Review of 41 patients operated on for primary hyperparathyroidism

We reviewed 41 cases of operation for primary hyperparathyroidism (PHPT) in our institution between 1987 and 1999. The objective of this study was 1) to evaluate the sensitivity and positive predictive value of several locali zation studies for an enlarged parathyroid gland; 2) to determine whether a selective, unilateral-exploration operation is safe; and 3) to investigate rates of coexisting malignancies of other organs. A total of 61 enlarged p arathyroid glands (701 +/- 131 mg wt) were removed, and the lesions consist ed of 32 adenomas, two cancers, and seven hyperplasias. MIBI scintigraphy h ad both a high sensitivity (88.9%) and positive predictive value (88.9%) fo r localization of abnormal parathyroid glands and yielded better performanc e than the other techniques, including ultrasonography, CT scanning, and Tl -Tc scintigraphy. However, all of the localization techniques failed to det ect enlarged glands (18/32 glands = 62.5%) in patients with multi-glandular parathyroid lesions. Initial operations with selective unilateral explorat ion of the neck were successful in 23 of 24 patients (95.8%). Operative fai lure was due to missing the second adenoma of a double adenoma. Malignant t umors were found in 11 patients (26.8%) previously treated or concurrently managed at the time of parathyroidectomy. There was a significant increase in serum-intact PTH level in patients with concurrent malignant tumors comp ared to patients who had no association of malignancies. In conclusion, 1) at least two preoperative localization tests, an MIBI scan and ultrasonogra phy, are helpful in accurately localizing an abnormal parathyroid gland; 2) Selective unilateral exploration is safe and desirable if the second ipsil ateral gland is normal macroscopically; and 3) systematic examination for m alignant tumors is necessary in PHPT patients before and after parathyroide ctomy. (C) 2000 Editions scientifiques et medicales Elsevier SAS.