Among 60 patients, 54 had solitary parathyroid adenoma (90%), while five patients (8.3%) had a multiglandular
disease, and all of them were hyperplasia.
Three false-positive findings in patients with complex multiglandular
disease that were classified with SPECT/CT alone remained falsely classified with the additional pinhole imaging.
Sin embargo, nuevas dificultades surgen en los pacientes con enfermedad multiglandular
debido a que algunos autores han descrito poca utilidad del monitoreo intraoperatorio de PTH en un porcentaje importante de este grupo de pacientes (20, 21), lo que justificaria la exploracion bilateral como el procedimiento estandar debido a que siempre existira el riesgo de pasar por alto una lesion del lado contralateral que ha sido reportada en 55% de pacientes con doble adenoma (14).
Current guidelines recommend screening for MEN-1 in patients younger than 30 years who present with primary hyperparathyroidism and for patients of any age who present with multiglandular
Nine primary conventional neck explorations (14%) were performed for various reasons including previous neck surgery, multinodular struma and suspected multiglandular
Aproximadamente el 15% de los pacientes tienen enfermedad multiglandular
(Brunt 1998, Cougard 1998) la cual esta virtualmente presente en todos los pacientes con hiperparatiroidismo secundario y en las formas hereditarias.
Primary hyperparathyroidism is caused by a single gland adenoma in most patients (up to 90%) or multiglandular
In the case of multiglandular
disease, it would be expected that the postresection samples would remain increased, indicating the presence of other hyperfunctioning glands, prompting the surgeon to do further exploration to look for additional abnormal glands.
This has been illustrated in cases of multiglandular
disease, for which surgical options have been limited by inadequate preoperative localization.
Twenty patients had a solitary parathyroid adenoma, two patients had double adenomas, and two patients had multiglandular
About 15% of patients with primary hyperparathyroidism have multiglandular
Non-reoperative primary hyperparathyroid patients were further subdivided into patients with uniglandular or multiglandular