Perioperative multidisciplinary integrated diagnosis and treatment of secondary hyperparathyroidism: a consensus from West China Hospital　_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Xun ¹ , LU Chunyan ² , ZHOU Li ³ , SHI Yunying ³ , OU Xiaohong ⁴ , WANG Qin ² , JIANG Chunling ⁵ , LU Qiang ⁶ , YU Boyang ⁶ , WANG Mian ⁷ , LIU Fang ³ , ZHOU Ke ⁴ , ZHONG Hui ³ ,  LI Zhihui ¹ , MDT for Parathyroid Disease from West China Hospital of Sichuan University

1. Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
6. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
7. Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Zhihui, Email: rockoliver@vip.sina.com

Keywords：

secondary hyperparathyroidism; perioperative period; chronic renal failure; surgical indication; consensus

DOI：

10.7507/1007-9424.202301017

Video：

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To standardize the treatment of secondary hyperparathyroidism and effectively meet the needs of practical clinical work, we gathered experts and nursing experts from Departments of Thyroid Surgery, Nephrology, Endocrinology and Metabolism, Nuclear Medicine, Ultrasound, Anesthesiology, Cardiology, and other departments at West China Hospital of Sichuan University to solicit opinions. This consensus was finally established based on published guidelines and the best evidence in Chinese and English combined with clinical practice. This consensus is intended to summarize and conclude, to the greatest extent possible, the practical issues encountered in diagnosing and treating secondary hyperparathyroidism in perioperative settings and to provide recommendations for clinical practice.

Citation： ZHENG Xun, LU Chunyan, ZHOU Li, SHI Yunying, OU Xiaohong, WANG Qin, JIANG Chunling, LU Qiang, YU Boyang, WANG Mian, LIU Fang, ZHOU Ke, ZHONG Hui, LI Zhihui, MDT for Parathyroid Disease from West China Hospital of Sichuan University. Perioperative multidisciplinary integrated diagnosis and treatment of secondary hyperparathyroidism: a consensus from West China Hospital　. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 129-136. doi: 10.7507/1007-9424.202301017 Copy

1.	GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
2.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3.	Wang F, Yang C, Long J, et al. Executive summary for the 2015 Annual Data Report of the China Kidney Disease Network (CK-NET). Kidney Int, 2019, 95(3): 501-505.
4.	Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011), 2017, 7(1): 1-59.
5.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
6.	Huppert BJ, Reading CC. Diagnostic ultrasound. 3rd ed. St. Louis, MO: Elsevier Mosby, 2005: 771-794.
7.	Fancy T, Gallagher D, Hornig JD. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin North Am, 2010, 43(2): 221-227.
8.	Kuntz, KM. Clinical guide to ultrasonography. St. Louis, MO: Elsevier Mosby, 2004: 439-450.
9.	Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med, 2005, 35(4): 266-276.
10.	Profanter C, Wetscher GJ, Gabriel M, et al. CT-MIBI image fusion: a new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism. Surgery, 2004, 135(2): 157-162.
11.	Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase ^99mTc-sestamibi parathyroid scintigraphy. J Nucl Med, 2007, 48(7): 1084-1089.
12.	Coakley AJ, Kettle AG, Wells CP, et al. ⁹⁹Tc^m sestamibi–a new agent for parathyroid imaging. Nucl Med Commun, 1989, 10(11): 791-794.
13.	Gallieni M, Brancaccio D, Padovese P, et al. Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients. Italian Group for the Study of Intravenous Calcitriol. Kidney Int, 1992, 42(5): 1191-1198.
14.	Liehn JC, Amico S, Delisle MJ, et al. Improvement of parathyroid Tl-Tc scintigraphy by using a new image subtraction method. Eur J Nucl Med Mol Imaging, 1988, 14(4): 184-189.
15.	Hayakawa N, Nakamoto Y, Kurihara K, et al. A comparison between ¹¹C-methionine PET/CT and MIBI SPECT/CT for localization of parathyroid adenomas/hyperplasia. Nucl Med Commun, 2015, 36(1): 53-59.
16.	Lenschow C, Gassmann P, Wenning C, et al. Preoperative ¹¹C-methionine PET/CT enables focused parathyroidectomy in MIBI-SPECT negative parathyroid adenoma. World J Surg, 2015, 39(7): 1750-1757.
17.	Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery, 2000, 128(1): 29-35.
18.	Hindié E, Mellière D. Hyperparathyroidism: rate surgery after preoperative scanning. Radiology, 1997, 204(1): 221-228.
19.	Kovacevic B, Ignjatovic M, Zivaljevic V, et al. Parathyroidectomy for the attainment of NKF-K/DOQITM and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg, 2012, 397(3): 413-420.
20.	Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg, 1998, 383(2): 174-179.
21.	Zhen L, Li H, Liu X, et al. The application of SPECT/CT for preoperative planning in patients with secondary hyperparathyroidism. Nucl Med Commun, 2013, 34(5): 439-444.
22.	Lee SH, Shin E, Ha S, et al. Is dual-phase SPECT/CT with ^99mTc-sestamibi better than single-phase SPECT/CT for lesion localization in patients with hyperparathyroidism? Medicine (Baltimore), 2020, 99(19): e19989. doi: 10.1097/ MD.0000000000019989.
23.	Spanu A, Falchi A, Manca A, et al. The usefulness of neck pinhole SPECT as a complementary tool to planar scintigraphy in primary and secondary hyperparathyroidism. J Nucl Med, 2004, 45(1): 40-48.
24.	Jaskowiak N, Norton JA, Alexander HR, et al. A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg, 1996, 224(3): 308-320.
25.	Fuster D, Ybarra J, Ortin J, et al. Role of pre-operative imaging using ^99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. Eur J Nucl Med Mol Imaging, 2006, 33(4): 467-473.
26.	Torregrosa JV, Fernández-Cruz L, Canalejo A, et al. ^99mTc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg, 2000, 24(11): 1386-1390.
27.	Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol, 2012, 269(6): 1565-1576.
28.	Piga M, Bolasco P, Satta L, et al. Double phase parathyroid technetium-99m-MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism. J Nucl Med, 1996, 37(4): 565-569.
29.	Udelsman R, Donovan PI. Remedial parathyroid surgery: changing trends in 130 consecutive cases. Ann Surg, 2006, 244(3): 471-479.
30.	国家肾脏疾病临床医学研究中心. 中国慢性肾脏病矿物质和骨异常诊治指南. 北京: 人民卫生出版社, 2018.
31.	Xiang T, Wang Y, Lan T, et al. Calcium-mediated parathyroid hormone suppression test in uraemic secondary hyperparathyroidism. Nephrology (Carlton), 2021, 26(2): 164-169.
32.	郑洵, 周莉, 李志辉. 继发性甲状旁腺功能亢进的外科治疗进展及展望. 中国普外基础与临床杂志, 2020, 27(10): 1196-1199.
33.	汪燕, 周莉, 付平. 手术治疗继发性甲状旁腺功能亢进多学科协作中的内科管理. 华西医学, 2019, 34(7): 759-763.
34.	郑洵, 陈宝杰, 苏安平, 等. 继发性甲状旁腺功能亢进外科治疗的发展历程现状与目标. 中国临床新医学, 2019, 12(3): 247-251.
35.	Hu SM, Bai YJ, Li YM, et al. Cholecalciferol supplementation effectively improved tertiary hyperparathyroidism, FGF23 resistance and lowered coronary calcification score: a prospective study. Endocr Connect, 2022, 11(8): e220123. doi: 10.1530/EC-22-0123.

1. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
2. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
3. Wang F, Yang C, Long J, et al. Executive summary for the 2015 Annual Data Report of the China Kidney Disease Network (CK-NET). Kidney Int, 2019, 95(3): 501-505.
4. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011), 2017, 7(1): 1-59.
5. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
6. Huppert BJ, Reading CC. Diagnostic ultrasound. 3rd ed. St. Louis, MO: Elsevier Mosby, 2005: 771-794.
7. Fancy T, Gallagher D, Hornig JD. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin North Am, 2010, 43(2): 221-227.
8. Kuntz, KM. Clinical guide to ultrasonography. St. Louis, MO: Elsevier Mosby, 2004: 439-450.
9. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med, 2005, 35(4): 266-276.
10. Profanter C, Wetscher GJ, Gabriel M, et al. CT-MIBI image fusion: a new preoperative localization technique for primary, recurrent, and persistent hyperparathyroidism. Surgery, 2004, 135(2): 157-162.
11. Lavely WC, Goetze S, Friedman KP, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase ^99mTc-sestamibi parathyroid scintigraphy. J Nucl Med, 2007, 48(7): 1084-1089.
12. Coakley AJ, Kettle AG, Wells CP, et al. ⁹⁹Tc^m sestamibi–a new agent for parathyroid imaging. Nucl Med Commun, 1989, 10(11): 791-794.
13. Gallieni M, Brancaccio D, Padovese P, et al. Low-dose intravenous calcitriol treatment of secondary hyperparathyroidism in hemodialysis patients. Italian Group for the Study of Intravenous Calcitriol. Kidney Int, 1992, 42(5): 1191-1198.
14. Liehn JC, Amico S, Delisle MJ, et al. Improvement of parathyroid Tl-Tc scintigraphy by using a new image subtraction method. Eur J Nucl Med Mol Imaging, 1988, 14(4): 184-189.
15. Hayakawa N, Nakamoto Y, Kurihara K, et al. A comparison between ¹¹C-methionine PET/CT and MIBI SPECT/CT for localization of parathyroid adenomas/hyperplasia. Nucl Med Commun, 2015, 36(1): 53-59.
16. Lenschow C, Gassmann P, Wenning C, et al. Preoperative ¹¹C-methionine PET/CT enables focused parathyroidectomy in MIBI-SPECT negative parathyroid adenoma. World J Surg, 2015, 39(7): 1750-1757.
17. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery, 2000, 128(1): 29-35.
18. Hindié E, Mellière D. Hyperparathyroidism: rate surgery after preoperative scanning. Radiology, 1997, 204(1): 221-228.
19. Kovacevic B, Ignjatovic M, Zivaljevic V, et al. Parathyroidectomy for the attainment of NKF-K/DOQITM and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg, 2012, 397(3): 413-420.
20. Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg, 1998, 383(2): 174-179.
21. Zhen L, Li H, Liu X, et al. The application of SPECT/CT for preoperative planning in patients with secondary hyperparathyroidism. Nucl Med Commun, 2013, 34(5): 439-444.
22. Lee SH, Shin E, Ha S, et al. Is dual-phase SPECT/CT with ^99mTc-sestamibi better than single-phase SPECT/CT for lesion localization in patients with hyperparathyroidism? Medicine (Baltimore), 2020, 99(19): e19989. doi: 10.1097/ MD.0000000000019989.
23. Spanu A, Falchi A, Manca A, et al. The usefulness of neck pinhole SPECT as a complementary tool to planar scintigraphy in primary and secondary hyperparathyroidism. J Nucl Med, 2004, 45(1): 40-48.
24. Jaskowiak N, Norton JA, Alexander HR, et al. A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg, 1996, 224(3): 308-320.
25. Fuster D, Ybarra J, Ortin J, et al. Role of pre-operative imaging using ^99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. Eur J Nucl Med Mol Imaging, 2006, 33(4): 467-473.
26. Torregrosa JV, Fernández-Cruz L, Canalejo A, et al. ^99mTc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg, 2000, 24(11): 1386-1390.
27. Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol, 2012, 269(6): 1565-1576.
28. Piga M, Bolasco P, Satta L, et al. Double phase parathyroid technetium-99m-MIBI scintigraphy to identify functional autonomy in secondary hyperparathyroidism. J Nucl Med, 1996, 37(4): 565-569.
29. Udelsman R, Donovan PI. Remedial parathyroid surgery: changing trends in 130 consecutive cases. Ann Surg, 2006, 244(3): 471-479.
30. 国家肾脏疾病临床医学研究中心. 中国慢性肾脏病矿物质和骨异常诊治指南. 北京: 人民卫生出版社, 2018.
31. Xiang T, Wang Y, Lan T, et al. Calcium-mediated parathyroid hormone suppression test in uraemic secondary hyperparathyroidism. Nephrology (Carlton), 2021, 26(2): 164-169.
32. 郑洵, 周莉, 李志辉. 继发性甲状旁腺功能亢进的外科治疗进展及展望. 中国普外基础与临床杂志, 2020, 27(10): 1196-1199.
33. 汪燕, 周莉, 付平. 手术治疗继发性甲状旁腺功能亢进多学科协作中的内科管理. 华西医学, 2019, 34(7): 759-763.
34. 郑洵, 陈宝杰, 苏安平, 等. 继发性甲状旁腺功能亢进外科治疗的发展历程现状与目标. 中国临床新医学, 2019, 12(3): 247-251.
35. Hu SM, Bai YJ, Li YM, et al. Cholecalciferol supplementation effectively improved tertiary hyperparathyroidism, FGF23 resistance and lowered coronary calcification score: a prospective study. Endocr Connect, 2022, 11(8): e220123. doi: 10.1530/EC-22-0123.

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Perioperative multidisciplinary integrated diagnosis and treatment of secondary hyperparathyroidism: a consensus from West China Hospital

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