Giant parathyroid tumours in primary hyperparathyroidism: a systematic review

Giant Parathyroid Tumor: Parathyroid Adenoma versus Parathyroid Carcinoma

“…In the current case, the course of treatment included surgery and follow-up, which were without complications. After approximately 18 months of follow-up, the patient was seen at the endocrinology outpatient clinic with normal calcium and PTH levels, in line with another reported giant parathyroid adenoma [3].…”

“…Giant parathyroid adenoma is a rare cause of PHPT, and consequently, only a few cases of GPA have been reported. A systematic review by Wong et al identified 62 GPAs from 1952 to 2021 [ 3 ]. Reporting a very rare case, namely this case, is important both paraclinically and clinically, as it can contribute to the assessment of this type of patient in possibly challenging situations.…”

“…Preoperative differentiation between giant parathyroid adenoma and parathyroid carcinoma is very challenging. The preoperative clinical and paraclinical presentation of giant parathyroid adenoma, especially with severely elevated PTH and calcium levels, may be very similar to that of parathyroid carcinoma [ 3 ]. A familial predisposition to MEN1, severely elevated serum corrected calcium level (>3 mmol/l) with several clinical symptoms of hypercalcemia, including nausea, vomiting, abdominal pain, constipation, myopathy and neurocognitive deficit, very high PTH levels (5–10 times more than the upper limit of the reference range), renal and bone involvement, very large tissue and younger age at presentation, can raise the suspicion of parathyroid carcinoma [ 12 – 17 ].…”

“…Therefore, the diagnosis of malignancy before surgery is difficult, and the intraoperative findings including histology are important for all cases of parathyroid tumors. Preoperative fine-needle biopsy is also not recommended due to the increased risk of dissemination and inferiority in differentiation between adenoma and carcinoma [ 3 , 5 ]. ( 99m Tc)-sestamibi scintigraphy is recommended as the first-line imaging method, and ultrasound is recommended as a complementary and hopefully confirmatory examination for preoperative localization.…”

“…The most common cause of PHPT is a solitary parathyroid adenoma (80–85%) [ 1 , 2 ]. A very enlarged parathyroid adenoma is a rare variation in which the adenoma weighs more than 3500 mg and is known as a giant parathyroid adenoma (GPA) [ 3 , 4 ]. In addition to clinical complications such as very high levels of calcium and PTH and possible mass effects, GPA can also cause operative challenges during surgical resection [ 1 ].…”