PERSISTENCE AND RECURRENCE IN PRIMARY HYPERPARATHYROIDISM IN A SERIES OF 350 PATIENTS UNDERGOING SURGERY FOR PRIMARY HYPERPARATHYROIDISM

AUTHORS:
A. Camacho Aroca (MADRID, Spain) , E. Colmenarejo García (MADRID, Spain) , L. Luján Sardiña (MADRID, Spain) , C. Ferrero San Román (MADRID, Spain) , A. Valdazo Gómez (MADRID, Spain) , A. León Brestcher (MADRID, Spain) , M. Ramírez Bescós (MADRID, Spain) , P. Soto García (MADRID, Spain) , P. Gadea Uría (MADRID, Spain) , C. Pardo Martínez (MADRID, Spain) , M. Zubillaga Gómez (MADRID, Spain) , A.D. Castillo Zambrano (MADRID, Spain) , C. Sevillano Collantes (MADRID, Spain) , O. Meizoso Pita (MADRID, Spain) , V. Triviño Yannuzzi (MADRID, Spain) , I. Huguet Moreno (MADRID, Spain) , M. Llavero Valero (MADRID, Spain) , J. Modamio Molina (MADRID, Spain) , Á. Carretero García (MADRID, Spain) , T. Talaván Zanón (MADRID, Spain) , D. Roldán Cortés (MADRID, Spain) , S. Alonso García (MADRID, Spain) , I. Galán González (MADRID, Spain) , R. Pastorín Salís (MADRID, Spain) , A. Ruiz De La Hermosa García-Pardo (MADRID, Spain) , I. Sánchez Egido (MADRID, Spain) , L.D.P. Latorre Marlasca (MADRID, Spain) , G. Paseiro Crespo (MADRID, Spain)
Background:
The lack of specific causes for the persistence and recurrence in primary hyperparathyroidism operated on in Endocrine Surgery Units entails the follow-up of these patients for periods of no less than 5 years. New intraoperative localization techniques could further reduce cases of persistence.
Methods:
Review of the series of 350 patients. Period of 10 years. "Infanta Leonor" University Hospital Madrid, Spain.
Results:
Persistent: 4 ( 1,14%); Recurring: 1 ( 0,28%). Age: 63.2 years; 3 Women and 2 men; Pre-surgical calcium: 11.08; 2.88% higher than the rest of the series. Pre-surgical PTH: 344.8(132-703) pg/ml, 24.% higher than the rest of the series. PTH 30 days after surgery: 286 pg/ml (148-509 pg/ml); Cinecalcet:2 Yes, 3 No; Scintigraphy: locates all; ultrasound concordant with scintigraphy 2 of 5 (40%); SPECT CT agreement with scintigraphy: 4 of 5 (80%). No concomitant thyroid pathology. Persistence: 2 non-parathyroid tissue and two undiagnosed double adenomas. Recurrence after 3 years. Healing: of all after reintervention. No new cases in follow-up.
Conclusions:
The series studied maintains the percentages of persistence and recurrence in primary hyperparathyroidism according to the reviewed literature. Both preoperative calcemia and PTH are clearly higher than in the rest of the series. The imaging tests carried out do not allow significant differences compared to the rest of the series. In the case of persistence, but not in recurrence, the surgeon's experience is essential when making intraoperative decisions and in follow-up.