Double adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity?

Goodsell, Kristin E.; Ermer, Jae P.; Zaheer, Salman; Kelz, Rachel R.; Fraker, Douglas L.; Wachtel, Heather

doi:10.1016/j.amjsurg.2021.01.021

Cited by 12 publications

(20 citation statements)

References 23 publications

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“…If they have symptoms and primary hyperparathyroidism is suspected, investigation begins with serum calcium and PTH levels and progress to imaging in order to localize the cause of this condition [9]. Some authors found that higher preoperative PTH level is related to larger adenomas and to higher risk of recurrence [2,7,[14][15][16]. Considering given information, it is important to know exact PTH level before parathyroidectomy, as it is related to expected size of adenoma and outcomes afterwards.…”

Section: Discussionmentioning

confidence: 99%

Double Parathyroid Adenoma Presenting as One Mass: A Case Report

Petruokaitė,

Eismontas,

Samalavičius

2024

AML

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Background and Objectives: Primary hyperparathyroidism is a common endocrinological condition, which is usually caused by solitary parathyroid adenoma. The aim of this article is to present a case of double adenoma presenting as one and literature review on this topic.Case presentation: 56 years old female suffering from generalized fatigue, bone pain, unstable body weight and palpitations was diagnosed with primary hyperparathyroidism. Further investigation revealed elevated parathyroid hormone (PTH), ionized and total calcium levels. Imaging showed two adenomas merging into one. Parathyroidectomy was performed and final intraoperative PTH (IOPTH) decreased by 71.6%. Parathyroid adenoma measuring 40 mm x 15 mm x 11 mm and weighing 1 g 483 mg was excised. 7 weeks after surgery patient was feeling well but her PTH level was elevated again.Conclusions: As far as we know, the double parathyroid adenoma presented in this case report is the largest reported in the Northern Europe and the first one that presents as one mass within the region. Double adenoma increases the risk of recurrent primary hyperparathyroidism (PHPT) and requires more careful and longer follow up after surgery than solitary adenomas. Final IOPTH must decrease by at least 50% within 10 minutes. This case shows that despite final IOPTH drop by more than 50%, after few weeks normocalcemic elevated parathyroid hormone (NCePTH) phenomenon was noticed. This phenomenon does not indicate surgical failure.

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Section: Discussionmentioning

confidence: 99%

Double Parathyroid Adenoma Presenting as One Mass: A Case Report

Petruokaitė,

Eismontas,

Samalavičius

2024

AML

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“…These findings are usually reliable in distinguishing a PA from parathyroid hyperplasia 4. In rare cases, PA may present with multiglandular involvement as double adenomas 12,13…”

Section: Pathology Of Hyperparathyroidismmentioning

confidence: 98%

“…4 In rare cases, PA may present with multiglandular involvement as double adenomas. 12,13 PAs may be composed of a mixture of cell types (chief, oncocytic, clear cells) usually with one cell type predominating (Fig. 1).…”

Section: Pathology Of Hyperparathyroidismmentioning

confidence: 99%

Advances and Updates in Parathyroid Pathology

Gokozan

Scognamiglio

2022

Advances in Anatomic Pathology

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Hyperparathyroidism is a common endocrine disorder characterized by elevated levels of parathyroid hormone and hypercalcemia and is divided into 3 types: primary, secondary, and tertiary. Distinction between these types is accomplished by correlation of clinical, radiologic, and laboratory findings with pathologic features. Primary hyperparathyroidism occurs sporadically in 85% of cases with the remaining cases associated with multiple familial syndromes. The pathologic manifestations of primary hyperparathyroidism include parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma. Recent advances in the understanding of the pathogenesis of parathyroid disease has helped to refine the diagnosis and classification of parathyroid lesions. The identification of multiple clonal proliferations in traditional multiglandular parathyroid hyperplasia has led to the adoption by the World Health Organization (WHO) of the alternate term of primary hyperparathyroidism-related multiglandular parathyroid disease. Additional nomenclature changes include the adoption of the term atypical parathyroid tumor in lieu of atypical parathyroid adenoma to reflect the uncertain malignant potential of these neoplasms. Clinical and morphologic features characteristic of familial disease have been described that can help the practicing pathologist identify underlying familial disease and provide appropriate management. Use of ancillary immunohistochemistry and molecular studies can be helpful in classifying parathyroid neoplasms. Parafibromin has proven useful as a diagnostic and prognostic marker in atypical parathyroid tumors and parathyroid carcinomas. This review provides an update on the diagnosis and classification of parathyroid lesions considering the recent advances in the understanding of the molecular and clinical features of parathyroid disease and highlights the use of ancillary studies (immunohistochemical, and molecular) to refine the diagnosis of parathyroid lesions.

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“…In multivariable analysis, double adenoma was found to be associated with increased persistent/recurrent disease. [ 56 ]…”

Section: Predictive Factors For Perhpt and Rechptmentioning

confidence: 99%

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the pre-operative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography (4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fine-needle aspiration biopsy, and parathormone washout are invasive methods.

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Double adenoma as a cause of primary hyperparathyroidism: Asymmetric hyperplasia or a distinct pathologic entity?

Cited by 12 publications

References 23 publications

Double Parathyroid Adenoma Presenting as One Mass: A Case Report

Double Parathyroid Adenoma Presenting as One Mass: A Case Report

Advances and Updates in Parathyroid Pathology

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

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