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Med Bull Sisli Etfal Hosp. 2023; 57(1): 1-17 | DOI: 10.14744/SEMB.2023.39260 | |||
Persistan ve Reküren Primer Hiperparatiroidizm: Etyolojik Faktörler ve Preoperatif DeğerlendirmeMehmet Uludag1, Mehmet Taner Unlu1, Mehmet Kostek1, Ozan Caliskan1, Nurcihan Aygun1, Adnan Isgor21Türkiye Sağlık Bilimleri Üniversitesi, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul2Şişli Memorial Hastanesi, Genel Cerrahi Kliniği, İstanbul Primer hiperparatiroidi (pHPT) hiperkalseminin en sık sebebi olup, günümüzde halen tek definif tedavisi cerrahidir. Deneyimli merkezlerde paratiroidektominin başarı oranı %95’in üzerinde olmasına ragmen günümüzde cerrahi başarısızlık en sık komplikasyondur. Paratirodektomi sonrası hiperkalseminin devam etmesi veya ilk 6 ay içinde hiperkalseminin tekrar ortaya çıkması persistan HPT (perHPT), 6 aydan fazla bir normokalsemik dönemden sonra hiperkalseminin tekrarlaması ise reküren HPT (recHPT) olarak tanımlanmaktadır. Literatürde perHPT 2-22%, reküren hiperparatiroidi (recHPT) hastalık oranı 1-15% arasında bildirilmektedir. perHPT genelde gözden kaçan patoloji veya hiperfonksiyone paratiroid dokusunun yetersiz rezeksiyonu, recHPT ilk cerrahide yerinde bırakılan potansiyel patolojik natürü olan dokudan yeni gelişen patoloji ile ilişkilidir. Preoperatif değerlendirmede perHPT ve recHPT öntanısı (şüphesi) ile değerlendirilen hastalarda öncelikle ilk pHPT tanısının ve Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Pre-Operative EvaluationMehmet Uludag1, Mehmet Taner Unlu1, Mehmet Kostek1, Ozan Caliskan1, Nurcihan Aygun1, Adnan Isgor21Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye2Department of General Surgery, Sisli Memorial Hospital, Istanbul, Türkiye Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the preoperative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography Mehmet Uludag, Mehmet Taner Unlu, Mehmet Kostek, Ozan Caliskan, Nurcihan Aygun, Adnan Isgor. Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Pre-Operative Evaluation. Med Bull Sisli Etfal Hosp. 2023; 57(1): 1-17 Sorumlu Yazar: Mehmet Taner Unlu |
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