The aim of this study was to analyze whether difference exists in the sensitivity of preoperative localization studies, and in the duration of hospital stay for patients with proved primary hyperparathyroidism (HPT) who underwent surgery before and after the intact-PTH assay was available. A series of 326 patients (median age 56 years, range 13-82 years) who underwent successful parathyroidectomy (PTx) was reviewed. There were 81 (24.8%) men and 245 (75.2%) women. Patients were divided into two groups: Group 1: 122 patients (37.4%) who underwent PTx before the availability of the intact-PTH assay; Group 2: 204 patients (62.6%), in whom the intact-PTH assay was available. All patients underwent double tracer subtraction scintigraphy (SS). Neck ultrasonography (US) was performed in 267 (81.9%) patients, and computerized tomography (CT) in 134 (41.1%). The main clinical and biochemical findings were recorded, and the results of the localizing tests were analyzed. There were no differences between Groups A and B in (1) age (53.312.3 vs. 52.813.5 years; p=0.76), (2) the rate of rheumatologic symptoms, such as bone and joint pain (46.0% vs. 33.3%; p=0.16), (3) serum creatinine levels (86.20.5 vs. 80.424.6 ml/L; p=0.06), and (4) greatest diameter of the excised parathyroid gland (21.215.1 vs. 18.79.2 mm; p=0.06) measured by the pathologist. Renal (polyuria, nocturia, renal colic due to lithiasis) symptoms were most frequent in Group A patients (65.6% vs. 31.4%; p=0.0004), who had higher serum calcium (3.100.4 vs. 2.89±0.3 mmol/L; p=0) levels. The rate of asymptomatic HPT was higher in Group B (9.8% vs. 40.2%; p=0). Thus, an earlier diagnosis of HPT was obtained in Group B patients. The sensitivity of SS (85.2% vs. 88.7%; p=0.88), US (83.6% vs. 85.1%; p=0.99), and CT (78.4% vs. 82.5%; p=0.98) did not differ significantly, although it was higher in Group B. By the combination of SS and US the overall sensitivity of the localizing tests has improved, reaching 86.9% and 94.5% in Group A and B, respectively. Both hospital stay (4.42.3 vs. 2.11.7 days; p=0) and mean operative time (13241 vs. 8825 minutes; p=0) were significantly lower in Group B. In conclusion, the availability of intact-PTH assay and the improved sensitivity of preoperative localizing procedures has resulted in a shorter hospital stay and duration of the operative time.

Improved sensitivity of localizing studies has reduced the hospital stay of patients who underwent parathyroidectomy for primary hyperparathyroidism

LUMACHI, FRANCO;LUISETTO, GIOVANNI;ZUCCHETTA, PIETRO;MARZOLA, MARIA CRISTINA;BUI, FRANCO;
2002

Abstract

The aim of this study was to analyze whether difference exists in the sensitivity of preoperative localization studies, and in the duration of hospital stay for patients with proved primary hyperparathyroidism (HPT) who underwent surgery before and after the intact-PTH assay was available. A series of 326 patients (median age 56 years, range 13-82 years) who underwent successful parathyroidectomy (PTx) was reviewed. There were 81 (24.8%) men and 245 (75.2%) women. Patients were divided into two groups: Group 1: 122 patients (37.4%) who underwent PTx before the availability of the intact-PTH assay; Group 2: 204 patients (62.6%), in whom the intact-PTH assay was available. All patients underwent double tracer subtraction scintigraphy (SS). Neck ultrasonography (US) was performed in 267 (81.9%) patients, and computerized tomography (CT) in 134 (41.1%). The main clinical and biochemical findings were recorded, and the results of the localizing tests were analyzed. There were no differences between Groups A and B in (1) age (53.312.3 vs. 52.813.5 years; p=0.76), (2) the rate of rheumatologic symptoms, such as bone and joint pain (46.0% vs. 33.3%; p=0.16), (3) serum creatinine levels (86.20.5 vs. 80.424.6 ml/L; p=0.06), and (4) greatest diameter of the excised parathyroid gland (21.215.1 vs. 18.79.2 mm; p=0.06) measured by the pathologist. Renal (polyuria, nocturia, renal colic due to lithiasis) symptoms were most frequent in Group A patients (65.6% vs. 31.4%; p=0.0004), who had higher serum calcium (3.100.4 vs. 2.89±0.3 mmol/L; p=0) levels. The rate of asymptomatic HPT was higher in Group B (9.8% vs. 40.2%; p=0). Thus, an earlier diagnosis of HPT was obtained in Group B patients. The sensitivity of SS (85.2% vs. 88.7%; p=0.88), US (83.6% vs. 85.1%; p=0.99), and CT (78.4% vs. 82.5%; p=0.98) did not differ significantly, although it was higher in Group B. By the combination of SS and US the overall sensitivity of the localizing tests has improved, reaching 86.9% and 94.5% in Group A and B, respectively. Both hospital stay (4.42.3 vs. 2.11.7 days; p=0) and mean operative time (13241 vs. 8825 minutes; p=0) were significantly lower in Group B. In conclusion, the availability of intact-PTH assay and the improved sensitivity of preoperative localizing procedures has resulted in a shorter hospital stay and duration of the operative time.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11577/1350540
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