidism with negative 99mTc-sestamibi scintigraphy, operated consecutively in an endocrine surgery unit for 18 years. The cure rate, the intraoperatory PTH, the etiology and the pathological glands location were analyzed.

Results

In the study were included 120 patients. After surgery 95% of patients (n = 114) presented cure criteria of hyperparathyroidism. 14.1% presented a multigland disease. 69% of the adenomas presented a typical perithyroid location, founding a percentage of 23.9% of ectopic adenomas in cervical location and a 7.1% in mediastinum.

Conclusions

The absence of uptake in the 99mTc-sestamibi scintigraphy should not condition the surgical indication. The success with experienced surgeons is similar to patients with positive results. The surgical indication must be established by clinical and biochemistry criteria.

Keywords:
Primary hyperparathyroidism
Negative sestamibi scintigraphy
Cure
Adenoma location
Resumen
Introducción

El hiperparatiroidismo primario es una enfermedad endocrina frecuente siendo la cirugía el único tratamiento curativo. La técnica quirúrgica puede estar condicionada por las pruebas de localización preoperatorias. Nuestro objetivo ha sido analizar los resultados quirúrgicos en cuanto a la tasa de curación, etiología y localización de las glándulas responsables del hiperparatiroidismo primario en pacientes con gammagrafía con 99mTc-sestamibi preoperatoria negativa.

Métodos

Estudio observacional en pacientes con diagnóstico de hiperparatiroidismo primario esporádico con gammagrafía 99mTc-sestamibi negativa operados de forma consecutiva en una unidad de cirugía endocrina durante 18 años. Se analizaron las tasas de curación, la PTH intraoperatoria (PTHio), etiología y la localización de las glándulas patológicas.

Resultados

En el estudio se incluyeron 120 pacientes. Tras la cirugía el 95% (n = 114) presentaron criterios de curación de hiperparatiroidismo. El 14.1% presentaba una enfermedad multiglandular. Respecto a la localización de los adenomas el 69% presentaban una localización peritiroidea habitual, objetivando un 23.9% de ectopias que se localizan a nivel cervical y un 7.1% de localización mediastínica.

Conclusiones

La ausencia de captación en gammagrafía con 99mTc-sestamibi no debe condicionar la indicación quirúrgica, ya que en manos expertas el porcentaje de éxito es similar a los pacientes con la prueba positiva. La indicación debe ser establecida por criterios clínicos y bioquímicos.

Palabras clave:
Hiperparatiroidismo primario
Gammagrafía MIBI negativa
Curación
Localización de adenoma

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