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World Journal of Surgery Jan 2004There is a considerable discrepancy in the literature concerning the sensitivity of parathyroid scintigraphy (PS) with 99mTc-MIBI. We therefore analyzed our own data and... (Comparative Study)
Comparative Study Meta-Analysis Review
There is a considerable discrepancy in the literature concerning the sensitivity of parathyroid scintigraphy (PS) with 99mTc-MIBI. We therefore analyzed our own data and compared them to the literature in a metaanalysis. All patients who received 99mTc -MIBI scintigraphy and subsequent surgery in our department for the detection of enlarged parathyroid glands in primary (pHPT) or secondary (sHPT) hyperparathyroidism between 1991 and 1999 were included in our retrospective analysis. The results of surgery served as the gold standard. For a true positive result, the scintigraphy had to predict the exact location of parathyroid adenoma (PA) or parathyroid hyperplasia (PH). We then compared these data to the results of a nonstatistical systematic metaanalysis of the literature. Patients (178) underwent PS between 1991 and 1999; 139 were operated on and included in this study. Of these, 109 had pHPT and 30 had sHPT. The sensitivity and specificity of the PS were found to be 45%/94% for pHPT and 39%/40% for sHPT. Fifty-two studies concerning PS were included in the metaanalysis. Sensitivities reported varied from 39% to >90%. Consideration of the different possible techniques used for PS could not explain these discrepancies. Our data show that the sensitivity of PS in clinical routine may be lower than expected from the literature. Our data are consistent with other studies and with partially unpublished clinical observations from other university hospitals. We believe that a well-designed and properly conducted prospective study is necessary to evaluate the reasons for the differences observed.
Topics: Follow-Up Studies; Humans; Hyperparathyroidism; Parathyroid Diseases; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Surveys and Questionnaires; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 14639488
DOI: 10.1007/s00268-003-6991-y -
Endocrine Journal Feb 2017Parathyroid cysts (PCs) account for less than 1% of all parathyroid lesions and are most commonly located along thyroid lobes, rarely at ectopic sites. PCs are important...
Parathyroid cysts (PCs) account for less than 1% of all parathyroid lesions and are most commonly located along thyroid lobes, rarely at ectopic sites. PCs are important because they can pose a differential diagnostic challenge against other cystic formations of the neck. PCs can be functional (elevated serum parathyroid hormone level) and nonfunctional. Four cases of nonfunctional PCs are presented. All four female patients underwent physical examination and ultrasonography of the neck with ultrasound-guided fine-needle aspiration biopsy (UG-FNA). The material thus obtained was stained by the standard May-Grünwald-Giemsa method. Parathyroid hormone level was determined in aspirate and serum, along with serum levels of total calcium, inorganic phosphates. In two asymptomatic patients, remission occurred after initial aspiration biopsy; one patient had compression syndrome with vocal cord paresis that required surgical treatment; and one patient had cyst recurrence that was surgically removed. Cystic neck masses can pose a major differential diagnostic problem considering different approach, treatment method, and preoperative and postoperative follow up. Surgical treatment is necessary in case of functional and large nonfunctional PCs (due to compression syndrome), whereas individualized therapeutic approach is used in case of small nonfunctional PCs. Ultrasonography with UG-FNA, cytologic analysis of the material obtained, and determination of parathyroid hormone level in aspirate and serum are crucial for making an accurate diagnosis.
Topics: Adult; Aged; Biopsy, Fine-Needle; Cysts; Diagnosis, Differential; Female; Humans; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Retrospective Studies; Thyroid Gland; Ultrasonography, Interventional
PubMed: 27760899
DOI: 10.1507/endocrj.EJ16-0398 -
Clinics in Laboratory Medicine Mar 2004There has been a clear progression in assays for the analysis of PTH and its clinical applications. This includes the innovative use of PTH as a point-of-care assay as... (Review)
Review
There has been a clear progression in assays for the analysis of PTH and its clinical applications. This includes the innovative use of PTH as a point-of-care assay as an intraoperative measure of the success of parathyroid surgery. The rapid PTH assay has served as a model for the development of other rapid hormone assays, such as for adrenocorticotropic hormone,although the clinical usefulness of these other applications is less well established. Knowledge of the circulating forms of PTH continues to progress. Information about the biologic and immunologic activities of these forms will aid in the interpretation and clinical use of current assays and in the development of new assays with improved specificities. The clinical laboratory will continue to play a vital role in providing testing and support for this important mediator of mineral metabolism.
Topics: Biomarkers; Chemistry, Clinical; Humans; Monitoring, Intraoperative; Parathyroid Diseases; Parathyroid Hormone
PubMed: 15157563
DOI: 10.1016/j.cll.2004.01.005 -
The Annals of Thoracic Surgery Feb 1999A case of a functioning mediastinal cyst is presented. (Review)
Review
BACKGROUND
A case of a functioning mediastinal cyst is presented.
METHODS
A comprehensive review of the literature found 93 patients in whom a parathyroid cyst or cysts extended into, or was completely contained within, the mediastinum. Including our patient, there were 46 men and 45 women, and the gender was not recorded in three.
RESULTS
The cysts were located in the anterosuperior region in 56 patients, in the middle region of the mediastinum in 26, and in the anterior, prevascular region in 12. Thirty-nine patients had functioning cysts associated with hyperparathyroidism of varying severity; seven patients presented with a hypercalcemic crisis. Local symptomatology consisted of a neck mass, respiratory distress, and occasional dysphagia or chest pain. Recurrent laryngeal nerve paresis was present in nine patients, and innominate vein compression or thrombosis was present in two. The cysts in all but four patients were treated by open surgical excision; two were treated by thoracoscopy, and two patients only had fine-needle aspiration of the cyst. The cyst was excised via a cervical approach in 67 patients and by a thoracotomy or median sternotomy or a variation thereof in 23. There was no operative mortality and morbidity was minimal.
CONCLUSION
Surgical resection was successful in all and remains the treatment of choice for mediastinal parathyroid cysts.
Topics: Female; Humans; Hyperparathyroidism; Male; Mediastinal Cyst; Middle Aged; Parathyroid Diseases; Thoracotomy
PubMed: 10197708
DOI: 10.1016/s0003-4975(99)00018-1 -
Histopathology Jun 2010Parathyroid glands are received for histological examination during treatment of hyperparathyroidism. There are a small number of likely diagnoses available to the... (Review)
Review
Parathyroid glands are received for histological examination during treatment of hyperparathyroidism. There are a small number of likely diagnoses available to the histopathologist, but distinction between these can be difficult due to overlap of morphological features. Recent developments in surgical approaches and preoperative imaging techniques have led to increased use of focused surgical approaches after preoperative localization of any abnormal parathyroid glands, thereby reducing the number of glands received for histological examination. Pathologists need to be aware of these clinical developments and the possible impact on their diagnostic practice. The pathogenesis of hyperparathyroidism is also reviewed, as is the rare but important diagnosis of parathyroid carcinoma.
Topics: Frozen Sections; Humans; Parathyroid Diseases; Parathyroid Glands; Parathyroidectomy
PubMed: 20497243
DOI: 10.1111/j.1365-2559.2010.03515.x -
ANZ Journal of Surgery Apr 2007Parathyroid cysts are rare and even more rarely cause a neck mass resembling a goitre. Such large parathyroid cysts may involve the mediastinum, growing to a sufficient... (Review)
Review
Parathyroid cysts are rare and even more rarely cause a neck mass resembling a goitre. Such large parathyroid cysts may involve the mediastinum, growing to a sufficient size to produce symptoms related to obstruction, and if functioning, primary hyperparathyroidism. Parathyroid cysts should be considered in the list of differential diagnoses of anterior neck masses to allow for appropriate preoperative investigation to avoid unnecessary confusion at the time of operation. We report a case where a functioning parathyroid cyst presented as a retrosternal goitre to emphasize the potential pitfalls associated with their diagnosis and management.
Topics: Aged; Cysts; Diagnosis, Differential; Goiter, Substernal; Humans; Male; Parathyroid Diseases; Thyroidectomy; Tomography, X-Ray Computed; Ultrasonography
PubMed: 17388841
DOI: 10.1111/j.1445-2197.2007.04037.x -
Hormones (Athens, Greece) Mar 2022
Topics: Humans; Parathyroid Diseases; Parathyroid Neoplasms
PubMed: 34822134
DOI: 10.1007/s42000-021-00340-z -
The British Journal of Surgery May 1974
Topics: Adult; Calcium; Cysts; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Kidney Calculi; Male; Middle Aged; Nephrocalcinosis; Parathyroid Diseases; Phosphates; Thyroid Diseases
PubMed: 4832222
DOI: 10.1002/bjs.1800610509 -
International Surgery 1997
Topics: Cysts; Humans; Neck Injuries; Parathyroid Diseases; Thoracic Injuries
PubMed: 9412848
DOI: No ID Found -
PloS One 2020Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis...
Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis originates variable symptoms that affect bone remodelling among other processes. This study aimed to provide data on the epidemiology and characteristics of patients admitted with these disorders in Spain between 2003 and 2017, and to analyse disease management and direct medical costs. Medical records in which a disorder of the parathyroid gland was registered as the admission motive were extracted from a nationwide hospital-discharge database via the Spanish Ministry of Health. Records from 12,903 patients were obtained, with predominance of female patients (74.70%) and of admissions due to hyperparathyroidism (90.23%). The number of patients admitted per year increased over the study period along the incidence of these disorders. The year 2017 incidence of hyperparathyroidism was 2.95 per 10,000, 4.03 per 10,000 in females and 1.37 in males; the same year, the incidence of hypoparathyroidism was 0.17 per 10,000. Length of hospital stay was significantly extended in patients with hypoparathyroidism (7.16 days), admitted mostly due to emergencies. Heart failure was diagnosed in more than 20% of admissions in patients with secondary and tertiary hyperparathyroidism and hypoparathyroidism, while this last group displayed the highest levels of mineral metabolism disruption. Parathyroidectomy was performed in 78.95% of all admissions for primary hyperparathyroidism. The total annual direct medical cost parathyroid gland disorders has increased over the study period, due to the increase of the costs associated to hyperparathyroidism, whereas the cost per patient remained relatively stable, with an average of €3,748, €3,430 and €3,737 for patients with hyperparathyroidism, hypoparathyroidism and other disorders of the parathyroid gland, respectively. This study provides novel data to extend the scarce available knowledge on parathyroid gland disorders' epidemiology and management in Spain.
Topics: Adult; Female; Humans; Hyperparathyroidism, Primary; Hypoparathyroidism; Incidence; Male; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies; Spain
PubMed: 32155210
DOI: 10.1371/journal.pone.0230130