Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10031-10041
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10031
Analysis of the successful clinical treatment of 140 patients with parathyroid adenoma: A retrospective study
Zhen-Xing Peng, Yong Qin, Juan Bai, Jin-Shu Yin, Bo-Jun Wei
Zhen-Xing Peng, Juan Bai, Jin-Shu Yin, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yong Qin, Department of Otorhinolaryngology and Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
Bo-Jun Wei, Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Peng ZX contributed to conceptualization, methodology, and writing the original draft; Qin Y contributed to validation, writing-review, and editing; Bai J contributed to data curation, software, and formal analysis; Yin JS contributed to supervision; Wei BJ contributed to investigation and visualization.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Beijing Shijitan Hospital, Capital Medical University.
Informed consent statement: According to the Ethics Committee policy, this is an anonymous, retrospective study exempt from obtaining informed consent from the patients.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo-Jun Wei, MD, Professor, Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing 100020, China. weibojun1015@sina.com
Received: September 15, 2021
Peer-review started: September 15, 2021
First decision: January 22, 2022
Revised: February 15, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: October 6, 2022
Processing time: 377 Days and 4 Hours
Abstract
BACKGROUND

Parathyroid adenoma (PA) sometimes recurs after surgery, how to improve the surgical success rate of PA is the key to the treatment of this disease.

AIM

To investigate the clinical features, diagnosis, and surgical treatment of patients with PA.

METHODS

Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study. The clinical features, localization diagnosis, and surgical treatment of these patients were analyzed.

RESULTS

Of the 140 patients, 32 were male and 108 were female; 132 cases had one adenoma, and 8 had two adenomas. In addition, 114 cases had clinical symptoms, among which 51, 28, 23, 8, and 4 had urinary system, skeletal system, digestive system, neuromuscular system, and neuropsychiatric symptoms, respectively, while 26 cases had no obvious symptoms. The median level of preoperative parathyroid hormone (PTH) was 201.0 pg/mL. The positive detection rate of technetium-99m sestamibi (Tc-99m MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT), ultrasound examination, and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%, 85.5%, and 96.4%, respectively. Open surgery was performed in all patients, and PTH was monitored during surgery. The success rate of surgery was 98.6%. After surgery, 21 cases developed hypocalcemia, 1 case developed temporary hoarseness, and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism, postoperative hemorrhage, or hematoma in the surgical area.

CONCLUSION

For patients with clinically unexplained skeletal system, urinary system, and neuropsychiatric symptoms, the possibility of PA should be considered. Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis. Precise preoperative localization, intraoperative PTH monitoring, and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.

Keywords: Primary hyperparathyroidism; Parathyroid adenoma; Technetium-99m sestamibi; SPECT/CT; Surgical treatment; Localization diagnosis; Intraoperative parathyroid hormone monitoring

Core Tip: In this study, we retrospectively analyzed the clinical data of 140 patients with parathyroid adenoma (PA). We found that, for patients with clinically unexplained skeletal system, urinary system, and neuropsychiatric symptoms, the possibility of PA should be considered. Imaging examinations such as ultrasound, technetium-99m sestamibi single-photon emission computed tomography/computed tomography could be integrated before surgery to obtain accurate localization diagnosis. Precise preoperative localization, intraoperative parathyroid hormone monitoring, and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.