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Predictors of multiglandular disease in primary hyperparathyroidism

Thier, Mark LU ; Daudi, Sébastien; Bergenfelz, Anders LU and Almquist, Martin LU (2018) In Langenbeck's Archives of Surgery 403(1). p.103-109
Abstract

Background: Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT. Methods: We retrospectively evaluated patients operated 1989–2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and... (More)

Background: Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT. Methods: We retrospectively evaluated patients operated 1989–2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and multiglandular disease. Logistic regression was used to identify variables predicting MGD, yielding odds ratios (OR) with 95% confidence intervals (CI). Results: There were 707 patients, of which 79 (11%) had MGD. Patients with MGD were more likely to have negative sestamibi scintigraphy than patients with single-gland disease, 15 of 49 (31%) vs. 70 of 402 (17%; p = 0.03), to suffer from diabetes (12 of 74, 16%) vs. 45 out of 626 patients (7.2%; p < 0.01) and had lower preoperative levels of urinary calcium (3.80 vs. 4.44 mmol/L; p = 0.04). Multivariable analysis identified negative scintigraphy (OR 2.42; 95% CI 1.18 to 4.79), diabetes (OR 2.75; 95% CI 1.31 to 4.97) and elevated levels of osteocalcin (OR 3.79, 95% CI: 1.75 to 8.21) as predictors of MGD. Conclusion: Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels were predictors of MGD.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Multiglandular disease, Negative scintigraphy, Parathyroid hyperplasia, Prediction, Primary hyperparathyroidism
in
Langenbeck's Archives of Surgery
volume
403
issue
1
pages
103 - 109
publisher
Springer
external identifiers
  • scopus:85039859967
ISSN
1435-2443
DOI
10.1007/s00423-017-1647-9
language
English
LU publication?
yes
id
92e0b3ca-a339-4cdb-9f67-acaed1233ff2
date added to LUP
2018-01-23 15:04:01
date last changed
2018-02-19 02:47:02
@article{92e0b3ca-a339-4cdb-9f67-acaed1233ff2,
  abstract     = {<p>Background: Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT. Methods: We retrospectively evaluated patients operated 1989–2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and multiglandular disease. Logistic regression was used to identify variables predicting MGD, yielding odds ratios (OR) with 95% confidence intervals (CI). Results: There were 707 patients, of which 79 (11%) had MGD. Patients with MGD were more likely to have negative sestamibi scintigraphy than patients with single-gland disease, 15 of 49 (31%) vs. 70 of 402 (17%; p = 0.03), to suffer from diabetes (12 of 74, 16%) vs. 45 out of 626 patients (7.2%; p &lt; 0.01) and had lower preoperative levels of urinary calcium (3.80 vs. 4.44 mmol/L; p = 0.04). Multivariable analysis identified negative scintigraphy (OR 2.42; 95% CI 1.18 to 4.79), diabetes (OR 2.75; 95% CI 1.31 to 4.97) and elevated levels of osteocalcin (OR 3.79, 95% CI: 1.75 to 8.21) as predictors of MGD. Conclusion: Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels were predictors of MGD.</p>},
  author       = {Thier, Mark and Daudi, Sébastien and Bergenfelz, Anders and Almquist, Martin},
  issn         = {1435-2443},
  keyword      = {Multiglandular disease,Negative scintigraphy,Parathyroid hyperplasia,Prediction,Primary hyperparathyroidism},
  language     = {eng},
  number       = {1},
  pages        = {103--109},
  publisher    = {Springer},
  series       = {Langenbeck's Archives of Surgery},
  title        = {Predictors of multiglandular disease in primary hyperparathyroidism},
  url          = {http://dx.doi.org/10.1007/s00423-017-1647-9},
  volume       = {403},
  year         = {2018},
}