Revisiting lithium-associated hyperparathyroidism in the era of intraoperative parathyroid hormone monitoring

被引:40
作者
Hundley, JC [1 ]
Woodrum, DT [1 ]
Saunders, BD [1 ]
Doherty, GM [1 ]
Gauger, PG [1 ]
机构
[1] Univ Michigan, Dept Surg, Div Endocrine Surg, Ann Arbor, MI 48109 USA
关键词
D O I
10.1016/j.surg.2005.09.028
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Chronic lithium therapy may cause hyperparathyroidism (HPT). The utility of intraoperative parathyroid hormone monitoring (IOPTH) in these patients is unknown. The authors' hypothesis was that multiglandular disease is more common in these Patients, and the ability of IOPTH to predict cure may be limited. Methods. Twelve patients had HPT during chronic lithium therapy and underwent parathyroidectomy with IOPTH. Criteria for curative resection were a decrease >= 50% from baseline and into the normal range. Calcium and PTH levels were measured during follow-up. Results. Preoperatively, mean calcium was 11.0 +/- 0.1 mg/dL, and PTH was 116 +/- 14 pg/mL. Fifty Percent of patients had multiglandular disease confirmed by IOPTH levels. Mean IOPTH decrease from baseline was 74 +/- 4%. Although 10 of 12 patients met criteria for curative resection, only 8 remain normocalcemic. The 2 patients who did not meet criteria remain normocalcemic. Mean postoperative calcium for all patients was 9.5 +/- 0.2 mg/dL. Of the 10 normocalcemic patients, 4 also have hyperparathormonemia (mean PTH, 119 +/- 19 pg/mL). Conclusions. The incidence of multiglandular disease in HPT after chronic lithium exposure is higher than standard. HPT The ability of IOPTH to predict durable normocalcemia is limited. Bilateral neck exploration should be considered for these patients regardless of whether IOPTH monitoring is used.
引用
收藏
页码:1027 / 1031
页数:5
相关论文
共 14 条
[1]   Pathology and outcome of surgical treatment for lithium-associated hyperparathyroidism [J].
Abdullah, H ;
Bliss, R ;
Guinea, AI ;
Delbridge, L .
BRITISH JOURNAL OF SURGERY, 1999, 86 (01) :91-93
[2]   Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy [J].
Awad, SS ;
Miskulin, J ;
Thompson, N .
WORLD JOURNAL OF SURGERY, 2003, 27 (04) :486-488
[3]   Hyperparathyroidism and long-term lithium therapy - A cross-sectional study and the effect of lithium withdrawal [J].
Bendz, H ;
Sjodin, L ;
Toss, G ;
Berglund, K .
JOURNAL OF INTERNAL MEDICINE, 1996, 240 (06) :357-365
[4]   LITHIUM INDUCES ABNORMAL CALCIUM-REGULATED PTH RELEASE IN DISPERSED BOVINE PARATHYROID CELLS [J].
BROWN, EM .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1981, 52 (05) :1046-1048
[5]   Elevated serum parathormone level after "concise parathyroidectomy" for primary sporadic hyperparathyroidism [J].
Carty, SE ;
Roberts, MM ;
Virji, MA ;
Haywood, L ;
Yim, JH .
SURGERY, 2002, 132 (06) :1086-1092
[6]  
GARFINKEL PE, 1973, LANCET, V2, P331
[7]   Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: A 2-institution experience [J].
Gauger, PG ;
Agarwal, G ;
England, BG ;
Delbridge, LW ;
Matz, KA ;
Wilkinson, M ;
Robinson, BG ;
Thompson, NW .
SURGERY, 2001, 130 (06) :1005-1010
[8]   Alterations in parathyroid dynamics in lithium-treated subjects [J].
Haden, ST ;
Stoll, AL ;
McCormick, S ;
Scott, J ;
El-Hajj Fuleihan, G .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1997, 82 (09) :2844-2848
[9]   Effects of lithium therapy on bone mineral metabolism: A two-year prospective longitudinal study [J].
Mak, TWL ;
Shek, CC ;
Chow, CC ;
Wing, YK ;
Lee, S .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1998, 83 (11) :3857-3859
[10]   LITHIUM TREATMENT INCREASES INTACT AND MIDREGION PARATHYROID-HORMONE AND PARATHYROID VOLUME [J].
MALLETTE, LE ;
KHOURI, K ;
ZENGOTITA, H ;
HOLLIS, BW ;
MALINI, S .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1989, 68 (03) :654-660