Surgical approach and outcomes in patients with lithium-associated hyperparathyroidism
Annals of Surgical Oncology, 06/12/2012
LastName FI et al. (Type summary here) Marti JL et al. – Lithium–associated hyperparathyroidism (LAH) patients have a high incidence of MGD, and bilateral exploration is frequently necessary. With access to the intraoperative PTH assay, it is reasonable to initiate a unilateral approach because many patients will harbor single adenomas and can be reliably rendered normocalcemic. Patients with MGD remain at higher risk of persistent/recurrent disease.Methods
- Retrospective analysis of 27 patients with LAH undergoing parathyroidectomy with the intraoperative parathyroid hormone (PTH) assay.
- The median postoperative follow–up was 7 months; 17 patients had >6 months follow–up.
- Cervical exploration was unilateral in 9, bilateral in 18 (3 were converted from unilateral).
- Sixteen patients (62 %) had MGD, 12 with four–gland hyperplasia and 4 with double adenomas.
- Ten patients (38 %) had a single adenoma. Twenty–five (93 %) of 27 patients had initially successful surgery.
- Of the 17 patients with >6 months follow–up, two had persistent disease and two experienced recurrent disease.
- All patients with a single adenoma remain free of disease.
- Three (75 %) of four patients with persistent/recurrent disease had MGD and were receiving lithium at the time of surgery.
- Patients with persistent/recurrent disease were older (p = 0.01) and had experienced a longer duration of hypercalcemia (p = 0.04).