Publications
55 results found
Chidambaram S, Van Den Heede K, Damji S, et al., 2023, The Impact of Obesity on the Resolution of Hypertension Following Adrenalectomy for Primary Hyperaldosteronism, WORLD JOURNAL OF SURGERY, Vol: 47, Pages: 2188-2196, ISSN: 0364-2313
Mumtaz R, Hatfield E, Di Marco A, et al., 2023, Dual Left Adrenal Venous Drainage Detected during Adrenal Vein Sampling, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 34, Pages: 926-927, ISSN: 1051-0443
Chander NR, Chidambaram S, Van Den Heede K, et al., 2022, Response to Letter to the Editor From Cuny et al: "Correlation of Preoperative Imaging Findings and Parathyroidectomy Outcomes Support NICE 2019 Guidance", JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol: 107, Pages: E2650-E2650, ISSN: 0021-972X
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- Citations: 1
Chidambaram S, Di Marco A, Van Den Heede K, et al., 2022, Are obese patients with primary hyperaldosteronism less likely to benefit from adrenalectomy?, Annual Scientific Meeting of the British-Association-of-Endocrine-and-Thyroid-Surgeons, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Jaafar M, Anneback M, Di Marco A, et al., 2022, An audit of MEN-1 screening in a large tertiary endocrine surgery centre - A single centre experience, Annual Scientific Meeting of the British-Association-of-Endocrine-and-Thyroid-Surgeons, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Jones L, Khan S, Tolley N, et al., 2022, An audit of thyroidectomy for Graves' Disease, in a large UK tertiary centre, Annual Scientific Meeting of the British-Association-of-Endocrine-and-Thyroid-Surgeons, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Chander NR, Chidambaram S, Van den Heede K, et al., 2022, Correlation of Preoperative Imaging Findings and Parathyroidectomy Outcomes Support NICE 2019 Guidance, JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol: 107, Pages: E1242-E1248, ISSN: 0021-972X
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- Citations: 7
Van Den Heede K, Paspala A, Chander N, et al., 2022, To block, or not to block … is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis., Ann R Coll Surg Engl, Vol: 104, Pages: 138-143
INTRODUCTION: Phaeochromocytomas/paraganglioma (PPGL) surgery was historically associated with significant risks of perioperative complications. The decreased mortality (<3.0%) had been attributed in part to optimal preoperative alpha-blockade. The value of alpha-blockade in decreasing morbidity is being challenged. The aim of our study is to present an institutional experience of preoperative alpha-blocking of PPGL and its effect on cardiovascular stability and postoperative morbidity. METHODS: A retrospective study using data from our institutional database was conducted. All patients undergoing adrenalectomy for PPGL from October 2011 to September 2020 were included. All patients were routinely alpha-blocked. Intraoperative cardiovascular instability (ICI) was assessed through number of systolic blood pressure (SBP) episodes >160mmHg, SBP <90mmHg, the need for vasoactive drugs and volume of intraoperative crystalloids administered. Morbidity was also evaluated. RESULTS: A total of 100 consecutive patients undergoing surgery were identified of whom 53 patients had complete anaesthetic records available for analysis. Thirty-two patients (60%) had at least one episode with an SBP >160mmHg. Nine (17%) cases had no intraoperative hypotensive episodes, while 3 (6%) patients had >10 intraoperative episodes of an SBP <90mmHg. Twenty-one (40%) patients received vasoactive drugs during surgery. The median volume of intraoperative crystalloids was 2 litres (1-4). Postoperatively, no patient experienced cardiovascular complications, including arrhythmia or myocardial ischaemia. Only two were admitted to an intensive care unit (ICU) and one 30-day readmission occurred. CONCLUSIONS: Cardiac instability remained significant in PPGL surgery despite optimal alpha- and beta-blockade. While omitting blockade would appear empirically questionable, a randomised controlled trial (RCT) of surgery with and without alpha-blockade will provide an answer.
Di Marco A, Mechera R, Glover A, et al., 2021, Focused parathyroidectomy without intraoperative parathyroid hormone measurement in primary hyperparathyroidism: Still a valid approach?, SURGERY, Vol: 170, Pages: 1383-1388, ISSN: 0039-6060
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- Citations: 7
Van Den Heede K, Chidambaram S, Winter Beatty J, et al., 2021, The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 pandemic, World Journal of Surgery, Vol: 45, Pages: 2315-2324, ISSN: 0364-2313
BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this
Di Marco A, Palazzo F, 2021, Goitre and thyroid cancer, Medicine (United Kingdom), Vol: 49, Pages: 522-526, ISSN: 1357-3039
Goitre is the generic term for thyroid enlargement and encompasses relatively common benign disease as well as thyroid malignancy, which is less common. Unfortunately, the clinical presentations of benign and malignant thyroid disease are similar. The aim of clinical assessment and investigations is therefore to identify the small number of cancers among the frequent non-malignant goitres. Key investigations include thyroid function tests, ultrasonography and fine needle aspiration cytology. Benign thyroid disease requires treatment only in the presence of dysfunction or local compressive symptoms. The treatment of thyroid cancer is multidisciplinary and includes surgery, radioiodine therapy and life-long suppression of thyroid-stimulating hormone. Novel targeted therapies are being introduced for cancers refractory to standard optimal therapy. The diagnosis and management of thyroid cancer are being centralized around a multidisciplinary team structure in order to improve outcomes in the UK. Recent developments in the management of thyroid cancer include the use of molecular biomarkers to identify malignancy in thyroid nodules, assist with prognostication and facilitate targeted therapy for advanced disease.
Van den Heede K, Chidambaram S, Beatty JW, et al., 2021, Correction to: The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 Pandemic, World Journal of Surgery, Vol: 45, Pages: 1-1, ISSN: 0364-2313
Correction to: World J Surg https://doi.org/10.1007/s00268-021-06099-z
Zaman S, Almazrouei R, Sam AH, et al., 2021, Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution, Frontiers in Endocrinology, Vol: 12, Pages: 1-7, ISSN: 1664-2392
Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded.Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
Van Den Heede K, Tolley NS, Di Marco AN, et al., 2021, Differentiated Thyroid Cancer: A Health Economic Review, CANCERS, Vol: 13
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- Citations: 13
Gavriilidis P, Camenzuli C, Paspala A, et al., 2021, Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta-Analysis, WORLD JOURNAL OF SURGERY, Vol: 45, Pages: 168-179, ISSN: 0364-2313
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- Citations: 15
Camenzuli C, DiMarco AN, Isaacs KE, et al., 2021, The changing face of reoperative parathyroidectom a single-centre comparison of 147 parathyroid reoperations, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 103, Pages: 29-34, ISSN: 0035-8843
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- Citations: 4
Di Marco AN, Glover A, Sywak MS, et al., 2020, Letter to the Editor: Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management, WORLD JOURNAL OF SURGERY, Vol: 44, Pages: 2441-2442, ISSN: 0364-2313
Krawitz R, Glover A, Koneru S, et al., 2020, The Significance of Histologically "Large Normal" Parathyroid Glands in Primary Hyperparathyroidism, WORLD JOURNAL OF SURGERY, Vol: 44, Pages: 1149-1155, ISSN: 0364-2313
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- Citations: 6
Di Marco AN, Palazzo FF, 2020, Near-infrared autofluorescence in thyroid and parathyroid surgery, GLAND SURGERY, Vol: 9, Pages: S136-S146, ISSN: 2227-684X
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- Citations: 23
Isaacs K, Belete S, Miller B, et al., 2019, Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma, BJS Open, Vol: 3, Pages: 743-749, ISSN: 2474-9842
Background: Primary hyperparathyroidism (pHPT) caused by an ectopic mediastinal parathyroid adenoma is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video-assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach for this problem.Methods: Information was obtained related to patients undergoing VATS from a specific database, including clinical presentation, biochemistry, pre-operative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.Results: Over a 2-year period, 9 patients underwent VATS parathyroidectomy for sporadic pHPT, of whom five had persistent pHPT following previous unsuccessful parathyroidectomy via cervicotomy, while four had had no previous parathyroid surgery. The mean operating time was 101 minutes (range 60 – 160). 8 patients were biochemically cured, with no major complications. 1 patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false positive preoperative imaging.Conclusion: With appropriate pre-operative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well-tolerated approach to an ectopic mediastinal parathyroid adenoma.
Hadjidemetriou I, Mariniello K, Ruiz-Babot G, et al., 2019, DLK1/PREF1 marks a novel cell population in the human adrenal cortex, JOURNAL OF STEROID BIOCHEMISTRY AND MOLECULAR BIOLOGY, Vol: 193, ISSN: 0960-0760
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- Citations: 8
DiMarco A, Chotalia R, Bloxham R, et al., 2019, Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery?, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 101, Pages: 508-513, ISSN: 0035-8843
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- Citations: 33
Gartland RM, Di Marco A, Sywak M, 2019, Posterior retroperitoneoscopic approach is feasible in selected patients requiring revision adrenal surgery, ANZ JOURNAL OF SURGERY, Vol: 89, Pages: 1175-1176, ISSN: 1445-1433
Di Marco A, Chotalia R, Bloxham R, et al., 2019, Autofluorescence in parathyroidectomy: signal intensity correlates with serum calcium and parathyroid hormone but routine clinical use is not justified, World Journal of Surgery, Vol: 43, Pages: 1532-1537, ISSN: 1432-2323
BACKGROUND: The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery. METHODS: Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition. RESULTS: Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF. CONCLUSION: Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
DiMarco AN, Wong MS, Jayasekara J, et al., 2019, Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy, BJS Open, Vol: 3, Pages: 299-304, ISSN: 2474-9842
BackgroundLow‐risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy.MethodsPatients with PTC treated over 5 years (2013–2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high‐volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy.ResultsOf 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required.ConclusionAlthough many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low‐risk 1–4‐cm PTC in the hands of high‐volume thyroid surgeons who can demonstrate low complication rates.
Di Marco A, Meeran K, Christakis I, et al., 2019, Seventeen cases of primary hyperparathyroidism in pregnancy: a call for management guidelines, Journal of the Endocrine Society, Vol: 3, Pages: 1009-1021, ISSN: 2472-1972
IntroductionThe risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses are well-reported and appear to increase commensurate with serum calcium. The management strategy of pHPT must be adapted in pregnancy and should reflect the severity of hypercalcaemia. However, no guidelines exist to assist clinicians facing this dilemma.MethodsThe experience of a high-volume multidisciplinary endocrine surgical service in managing a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and compared to a non-pregnant cohort with pHPT. Evidence in the published literature is explored via a review on pHPT and pregnancy outcomes.ResultsSeventeen pregnant women and 247 age range-matched non-pregnant women with pHPT were referred for surgery over 11 years. Serum calcium was higher in the pregnant cohort 2.89mmol/l vs 2.78mmol/l (p=0.03). Pre-operative localisation with ultrasound succeeded in 8(47%) pregnant women and SestaMIBI in 2/6(33% imaged pre-conception) compared to 84(34%) and 102(42%) controls (NS at 0.36 and 0.59). Parathyroidectomy was performed under general anaesthesia between 12 and 28 weeks gestation, with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls.ConclusionspHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease (serum calcium <0.25mmol/l above the normal range) but in moderate-severe disease, parathyroidectomy under general anaesthesia in the second trimester is safe. Localisation using ionising radiation/MRI is unnecessary as surgical intervention in a high-volume multi-disciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians in this complex decision-making process.
diMarco AN, Sywak MS, Sidhu SB, 2018, Primary Hyperparathyroidism, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 379, ISSN: 0028-4793
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- Citations: 1
Di Marco AN, Chotalia R, Bloxham R, et al., 2018, Autofluorescence in Parathyroidectomy: Clinically Valuable Correlations?, European Society of Endocrine Surgeons
DiMarco A, Christakis I, Constantinides V, et al., 2018, Undiagnosed Primary Hyperparathyroidism and Recurrent Miscarriage: The First Prospective Pilot Study., World Journal of Surgery, Vol: 42, Pages: 639-645, ISSN: 1432-2323
BACKGROUND: Primary hyperparathyroidism (pHPT) in pregnancy is reported to be associated with significant maternal and foetal complications and an up to threefold increase in the risk of miscarriage. However, the true incidence of pHPT in pregnancy, complete and miscarried, is unknown and there are no data on the prevalence of undiagnosed pHPT in recurrent miscarriage (RM) (≥3 consecutive miscarriages under 24-week gestation). This is the first prospective study aiming to establish the prevalence of undiagnosed pHPT in RM. METHODS: Following UK National ethics committee approval, women who had experienced 3 or more consecutive miscarriages were recruited from a nationwide RM clinic. Serum corrected calcium, phosphate, PTH and vitamin D were evaluated. Patients with raised serum calcium and/or PTH were recalled for confirmatory tests. Power calculations suggested that a minimum of 272 patients were required to demonstrate a clinically significant incidence of pHPT. RESULTS: Three hundred women were recruited, median age 35 years (range 19-42). Eleven patients had incomplete data, leaving 289 patients suitable for analysis; 50/289 patients (17%) with abnormal tests were recalled. The prevalence of vitamin D deficiency (<25 nmol/l) and insufficiency (25-75 nmol/l) was 8.7 and 67.8%, respectively. One patient was diagnosed with pHPT (0.34%) and underwent successful parathyroidectomy. CONCLUSIONS: The prevalence of undiagnosed pHPT (0.34%) in RM in this study appears to be many times greater than the 0.05% expected in this age group. The findings of this pilot study merit follow-up with a larger-scale study. Routine serum calcium estimation is not currently undertaken in RM and should be considered.
Plonczak AM, DiMarco AN, Dina R, et al., 2017, Correction to: Breast cancer metastases to the thyroid gland - An uncommon sentinel for diffuse metastatic disease: A case report and literature review., Journal of Medical Case Reports, Vol: 11, ISSN: 1752-1947
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