• [Uncontrollable hypercalcemia in a dialysis patient--parathyromatosis or parathyroid carcinoma?]

• Familial parathyroid carcinoma in a child.

• Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications.

• Reduced parathyroid vitamin D receptor messenger ribonucleic acid levels in primary and secondary hyperparathyroidism.

• Can localization studies be used to direct focused parathyroid operations?

• [Surgical treatment of primary and secondary hyperparathyroidism]

• [Bone pain revealing parathyroid adenoma]

• [Bone pain revealing parathyroid adenoma]

• 'Suppressed' double adenoma--a rare pitfall in minimally invasive parathyroidectomy.

• Unilateral parathyroid exploration.

• Unilateral vs bilateral parathyroid gland exploration: a continuing controversy.

• Minimally invasive parathyroidectomy using the 'focused' lateral approach. I. Results of the first 100 consecutive cases.

• Minimally invasive parathyroidectomy using the 'focused' lateral approach. II. Surgical technique.

• (99m)Tc sestamibi accumulation in the chest mimicking an ectopic parathyroid adenoma.

• Detecting parathyroid adenoma using technetium-99m tetrofosmin: comparison with P-glycoprotein and multidrug resistance related protein

1
UI - 12092371
AU - Makela S; Saha H; Helin H; Sand J; Pasternack A
TI - [Uncontrollable hypercalcemia in a dialysis patient--parathyromatosis or parathyroid carcinoma?]
SO - Duodecim 2001;117(2):183-6
AD - TAYS:n sisatautien klinikka PL 2000, 33521 Tampere. satu.marjo.makela@uta.fi

2
UI - 12047705
AU - Hamill J; Maoate K; Beasley SW; Corbett R; Evans J
TI - Familial parathyroid carcinoma in a child.
SO - J Paediatr Child Health 2002 Jun;38(3):314-7
AD - Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Familial hyperparathyroidism and parathyroid carcinoma are rare diseases. A case of parathyroid carcinoma in an 8-year-old girl whose mother had previously undergone parathyroidectomy for primary hyperparathyroidism is reported. Parathyroid carcinoma in a preadolescent child has not been described previously, and may have a familial basis.

3
UI - 10720039
AU - Rao DS; Honasoge M; Divine GW; Phillips ER; Lee MW; Ansari MR; Talpos
TI - GB; Parfitt AM Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications.
SO - J Clin Endocrinol Metab 2000 Mar;85(3):1054-8
AD - Department of Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA. danrao50@hotmail.com
In primary hyperparathyroidism, adenoma size is a major determinant of disease severity and manner of presentation, but the reason for the large variation in size (>100-fold) is unknown. One factor could be the level of vitamin D nutrition, because in India, where vitamin D deficiency is endemic, adenomas are larger and the disease more severe than in the U.S. Accordingly, we determined the relationship between vitamin D nutrition, as measured by serum levels of 25-hydroxyvitamin D (25OHD), and parathyroid gland weight, expressed on a logarithmic scale, in 148 U.S. patients with primary hyperparathyroidism. A significant inverse relationship was found between log gland weight as dependent variable and serum 25OHD as independent variable (r = -0.365; P < 0.0001). The only other influence on gland weight was a weak inverse correlation with age. Log gland weight as an independent variable was significantly related to adjusted calcium, PTH, and alkaline phosphatase (AP) as dependent variables. In 51 patients with serum 25OHD levels less than 15 ng/mL, gland weight, PTH, AP, and adjusted calcium were each significantly higher than in 97 patients with 25OHD levels of 15 ng/mL or more, but 1,25-dihydroxyvitamin D levels were similarly increased in both groups. In the former group the response of adjusted calcium to PTH was blunted, and the response of AP was enhanced, based on significant differences in regression slopes (P = 0.0004 and 0.0022, respectively). Suboptimal vitamin D nutrition stimulates parathyroid adenoma growth by a mechanism unrelated to hypocalcemia or 1,25-dihydroxyvitamin D deficiency and reduces the calcemic response to PTH, so that a higher PTH level and more parathyroid cells are needed to raise the patient's serum calcium to the level corresponding to the increased set-point that is characteristic of the disease. Improved vitamin D nutrition in the population is partly, perhaps largely, responsible for the historical changes in disease severity and manner of presentation that have occurred over the last 50 yr.

4
UI - 10843188
AU - Carling T; Rastad J; Szabo E; Westin G; Akerstrom G
TI - Reduced parathyroid vitamin D receptor messenger ribonucleic acid levels in primary and secondary hyperparathyroidism.
SO - J Clin Endocrinol Metab 2000 May;85(5):2000-3
AD - Department of Surgery, Uppsala University Hospital, Sweden. Tobias.Carling@kirurgi.uu.se
Vitamin D, via its receptor (VDR), inhibits the hormone secretion and proliferation of parathyroid cells. Vitamin D deficiency and reduced parathyroid VDR expression has been associated with development of hyperparathyroidism (HPT) secondary to uremia. VDR polymorphisms may influence VDR messenger RNA (mRNA) levels and have been coupled to an increased risk of parathyroid adenoma of primary HPT. VDR mRNA relative to glyceraldehyde-3-phosphate dehydrogenase mRNA levels were determined by RNase protection assay in 42 single parathyroid adenomas of patients with primary HPT, 23 hyperplastic glands of eight patients with uremic HPT, and 15 normal human parathyroid glands. The adenomas and hyperplasias demonstrated similar VDR mRNA levels, which were reduced (42 +/- 2.8% and 44 +/- 4.0%) compared with the normal glands (P < 0.0001). Comparison of parathyroid adenoma with a normal-sized parathyroid gland of the same individual (n = 3 pairs) showed a 20-58% reduction in the tumor. Nodularly enlarged glands represent a more advanced form of secondary HPT and showed greater reduction in the VDR mRNA levels than the diffusely enlarged glands (P < 0.005). The reduced VDR expression is likely to impair the 1,25(OH)2D3-mediated control of parathyroid functions, and to be of importance for the pathogenesis of not only uremic but also primary HPT. Circulating factors like calcium, PTH, and 1,25(OH)2D3 seem to be less likely candidates mediating the decreased VDR gene expression in HPT.

5
UI - 11391371
AU - Arici C; Cheah WK; Ituarte PH; Morita E; Lynch TC; Siperstein AE; Duh
TI - QY; Clark OH Can localization studies be used to direct focused parathyroid operations?
SO - Surgery 2001 Jun;129(6):720-9
AD - Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
BACKGROUND: There is considerable controversy today concerning the most appropriate surgical approach for patients with primary hyperparathyroidism. The conventional surgical operation involves a bilateral neck exploration through a collar incision with identification of all parathyroid tissue and removal of abnormal parathyroid glands while the patient is under general anesthesia. The success rate of this operation is about 95% or greater in the hands of an experienced endocrine surgeon. Preoperative localization techniques are generally considered to be unnecessary before initial parathyroid operations. The purpose of this investigation was (1) to evaluate the individual and combined accuracy of ultrasonography and technetium 99m sestamibi scans in localizing abnormal parathyroid glands and (2) to determine whether such scans could be used to direct a focused operation. METHODS: We retrospectively studied 338 patients with sporadic primary hyperparathyroidism who had preoperative neck localization studies, ultrasonography and/or technetium 99m sestamibi scans, and parathyroid exploration (238 patients or, reexploration, 60 patients) from January Zion Medical Center. The preoperative localization studies were recorded as true-positive, false-positive, and false-negative and compared with the surgical and pathologic findings and with the outcome of the operation. RESULTS: All of the abnormal parathyroid glands were correctly identified by ultrasonography in 184 of 303 patients (60.7%) and by technetium 99m sestamibi scanning in 183 of 237 patients (77.2%). The sensitivities of ultrasonography and sestamibi were 65% and 80%, respectively. Among the 202 patients who received both ultrasonography and sestamibi scans, a parathyroid tumor was identified at the same site in 105 (52%) of them. When both techniques identified a parathyroid tumor at the same site, the tests were correct in 101 of 105 patients and the sensitivity increased to 96%. CONCLUSIONS: When both the ultrasonography and sestamibi scans identified the same, solitary parathyroid tumor in patients with sporadic primary hyperparathyroidism, this was the only abnormal parathyroid gland in 96% of the patients. A focused parathyroidectomy could therefore be performed in such patients with an acceptable ( approximately 95%) success rate.

6
UI - 12152255
AU - Dadan J; Dzieciol J; Ladny JR; Hady HR; Puchalski Z
TI - [Surgical treatment of primary and secondary hyperparathyroidism]
SO - Przegl Lek 2002;59(2):84-7
AD - I Klinika Chirurgii Ogolnej Akademii Medycznej, ul. M. Sklodowskiej-Curie 24a, 15-276 Bialystok. klchirog@amb.ac.bialystok.pl
Primary hyperparathyroidism is a systemic disease, more and more frequently recognised--concerning 1 to 3% of the population. Statistically appears in 1 of 1000 adults, with significant advantage of women. In Poland every year about 30 new cases are noticed and incidence of it increases with an age. In spite of significant advance of the knowledge, it still makes a lot of diagnostic troubles. It appears to be non-specific illness, characterised by just one symptom, mainly urolithiasis, sometimes chronic ulcer disease, chronic pancreatitis, arterial hypertension, disorders of the movement or psychic disorders. Parathyroid adenoma which is the main reason of the disease is usually single and small, multiple and bigger ones are found exceptionally. In about 2% of cases they are localised in mediastinum. In the comparison to primary hyperparathyroidism the secondary one appears as an effect of the other general disorders. Our material contains 12 patients, 9 with primary and 3 with secondary hyperparathyroidism. All of them were diagnosed and prepared to the operation in the departments of internal diseases. We have not observed any serious complications during the operations and in the postoperative period. In the article the basic symptoms, diagnostic and therapeutic problems of primary and secondary hyperparathyroidism were shown, especially concerning surgical treatment which is safe, radical and efficacious method when performed by experienced surgical team.

7
UI - 7735434
AU - Rivas Crespo MF
TI - [Bone pain revealing parathyroid adenoma]
SO - Arch Pediatr 1995 Jan;2(1):89

8
UI - 7496465
AU - Beauvais P
TI - [Bone pain revealing parathyroid adenoma]
SO - Arch Pediatr 1995 Oct;2(10):1022

9
UI - 12006722
AU - Zettinig G; Kurtaran A; Prager G; Kaserer K; Dudczak R; Niederle B
TI - 'Suppressed' double adenoma--a rare pitfall in minimally invasive parathyroidectomy.
SO - Horm Res 2002;57(1-2):57-60
AD - Department of Nuclear Medicine, University of Vienna, Austria.
Since the introduction of a quick intraoperative parathyroid hormone (QPTH) assay, complete removal of hyperfunctioning parathyroid tissue can be proven during surgery. We report on a scintigraphically and biochemically documented patient with persistent primary hyperparathyroidism (PHPT) caused by suppressed hyperfunctioning parathyroid tissue. A left lower enlarged parathyroid gland was resected by minimally invasive open parathyroidectomy. QPTH measurements confirmed complete resection of hyperfunctioning tissue and histology showed a tumorous enlarged left lower parathyroid gland. The patient was normocalcemic until 1 month after surgery, when serum calcium increased again. A MIBI scan 6 months after surgery showed no evidence of hyperfunctioning parathyroid tissue. After an increase of PTH, a third MIBI scan another 3 months later was performed. Increased tracer uptake behind the lower pole of the right thyroid lobe was seen and confirmed by ultrasonography. Another tumorous enlarged parathyroid gland was removed. These findings support the hypothesis that smaller yet abnormal parathyroid glands can be suppressed and may become hypersecretory if left in situ after surgical removal of the larger gland. Copyright 2002 S. Karger AG, Basel

10
UI - 9738824
AU - Andersen PE; Cohen JI; Everts EC
TI - Unilateral parathyroid exploration.
SO - Arch Otolaryngol Head Neck Surg 1998 Sep;124(9):1052-4
AD - Department of Otolaryngology--Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA. andersep@ohsu.edu

11
UI - 9738825
AU - Khan A
TI - Unilateral vs bilateral parathyroid gland exploration: a continuing controversy.
SO - Arch Otolaryngol Head Neck Surg 1998 Sep;124(9):1055

12
UI - 12074059
AU - Agarwal G; Barraclough BH; Robinson BG; Reeve TS; Delbridge LW
TI - Minimally invasive parathyroidectomy using the 'focused' lateral approach. I. Results of the first 100 consecutive cases.
SO - ANZ J Surg 2002 Feb;72(2):100-4
AD - Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
BACKGROUND: A feasibility study of 'focused' minimally invasive parathyroidectomy (MIP) using a lateral approach was commenced in 1999. The aim of the present paper was to evaluate the effectiveness and safety of this procedure in the first 100 consecutive patients. METHODS: This was a prospective, non-randomized case-control study. One hundred consecutive patients with primary hyperparathyroidism (mean age 63.1 years; 74 females, 26 males) who fulfilled the inclusion criteria for the first and last 50 consecutive patients were compared to see whether they were reflective of a learning curve. The role of intraoperative quick parathyroid hormone (QPTH) estimation was also evaluated. RESULTS: Focused MIP was successfully completed in 93 of 100 patients, with seven conversions. Three (3.2%) of the 93 patients had persistent hyperparathyroidism. Quick PTH was measured in 81 patients and the results were true positive (for cure) in 72 patients, false negative in six patients, true negative in two patients and false positive in one patient. Transient recurrent laryngeal nerve paresis occurred in one patient. During the same time period, open parathyroidectomy was performed in 242 patients. The results were not different between the first and later 50 patients undergoing MIP, nor were the outcomes significantly different from patients undergoing open parathyroidectomy. CONCLUSIONS: Focused MIP is a safe and effective operative approach for appropriately selected patients. Failed procedures were invariably related to shortcomings of the localization studies. Measurement of QPTH, although accurate, is unreliable in the presence of multigland disease.

13
UI - 12074068
AU - Agarwal G; Barraclough BH; Reeve TS; Delbridge LW
TI - Minimally invasive parathyroidectomy using the 'focused' lateral approach. II. Surgical technique.
SO - ANZ J Surg 2002 Feb;72(2):147-51
AD - Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
BACKGROUND: This paper describes the technique of minimally invasive parathyroidectomy. The technique is based on a thorough understanding of the anatomy of the fascial planes in neck, the surgical pathology and embryology of parathyroid glands and precise anatomical interpretation of preoperative localization studies. METHODS: Tissue trauma is minimized by using a 2.0 cm incision placed directly over the abnormal parathyroid gland and by removing the adenoma, without compromising the basic endocrine surgical principles of identification and preservation of recurrent laryngeal nerve, avoidance of any capsular breech, and ligation of the vascular pedicle. RESULTS/CONCLUSIONS: With proper patient selection, this technique results in a failure rate of less than 4% and ensures that the incidence of complications, such as recurrent laryngeal nerve injury, remains comparable with that of standard open parathyroidectomy.

14
UI - 12105805
AU - Ozalp E; Bluemke D; Civelek AC
TI - (99m)Tc sestamibi accumulation in the chest mimicking an ectopic parathyroid adenoma.
SO - Semin Nucl Med 2002 Jul;32(3):223-7
AD - Russell H. Morgan Department of Radiology and Radiological Sciences and the Divisions of Nuclear Medicine and Radiation Health Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-0817, USA.

15
UI - 11929704
AU - Shiau YC; Tsai SC; Wang JJ; Ho ST; Kao A
TI - Detecting parathyroid adenoma using technetium-99m tetrofosmin: comparison with P-glycoprotein and multidrug resistance related protein expression--a preliminary report.
SO - Nucl Med Biol 2002 Apr;29(3):339-44
AD - Department of Nuclear Medicine, Far Eastern Memorial Hospital, Institute of Biomedical Engineering, College of Electrical Engineering, National Taiwan University, Taipei, Taiwan.
The aim of this study was to investigate the relationships among technetium-99m tetrofosmin (Tc-TF) accumulation in parathyroid adenoma and the expression of P-glycoprotein (Pgp) or multidrug resistance related protein (MRP). Before operation, 33 patients with parathyroid adenomas (larger than 1.5 gm) were studied with parathyroid scintigraphy 10 minutes and 2 hours after intravenous injection of Tc-TF before operation. Immunohistochemical analyses (IHA) were performed on multiple nonconsecutive sections of operative parathyroid specimens to detect Pgp or MRP expression. According to the results of IHA, the 33 parathyroid adenomas were separated into four groups: (1) 2 adenomas with both positive Pgp and positive MRP expression, (2) 1 adenomas with positive Pgp but negative MRP expression, (3) 2 adenomas with negative Pgp but positive MRP expression, and (4) 28 adenomas with both negative Pgp and negative MRP expression. All of 28 adenomas in the group 4 could be detected by Tc-TF parathyroid imaging. All of 5 adenomas in the groups 1 to 3 could not be detected by TcTF parathyroid imaging (p < 0.05). Not only the size of parathyroid adenomas, but also significant Pgp or MRP expression limited the sensitivity of Tc-TF parathyroid imaging to localize parathyroid adenomas before operation.

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