Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism

Gerard M. Doherty, John L. Doppman, Donald L. Miller, Mimi S. Gee, Stephen J. Marx, Allen M. Spiegel, Gerald D. Aurbach, Harvey I. Pass, Murray F. Brennan, Jeffrey A. Norton

Research output: Contribution to journalArticle

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Abstract

Persistent primary hyperparathyroidism due to mediastinal parathyroid adenoma was effectively treated by either angiographic ablation or median sternotomy in this study of 49 patients managed at the National Institutes of Health since 1977. Each patient presented here with symptomatic persistent primary hyperparathyroidism after failed initial surgical procedures done at other institutions. Each patient underwent extensive parathyroid localization procedures, including selective angiography, and most had a parathyroid adenoma localized to the mediastinum. Angiographic ablation, the deliberate injection of large doses of contrast material into the artery that selectively perfuses the adenoma, was initially successful in 22 of 30 procedures (73%) in 27 patients. Long-term control of persistent primary hyperparathyroidism was achieved in 17 of 27 patients (63%) by angiographic ablation. Each unsuccessful ablation could be easily salvaged by surgical resection. Surgical resection of the parathyroid adenoma by median sternotomy achieved immediate Success in 24 of 24 procedures (p2 < 0.02 versus ablation), and long-term cure in 23 of 23 evaluable patients (p2 < 0.001 versus ablation). However, ablation did have benefits for the patients in whom it was successfully performed. It was associated with a significantly shorter hospital stay (median, 6 days versus 9 days for sternotomy, p2 < 0.003), much less pain, and easier recuperation. Complications of each procedure were transient and similar in both groups. Operative resection is the most effective single means to eradicate mediastinal parathyroid adenoma; however, angiographic ablation can provide similar long-term control of hyperparathyroidism in 63% of patients with less pain and shorter convalescence than that seen in patients after median sternotomy. Our results suggest that angiographic ablation should be attempted as the initial procedure for patients with persistent primary hyperparathyroidism caused by an angiographically identified mediastinal parathyroid adenoma. Operation can be reserved for those who fail ablation.

Original languageEnglish (US)
Pages (from-to)101-106
Number of pages6
JournalAnnals of Surgery
Volume215
Issue number2
StatePublished - 1992
Externally publishedYes

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Parathyroid Neoplasms
Primary Hyperparathyroidism
Sternotomy
Pain
Hyperparathyroidism
National Institutes of Health (U.S.)
Mediastinum
Adenoma
Contrast Media
Length of Stay
Angiography
Arteries

ASJC Scopus subject areas

  • Surgery

Cite this

Doherty, G. M., Doppman, J. L., Miller, D. L., Gee, M. S., Marx, S. J., Spiegel, A. M., ... Norton, J. A. (1992). Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Annals of Surgery, 215(2), 101-106.

Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. / Doherty, Gerard M.; Doppman, John L.; Miller, Donald L.; Gee, Mimi S.; Marx, Stephen J.; Spiegel, Allen M.; Aurbach, Gerald D.; Pass, Harvey I.; Brennan, Murray F.; Norton, Jeffrey A.

In: Annals of Surgery, Vol. 215, No. 2, 1992, p. 101-106.

Research output: Contribution to journalArticle

Doherty, GM, Doppman, JL, Miller, DL, Gee, MS, Marx, SJ, Spiegel, AM, Aurbach, GD, Pass, HI, Brennan, MF & Norton, JA 1992, 'Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism', Annals of Surgery, vol. 215, no. 2, pp. 101-106.
Doherty, Gerard M. ; Doppman, John L. ; Miller, Donald L. ; Gee, Mimi S. ; Marx, Stephen J. ; Spiegel, Allen M. ; Aurbach, Gerald D. ; Pass, Harvey I. ; Brennan, Murray F. ; Norton, Jeffrey A. / Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. In: Annals of Surgery. 1992 ; Vol. 215, No. 2. pp. 101-106.
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abstract = "Persistent primary hyperparathyroidism due to mediastinal parathyroid adenoma was effectively treated by either angiographic ablation or median sternotomy in this study of 49 patients managed at the National Institutes of Health since 1977. Each patient presented here with symptomatic persistent primary hyperparathyroidism after failed initial surgical procedures done at other institutions. Each patient underwent extensive parathyroid localization procedures, including selective angiography, and most had a parathyroid adenoma localized to the mediastinum. Angiographic ablation, the deliberate injection of large doses of contrast material into the artery that selectively perfuses the adenoma, was initially successful in 22 of 30 procedures (73{\%}) in 27 patients. Long-term control of persistent primary hyperparathyroidism was achieved in 17 of 27 patients (63{\%}) by angiographic ablation. Each unsuccessful ablation could be easily salvaged by surgical resection. Surgical resection of the parathyroid adenoma by median sternotomy achieved immediate Success in 24 of 24 procedures (p2 < 0.02 versus ablation), and long-term cure in 23 of 23 evaluable patients (p2 < 0.001 versus ablation). However, ablation did have benefits for the patients in whom it was successfully performed. It was associated with a significantly shorter hospital stay (median, 6 days versus 9 days for sternotomy, p2 < 0.003), much less pain, and easier recuperation. Complications of each procedure were transient and similar in both groups. Operative resection is the most effective single means to eradicate mediastinal parathyroid adenoma; however, angiographic ablation can provide similar long-term control of hyperparathyroidism in 63{\%} of patients with less pain and shorter convalescence than that seen in patients after median sternotomy. Our results suggest that angiographic ablation should be attempted as the initial procedure for patients with persistent primary hyperparathyroidism caused by an angiographically identified mediastinal parathyroid adenoma. Operation can be reserved for those who fail ablation.",
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AU - Miller, Donald L.

AU - Gee, Mimi S.

AU - Marx, Stephen J.

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AU - Brennan, Murray F.

AU - Norton, Jeffrey A.

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N2 - Persistent primary hyperparathyroidism due to mediastinal parathyroid adenoma was effectively treated by either angiographic ablation or median sternotomy in this study of 49 patients managed at the National Institutes of Health since 1977. Each patient presented here with symptomatic persistent primary hyperparathyroidism after failed initial surgical procedures done at other institutions. Each patient underwent extensive parathyroid localization procedures, including selective angiography, and most had a parathyroid adenoma localized to the mediastinum. Angiographic ablation, the deliberate injection of large doses of contrast material into the artery that selectively perfuses the adenoma, was initially successful in 22 of 30 procedures (73%) in 27 patients. Long-term control of persistent primary hyperparathyroidism was achieved in 17 of 27 patients (63%) by angiographic ablation. Each unsuccessful ablation could be easily salvaged by surgical resection. Surgical resection of the parathyroid adenoma by median sternotomy achieved immediate Success in 24 of 24 procedures (p2 < 0.02 versus ablation), and long-term cure in 23 of 23 evaluable patients (p2 < 0.001 versus ablation). However, ablation did have benefits for the patients in whom it was successfully performed. It was associated with a significantly shorter hospital stay (median, 6 days versus 9 days for sternotomy, p2 < 0.003), much less pain, and easier recuperation. Complications of each procedure were transient and similar in both groups. Operative resection is the most effective single means to eradicate mediastinal parathyroid adenoma; however, angiographic ablation can provide similar long-term control of hyperparathyroidism in 63% of patients with less pain and shorter convalescence than that seen in patients after median sternotomy. Our results suggest that angiographic ablation should be attempted as the initial procedure for patients with persistent primary hyperparathyroidism caused by an angiographically identified mediastinal parathyroid adenoma. Operation can be reserved for those who fail ablation.

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