Radioguided parathyroidectomy effective in pediatric patients

• Published in: The Journal of surgical research Vol. 184; no. 1; pp. 312 - 317
• Main Authors: Burke, Jocelyn F., MD, Jacobson, Kaitlin, Gosain, Ankush, MD, PhD, FACS, FAAP, Sippel, Rebecca S., MD, FACS, Chen, Herbert, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2013
• Subjects: Adenoma - diagnostic imaging; Adenoma - surgery; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Databases, Factual; Female; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Male; Middle Aged; Minimally invasive parathyroidectomy; Minimally Invasive Surgical Procedures - methods; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy - methods; Pediatric endocrine surgery; Primary hyperparathyroidism; Radioguided parathyroidectomy; Radionuclide Imaging; Retrospective Studies; Surgery; Technetium Tc 99m Sestamibi; Technetium-99m sestamibi; Young Adult; Minimally invasive parathyroidectomy; Primary hyperparathyroidism; Pediatric endocrine surgery; Technetium-99m sestamibi; Radioguided parathyroidectomy
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.05.079

Abstract Background Radioguided parathyroidectomy (RGP) has been shown to be effective in adult patients with hyperparathyroidism (HPT), but the utility of RGP in pediatric patients has not been systematically examined. It is not known if adult criteria for radioactive counts can accurately detect hyperfunctioning parathyroid glands in pediatric patients. The purpose of our study was to determine the utility of RGP in children with primary HPT. Materials and methods A retrospective review of our prospectively maintained single-institution database for patients who underwent a RGP for primary HPT identified 1694 adult and 19 pediatric patients aged 19 y or younger. From the adult population, we selected a control group matched three to one for gland weight and gender and compared pre- and postoperative laboratory values, surgical findings, pathology, and radioguidance values between the control and the pediatric groups. Results Excised glands from pediatric patients were smaller than those in the total adult population (437 ± 60 mg versus 718 ± 31 mg, P = 0.0004). When controlled for gland weight, ex vivo counts as a percentage of background were lower in the pediatric group (51% ± 5% versus 91% ± 11%, P = 0.04). However, ex vivo radionuclide counts >20% of the background were found in 100% of pediatric patients and 95% of the adult-matched control group. Conclusions All pediatric patients met the adult detection criteria for parathyroid tissue removal when a RGP was performed, and 100% cure was achieved. We conclude that RGP is a useful treatment option for pediatric patients with primary HPT.