The definitive management of primary hyperparathyroidism who needs an operation?

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

IMPORTANCE Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. OBJECTIVE To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. EVIDENCE REVIEW A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. FINDINGS Initial evaluation should include 25-hydroxyvitaminD measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for Vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease.Ex vivo aspiration of resected parathyroid tissuemaybe used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed postoperatively for hematoma, evaluated for hypocalcemia and symptomsof hypocalcemia, and followed up to assess for cure defined as eucalcemia at more than6months. Calcium supplementation may be indicated postoperatively. Familial pHPT, reoperative parathyroidectomy, and parathyroid carcinoma are challenging entities that require special consideration and expertise.

Original languageEnglish (US)
Pages (from-to)959-968
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume317
Issue number11
DOIs
StatePublished - Mar 21 2017

Fingerprint

Parathyroidectomy
Primary Hyperparathyroidism
Hypocalcemia
Computer-Assisted Surgery
Calcium
Parathyroid Neoplasms
Vitamin D Deficiency
Thyroid Diseases
Parathyroid Hormone
PubMed
Hematoma
Ultrasonography
Observation
X-Rays
Urine
Guidelines
Physicians
Biopsy
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The definitive management of primary hyperparathyroidism who needs an operation? / Campbell, Michael.

In: JAMA - Journal of the American Medical Association, Vol. 317, No. 11, 21.03.2017, p. 959-968.

Research output: Contribution to journalReview article

@article{2bace9caa66a4cb5b660b1b63fb1e4a8,
title = "The definitive management of primary hyperparathyroidism who needs an operation?",
abstract = "IMPORTANCE Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. OBJECTIVE To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. EVIDENCE REVIEW A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. FINDINGS Initial evaluation should include 25-hydroxyvitaminD measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for Vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease.Ex vivo aspiration of resected parathyroid tissuemaybe used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed postoperatively for hematoma, evaluated for hypocalcemia and symptomsof hypocalcemia, and followed up to assess for cure defined as eucalcemia at more than6months. Calcium supplementation may be indicated postoperatively. Familial pHPT, reoperative parathyroidectomy, and parathyroid carcinoma are challenging entities that require special consideration and expertise.",
author = "Michael Campbell",
year = "2017",
month = "3",
day = "21",
doi = "10.1001/jamasurg.2016.2310",
language = "English (US)",
volume = "317",
pages = "959--968",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - The definitive management of primary hyperparathyroidism who needs an operation?

AU - Campbell, Michael

PY - 2017/3/21

Y1 - 2017/3/21

N2 - IMPORTANCE Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. OBJECTIVE To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. EVIDENCE REVIEW A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. FINDINGS Initial evaluation should include 25-hydroxyvitaminD measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for Vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease.Ex vivo aspiration of resected parathyroid tissuemaybe used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed postoperatively for hematoma, evaluated for hypocalcemia and symptomsof hypocalcemia, and followed up to assess for cure defined as eucalcemia at more than6months. Calcium supplementation may be indicated postoperatively. Familial pHPT, reoperative parathyroidectomy, and parathyroid carcinoma are challenging entities that require special consideration and expertise.

AB - IMPORTANCE Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades. OBJECTIVE To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. EVIDENCE REVIEW A multidisciplinary panel used PubMed to review the medical literature from January 1, 1985, to July 1, 2015. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. FINDINGS Initial evaluation should include 25-hydroxyvitaminD measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for Vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease.Ex vivo aspiration of resected parathyroid tissuemaybe used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed postoperatively for hematoma, evaluated for hypocalcemia and symptomsof hypocalcemia, and followed up to assess for cure defined as eucalcemia at more than6months. Calcium supplementation may be indicated postoperatively. Familial pHPT, reoperative parathyroidectomy, and parathyroid carcinoma are challenging entities that require special consideration and expertise.

UR - http://www.scopus.com/inward/record.url?scp=85016629755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016629755&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2016.2310

DO - 10.1001/jamasurg.2016.2310

M3 - Review article

AN - SCOPUS:85016629755

VL - 317

SP - 959

EP - 968

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 11

ER -