Parathyroid Adenomas in Adults and Adolescents. Critical Appraisal and Surgical Strategy in 18 Cases

Abstract

RezumatIntroducere: Studiul nostru subliniazã raritatea cazurilor de adenoame paratiroidiene (AP) publicate în literatura medicalã autohtonã, expresia clinicã diferitã în care predominã formele "istorice" ale bolii ca şi dificultãţile şi întârzierile de diagnostic confirmând totodatã chirurgia ca standardul de aur al tratamentului. Pacienţi şi metodã: Sunt analizate retrospectiv demografia, datele clinice, de laborator şi cele imagistice, procedurile chirurgicale şi constatãrile anatomopatologice ca şi rezultatele obţinute în 18 cazuri documentate de AP tratate chirurgical. Rezultate: Raportul m/f al cazurilor a fost de 1/5 iar vârsta acestora a variat între 16-58 (medie 46). Litiaza urinarã (n=9) şi leziunile osoase (n=6) au fost cele mai întâlnite manifestãri menţionate. Acestora li s-au adãugat tulburãri psihiatrice şi neuromusculare, cele digestive (pancreatita şi ulcerul peptic), hipertensiune arterialã ca şi prezenţa unui nodul palpabil. Diagnosticul a fost confirmat prin dozãrile calciului şi fosforului seric, fosfatazei alcaline şi PTH, ecografia şi scintigrafia cu techneţiu 99m. Au fost practicate 18 adenomectomii din care 16 dupã explorarea cervicalã bilateralã şi douã prin abord minim invaziv. În 9 situaţii s-a recurs la exereze tiroidiene concomitente pentru leziuni asociate sau în scop tactic. Examenul microscopic a confirmat diagnosticul de AP cu celule principale şi oxifile, într-un caz fiind identificat un adenom "atipic". Într-o altã observaţie, la 3 ani dupã exereza unui AP benign, s-a constatat o recidivã clinicã ipsilateralã care s-a dovedit a fi un carcinom (leziune nouã sau eroare a diagnosticului iniţial?). Evoluţia clinicã şi bioumoralã postoperatorie imediatã şi la distanţã a fost favorabilã în toate cazurile cu excepţia cazului de carcinom care a decedat dupã 14 luni de la reintervenţie. Concluzii: În pofida raritãţii şi dificultãţilor de diagnostic a cazurilor de AP, practicienii trebuie sã fie conştienţi de posibilitatea existenţei acestor leziuni în vederea unui tratament cât mai precoce şi adecvat în care chirurgia reprezintã standardul de aur. Original Article IntroductionPrimary hyperparathyroidism (PHP) is the third most common endocrine disorder after diabetes mellitus and thyroid illnesses, the case studies showing an estimated prevalence in general population of 0,5-1% and an annual incidence of 28 cases per 100000 people (1,2,3). Single gland sporadic parathyroid adenoma (PA) represents the most frequent cause (85-90%) of PHP cases. In the other affected patients hyperplasia, carcinoma and familial forms can occur (4,5). Demographics and clinical characteristics of PA underwent a dramatic change in the 1970s with the widespread availability of serum calcium screening by the multichannel autoanalyzer (6,7). Therefore the rare classical observations of PA diagnosed by consecrated clinical tetrad "painful bones, renal stones, abdominal groans and psychic moans" and objectification of hipercalcemia, become actually a common endocrine disease, 80% of cases appearing asymptomatic a...

Laparoscopic total gastrectomy for concurrent gastric cancer and complete agenesis of the dorsal pancreas

“…Nine cases of cancer with ADP, including our present case, have been reported 1,[4][5][6][7][8][9] during the past decade (Table 1). This cohort comprised six men and three women with a median age of 51 years (range, 29-72 years).…”

“…Most ADP cases are asymptomatic; the malformation is usually found incidentally during abdominal imaging and detailed examination of the abdominal cavity. 7,9 The patients with ADP may present with diabetes mellitus; hyperglycemia is reported in ~50% of patients with ADP, 5 while only one patient had diabetes mellitus. Although patients with ADP may have sporadic cancers, they have accompanying diabetes mellitus or pancreatitis, which may be associated with the occurrence of pancreatic cancer or ampullary carcinoma.…”

Clinical profile and outcome of parathyroid adenoma-associated pancreatitis

“…Similarly, Diaconescu et al . [29] showed that postoperative clinical and humoral outcome was favorable in all patients with parathyroid adenoma. Following parathyroidectomy, which is the definitive treatment for PHPT, PTH levels normalize within 30 h, while the serum calcium concentration reaches its lowest point in about 24–36 h.[30] With the eventual normalization of the serum calcium levels, there is no premature activation of trypsinogen to trypsin in the pancreatic acinar cells, thereby preventing further attacks of pancreatitis.…”

Case report: Successful treatment of a rare case of combined parathyroid adenoma, cervical bronchogenic cyst, and tracheal diverticulum with gasless endoscopic resection of neck masses via an axillary approach: A case report and literature review

“…PA is the most frequent cause of hyperparathyroidism, accounting for 80-85% of cases, which is usually manifested by elevations in serum parathyroid hormone (PTH) and serum calcium levels (1). Bronchogenic cysts are congenital cystic lesions of the bronchus that occur preferentially in the mediastinum and lung.…”