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Updates in Surgery
Guido Gasparri • Michele Camandona Nicola PalestiniEditors
Primary, Secondary and TertiaryHyperparathyroidism
Diagnostic and Therapeutic Updates
Foreword by Francesco Corcione
123
EditorsGuido Gasparri Michele CamandonaDepartment of Surgical Sciences Department of Surgical SciencesUniversity of Turin, Turin, Italy University of Turin, Turin, Italy
Nicola PalestiniDepartment of SurgeryCittà della Salute e della Scienza University Hospital, Turin, Italy
The publication and the distribution of this volume have been supported by theItalian Society of Surgery
ISSN 2280-9848ISBN 978-88-470-5757-9 ISBN 978-88-470-5758-6 (eBook)
DOI 10.1007/978-88-470-5758-6
Springer Milan Dordrecht Heidelberg London New York
Library of Congress Control Number: 2015948222
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Endocrine surgery certainly represents a highly specialized field, within whichparathyroid surgery has long been considered especially specialized and mul-tidisciplinary.
In this very interesting volume, which is also enjoyable to read, my friendGuido Gasparri has succeeded in addressing all the important aspects ofparathyroid diseases. Given the nature of the task, this success, while desir-able, was not inevitable.
Based on cooperation among surgeons, endocrinologists and other special-ists, the volume covers in detail all aspects from the origins of parathyroid sur-gery through to the modern treatment techniques. The embryological, anatom-ic, diagnostic and therapeutic characteristics of the different parathyroid dis-eases are clearly presented with the aid of excellent illustrations and up-to-date references.
This book highlights the remarkable advances made during recent years inthe field of endocrine surgery, from the pioneering work through to the stan-dardization of very difficult technical procedures. Furthermore, everyone whois looking for a reliable update in the treatment of parathyroid diseases willfind accurate messages and guidelines.
The most remarkable feature to emerge from this volume is the importanceof the organizational set-up and the technological advances that offer the sur-geon support when performing such difficult and noble surgery. These aspectsare crucial to the successful treatment of parathyroid diseases.
Thanks are due to Professor Gasparri and to all the eminent authors whohave collaborated brilliantly to produce this book, which offers an easy-to-read and detailed update that will be of value for every surgeon.
Rome, September 2015 Francesco CorcionePresident, Italian Society of Surgery
Foreword
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The discovery of the parathyroids dates back to the nineteenth century, but theirfunction and the associated diseases remained poorly understood for a long timethereafter. In 1907, referring to the four tiny glands posterior to the thyroid, WilliamHalsted observed that it was “hardly credible that the loss of bodies so tiny shouldbe followed by a result so disastrous”. It was not until 1925 that the first surgicaltreatment of primary hyperparathyroidism was performed, by Felix Mandl inVienna. Three years later, Isaac Olch of Barnes Hospital performed the first suc-cessful parathyroidectomy in the USA. After these initial attempts to treat primaryhyperparathyroidism surgically, the disease was well described and was associatednot only with solitary adenoma, but also with double adenomas and multiglandularhyperplasia. Conventional bilateral cervical exploration has remained the proce-dure of choice until the late 1990s, when minimally invasive procedures began togain acceptance.
Today, hyperparathyroidism is not uncommon: it is the third most commonendocrine disease, after diabetes and thyroid pathology. It seems certain that in thefuture biomolecular studies and genetic testing will open new horizons in the treat-ment of primary hyperparathyroidism. Studies on estrogen receptor gene polymor-phism are also very important, because they might influence both the peripheralaction of parathyroid hormone and regulation of calcium secretion. An importantissue is the role of the calcium sensing receptor mRNA in normal and abnormalparathyroid tissues, and this requires further investigation.
Another controversial point is the real incidence of asymptomatic hyperparathy-roidism. Analysis of outcomes after parathyroidectomy for asymptomatic primaryhyperparathyroidism has demonstrated improvements in all aspects of health status6 months postoperatively, the benefits being particularly evident with regard tobody pain, energy levels, and emotional and physical function.
The exact role of autotransplantation and cryopreservation in parathyroid sur-gery for correction of postoperative hypocalcemia remains a matter of debate.Autotransplantation is a good standardized technique but the indications for cryop-reservation are rare and they should be refined.
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Preface
The aim of this book on primary, secondary, and tertiary hyperparathyroidismis to provide the reader with a complete understanding of the history, surgicalanatomy, etiology, pathogenesis, clinical aspects, and medical and surgical thera-pies, including new avenues. The book is intended primarily for endocrine sur-geons, but also for endocrinologists, specialists in internal medicine, nephrologists,urologists, gynecologists, and radiologists.
We hope that readers will find subjects of relevance to daily practice and newtechnical points regarding minimally invasive surgery, intraoperative parathyroidhormone assay, and reoperations.
Turin, September 2015 Guido GasparriMichele Camandona
Nicola Palestini
Prefaceviii
1 History of Parathyroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Guido Gasparri, Michele Camandona, and Nicola Palestini
2 Surgical Anatomy of the Parathyroid Glands . . . . . . . . . . . . . . . . . . . 9Nicola Palestini
3 Parathyroid Hormone Secretion and Action . . . . . . . . . . . . . . . . . . . . 21Giancarlo Isaia, Lorenzo Marchese, Margherita Marchetti,Patrizia D’Amelio, and Giorgia Fornelli
4 Clinical Use of the Parathyroid Hormone Assay . . . . . . . . . . . . . . . . . 29Giulio Mengozzi
5 Etiology and Pathogenesis of Primary Hyperparathyroidism and Hypercalcemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Paolo P. Limone, Maurilio Deandrea, Elena Gamarra, Francesca Garino, Aurora Grassi, Gabriella Magliona, Alberto Mormile, Federico Ragazzoni, Maria Josefina Ramunni, and Paola Razzore
6 Clinical Manifestations of Primary Hyperparathyroidism . . . . . . . . . 57Massimo Procopio, Marco Barale, Ruth Rossetto Giaccherino,Alessandro Piovesan, and Ezio Ghigo
7 Diagnosis and Differential Diagnosis of Primary Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Fabio Orlandi, Federico Arecco, Stefania Corvisieri, and Ilaria Messuti
8 Management of Primary Hyperparathyroidism . . . . . . . . . . . . . . . . . 85Michele Camandona
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Contents
9 Preoperative Localization for Parathyroid Surgery in Primary and Secondary Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . 91Giovanni Gandini, Filippo Marchisio, Giuseppe Isolato,Antonella Sargiotto, Michela Zotta, and Gianni Bisi
10 Pathology of the Parathyroid Glands . . . . . . . . . . . . . . . . . . . . . . . . . . 111Eleonora Duregon, Marco Volante, and Mauro Papotti
11 Parathyroid Exploration for Primary Hyperparathyroidism . . . . . . . 117Guido Gasparri, Nicola Palestini, Milena Freddi, Gabriella Sisto, and Michele Camandona
12 Minimally Invasive Video-Assisted Parathyroidectomy . . . . . . . . . . . 133Paolo Miccoli and Gabriele Materazzi
13 Surgical Technique in Reoperations . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Rocco Bellantone, Emanuela Traini, Marco Raffaelli,and Celestino P. Lombardi
14 Genetic Syndromes Associated with Primary Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Maria L. Brandi and Francesco Tonelli
15 Parathyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Gennaro Favia and Maurizio Iacobone
16 Hypocalcemia After Parathyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . 193Matteo A. Cannizzaro and Massimiliano Veroux
17 Secondary Hyperparathyrodism in Adult Predialysis and Dialysis Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Luigi Biancone, Gianluca Leonardi, Massimo Gai, and Giuseppe P. Segoloni
18 Indications for Parathyroidectomy in End-Stage Renal Disease and After Renal Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215Guido Gasparri, Michele Camandona, Michele Giaccone, Mario Pio Capozzi, and Nicola Palestini
19 Patient Information for Surgery in Primary and Secondary Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231Pier Giorgio Nasi and Lodovico Rosato
Contentsx
Federico Arecco Endocrinology Unit, Gradenigo Hospital, Turin, Italy
Marco Barale Department of Medical Sciences, University of Turin, Turin, Italy
Rocco Bellantone Endocrine and Metabolic Surgery Unit, Agostino GemelliHospital, Università Cattolica del Sacro Cuore, Rome, Italy
Luigi Biancone Department of Medical Sciences, University of Turin, Turin, Italy
Gianni Bisi Department of Medical Sciences, University of Turin, Turin, Italy
Maria L. Brandi Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Michele Camandona Department of Surgical Sciences, University of Turin,Turin, Italy
Matteo A. Cannizzaro Department of Medical and Surgical Sciences andAdvanced Technologies, University of Catania, Catania, Italy
Mario Pio Capozzi Department of Surgery, Città della Salute e della ScienzaUniversity Hospital, Turin, Italy
Stefania Corvisieri Department of Oncology, University of Turin, Turin, Italy
Patrizia D’Amelio Department of Medical Sciences, University of Turin, Turin, Italy
Maurilio Deandrea Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Eleonora Duregon Department of Oncology, University of Turin, Turin, Italy
Gennaro Favia Endocrine Surgery Unit, 3rd Surgical Clinic, University Hospitalof Padua, Padua, Italy
Contributors
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xii Contributors
Giorgia Fornelli Department of Medical Sciences, University of Turin, Turin, Italy
Milena Freddi Department of Surgery, Città della Salute e della ScienzaUniversity Hospital, Turin, Italy
Massimo Gai Division of Nephrology, Dialysis and Transplantation, Città della Salute e della Scienza University Hospital, Turin, Italy
Elena Gamarra Division of Endocrinology, Diabetes and Metabolism, A.O.Ordine Mauriziano, Turin, Italy
Giovanni Gandini Department of Surgical Sciences, University of Turin, Turin, Italy
Francesca Garino Division of Endocrinology, Diabetes and Metabolism, A.O.Ordine Mauriziano, Turin, Italy
Guido Gasparri Department of Surgical Sciences, University of Turin, Turin, Italy
Ezio Ghigo Department of Medical Sciences, University of Turin. Turin, Italy
Michele Giaccone Department of Surgery, Città della Salute e della ScienzaUniversity Hospital, Turin, Italy
Aurora Grassi Division of Endocrinology, Diabetes and Metabolism, A.O.Ordine Mauriziano, Turin, Italy
Maurizio Iacobone Endocrine Surgery Unit, 3rd Surgical Clinic, UniversityHospital of Padua, Padua, Italy
Giancarlo Isaia Department of Medical Sciences, University of Turin, Turin, Italy
Giuseppe Isolato Department of Diagnostic Imaging and Radiotherapy, Città della Salute e della Scienza University Hospital, Turin, Italy
Gianluca Leonardi Division of Nephrology, Dialysis and Transplantation, Città della Salute e della Scienza University Hospital, Turin, Italy
Paolo P. Limone Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Celestino P. Lombardi Endocrine and Metabolic Surgery Unit, Agostino GemelliHospital, Università Cattolica del Sacro Cuore, Rome, Italy
Gabriella Magliona Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Lorenzo Marchese Department of Medical Sciences, University of Turin, Turin, Italy
Margherita Marchetti Department of Medical Sciences, University of Turin,Turin, Italy
Filippo Marchisio Department of Diagnostic Imaging and Radiotherapy, Città della Salute e della Scienza University Hospital, Turin, Italy
Gabriele Materazzi Department of Surgical, Medical, Molecular and CriticalArea Pathology, University of Pisa, Pisa, Italy
Giulio Mengozzi Department of Laboratory Medicine, Città della Salute e dellaScienza University Hospital, Turin, Italy
Ilaria Messuti Department of Oncology, University of Turin, Turin, Italy
Paolo Miccoli Department of Surgical, Medical, Molecular and Critical AreaPathology, University of Pisa, Pisa, Italy
Alberto Mormile Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Pier Giorgio Nasi Thyroid Disease and Endocrine Surgery, Sedes SapientiaePrivate Hospital, Turin, Italy
Fabio Orlandi Department of Oncology, University of Turin, Turin, Italy
Nicola Palestini Department of Surgery, Città della Salute e della ScienzaUniversity Hospital, Turin, Italy
Mauro Papotti Department of Oncology, University of Turin, Turin, Italy
Alessandro Piovesan Division of Oncological Endocrinology, Città della Salute e della Scienza University Hospital, Turin, Italy
Massimo Procopio Division of Endocrinology, Diabetes and Metabolism, Città della Salute e della Scienza University Hospital, Turin, Italy
Marco Raffaelli Endocrine and Metabolic Surgery Unit, Agostino GemelliHospital, Università Cattolica del Sacro Cuore, Rome, Italy
Federico Ragazzoni Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Maria Josefina Ramunni Division of Endocrinology, Diabetes and Metabolism,A.O. Ordine Mauriziano, Turin, Italy
Paola Razzore Division of Endocrinology, Diabetes and Metabolism, A.O. Ordine Mauriziano, Turin, Italy
Lodovico Rosato Department of Surgery, ASL4, Ivrea Hospital, Ivrea, Italy
Ruth Rossetto Giaccherino Division of Endocrinology, Diabetes andMetabolism, Città della Salute e della Scienza University Hospital, Turin, Italy
Contributors xiii
Antonella Sargiotto Department of Diagnostic Imaging and Radiotherapy, Città della Salute e della Scienza University Hospital, Turin, Italy
Giuseppe P. Segoloni Department of Medical Sciences, University of Turin,Turin, Italy
Gabriella Sisto Department of Surgery, Città della Salute e della ScienzaUniversity Hospital, Turin, Italy
Francesco Tonelli Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Emanuela Traini Endocrine and Metabolic Surgery Unit, Agostino GemelliHospital, Università Cattolica del Sacro Cuore, Rome, Italy
Massimiliano Veroux Department of Medical and Surgical Sciences andAdvanced Technologies, University of Catania, Catania, Italy
Marco Volante Department of Oncology, University of Turin, Turin, Italy
Michela Zotta Department of Medical Sciences, University of Turin, Turin, Italy
Contributorsxiv