Sara Abou Azar, Joseph Tobias, Rachel Nordgren, Edwin L Kaplan, Peter Angelos, Xavier M Keutgen, Megan K Applewhite
{"title":"Adolescent Hyperparathyroidism: An Updated Contemporary Surgical Experience at a Tertiary Center.","authors":"Sara Abou Azar, Joseph Tobias, Rachel Nordgren, Edwin L Kaplan, Peter Angelos, Xavier M Keutgen, Megan K Applewhite","doi":"10.1016/j.jss.2024.11.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Primary hyperparathyroidism (pHPT) in children is uncommon, resulting in a paucity of data describing the disease process in this population. Herein, in an effort to bridge the information gap, we review our experience with pHPT in adolescent patients under 20 y of age at a specialized tertiary referral center.</p><p><strong>Methods: </strong>A retrospective chart review included all adolescent patients with pHPT, who underwent surgery at our institution between 2004 and 2023. Presenting symptoms, biochemical workup, intraoperative findings, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Forty-nine adolescent patients were included, with 45% (n = 22) being male. The median age at diagnosis was 16.6 y (14.1-20). On presentation, 71% (n = 35) were symptomatic, most commonly nephrolithiasis (35%, n = 17). The median preoperative calcium and parathyroid hormone were 12 mg/dL (11.3-12.6) and 128pg/mL (105-170.5), respectively. Focused parathyroidectomy was performed in 61% (n = 30) and four-gland exploration in 39% (n = 19) of patients. Eighty-six percent were found to have a single adenoma and 14% had multigland disease. Preoperative localization with ultrasound and Sestamibi had a sensitivity of 57% and 59%, respectively. When combining both imaging modalities, sensitivity increased to 78% (positive predictive value 91%). There were no surgical complications. At the median follow-up of 61.0 mo, 4% of patients were found to have recurrent pHPT. Younger age (OR 0.64, P = 0.038) and sporadic disease (OR 0.04, P = 0.050) had less likelihood of recurrence.</p><p><strong>Conclusions: </strong>Most adolescent patients with pHPT present with symptoms and have single gland disease. Adolescent pHPT should be treated like adult pHPT, utilizing intraoperative PTH and two preoperative imaging modalities.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"150-155"},"PeriodicalIF":1.8000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jss.2024.11.007","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Primary hyperparathyroidism (pHPT) in children is uncommon, resulting in a paucity of data describing the disease process in this population. Herein, in an effort to bridge the information gap, we review our experience with pHPT in adolescent patients under 20 y of age at a specialized tertiary referral center.
Methods: A retrospective chart review included all adolescent patients with pHPT, who underwent surgery at our institution between 2004 and 2023. Presenting symptoms, biochemical workup, intraoperative findings, and outcomes were collected and analyzed.
Results: Forty-nine adolescent patients were included, with 45% (n = 22) being male. The median age at diagnosis was 16.6 y (14.1-20). On presentation, 71% (n = 35) were symptomatic, most commonly nephrolithiasis (35%, n = 17). The median preoperative calcium and parathyroid hormone were 12 mg/dL (11.3-12.6) and 128pg/mL (105-170.5), respectively. Focused parathyroidectomy was performed in 61% (n = 30) and four-gland exploration in 39% (n = 19) of patients. Eighty-six percent were found to have a single adenoma and 14% had multigland disease. Preoperative localization with ultrasound and Sestamibi had a sensitivity of 57% and 59%, respectively. When combining both imaging modalities, sensitivity increased to 78% (positive predictive value 91%). There were no surgical complications. At the median follow-up of 61.0 mo, 4% of patients were found to have recurrent pHPT. Younger age (OR 0.64, P = 0.038) and sporadic disease (OR 0.04, P = 0.050) had less likelihood of recurrence.
Conclusions: Most adolescent patients with pHPT present with symptoms and have single gland disease. Adolescent pHPT should be treated like adult pHPT, utilizing intraoperative PTH and two preoperative imaging modalities.
期刊介绍:
The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.