Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지

Clinical Aspects of Surgically Treated Parathyroid Adenoma with Primary Hyperparathyroidism

수술적으로 치료한 원발성 부갑상선 기능항진증을 동반한 부갑상선종의 임상적 고찰

  • Lyu, Sun-Ho (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Lee, Kyung-Seok (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Cho, Young-Ju (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Kong, Il-Seong (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Lee, Eun-Jung (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Yang, Yun-Su (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine) ;
  • Hong, Ki-Hwan (Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University School of Medicine)
  • 유순호 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 이경석 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 조영주 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 공일승 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 이은정 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 양윤수 (전북대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 홍기환 (전북대학교 의학전문대학원 이비인후-두경부외과학교실)
  • Published : 2010.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background and Objectives : Parathyroid adenoma is a rare disease in Korea, but the incidence of parathyroid adenoma has gradually increased due to generalized measurement of serum calcium and imaging study according to wide spread public health screening program. In previous researches, the analysis of clinical aspects were insufficient due to a few cases. The purpose of this study was to assess the clinical analysis of surgically treated parathyroid adenoma with hyperparathyroidism. Methods : We reviewed the medical records of nineteen cases of parathyroid adenoma with hyperparathyroidism. Initial symptom to visit hospital, hypercalcemia associated medical symptom, surgical outcome and complication were investigated. Serum total calcium, parathyroid hormone, phosphate, alkaline phosphatase were checked before and after surgery. Imaging study was performed with combination of radionuclide parathyroid scan, ultrasonography and neck CT scan. Results : The initial symptoms were no symptom(6/19), pelvic pain(5/19), muscular weakness (3/19), bone pain(3/19) and palpable neck mass(2/19) in order of frequency. Serum total calcium, parathyroid hormone decreased and phosphate increased after surgery than before surgery statistically significantly. Sensitivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 88.2%, 72.7%, 73.3% each. The most common postoperative complication was transient hypocalcemia(9/19). Conclusion : Similar to previous study, parathyroid adenomas have numerous clinical features and surgical treatment via unilateral approach with preoperatively localized single parathyroid adenoma was successful. In our study, parathyroid adenoma was predominantly detected by elevated serum calcium level with no clinical symptom so we need to evaluate parathyroid adenoma, if serum calcium elevated.

Keywords

References

  1. Krempl GA, Medina JE. Current issues in hyperparathyroidism. Otolaryngol Clin North Am. 2003;36(1) :207-15. https://doi.org/10.1016/S0030-6665(02)00154-8
  2. Clark OH, Wilkes W, Siperstein AE, Duh QY. Diagnosis and management of asymptomatic hyperparathyroidism: Safety, efficacy, and deficiencies in our knowledge. J Bone Miner Res. 1991; 6Supple2:S15-S42.
  3. Jung SH, Kim WC, Kang NP. A case of primary hyperparathyroidism with thyroid adenoma. Korean J Head Neck Oncology. 1999;15:80-84.
  4. Clark OH, Okerlund GA, Moss AA, Stark D, Norman D, Newton TH, et al. Localization studies in patient with persistent or recurrent hyperparathyroidism. Surgery. 1985;98:1083-1094.
  5. Ferlin G, Borsato N, Camerani M, Conte N, Zotti D. New perspectives in localizing enlarged parathyroids by Technetiumthalium subtraction scan. J Nucl Med. 1983;24:438-441.
  6. Coakley AJ, Kettle AG, Wells CP, O'Doherty MJ, Collins RE. Tc-99m sestamibi-a new agent for parathyroid imaging. Nucl Med Commun. 1989;10:791-794. https://doi.org/10.1097/00006231-198911000-00003
  7. Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Comparison of technetium-99m-MIBI, technetium- 99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 1998;39:320-324.
  8. Smith JR, Oates ME. Radionuclide imaging of the parathyroid glands: Patterns, pearls, and pitfalls. Radiographics. 2004;24: 1101-1115. https://doi.org/10.1148/rg.244035718
  9. Gross ND, Wax MK. Unilateral and bilateral surgery for parathyroid disease. Otolaryngol Clin North Am. 2004;37:799-817, ix-x. https://doi.org/10.1016/j.otc.2004.02.011
  10. Miccoli P, Monchik JM. Minimally invasive parathyroid surgery. Surg Endosc. 2000;14:987-990. https://doi.org/10.1007/s004640000192
  11. Grimelius L, Akerstrom G, Johansson H, Bergstrom R. Anatomy and histopathology of human parathyroid glands. Pathol Annu. 1981;16(1):1-24.