PURPOSE: Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or 99mTc-Sestamibi scintigraphy, can be challenging. PET/CT with 18F-Fluorocholine (18F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of 18F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US. METHODS: Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope 99mTc-Pertechnetate/99mTc-Sestamibi scintigraphy, and 18F-FCH-PET/CT. RESULTS: In the whole patients' group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for 18F-FCH-PET/CT, and only 15% for 99mTc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for 18F-FCH-PET/CT, and 0 and 18% for 99mTc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for 18F-FCH-PET/CT, and only 17% for 99mTc-Sestamibi scintigraphy. CONCLUSIONS: 18F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.

• Klíčová slova
• Normocalcemic hyperparathyroidism, PETC/CT with 18F-Choline, Primary hyperparathyroidism,
• MeSH
• cholin analogy a deriváty   MeSH
• dospělí MeSH
• hyperkalcemie diagnostické zobrazování   patologie   chirurgie   MeSH
• hyperparatyreóza diagnostické zobrazování   patologie   chirurgie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory příštítného tělíska diagnostické zobrazování   patologie   chirurgie   MeSH
• následné studie MeSH
• PET/CT metody   MeSH
• prognóza MeSH
• radiofarmaka MeSH
• radioisotopová scintigrafie metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ultrasonografie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cholin MeSH
• fluorocholine MeSH Prohlížeč
• radiofarmaka MeSH

We present a male patient with neonatal severe primary hyperparathyroidism, whose manifestation was exceptionally serious for the heterozygous inactivating mutation he carried in the CASR gene. The patient presented soon after birth with respiratory distress requiring long-term mechanical ventilation, bone and chest deformities, feeding problems, and hypotonia. He had hypercalcaemia, hypophosphataemia, and hyperparathyroidism. There was no known history of calcium metabolism disorders in the family. As the impact on calcaemia of a rescue therapy with bisphosphonates was only transient, a subtotal and subsequently total parathyroidectomy were performed in the fourth month of life. Afterwards his clinical status improved and the fractures healed, but his neuropsychological development is delayed due to cerebral atrophy. Genetic analysis revealed a heterozygous missense CASR mutation R185Q, and an approximately equal expression of the mutated and wild-type RNA in the parathyroid tissue. The mother of the child was homozygous for the wild-type allele; the father is unknown. In conclusion, this patient demonstrates how serious neonatal hyperparathyroidism can be when caused by a heterozygous mutation. This may be attributable to a combination of dominant-negative action of the mutant allele with an intrauterine foetal hyperparathyroidism developed in the mother's normocalcaemic environment, further aggravated by a putative maternal vitamin D deficiency during pregnancy.

• MeSH
• bodová mutace genetika   MeSH
• dospělí MeSH
• fenotyp * MeSH
• heterozygot * MeSH
• hyperkalcemie komplikace   genetika   MeSH
• hyperparatyreóza komplikace   genetika   chirurgie   MeSH
• lidé MeSH
• nedostatek vitaminu D diagnóza   epidemiologie   MeSH
• novorozenec MeSH
• paratyreoidektomie MeSH
• prenatální diagnóza MeSH
• receptory "calcium-sensing" genetika   MeSH
• stupeň závažnosti nemoci MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• CASR protein, human MeSH Prohlížeč
• receptory "calcium-sensing" MeSH

In hemodialyzed patients hormonal disturbances are known to occur. However, melatonin levels have not been completely studied. The aim of the study was to find whether changes in calcaemia affect melatonin secretion. For this reason we followed the nocturnal serum concentrations of melatonin and parathyroid hormone (PTH) in 9 hemodialyzed patients (6 women and 3 men, aged 37-65 years) both before and 1-3 months after parathyroidectomy at 6 p.m., 9 p.m., 11 p.m., 2 a.m., 5 a.m. and 7 a.m. At 6 p.m. blood samples to evaluate the levels of calcium and phosphate were also collected. Parathyroidectomy resulted in an increase in nocturnal melatonin levels. As expected, the parathyroidectomy was followed by considerable PTH decrease. PTH showed no nocturnal variation before or after parathyroidectomy. Calcium levels significantly decreased after the operation while phosphate levels increased. In summary, in hemodialyzed patients with hyperparathyroidism, parathyroidectomy significantly increases the nocturnal secretion of melatonin. Relationships between the pineal gland and parathyroid glands have yet to be elucidated.

• MeSH
• chronické selhání ledvin krev   terapie   MeSH
• cirkadiánní rytmus fyziologie   MeSH
• dialýza ledvin * MeSH
• dospělí MeSH
• fosfáty krev   MeSH
• hyperparatyreóza krev   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• melatonin krev   MeSH
• parathormon krev   MeSH
• paratyreoidektomie * MeSH
• pilotní projekty MeSH
• senioři MeSH
• vápník krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• fosfáty MeSH
• melatonin MeSH
• parathormon MeSH
• vápník MeSH

Systematic bilateral neck exploration remains the gold standard for the treatment of primary hyperparathyroidism. Techniques of miniinvasive parathyroidectomy have been developing on the basis of the improvement of preoperative localization methods. The miniinvasive videoasissted parathyroidectomy was performed in 17 from 123 patients with primary hyperparathyroidism. All patients were examined using ultrasonography and sestamibi scintigraphy; the level of inactive parathormone was monitored peroperatively. One patient required a conversion to the bilateral neck exploration. Authors emphasize the necessity of the good knowledge of the classical bilateral neck exploration for the correct performance of the operation. Mininvasive videoasisted parathyroidectomy is a safe method in patients with a single, preoperatively localized adenoma.

• MeSH
• dospělí MeSH
• endoskopie * MeSH
• hyperparatyreóza chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• paratyreoidektomie * MeSH
• senioři MeSH
• video-asistovaná chirurgie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

453 patients underwent surgery for primary hyperparathyreoidism between 1994 and 2003. In all patients, biochemical parameters were monitored and X-ray with USG of the neck was done. Struma nodosa was concommitantly present in 48 % of treated patients with primary hyperparathyroidism. In such cases, MRI offers better resolution of soft tissues. 98.6 % of treated patients had postoperative decrease of blood calcium to normal level. 5.4 % of cases were reoperations for primary hyperparathyroidism. In 12 % of cases, pathologically changed parathyroid glands in dystopic localization were found. In these dystopic localizations, pathologic parathyroid glands were found: in 3 % intrathyroid, in 7 % mediastinal and in 2 % of all 453 cases in other localization. In 4 % of patients, sternotomy was necessary. Persistent hypocalcemia was not registered in any patient. Transient hypocalcemia with necessity of infusion therapy was observed in 3.5 % of patients. Postoperative hypercalcemia persisted in 1.2 % of patients. Recurrent hypercalcemia was present in 0.2 % of cases. In three cases (0.7 %), unilateral injury of recurrent laryngeal nerve was observed.

• MeSH
• adenom chirurgie   MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• dospělí MeSH
• hyperkalcemie etiologie   MeSH
• hyperparatyreóza krev   diagnóza   chirurgie   MeSH
• hyperplazie MeSH
• krk diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• nádory příštítného tělíska chirurgie   MeSH
• parathormon krev   MeSH
• paratyreoidea abnormality   patologie   MeSH
• peroperační komplikace MeSH
• pooperační komplikace MeSH
• poranění nervus laryngeus recurrens MeSH
• radiografie MeSH
• recidiva MeSH
• reoperace MeSH
• rizikové faktory MeSH
• senioři MeSH
• ultrasonografie MeSH
• uzlová struma diagnóza   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• parathormon MeSH

Surgical management of primary hyperparathyroidism is a very effective method. The target is to cure primary hyperparathyroidism and to reach normal calcium levels. This results in an improvement of health condition and resolution or at least moderation of symptoms. Complications are infrequent and mortality is very low. Surgical management is definite, safe and effective. Authors of this article address the diagnosis of primary hyperparathyroidism, clarify bone, metabolic and biochemical syndromes and present series of 151 patients that have been operated on at the 3rd Department of Surgery of the Motol University Hospital, Prague, with the diagnosis of primary hyperparathyroidism. The survey is focused on the primary hyperparathyroidism concomitant diseases and on the possible sequelae in the postoperative period.

• MeSH
• dítě MeSH
• dospělí MeSH
• hyperparatyreóza diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paratyreoidektomie škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The authors submit their own experience with the surgical treatment of all types of hyperparathyroidism (HPT). Since 1992 till the end of April 2002 in the Institute of Clinical and Experimental Medicine 151 operations were performed in 132 patients, in particular secondary HPT (69.8%). Among surgical operations partial parathyroidectomy (PTE) predominated, as a rule without peroperative implantation of parts of the removed parathyroid glands(PT)(64.8%). The high ratio of this type of operations was due among others to a recent increase of tertiary posttransplantation HPT. Advanced secondary HPT of haemodialyzed patients was treated by total PTE with implantation of PT tissue. The incidence of surgical complications was low (7.1%) and insignificant from the aspect of the long-term postoperative condition. Persisting or relapsing HPT was revised in 15 patients (in 12.6% of all operations).

• MeSH
• autologní transplantace MeSH
• dospělí MeSH
• hyperparatyreóza chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paratyreoidea transplantace   MeSH
• paratyreoidektomie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Surgical treatment offers a definite cure of patients with primary hyperparathyroidism. When making the diagnosis of primary hyperparathyroidism the success of a surgical solution depends on the experience and judgment of the surgeon. Our experience with 222 operations and re-operations convinced us on the preference of a bilateral approach, i.e. exploration of both sides of the neck. The ectopic localization of the parathyroid glands, the limited possibilities of an unequivocal interpretation of the histological examinations but also the frequent incidence of thyropathies leads the surgeon, in our opinion, to the complete exploration of both sides of the neck within the framework of the primary operation for primary hyperparathyroidism. This approach leads most probably to the best results. We use an aimed unilateral approach only in old patients who are in a very bad condition where we anticipate a benefit from a short operation.

• MeSH
• dítě MeSH
• dospělí MeSH
• hyperparatyreóza diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paratyreoidektomie metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The period of six years is discussed by the authors during which 39 patients were confirmed having primary or secondary hyperparathyroidism. All of them finally underwent the surgical procedure. The possibility of immunoreactive PTH measurement has been highly appreciated. Despite that key position of the experienced surgeon remains of the utmost importance.

• MeSH
• dospělí MeSH
• hyperparatyreóza diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• sekundární hyperparatyreóza diagnóza   etiologie   chirurgie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

In our group of 176 performed operations with diagnosis of primary hyperparathyreosis during the period of 1994-1999 present thyreopathy has been established peroperatively as well as postoperatively in altogether 47% of patients. Due to high percentage of coincidence of these diagnoses the condition of establishing indication for surgical therapy appears to be necessary not only on parathyroidal glands, but also determining the extent of resection on the thyroidal gland. In terms of preoperative screening, besides usual investigation of sonography and scintigraphy, we can recommend MRI test, which is highly positive for patients with thyreopathy, particularly in the area of nodular thyroid mass. The advantage of MRI investigation enables more precise localization of ectopic parathyroidal adenoma.

• MeSH
• adenom komplikace   diagnóza   chirurgie   MeSH
• hyperparatyreóza komplikace   diagnóza   etiologie   chirurgie   MeSH
• hyperplazie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory příštítného tělíska komplikace   diagnóza   chirurgie   MeSH
• paratyreoidea diagnostické zobrazování   patologie   MeSH
• radioisotopová scintigrafie MeSH
• reoperace MeSH
• štítná žláza diagnostické zobrazování   patologie   MeSH
• ultrasonografie MeSH
• uzlová struma komplikace   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH