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Review
. 2023 Oct 9;408(1):389.
doi: 10.1007/s00423-023-03087-w.

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

E Lawrence #  1 , G Johri #  1 , R Dave  1 , R Li  1 , A Gandhi  2   3
Affiliations
Review

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

E Lawrence et al. Langenbecks Arch Surg. .

Abstract

Background: Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity.

Methods: We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy.

Conclusion: Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.

Keywords: Discordant parathyroid imaging; Multigland parathyroid disease; Sporadic primary hyperparathyroidism; Subtotal parathyroidectomy.

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Conflict of interest statement

The authors declare no competing interests.

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