J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 5250KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 80(2): 98-107, 1979

Original article

CLINICAL EXPERIENCES IN 73 CASES WITH PRIMARY HYPERPARATHYROIDISM

*) Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
**) The 2nd Department of Surgery, Faculty of Medicine, University of Tokyo
***) Department of Surgery, Red Cross Medical Center
****) Department of Surgery, Toranomon Hospital

Takao Obara*), Yoshihide Fujimoto*), Kyotaro Kanazawa*), Yuji Aiyoshi*), Yukio Ito*), Masamitsu Fukumitsu**), Atsushi Oka**), Ko Hidai**), Tatsuo Wada**), Yuji Takahashi***), Hirosh Futonaka***), Hideki Nakazawa****)

Seventy-three patients with primary hyperparathyroidism were experienced between January, 1968 and March, 1978. The patients were subdivied into three clinical groups: Bone change group (20 cases), renal lithiasis group (29 cases) and chemical hyperparathyroidism (24 cases). The diagnosis was confirmed pathologically on the resected parathyroid glands. There were two cases of carcinoma, 46 cases of adenoma, seven cases of pseudoadenomatous hyperplasia, seven cases of classic-type hyperplasia and seven cases of occult-type hyperplasia. In the other four patients, pathological classification was not determined, because abnormal parathyroid glands were not found and hypercalcemia persisted postoperatively. Clinico-pathological features and operative results were analysed based on the clinical and pathological classification. Results obtained were summarized as follows;
1) In the patients with chemical hyperparathyroidism, careful pre-and postoperative questioning on the subjective symptoms revealed that about 50% of patients had some of the symptoms related to hypercalcemia. Those symptoms disappeared when the serum calcium level returned to normal postoperatively.
2) After surgical removal of parathyroid glands, hypercalcemia was persistent or recurred in three patients with classic or occult-type hyperplasia. Recurrence of hypercalcemia was never seen in 55 patients in whom either carcinoma, adenoma or pseudoadenomatous hyperplasia was removed, although in 69% of them only the enlarged gland was removed. Postoperative hypoparathyroidism was found only in four patients with adenoma or pseudoadenomatous hyperplasia, in all of whom 3 to 31/2 parathyroid glands were resected.
3) These findings suggested that in patients with carcinoma, adenoma or pseudoadenomatous hyperplasia, removal of the single enlarged gland along with biopsy of the remaining grossly normal glands glands was appropriate. On the other hand, in patients with classic or occult-type hyperplasia, a subtotal parathyroidectomy, leaving only approximately 50 mg of parathyroid tissue, is necessary to obtain encalcemic state. So long as the operative procedure is determined after trying to find out all four glands and having identified the pathology occurred, preoperative localization seems not to be necessary.
4) In two patients, parathyroid abnormality was accompanied with medullary thyroid carcinoma (multiple endocrine neoplasia type 2). Two families with multiple endocrine neoplasia type 1 were found. Besides, papillary or follicular carcinoma of the thyroid were found in 10% of patients. The incidence of the presence of non-medullary thyroid carcinoma in patients with primary hyperparathyroidism was unexpectedly high.

<< To previous pageTo next page >>

To read the PDF file you will need Adobe Reader installed on your computer.