Endocrine Abstracts (2009) 20 P257

Primary hyperparathyroidism surgery: team report 2002-2008

Miguel Allen, Ana Rafael, Carlos Xió, Luís Fernandes & Joaquim Torrinha

Hospital de Egas Moniz, Lisboa, Portugal.

Introduction: Single adenoma is the most frequent cause of Primary hyperparathyroidism (HPT1). Surgical excision has a high success rate, particularly when associated with a fast intraoperative intact parathyroid hormone assay (PTHi).

Aim: Evaluate the success rate of primary hyperparathyroidism surgery in our unit.

Methods: Descriptive study of the last 33 consecutive HPT1 patients who undertook surgery, 27 of which with PTHi. The PTHi assays were performed at 10, 15 and 30 min after adenoma excision. Mean age was 57.56±14 years.

Results: The sensitivity of the localization exams was >75%. Minicervicotomy was the preferred surgical approach, and was associated with a >50% decrease in the PTHi intra-operatória at 10 min in all patients. No surgical complications were subsequently observed (mean follow-up 13 months, range 3–48). On average, calcemia levels decreased from 10.9±0.8 (range 9.2–13) pre-surgery to 9.2±0.5 (range 8.5–10) mg/dl at the last follow-up appointment. Similarly, PTH decreased from 203±131.2 (range 89.4–754) to 53.3±30 (12.3–151) pg/ml. Symptoms improved in all patients.

Conclusions: Pre-surgery localization exams increased the number of unilateral and mini-invasive explorations, making this the preferred surgical approach. Intraoperative PTHi played a crucial role in the success rate of the approach by decreasing the operative time and the post-operative hypocalcaemia.

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