One hundred double adenomas in primary hyperparathyroidism

Abstract

One hundred double adenomas in primary hyperparathyroidism 295 1 3 SummaryBackground Double adenomas (DAs) occur in 2-15 % of primary hyperparathyroidism (pHPT) patients. To date, the existence of this distinct entity remains controversial. The aim of this study was to evaluate the clinical characteristics and anatomic distribution of DAs to identify anatomic patterns and implications for surgical management.Methods We reviewed prospective database records of 1,464 unselected, consecutive patients who were treated for pHPT in our institution between 1986 and 2012. We identified 100 DA patients (6.8 %) and compared their clinical characteristics with those of solitary adenomas (SAs; n = 1,226) and hyperplasia (including multiple endocrine neoplasia; n = 101).Results A total of 74 % of our patient collective was female. DAs were predominantly located on the right side (30 %) or crossed (23 %) and demonstrated an increased incidence of atypical position (38 %). Patients with DA showed significantly more neuropsychiatric disorders and pancreatitis compared with those in the other groups. Our results revealed higher parathyroid hormone levels in patients with DA compared with those with SA or hyperplasia. In 74 patients, the DA was primarily found, whereas 26 patients needed reoperation. Only nine DAs had developed metachronously. The overall cure rate of all patients with pHPT was 96.4 % (carcinomas excluded).Conclusions DAs are a distinct entity and show no specific characteristic features that could facilitate easy detection. The chance of a metachronous appearance is statistically low, but has significant clinical impact as a major cause for late recurrence of hyperparathyroidism and need for reoperation.Keywords Double adenoma · Primary hyperparathyroidism · Hyperplasia · Hypercalcemia Abbreviations DA double adenoma IOPTH intraoperative parathyroid hormone assay MEN multiple endocrine neoplasia PTH parathyroid hormone pHPT primary hyperparathyroidism SA single adenomaThe first two authors contributed equally to this work.

Metachronous parathyroid adenoma characterised by recurrent nephrolithiasis

“…Both synchronous and metachronous double adenomata cause about 4%–5% of primary hyperparathyroidism 1. One study found that 9% of their participants with double adenomata were metachronous 2. The average time interval from removing a primary parathyroid adenoma to identifying a second parathyroid adenoma is 8 years, which is consistent with this patient’s 9-year latency period 4…”

“…Primary hyperparathyroidism is often diagnosed by elevated calcium levels while the patient is asymptomatic; however, the most common symptom associated with this condition is nephrolithiasis, which is seen in 39% of patients with a parathyroid adenoma 2. Other symptoms include polyuria, constipation, fatigue, bone pain and psychiatric manifestations 1.…”