Primary Hyperparathyroidism from Parathyroid Microadenoma: Specific Features and Implications for a Surgical Strategy in the Era of Minimally Invasive Parathyroidectomy

• Published in: Journal of the American College of Surgeons Vol. 210; no. 4; pp. 456 - 462
• Main Authors: Goasguen, Nicolas, MD, Chirica, Mircea, MD, Roger, Natacha, MD, Munoz-Bongrand, Nicolas, MD, Zohar, Sarah, MD, Noullet, Severine, MD, de Roquancourt, Anne, MD, Cattan, Pierre, MD, PhD, Sarfati, Emile, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2010; Elsevier
• Subjects: Adenoma - blood; Adenoma - complications; Adenoma - diagnosis; Adenoma - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Calcium - blood; Endocrinopathies; Female; General aspects; Humans; Hyperparathyroidism, Primary - blood; Hyperparathyroidism, Primary - etiology; Logistic Models; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Hormone - blood; Parathyroid Neoplasms - blood; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnosis; Parathyroid Neoplasms - surgery; Parathyroidectomy - methods; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Predictive Value of Tests; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; Treatment Outcome; Endocrinopathy; Adenoma; Parathyroidectomy; Secretory tumor; Medicine; Microadenoma; Treatment; Parathyroid diseases; Surgery; Primary; Parathyroid glands; Strategy; Benign neoplasm; Hyperparathyroidism
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2009.12.017

Background The aim of this study was to identify the specific preoperative characteristics of patients with parathyroid microadenoma and to report their outcomes after surgical treatment. Study Design Parathyroid microadenomas (weight < 100 mg) were identified in 62 (6%) of the 1,012 patients operated on for a parathyroid adenoma between 1995 and 2004. Presentation and outcomes after surgery were compared with those of 124 patients operated on consecutively for parathyroid adenoma (>100 mg) during the last year of the study. All patients underwent bilateral surgical exploration of the neck. Success was defined as resection of a pathologic gland combined with normocalcemia at 6 months after operation. Logistic regression was used to test the relationship between groups and potential predictive factors of microadenoma. Results There were 57 women (92%) and the median age was 57 years (range 29 to 77 years). Median preoperative calcemia and parathyroid hormone (PTH) serum levels were 2.64 mmol/L (range 2.31 to 3 mmol/L) and 79 pg/mL (range 30 to 189 pg/mL), respectively. There was no difference in the clinical presentation between patients with microadenoma and adenoma. Preoperative calcium (p < 0.001) and PTH serum levels (p = 0.014) were significantly higher in patients with adenoma. Calcium and PTH serum levels lower than 2.6 mmol/L and 60 pg/mL, respectively, predicted the presence of microadenoma with respective specificities of 0.89 and 0.87. Success rates were similar in the microadenoma and adenoma groups (92% vs 98%; p = 0.11). Conclusions Mild preoperative elevations of calcium or PTH serum levels should warn about the risk of microadenoma. In this setting, intraoperative difficulties should be expected in identifying the pathologic gland, and bilateral neck exploration should be the preferred surgical approach.