Parathyroid Adenoma - From Surgical to Biochemical Cure (original) (raw)
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Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?
World Journal of Endocrine Surgery, 2015
Purpose: Preoperative localization studies for parathyroid adenomas are very essential to perform minimal invasive parathyroidectomy (MIP) with decreased operative time and potential complications. Although most of these studies based on radiological imaging, intraoperative assessment provides the most accurate anatomical description of the location of parathyroid adenomas. In this study, we aim to evaluate the surgical variations of locations of parathyroid adenomas in patients performed parathyroid surgery for primary hyperpara thyroidism (PHPT). Materials and methods: Between January 2010 and December 2013, 243 patients (201 women/42 men) who underwent parathyroid surgery due to PHPT were included. A total of 254 parathyroid adenomas were detected. Demographic features, preoperative workup, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using ttest and chisquare. continuous data are expressed as mean ± standard deviation. Results: With regard to the most frequently observed, location of adenomas were as follows; right inferior (n = 89, 37.7%), left inferior (n = 78, 33%), right superior (n = 44, 18.6%), left superior (n = 25, 10.5%) and ectopic locations (n = 18). Ectopic adenomas were mostly located in the thymus (n = 9) and intrathyroidal tissue (n = 6) at a rate of 83%. Postoperative hypocalcemia (11%) was mostly seen in those with parathyroid adenoma located around the inferior lobes of the thyroid (86%) and undergoing bilateral neck exploration (75%). Conclusion: The most of the parathyroid adenomas were found in orthotopic position and located around the lower pole of the thyroid gland. Ectopic adenomas were mostly located in thymus or intrathyroidal. Postoperative hypocalcemia was also higher in those with parathyroid adenoma located around the inferior lobe of the thyroid.
ASSOCIATION BETWEEN PRIMARY HYPERPARATHYROIDISM AND PARATHYROID GLAND ADENOMA (Atena Editora)
ASSOCIATION BETWEEN PRIMARY HYPERPARATHYROIDISM AND PARATHYROID GLAND ADENOMA (Atena Editora), 2024
metabolism. Typically, it is characterized by hypercalcemia and elevated serum concentrations of parathyroid hormone (PTH), the hormone produced by the parathyroid glands. Most cases of primary hyperparathyroidism occur due to an adenoma of the parathyroid glands (85% of cases). Biochemical screening tests, introduced in the 1970s, made it possible to diagnose the disease earlier, even in the asymptomatic phase. The disease can be diagnosed at a symptomatic stage, typically in countries where screening tests are not common. In the symptomatic phase, the disease can cause bone loss, kidney stone formation, as well as gastrointestinal, cardiovascular and neuropsychiatric manifestations. Primary hyperparathyroidism may present with serum calcium concentration within the normal range, but with parathyroid hormone at levels above the normal limit. Diagnosis of the disease involves clinical manifestations, laboratory tests and imaging tests, with ultrasound and 99mTc-sestamibi scintigraphy being the most commonly used imaging methods. The only treatment that can cure the disease is parathyroidectomy, in which one or more parathyroid glands are removed. Surgery allows an increase in bone mineral density and reduces the incidence of nephrolithiasis. For patients who do not undergo surgery, monitoring of serum calcium concentrations and bone mineral density is indicated.
Anatomical description of location of parathyroid adenoma: Case series
IJLTEM.COM, 2018
Parathyroid adenoma accounts for the majority of cases of primary hyperparathyroidism. Mainstay of treatment is surgery. Preoperative localization and intra operative identification of adenoma is essential for the definitive treatment. We present a case series of parathyroid adenomas with regard to anatomical localization. According to our study, Superior glands which are known to be more constant in position were found even at unusual positions like buried within t he parenchyma of the thyroid.
The Journal of Clinical Endocrinology & Metabolism, 2022
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia driven by excess parathyroid hormone (PTH) secretion. PHPT is a common endocrine condition with a prevalence of 1 to 7 cases per 1000 adults. PHPT typically presents in the fifth or sixth decade and shows significant female preponderance. Solitary hyperfunctioning parathyroid adenomas account for 85% to 90% of PHPT cases. The remaining 10% to 15% include cases of multiglandular disease (multiple adenomas or hyperplasia) and, rarely, parathyroid carcinoma (1%). Ectopic parathyroid adenomas may arise due to abnormal embryological migration of the parathyroid glands and can be difficult to localize preoperatively, making surgical cure challenging on the first attempt. The potential existence of multiglandular disease should be considered in all patients in whom preoperative localization fails to identify a target adenoma or following unsuccessful parathyroidectomy. Risk factors for multiglandular disease include under...
Surgical pathology of hyperparathyroidism
Biomedicine Pharmacotherapy, 2000
The pathological diagnosis of the causes of primary hyperparathyroidism is often quite difficult, similar to other endocrine disorders, because the diagnostic criteria for hyperplasia, adenoma, and carcinoma of the parathyroid is still controversial. Pathologists often have difficulty making a definitive diagnosis due to the discrepancy between the histologic features and the clinical condition of the patients. Thus, clinicopathologic correlation is often required for diagnosis.
THE PARATHYROID ADENOMAS CLINICAL AND THERAPEUTIC STUDY
The purpose of our study was the evaluation of epidemiological profile, the diagnosis, the therapeutic management and post-operative complications for patients suffering from parathyroid adenomas. This work is based on a retrspective study. Its purpose is to discuss the results found of 26 patients operated for parathyroid adenoma at the department of visceral surgery at the Ibn Rochd University hospital of Casablanca, during a period of 07 years, from January 2010 to December 2016, based on the data collected from the clinical files of the patients. The average age of our patients was 53 with a female predominance. The circumstances of discovery for disease were various: like the etiological assessment of a bone tumor and the fortuitous discovery at the time of a cervical surgery. The clinical signs of hypocalcemia were found among 61,54% of patients (asthenia, vomiting, polyuriapolydipsia syndrome, headache, and weight loss), while bone signs were found in 19,23% of patient and renal events were found in 7,69% of patient either. The value of blood-calcium among our patients was between 94 and 176mg /l with an average of 121,81 mg /l. All of our patients presented high levels of parathormone with an average to 115,06 pg/ml and extremes with 94 and 2897 pg/ml. The ultrasound revealed the parathyoid adenoma in 84,62% cases while i twas not decisive in 15,38% cases. On the other hand, the scintigraphy was decisive for all the patients having benefited from this examination. All our patients benefited from a parathyroidectomy of pathological gland. Extemporaneous examination revealed an appearance of parathyroid adenoma in 65.38% of cases, and parathyroid hyperplasia in 34.62% of cases. Nevertheless, conventional pathological examination revealed a parathyroid adenoma in all of our patients. Two of our patients developed a transitory hypocalcemia. The evolution was marked by a normalization of the bloos-calcium of all our patients.
Annals of Surgery, 1993
OBJECTIVE: There is considerable debate about whether double parathyroid adenomas are a discrete entity or represent hyperplasia with parathyroid glands of varying sizes. This distinction is important because it impacts on the extent of parathyroid resection and the success of the parathyroid operation.SUMMARY BACKGROUND DATA: Double parathyroid adenomas have been reported to occur in 1.7% to 9% of patients with primary hyperparathyroidism (HPT). It is important for surgeons to differentiate between double adenoma and hyperplasia with glands of varying sizes using gross examination during the initial procedure because microscopic findings of a small biopsy specimen at frozen-section examination may not be diagnostic.METHODS: From 1982 to 1992, 416 unselected patients (309 women and 107 men) with primary HPT without familial HPT or multiple endocrine neoplasia (MEN) were treated by one surgeon at the University of California at San Francisco. Double adenoma occurred in 49 patients, solitary adenoma in 309 patients, and hyperplasia in 58 patients. The authors analyzed the clinical manifestations, the preoperative and postoperative serum levels of calcium, phosphate, and parathyroid hormone (PTH), and the success rate and outcome after parathyroidectomy and compared their results in 49 patients with double adenomas to the results for patients with solitary adenomas or hyperplasia.RESULTS: Ten of the patients with double adenomas (20.4%) were referred for persistent HPT after removal of one abnormal parathyroid gland. The ages of the patients with double adenoma, single adenoma, and hyperplasia were 61 +/- 14, 56 +/- 15, and 58 +/- 7 years, respectively. Fatigue, muscle weakness, and bone pain were common in patients with double adenomas, whereas nephrolithiasis occurred more frequently in patients with solitary adenoma (p = 0.0001). Serum calcium and PTH levels (per cent of upper limit of normal) fell from 11.5 +/- 1.2 mg/dL and 487% to 9.5 +/- 0.8 mg/dL and 61% for patients with double adenomas; from 11.9 +/- 0.9 mg/dL and 378% to 9.3 +/- 1.4 mg/dL and 101% for patients with single adenoma; and from 10.9 +/- 0.5 mg/dL and 418% to 9.1 +/- 0.7 mg/dL and 94% for patients with hyperplasia, respectively. There was no recurrence in the patients with double adenomas with a mean follow-up time of 5.8 years.CONCLUSIONS: Double adenomas are a discrete entity and occur more often in older patients. Patients with double adenomas can be successfully treated by removal of the two abnormal glands.
A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis
Case Reports in Medicine, 2010
Hyperparathyroid crisis is a rare manifestation of parathyroid disease. We present the case of a 53-year-old gentleman with a review of the current literature. He presented in acute renal failure with epigastric pain and vomiting. His serum-corrected calcium (CCa2+) was raised at 5.2 mmol/L, in addition to a massively raised parathyroid hormone (PTH) level (3957 ng/L). Ultrasound studies of the neck revealed a 2 cm well-defined mass inferoposterior to right thyroid lobe. CT scans of the neck showed a normal mediastinum and confirmed no associated lymphadenopathy. Having undergone medical resuscitation for 9 days, a neck exploration revealed a cystic mass, which was excised. Histological investigations revealed a 9.25 g, cystic parathyroid adenoma with no features of malignancy. His PTH and CCa2+returned to normal postoperatively. This suspicious presentation of benign disease, including a marked elevation in PTH, highlights the challenges facing the endocrine surgeon in dealing with...
Revista da Associação Médica Brasileira (English Edition), 2012
Objective: To evaluate frequency, anatomic presentation, and quantities of supernumerary parathyroids glands in patients with primary hyperparathyroidism (HPT1) associated with multiple endocrine neoplasia type 1 (MEN1), as well as the importance of thymectomy, and the benefits of localizing examinations for those glands. Methods: Forty-one patients with hyperparathyroidism associated with MEN1 who underwent parathyroidectomy between 1997 and 2007 were retrospectively studied. The location and number of supernumerary parathyroids were reviewed, as well as whether cervical ultrasound and parathyroid SESTAMIBI scan (MIBI) were useful diagnostic tools. Results: In five patients (12.2%) a supernumerary gland was identified. In three of these cases (40%), the glands were near the thyroid gland and were found during the procedure. None of the imaging examinations were able to detect supernumerary parathyroids. In one case, only the pathologic examination could find a microscopic fifth gland in the thymus. In the last case, the supernumerary gland was resected through a sternotomy after a recurrence of hyperparathyroidism, ten years after the initial four-gland parathyroidectomy without thymectomy. MIBI was capable of detecting this gland, but only in the recurrent setting. Cervical ultrasound did not detect any supernumerary glands. Conclusion: The frequency of supernumerary parathyroid gland in the HPT1/MEN1 patients studied (12.2%) was significant. Surgeons should be aware of the need to search for supernumerary glands during neck exploration, besides the thymus. Imaging examinations were not useful in the pre-surgical location of these glands, and one case presented a recurrence of hyperparathyroidism.
Parathyroid adenoma: a case report
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020
The incidence of primary hyperparathyroidism in India is 2.5/1000 individuals. Primary hyperparathyroidism can be caused by a non-cancerous parathyroid adenoma, hyperplasia or rarely by parathyroid carcinoma. Most of these patients have few or no symptoms. Correct diagnosis can be reached by clinical settings, biochemical and radiological tests and final confirmation by histopathology of the specimen.