Skip to main content
SpringerLink
Log in

Lokalisationsdiagnostik und Operationsstrategie beim Ersteingriff bei sporadischem primärem Hyperparathyreoidismus

Localization diagnostics and operative strategy for the first intervention in sporadic primary hyperparathyroidism

  • Leitthema
  • Published:
Die Chirurgie Aims and scope Submit manuscript

Zusammenfassung

Der primäre Hyperparathyreoidismus (pHPT) ist eine häufige endokrine Erkrankung, deren Inzidenz deutlich ansteigt. Neben den klassischen Symptomen wie Knochenschmerzen, Osteoporose und Nierensteinen stehen oft unspezifische Beschwerden wie Antriebslosigkeit und Erschöpfung sowie auch Angstzustände und depressive Symptome im Vordergrund. Die Diagnose ist einfach und erfolgt durch Bestimmung der Serumspiegel von Kalzium und Parathormon (PTH). Mittels Sonographie und Tc-99m-MIBI-Szintigraphie kann dann ein Großteil der Nebenschilddrüsenadenome lokalisiert werden. Schon beim laborchemischen Nachweis ist die Operationsindikation in aller Regel indiziert. Die Operation ist die einzige kurative Therapie des pHPT. Sie ist in der Regel erfolgreich. Neben der bilateralen Exploration kann die Operation auch fokussiert geplant werden. Dabei kann der Operationserfolg intraoperativ durch die Bestimmung des intraoperativen Quick-PTH (IOPTH) dokumentiert werden.

Abstract

Primary hyperparathyroidism (pHPT) is a frequent endocrine disease, the incidence of which is clearly increasing. In addition to the classical symptoms of bone pain, osteoporosis and renal calculi, nonspecific complaints, such as listlessness and exhaustion, anxiety states and depressive symptoms also often occur. The diagnosis is simple and is carried out by determination of calcium and parathormone (PTH) serum levels. The majority of parathyroid adenomas can be localized by ultrasound and Tc-99m-MIBI scintigraphy. The indications for surgery can normally already be identified by the laboratory biochemical detection. Surgery is the only curative treatment of pHPT and is normally successful. In addition to bilateral exploration, a focused parathyroidectomy can be planned. The success of surgery can be intraoperatively documented by the determination of intraoperative Quick PTH (IOPTH).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Ahmadieh H, Kreidieh O, Akl EA, El-Hajj Fuleihan G (2020) Minimally invasive parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IOPTH) and preoperative imaging versus bilateral neck exploration for primary hyperparathyroidism in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010787.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Akerström G, Malmacus J, Bergström R (1982) Surgical anatomy of human parathyroid glands. Surgery 95:14–21

    Google Scholar 

  3. Bollerslev J, Reijnmark L, Zahn A, Heck A et al (2022) European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educationsal program of parathyroid disorders (PARAT 2021). Eur J Endocrinol 186:R33–R63

    Article  CAS  PubMed  Google Scholar 

  4. Broome DT, Naples R, Bailey R, Tekin Z, Hamidi M, Bena JF, Morrison SL, Berber E, Siperstein AE, Scharpf J, Skugor M (2020) Use of preoperative imaging in primary hyperparathyroidism. J Clin Endocrinol Metab 106:e328–e337

    Article  Google Scholar 

  5. De Lellis R (2011) Parathyroid tumors and related disorders. Mod Pathol 24:578–593

    Google Scholar 

  6. Erbil Y, Kapran Y, Isserver H et al (2006) The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99m-Tc-sestamibi scanning for primary hyperparathyreoidism. Am J Surg 195:34–39

    Article  Google Scholar 

  7. Fitzpatrick LA, Bilezikian JP, Silberberg SJ (2008) Parathyoid hormone and the cardiovascular system. Curr Osteoporos Rep 6:77–83

    Article  PubMed  Google Scholar 

  8. Goodman A, Politz D, Lopez J, Norman J (2011) Intrathyroid parathyroid adenoma: incidence and location-the case against thyroid lobectomy. Head Neck Surg 144:867–871

    Article  Google Scholar 

  9. Hoang T, Jani A, Mai V et al (2019) Associations of serum ionized calcium, phophate and PTH Levels with parathyroid scan in primary hyperparathyroidism. Endocr Pract 25:16–21

    Article  PubMed  Google Scholar 

  10. Iwen K, Kußmann J, Fendrich V, Lindner K, Zahn A (2022) Accuracy of Parathyroid adenoma localization by preoperative Ultrasound and Sestamibi ín 1089 patients with primary Hyperparathyreoidism. World J Surg 46:2197–2205

    Article  PubMed  Google Scholar 

  11. Kebewew E, Hwang J, Reiff E, Duh Q‑Y, Orlo HC (2006) Predictors of single-gland vs. multigland parathyorid disease in primary hyperparathyroidism. Arch Surg 141:777–782

    Article  Google Scholar 

  12. Khan A, Hanley D, Rizolli R, Bollerslev J et al (2017) Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis and management. A Canadian and international consensus. Osteoporos Int 28:1–19

    Article  CAS  PubMed  Google Scholar 

  13. Koman A, Bränström R, Pernow Y et al (2022) Neuropsychiatric comorbidity in primary hyperparathyroidism before and after parathyreoidectomy: a population study. World J Surg 46:1420–1430

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Marti JL, Yang CS, Carling T, Roman SA, Sosa JA, Donovan P et al (2012) Surgical approach and outcomes in patients with lithiumassociated hyperparathyroidism. Ann Surg Oncol 19:3465–3471

    Article  PubMed  Google Scholar 

  15. Milas M, Mandel S, Langer J (2017) Advanced thyroid and parathyroid ultrasound ISBN 978-3-319-44098‑9.

    Book  Google Scholar 

  16. Naples R, Shin JJ, Berber E, Jin J, Krishnamurthy VD, Siperstein AE (2020) Recognition of primary hyperparathyroidism: delayed time course from hypercalcemia to surgery. Surgery 167:358–364

    Article  PubMed  Google Scholar 

  17. Pretorius M, Lundstam K, Heck A et al (2022) Mortality and morbidity in mild primary hyperparathyroidism: results from a 10-year prospective randomized controlled trial of parathyroidectomy versus observation. Ann Intern Med 175:812–819

    Article  PubMed  Google Scholar 

  18. Schwarz P, Body JJ, Cap J et al (2014) The PRIMARA study: a prospective, descriptive, observational study to review cinacalcet use in patients with primary hyperparathyroidism in clinical practice. Eur J Endocrinol 171:727–735

    Article  CAS  PubMed  Google Scholar 

  19. Seib C, Suh I, Mang T, Trickey A et al (2021) Patients factors associated with parathyroidectomy in Adults with primary hyperparathyoidism. JAMA Surg 156:334–342

    Article  PubMed  PubMed Central  Google Scholar 

  20. Taterra D, Wong LM, Vikse J et al (2019) The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery. Langenbecks Arch Surg 404:63–70

    Article  PubMed  PubMed Central  Google Scholar 

  21. Walker MD, Silverberg SJ (2018) Primary hyperparathyroidism. Nat Rev Endocrinol 14:115–125

    Article  CAS  PubMed  Google Scholar 

  22. Weber T, Hillenbrand A, Peth S, Hummel R (2020) Symptoms of primary hyperparathyroidism in men and women: the same but different? Visc Med 36:41–47

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wilhelm SM, Wang TS, Ruan DT et al (2016) The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA 151:959–968

    Google Scholar 

  24. Woll ML, Mazeh H, Anderson BM, Chen H, Sippel RS (2012) Breast radiation correlates with side of parathyroid adenoma. World J Surg 36:607–611

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Endokrine Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland

    V. Fendrich & A. Zahn

Authors
  1. V. Fendrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Zahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Fendrich.

Ethics declarations

Interessenkonflikt

V. Fendrich und A. Zahn geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fendrich, V., Zahn, A. Lokalisationsdiagnostik und Operationsstrategie beim Ersteingriff bei sporadischem primärem Hyperparathyreoidismus. Chirurgie 94, 573–579 (2023). https://doi.org/10.1007/s00104-023-01868-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-023-01868-z

Schlüsselwörter

Keywords

Search

Navigation