Article Text

other Versions

PDF
Focused image-guided parathyroidectomy in the current management of primary hyperparathyroidism
  1. Catherine C Langusch1,
  2. Olov Norlen2,
  3. Angela Titmuss3,
  4. Kim Donoghue3,
  5. Andrew J A Holland1,
  6. Albert Shun1,
  7. Leigh Delbridge2
  1. 1Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  2. 2University of Sydney Endocrine Surgical Unit, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Endocrinology, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Andrew Holland, Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Locked bag 4001, Westmead, NSW 2145, Australia; andrew.holland{at}health.nsw.gov.au

Abstract

Objective Primary hyperparathyroidism (PHPT) in childhood and adolescence has been considered a different disease to that seen in adults, with predominantly familial aetiology mandating open exploration to exclude parathyroid hyperplasia in contrast to the adoption of focused image-guided parathyroidectomy (FP) in adults.

Study design A retrospective cohort study in a tertiary referral hospital setting of all children and adolescents (<18 years) undergoing parathyroid surgery for PHPT. Data were obtained from a dedicated endocrine surgery database and hospital medical records.

Results Over the 35-year study period (1980–2014), there were 31 patients who underwent parathyroidectomy for PHPT. 3 patients were from known multiple endocrine neoplasia type 1 syndrome (MEN1) families, 3 had an isolated family history of PHPT and 25 were sporadic. In the sporadic group, 24 (96%) presented with symptomatic hypercalcaemia, affecting the gastrointestinal, musculoskeletal, genitourinary or neuropsychiatric systems. In the 25 patients with sporadic PHPT, nine (36%) had FP with a single adenoma removed with a 100% initial cure rate. Sixteen patients (64%) in the sporadic group had an open exploration: 14 had single gland disease while 2 patients required a second procedure to achieve a final cure rate of 100%. Of the three patients with MEN1, one was cured, one has persistent hyperparathyroidism after FP and the third has permanent hypoparathyroidism after open exploration.

Conclusions The majority of children and adolescents with PHPT have symptomatic disease due to a single adenoma. They can therefore be managed in a similar fashion to their adult counterparts with preoperative localisation studies aiming to permit FP in a day case setting.

  • Endocrinology
  • Paediatric Surgery
  • Procedures

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles