caa a22 4500 475791010 CHVBK 20180406123710.0 cr unu---uuuuu 170329e20001201xx s 000 0 eng 10.1007/s004230000171 doi (NATIONALLICENCE)springer-10.1007/s004230000171 Primary hyperparathyroidism - early diagnosis in patients referred for thyroid surgery [Elektronische Daten] [Robert A. Wahl, Franziska Hentschel, Christian Vorländer, Jochen Schabram] Abstract.: Background and aims: From 1986 to 1998, 190 patients presented for first-time operations for sporadic, non-malignant, non-multiple endocrine neplasia primary hyperparathyroidism. Of these patients, 54% had been classified as "asymptomatic", 41% as symptomatic and 5% as acute. One hundred and thirty-five patients (71%) were referred to us for parathyroid surgery. Fifty-five patients (29%) were referred for thyroid surgery with hitherto unknown hyperparathyroidism. This corresponds to a prevalence of primary hyperparathyroidism of 1% in patients referred for thyroid surgery (5450 patients during the same period of time). Patients/Methods: Patients referred for parathyroid surgery (group I, n=135) were compared with patients originally referred for thyroid surgery (group II, n=55). Group II was divided into group IIa: hyperparathyroidism preoperatively biochemically evident (n=26), and group IIb: borderline biochemistry, parathyroid enlargement evident at the operation (n=29). The groups were compared regarding clinical manifestations, serum calcium and parathyroid hormone, pathologic-anatomical substrates, operative complications and outcome. Results: Renal, osseous and gastrointestinal manifestations were more frequent in group I than in groups IIa and IIb (P<0.05). However, cardiovascular and neuromuscular symptoms were present in groups IIa and IIb in more than one-third of patients. Patients from group IIb were younger (49±12years) than patients from groups IIa (60±13years) and I (60±14years). Adenomas were found in 85% of group I patients, in 45% of group IIa patients and in 21% of group IIb patients (P<0.01). In all other cases, hyperplasia was confirmed histologically. Serum calcium was higher in group I (3.0±0.42mmol/l) than in groups IIa (2.63±0.16mmol/l) and IIb (2.46±0.14mmol/l) (P<0.01). Serum PTH was higher in group I (median 11.0 pmol/l) than in groups IIa and IIb (median 7.1 and 6.4 pmol/l, respectively) (P<0.05). Postoperatively, hypercalcemia persisted in two patients (1.1%) belonging to group I, with mediastinal adenomas. Serum calcium at discharge showed no differences between groups (group I: 2.22±0.16; group IIa: 2.22±0.15; group IIb: 2.20±0.11mmol/l). Recurrent laryngeal nerve paralysis occurred early (4.2% of "nerves at risk") and remained permanent (0.8% of "nerves at risk") without significant differences between groups. Conclusion: Diagnostic efforts regarding parathyroid function should be mandatory before thyroid operations. "Asymptomatic" patients frequently (more than 30%) present with cardiovascular and neuromuscular, "unspecific" symptoms. Simultaneous parathyroid exploration is obvious in cases with biochemically evident primary hyperparathyroidism, but should also be performed in patients with borderline biochemistry. Springer-Verlag, 2000 Primary hyperparathyroidism Calcium-screening Parathyroid surgery Thyroid surgery nationallicence Wahl Robert A. Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut Hentschel Franziska Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut Vorländer Christian Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut Schabram Jochen Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut https://doi.org/10.1007/s004230000171 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004230000171 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Wahl Robert A. Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut NATIONALLICENCE 700 1- Hentschel Franziska Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut NATIONALLICENCE 700 1- Vorländer Christian Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut NATIONALLICENCE 700 1- Schabram Jochen Chirurgische Klinik, Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer