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Changing biochemical presentation of primary hyperparathyroidism.

Almquist, Martin LU ; Bergenfelz, Anders LU ; Mårtensson, Hans; Thier, Mark and Nordenström, Erik (2010) In Langenbeck's Archives of Surgery 395. p.925-928
Abstract
PURPOSE: Patients with primary hyperparathyroidism, pHPT, present with milder symptoms than previously. Some, but not all studies, suggest that this change in clinical pattern also implies lower preoperative parathyroid hormone (PTH) and/or calcium levels and smaller adenomas. This is important since reports indicate that smaller adenomas are more difficult to detect on preoperative imaging, possibly increasing the risk of surgical failure. METHODS: There were 640 patients with histologically confirmed single-gland pHPT identified in a prospectively collected database. Median values of preoperative calcium, PTH, as well as adenoma weight were compared in three different time periods: 1990-1995, 1996-2000, and 2000-2007. Correlation between... (More)
PURPOSE: Patients with primary hyperparathyroidism, pHPT, present with milder symptoms than previously. Some, but not all studies, suggest that this change in clinical pattern also implies lower preoperative parathyroid hormone (PTH) and/or calcium levels and smaller adenomas. This is important since reports indicate that smaller adenomas are more difficult to detect on preoperative imaging, possibly increasing the risk of surgical failure. METHODS: There were 640 patients with histologically confirmed single-gland pHPT identified in a prospectively collected database. Median values of preoperative calcium, PTH, as well as adenoma weight were compared in three different time periods: 1990-1995, 1996-2000, and 2000-2007. Correlation between the preoperative levels of calcium and PTH and adenoma weight was calculated. RESULTS: Preoperative ionized calcium decreased significantly over time (p < 0.001). There was a positive correlation between preoperative PTH and adenoma weight (r = 0.32, p < 0.001). The magnitude of this correlation decreased over time. In women, adenoma weight decreased significantly over time (p = 0.03). Median (25th-75th percentile) adenoma weight in women was 750 (400-1,380) mg, 650 (350-1,205) mg, and 520 (305-1,065) mg in the first, second, and third period, respectively. CONCLUSION: From 1990 to 2007, there was a significant trend to operate pHPT patients with lower preoperative serum ionized calcium levels. In women, the adenoma weight decreased. This trend could potentially lead to decreased sensitivity in preoperative localization procedures. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Langenbeck's Archives of Surgery
volume
395
pages
925 - 928
publisher
Springer
external identifiers
  • WOS:000283474100014
  • PMID:20623136
  • Scopus:78149416691
ISSN
1435-2451
DOI
10.1007/s00423-010-0675-5
language
English
LU publication?
yes
id
ed9b54cf-ac10-4926-986f-01a1d1b185e0 (old id 1645057)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20623136?dopt=Abstract
date added to LUP
2010-08-03 09:28:00
date last changed
2016-10-27 16:10:02
@misc{ed9b54cf-ac10-4926-986f-01a1d1b185e0,
  abstract     = {PURPOSE: Patients with primary hyperparathyroidism, pHPT, present with milder symptoms than previously. Some, but not all studies, suggest that this change in clinical pattern also implies lower preoperative parathyroid hormone (PTH) and/or calcium levels and smaller adenomas. This is important since reports indicate that smaller adenomas are more difficult to detect on preoperative imaging, possibly increasing the risk of surgical failure. METHODS: There were 640 patients with histologically confirmed single-gland pHPT identified in a prospectively collected database. Median values of preoperative calcium, PTH, as well as adenoma weight were compared in three different time periods: 1990-1995, 1996-2000, and 2000-2007. Correlation between the preoperative levels of calcium and PTH and adenoma weight was calculated. RESULTS: Preoperative ionized calcium decreased significantly over time (p &lt; 0.001). There was a positive correlation between preoperative PTH and adenoma weight (r = 0.32, p &lt; 0.001). The magnitude of this correlation decreased over time. In women, adenoma weight decreased significantly over time (p = 0.03). Median (25th-75th percentile) adenoma weight in women was 750 (400-1,380) mg, 650 (350-1,205) mg, and 520 (305-1,065) mg in the first, second, and third period, respectively. CONCLUSION: From 1990 to 2007, there was a significant trend to operate pHPT patients with lower preoperative serum ionized calcium levels. In women, the adenoma weight decreased. This trend could potentially lead to decreased sensitivity in preoperative localization procedures.},
  author       = {Almquist, Martin and Bergenfelz, Anders and Mårtensson, Hans and Thier, Mark and Nordenström, Erik},
  issn         = {1435-2451},
  language     = {eng},
  pages        = {925--928},
  publisher    = {ARRAY(0x9f55f48)},
  series       = {Langenbeck's Archives of Surgery},
  title        = {Changing biochemical presentation of primary hyperparathyroidism.},
  url          = {http://dx.doi.org/10.1007/s00423-010-0675-5},
  volume       = {395},
  year         = {2010},
}