일차성 부갑상선기능항진증으로 수술적 치료를 받은 환자들에 대한 임상적 고찰
Clinical Analysis of Primary Hyperparathyroidism after Parathyroidectomy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives：To evaluate the accuracy of ultrasound (US), computed tomography (CT) and 99Tc sestamibi scan (MIBI) for preoperative localization of solitary parathyroid mass in patients with primary hyperparathyroidism and analyze our surgical outcomes. Materials and Methods：In a retrospective study of 57 consecutive patients with primary hyperparathyroidism, all patients underwent parathyroidectomy from Jan. 2003 through Dec. 2013. Patients were performed ultrasound, computed tomography and Technetium-99m sestamibi scan before surgery. We also reviewed serum calcium, serum parathyroid hormone (iPTH), associated symptoms and pathologic results through electronic medical records (EMR). Results：All 57 patients were enrolled and they had single solitary parathyroid mass. In final pathologic results, 45 patients had solitary parathyroid adenoma, 7 patients had nodular hyperplasia and 5 patients were diagnosed as parathyroid cancer. In adenoma and carcinoma as a single nodule, accuracy of US was 95.2% (40/42), CT was 91.7% (44/48), MIBI was 81.5% (31/38). The most common symptoms were general weakness and nausea. Interestingly, asymptomatic hypercalcemia, incidentaloma were over the half patients. Postoperative numbness was observed in 4 patients and they were treated with calcium supplementation but not persisted longer than 4th day postoperatively. Conclusions：Our results show that the combination of US, CT, MIBI has benefits for preoperative localization of parathyroid mass in primary hyperparathyroidism and parathyroidectomy was useful for patients with primary hyperparathyroidism.
Abstract
Background and Objectives：To evaluate the accuracy of ultrasound (US), computed tomography (CT) and 99Tc sestamibi scan (MIBI) for preoperative localization of solitary parathyroid mass in patients with primary hyperparathyroidism and analyze our surgical outcomes. Materials and Methods：In a retrospective study of 57 consecutive patients with primary hyperparathyroidism, all patients underwent parathyroidectomy from Jan. 2003 through Dec. 2013. Patients were performed ultrasound, computed tomography and Technetium-99m sestamibi scan before surgery. We also reviewed serum calcium, serum parathyroid hormone (iPTH), associated symptoms and pathologic results through electronic medical records (EMR). Results：All 57 patients were enrolled and they had single solitary parathyroid mass. In final pathologic results, 45 patients had solitary parathyroid adenoma, 7 patients had nodular hyperplasia and 5 patients were diagnosed as parathyroid cancer. In adenoma and carcinoma as a single nodule, accuracy of US was 95.2% (40/42), CT was 91.7% (44/48), MIBI was 81.5% (31/38). The most common symptoms were general weakness and nausea. Interestingly, asymptomatic hypercalcemia, incidentaloma were over the half patients. Postoperative numbness was observed in 4 patients and they were treated with calcium supplementation but not persisted longer than 4th day postoperatively. Conclusions：Our results show that the combination of US, CT, MIBI has benefits for preoperative localization of parathyroid mass in primary hyperparathyroidism and parathyroidectomy was useful for patients with primary hyperparathyroidism.
참고문헌 (14)
- Welsh DA, "Concerning the parathyroid glands: A critical, anatomical, and experimental study", J Anat Physiol, 32, pp.292~307 (1898)
- Larsen WJ, "Human Embryology" (2001), Churchill Livingstone
- Mohebati A, "Anatomy of thyroid and parathyroid glands and neurovascular relations", Clin Anat, 25(1), pp.19~31 (2012)
- 이승원, "부갑상선 기능항진증을 동반한 부갑상선 선종에 대한 임상적 고찰", 대한이비인후과학회지 두경부외과학, 49(1), pp.72~78 (2006), 대한이비인후과학회
- DeLellis RA, "Surgery of the thyroid and parathyroid glands", pp.571~577 (2003), Saunders
- Clarke BL, "Epidemiology of Primary Hyperparathyroidism", J Clin Densitom, 16(1), pp.8~13 (2013)
- Gluckman JL, "Renewal of certification study group in otolaryngology head and neck surgery", pp.1998, Kendall
- 성의숙, "부갑상선 기능 항진증에서 병변의 영상학적 진단과 위치 탐색 방법의 비교 연구", 대한이비인후과학회지 두경부외과학, 55(9), pp.565~570 (2012), 대한이비인후과학회[DOI]
- Murray SE, "Timing of Symptom Improvement After Parathyroidectomy for Primary Hyperparathyroidism", Surgery, 154(6), pp.1463~1469 (2013)
- Adkisson CD, "Predictors of accuracy in preoperative parathyroid adenoma localization using ultrasound and Tc-99 m-Sestamibi: a 4-quadrant analysis", Am J Otolaryngol, 34(5), pp.508~516 (2013)
- Braiser AR, "Hungry bone syndrome: Clinical and Biochemical Predictors of Its Occurence after Parathyroid Surgery", Am J Med, 84(4), pp.654~660 (1988)
- Press DM, "The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a populationbased analysis from the electronic medical record", Surgery, 154(6), pp.1232~1238 (2013)
- Bilezikian JP, "Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the fourth international workshop", J Clin Endocrinol Metab, 99(10), pp.3561~3569 (2014)
- 정도영, "가역적 성대마비의 원인이 된 비활성 부갑상선 선종 1예", 임상이비인후과, 27(2), pp.401~404 (2016), 대한이비인후과학회 부산,울산,경남 지부회