Primary Hyperparathyroidism: A 26-year Experience at Seoul National University Hospital

Kwon, Wooil; Jang, Myung Cheol; Noh, Dong Young; Youn, Yeo Kyu; Oh, Seung Keun

Abstract

PURPOSE
As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature.
METHODS
A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed.
RESULTS
Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²â°¹Tl-â¹â¹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²â°¹Tl-â¹â¹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months.
CONCLUSION
Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.