Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism
Background The accepted management of lithium‐associated hyperparathyroidism (LiHPT) is open four‐gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long‐term recurrence rates after OPTX, whereas some have promoted uni...
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| Veröffentlicht in: | British journal of surgery Jg. 101; H. 10; S. 1252 - 1256 |
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| Sprache: | Englisch |
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Chichester, UK
John Wiley & Sons, Ltd
01.09.2014
Oxford University Press |
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| ISSN: | 0007-1323, 1365-2168, 1365-2168 |
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| Abstract | Background
The accepted management of lithium‐associated hyperparathyroidism (LiHPT) is open four‐gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long‐term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long‐term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging.
Methods
This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan–Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single‐gland versus multigland disease was investigated using intraoperative assessment as reference.
Results
Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow‐up was 5·9 (range 0·3–22) years and 16 patients died during follow‐up. The 10‐year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty‐four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single‐gland versus multigland disease was five of nine and five of eight respectively.
Conclusion
Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long‐term cure rate of well over 80 per cent.
Surgery is an option |
|---|---|
| AbstractList | The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long-term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long-term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging.BACKGROUNDThe accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long-term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long-term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging.This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan-Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single-gland versus multigland disease was investigated using intraoperative assessment as reference.METHODSThis was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan-Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single-gland versus multigland disease was investigated using intraoperative assessment as reference.Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow-up was 5·9 (range 0·3-22) years and 16 patients died during follow-up. The 10-year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty-four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single-gland versus multigland disease was five of nine and five of eight respectively.RESULTSOf 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow-up was 5·9 (range 0·3-22) years and 16 patients died during follow-up. The 10-year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty-four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single-gland versus multigland disease was five of nine and five of eight respectively.Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent.CONCLUSIONSurgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent. Background: The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long-term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long-term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging. Methods: This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan-Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single-gland versus multigland disease was investigated using intraoperative assessment as reference. Results: Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow-up was 5.9 (range 0.3-22) years and 16 patients died during follow-up. The 10-year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty-four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single-gland versus multigland disease was five of nine and five of eight respectively. Conclusion: Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent. Background The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long-term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long-term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging. Methods This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan-Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single-gland versus multigland disease was investigated using intraoperative assessment as reference. Results Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow-up was 5·9 (range 0·3-22) years and 16 patients died during follow-up. The 10-year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty-four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single-gland versus multigland disease was five of nine and five of eight respectively. Conclusion Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent. Surgery is an option [PUBLICATION ABSTRACT] The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long-term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long-term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging. This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan-Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single-gland versus multigland disease was investigated using intraoperative assessment as reference. Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow-up was 5·9 (range 0·3-22) years and 16 patients died during follow-up. The 10-year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty-four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single-gland versus multigland disease was five of nine and five of eight respectively. Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent. Background The accepted management of lithium‐associated hyperparathyroidism (LiHPT) is open four‐gland parathyroid exploration (OPTX). This approach has recently been the subject of controversy. A recent study has shown very high long‐term recurrence rates after OPTX, whereas some have promoted unilateral focused parathyroidectomy as appropriate management. The aim was to evaluate long‐term outcomes after surgery for LiHPT and to assess the accuracy of preoperative imaging. Methods This was a retrospective cohort study that comprised all patients undergoing initial surgery for LiHPT between 1990 and 2013. The cumulative recurrence rate was calculated by the Kaplan–Meier method. The sensitivity and specificity of sestamibi scintigraphy and ultrasound imaging for identification of single‐gland versus multigland disease was investigated using intraoperative assessment as reference. Results Of 48 patients, 45 had OPTX and three underwent focused parathyroidectomy. Multiglandular disease was documented in 27 patients and 21 had a single adenoma. The median follow‐up was 5·9 (range 0·3–22) years and 16 patients died during follow‐up. The 10‐year cumulative recurrence rate was 16 (95 per cent confidence interval 2 to 29) per cent. No permanent complications occurred after primary surgery for LiHPT. Twenty‐four patients had at least one preoperative ultrasound or sestamibi scan. For concordant sestamibi scintigraphy and ultrasound imaging, the sensitivity and specificity for identifying single‐gland versus multigland disease was five of nine and five of eight respectively. Conclusion Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long‐term cure rate of well over 80 per cent. Surgery is an option |
| Author | Sywak, M. Norlén, O. Sidhu, S. Delbridge, L. |
| Author_xml | – sequence: 1 givenname: O. surname: Norlén fullname: Norlén, O. email: olov.norlen@me.com organization: University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia – sequence: 2 givenname: S. surname: Sidhu fullname: Sidhu, S. organization: University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia – sequence: 3 givenname: M. surname: Sywak fullname: Sywak, M. organization: University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia – sequence: 4 givenname: L. surname: Delbridge fullname: Delbridge, L. organization: University of Sydney Endocrine Surgery Unit, Sydney, New South Wales, Australia |
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| References | Marti JL, Yang CS, Carling T, Roman SA, Sosa JA, Donovan P et al. Surgical approach and outcomes in patients with lithium-associated hyperparathyroidism. Ann Surg Oncol 2012; 19: 3465-3471. Szalat A, Mazeh H, Freund HR. Lithium-associated hyperparathyroidism: report of four cases and review of the literature. Eur J Endocrinol 2009; 160: 317-323. Bendz H, Schon S, Attman PO, Aurell M. Renal failure occurs in chronic lithium treatment but is uncommon. Kidney Int 2010; 77: 219-224. Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S. Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume. J Clin Endocrinol Metab 1989; 68: 654-660. McHenry CR, Racke F, Meister M, Warnaka P, Sarasua M, Nemeth EF et al. Lithium effects on dispersed bovine parathyroid cells grown in tissue culture. Surgery 1991; 110: 1061-1066. Melkersson K, Dahl ML. Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs 2004; 64: 701-723. Kandil E, Dackiw AP, Alabbas H, Abdullah O, Tufaro AP, Tufano RP. A profile of patients with hyperparathyroidism undergoing lithium therapy for affective psychiatric disorders. Head Neck 2011; 33: 925-927. Bendz H, Sjodin I, Toss G, Berglund K. Hyperparathyroidism and long-term lithium therapy - a cross-sectional study and the effect of lithium withdrawal. J Int Med 1996; 240: 357-365. Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15 000 parathyroid operations. J Am Coll Surg 2012; 214: 260-269. Livingstone C, Rampes H. Lithium: a review of its metabolic adverse effects. J Psychopharmacol 2006; 20: 347-355. Sloand JA, Shelly MA. Normalization of lithium-induced hypercalcemia and hyperparathyroidism with cinacalcet hydrochloride. Am J Kidney Dis 2006; 48: 832-837. Wolf ME, Moffat M, Mosnaim J, Dempsey S. Lithium therapy, hypercalcemia, and hyperparathyroidism. Am J Ther 1997; 4: 323-325. Järhult J, Ander S, Asking B, Jansson S, Meehan A, Kristoffersson A et al. Long-term results of surgery for lithium-associated hyperparathyroidism. Br J Surg 2010; 97: 1680-1685. Ananth J, Dubin SE. Lithium and symptomatic hyperparathyroidism. J R Soc Med 1983; 76: 1026-1029. Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? J Affect Disord 2013; 146: 151-157. Rizwan MM, Perrier ND. Long-term lithium therapy leading to hyperparathyroidism: a case report. Perspect Psychiatr Care 2009; 45: 62-65. Geoffroy PA, Bellivier F, Henry C. [Treatment of manic phases of bipolar disorder: critical synthesis of international guidelines.] Encephale 2014; [Epub ahead of print]. Awad SS, Miskulin J, Thompson N. Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy. World J Surg 2003; 27: 486-488. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1000 cases. Surgery 2012; 152: 1008-1015. Abdullah H, Bliss R, Guinea AI, Delbridge L. Pathology and outcome of surgical treatment for lithium-associated hyperparathyroidism. Br J Surg 1999; 86: 91-93. Carchman E, Ogilvie J, Holst J, Yim J, Carty S. Appropriate surgical treatment of lithium-associated hyperparathyroidism. World J Surg 2008; 32: 2195-2199. 2009; 45 1991; 110 2010; 77 2012; 152 2004; 64 2010; 97 2006; 20 2009; 160 2006; 48 1983; 76 2011; 33 2013; 146 2003; 27 2012; 19 2008; 32 1999; 86 2014 1996; 240 2012; 214 1989; 68 1997; 4 |
| References_xml | – reference: Livingstone C, Rampes H. Lithium: a review of its metabolic adverse effects. J Psychopharmacol 2006; 20: 347-355. – reference: Kandil E, Dackiw AP, Alabbas H, Abdullah O, Tufaro AP, Tufano RP. A profile of patients with hyperparathyroidism undergoing lithium therapy for affective psychiatric disorders. Head Neck 2011; 33: 925-927. – reference: Marti JL, Yang CS, Carling T, Roman SA, Sosa JA, Donovan P et al. Surgical approach and outcomes in patients with lithium-associated hyperparathyroidism. Ann Surg Oncol 2012; 19: 3465-3471. – reference: Melkersson K, Dahl ML. Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs 2004; 64: 701-723. – reference: Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15 000 parathyroid operations. J Am Coll Surg 2012; 214: 260-269. – reference: Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S. Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume. J Clin Endocrinol Metab 1989; 68: 654-660. – reference: Szalat A, Mazeh H, Freund HR. Lithium-associated hyperparathyroidism: report of four cases and review of the literature. Eur J Endocrinol 2009; 160: 317-323. – reference: McHenry CR, Racke F, Meister M, Warnaka P, Sarasua M, Nemeth EF et al. Lithium effects on dispersed bovine parathyroid cells grown in tissue culture. Surgery 1991; 110: 1061-1066. – reference: Geoffroy PA, Bellivier F, Henry C. [Treatment of manic phases of bipolar disorder: critical synthesis of international guidelines.] Encephale 2014; [Epub ahead of print]. – reference: Awad SS, Miskulin J, Thompson N. Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy. World J Surg 2003; 27: 486-488. – reference: Sloand JA, Shelly MA. Normalization of lithium-induced hypercalcemia and hyperparathyroidism with cinacalcet hydrochloride. Am J Kidney Dis 2006; 48: 832-837. – reference: Lehmann SW, Lee J. Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: what do we know? J Affect Disord 2013; 146: 151-157. – reference: Järhult J, Ander S, Asking B, Jansson S, Meehan A, Kristoffersson A et al. Long-term results of surgery for lithium-associated hyperparathyroidism. Br J Surg 2010; 97: 1680-1685. – reference: Wolf ME, Moffat M, Mosnaim J, Dempsey S. Lithium therapy, hypercalcemia, and hyperparathyroidism. Am J Ther 1997; 4: 323-325. – reference: Ananth J, Dubin SE. Lithium and symptomatic hyperparathyroidism. J R Soc Med 1983; 76: 1026-1029. – reference: Rizwan MM, Perrier ND. Long-term lithium therapy leading to hyperparathyroidism: a case report. Perspect Psychiatr Care 2009; 45: 62-65. – reference: Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1000 cases. Surgery 2012; 152: 1008-1015. – reference: Abdullah H, Bliss R, Guinea AI, Delbridge L. Pathology and outcome of surgical treatment for lithium-associated hyperparathyroidism. Br J Surg 1999; 86: 91-93. – reference: Bendz H, Schon S, Attman PO, Aurell M. Renal failure occurs in chronic lithium treatment but is uncommon. Kidney Int 2010; 77: 219-224. – reference: Bendz H, Sjodin I, Toss G, Berglund K. Hyperparathyroidism and long-term lithium therapy - a cross-sectional study and the effect of lithium withdrawal. J Int Med 1996; 240: 357-365. – reference: Carchman E, Ogilvie J, Holst J, Yim J, Carty S. Appropriate surgical treatment of lithium-associated hyperparathyroidism. 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The accepted management of lithium‐associated hyperparathyroidism (LiHPT) is open four‐gland parathyroid exploration (OPTX). This approach has... The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has recently been... Background The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has... Background: The accepted management of lithium-associated hyperparathyroidism (LiHPT) is open four-gland parathyroid exploration (OPTX). This approach has... |
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| SubjectTerms | Adult Aged Aged, 80 and over Antidepressive Agents - adverse effects Diagnostic Imaging - methods Female Humans Hyperparathyroidism - chemically induced Hyperparathyroidism - diagnosis Hyperparathyroidism - surgery Lithium Carbonate - adverse effects Male Middle Aged Parathyroidectomy - methods Preoperative Care - methods Recurrence Retrospective Studies Treatment Outcome |
| Title | Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism |
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