We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Reexploration and Angiographic Ablation for Hyperparathyroidism

Robert C. McIntyre Jr, MD; David A. Kumpe, MD; R. Dale Liechty, MD
Arch Surg. 1994;129(5):499-505. doi:10.1001/archsurg.1994.01420290045007.
Text Size: A A A
Published online


Objective:  Persistent and recurrent hyperparathyroidism remains a challenging clinical problem. The purposes of this study were to determine the causes of initial failure, the accuracy of preoperative localization tests, the role of angiographic parathyroid ablation, and the safety and efficacy of reexploration for hyperparathyroidism.

Design:  A retrospective review of 42 patients undergoing reexploration or angiographic ablation for hyperparathyroidism was done, with a mean follow-up of 3 years, 7 months (range, 1 month to 13 years).

Setting:  This study was carried out in a university medical center and a Veterans Affairs hospital.

Patients:  All patients who underwent reexploration or angiographic ablation for hyperparathyroidism were included.

Intervention:  All patients underwent preoperative localization studies. The cervical approach was used when the abnormal gland was suspected to be in the neck or the mediastinum superior to the aortic arch; sternotomy was used for deeper mediastinal glands not resectable through a cervical approach. Angiographic ablation of mediastinal glands was performed using contrast administration after a catheter was wedged into the selective feeding artery.

Main Outcome Measures:  End points included causes of initial treatment failure, accuracy of preoperative localization studies, long-term correction of hypercalcemia with repeated treatment, need for subsequent intervention for hypercalcemia, and complications of therapy.

Results:  The most common reasons for initial failure were mediastinal glands (18 patients), surgeon's inexperience (12 patients), supernumerary glands (six patients), and other anatomic anomalies. Hyperplasia accounted for hyperparathyroidism in 11 patients (26%) and adenomas in 31 patients (74%). Preoperative localization studies included technetium-Tc-99m-sestamibi scanning (sensitivity, 86%), technetium-thallium scanning (67%), arteriography (63%), venous sampling (52%), computed tomography (42%), magnetic resonance imaging (33%), and ultrasonography (27%). Thirty-three (89%) of 37 patients who underwent reexploration had resolution of hypercalcemia. Localization study results were negative in all four patients who experienced failure. Angiographic ablation was successful in four (67%) of six patients. One of the patients with a failed ablation had successful mediastinal exploration. Hypoparathyroidism occurred in six patients (14.3%) and there was no instance of recurrent nerve injury.

Conclusions:  The most common causes of initial failure were ectopic mediastinal glands and incomplete surgical exploration; the most sensitive preoperative localization study is the technetium-Tc-99m-sestamibi scan; angiographic ablation of parathyroid tissue is most useful for poor-risk surgical patients or to avoid median sternotomy; and reexploration and angiographic ablation yield a high success rate with acceptable morbidity and mortality.(Arch Surg. 1994;129:499-505)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.