Chapter 15: Recurrent or persistent primary hyperparathyroidism, parathyromatosis

IF 2.9 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Miriam Ladsous , Sophie Deguelte , Elif Hindié , Robert Caiazzo , Brigitte Delemer
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Abstract

Persistent primary hyperparathyroidism is defined as the persistence or recurrence of hypercalcemia within 6 months of parathyroid surgery. Recurrent primary hyperparathyroidism is defined as the recurrence of primary hyperparathyroidism more than 6 months after an initially curative parathyroidectomy. In these situations, it is essential to rule out differential diagnoses, and in particular secondary hyperparathyroidism and familial hypocalciuric hypercalcemia. Failure to remove the pathological parathyroid gland or glands during initial surgery for primary hyperparathyroidism is the most common situation in non-expert centers. In other situations, genetically determined multi-glandular primary hyperparathyroidism must be screened for. More rarely, a second sporadic adenoma is identified, or, exceptionally, a parathyroid carcinoma or parathyromatosis. Effective morphological evaluation, combining a morphological and functional imaging, is essential prior to any new parathyroid surgery. The indications for surgery must be discussed in a multidisciplinary team, assessing the risk/benefit ratio, since the risk of surgical complications is higher. Revision surgery should be performed using a suitable approach, after laryngoscopy, in an expert center, ideally with intraoperative PTH measurement and recurrent nerve neuromonitoring.
第十五章:复发性或持续性原发性甲状旁腺功能亢进。
持续性原发性甲状旁腺功能亢进定义为甲状旁腺手术后6个月内持续或复发高钙血症。原发性甲状旁腺功能亢进症复发定义为原发性甲状旁腺功能亢进症在最初治愈的甲状旁腺切除术后超过6个月复发。在这些情况下,必须排除鉴别诊断,特别是继发性甲状旁腺功能亢进症和家族性低钙高钙血症。在原发性甲状旁腺功能亢进的初始手术中,未能切除病理性甲状旁腺或腺体是非专业中心最常见的情况。在其他情况下,基因决定的多腺体原发性甲状旁腺功能亢进必须筛查。更罕见的是,第二散发性腺瘤被确定,或,例外,甲状旁腺癌或甲状旁腺瘤病。有效的形态学评估,结合形态学和功能成像,在任何新的甲状旁腺手术之前是必不可少的。手术的适应症必须在一个多学科团队中讨论,评估风险/收益比,因为手术并发症的风险更高。翻修手术应在喉镜检查后,在专家中心采用合适的入路进行,最好术中进行甲状旁腺激素测量和复发神经监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annales d'endocrinologie
Annales d'endocrinologie 医学-内分泌学与代谢
CiteScore
4.40
自引率
6.50%
发文量
311
审稿时长
50 days
期刊介绍: The Annales d''Endocrinologie, mouthpiece of the French Society of Endocrinology (SFE), publishes reviews, articles and case reports coming from clinical, therapeutic and fundamental research in endocrinology and metabolic diseases. Every year, it carries a position paper by a work-group of French-language endocrinologists, on an endocrine pathology chosen by the Society''s Scientific Committee. The journal is also the organ of the Society''s annual Congress, publishing a summary of the symposia, presentations and posters. "Les Must de l''Endocrinologie" is a special booklet brought out for the Congress, with summary articles that are always very well received. And finally, we publish the high-level instructional courses delivered during the Henri-Pierre Klotz International Endocrinology Days. The Annales is a window on the world, keeping alert clinicians up to date on what is going on in diagnosis and treatment in all the areas of our specialty.
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