Postoperative Hypocalcemia Following Parathyroidectomy for Giant Parathyroid Adenoma

Abstract

Objective: Giant parathyroid adenomas (GPAs) are a rare type of parathyroid adenoma (PA) weighing >2 to 3 g. The objective of this manuscript is to report a case of giant parathyroid adenoma and highlight the risk of postoperative hypocalcemia. Methods: We describe the presentation and work-up of a woman with GPA confirmed with histopathology as well as management of postoperative hypocalcemia. Results: A 66-year-old Caucasian female with chronic fatigue was found to have elevated calcium levels at 13.7 mg/dL (normal, 8.9 to 10.2 mg/dL) and elevated parathyroid hormone levels at 1,240 pg/mL (normal, 12 to 72 pg/mL). Contrast enhanced computed tomography scan of the neck showed a 5.6 cm heterogeneous mass posterior to the right thyroid. The patient underwent right parathyroidectomy and histopathology confirmed the diagnosis of a giant parathyroid adenoma (GPA) weighing 28.7 g. Postoperatively, the patient developed hypocalcemia secondary to hungry bone syndrome and was treated aggressively with intravenous calcium supplementation. At 4 weeks postoperatively, she had normal calcium levels without any calcium supplementation. Conclusion: GPAs are a rare variant of PA, and could be a distinct clinical entity with features different from both PA and parathyroid carcinoma. We further postulate that the risk of postoperative hypocalcemia secondary to hungry bone syndrome could be higher among patients with GPA compared to patients with PA. These hypotheses needs to be validated with further studies.

Atypical parathyroid adenomas as a rare cause of primary hyperparathyroidism: In an academic institution experience

“…Unfortunately, recent studies showed that even this method is not very accurate and many patients cannot be diagnosed only upon the results of both of these examinations [10]. APA are extremely rare and have only been described 23 times in literature [12,27]. They lack specific criteria from histopathological point of view, it is not possible to differentiate them from benign adenomas and cancerous lesions neither by imaging methods nor macroscopically.…”

“…They lack specific criteria from histopathological point of view, it is not possible to differentiate them from benign adenomas and cancerous lesions neither by imaging methods nor macroscopically. Microscopically, they have some features of carcinomathey adhere to contiguous structures, bends of fibrosis, solid trabecular growth, mitotic activity, but they do not invade the capsule, what is a hallmark of malignancy [12,13,26]. Although, the lack of specific criteria for histopathologic makes it extremely hard to always correctly diagnose the Atypical Adenoma (APA).…”

Atypical parathyroid adenomas as a rare cause of primary hyperparathyroidism - in an academic institution experience

“…Unfortunately, recent studies showed that even this method is not very accurate and many patients cannot be diagnosed only upon the results of both of these examinations [10]. APA are extremely rare and have only been described 23 times in literature [12,27]. They lack speci c criteria from histopathological point of view, it is not possible to differentiate them from benign adenomas and cancerous lesions neither by imaging methods nor macroscopically.…”

“…They lack speci c criteria from histopathological point of view, it is not possible to differentiate them from benign adenomas and cancerous lesions neither by imaging methods nor macroscopically. Microscopically, they have some features of carcinoma -they adhere to contiguous structures, bends of brosis, solid trabecular growth, mitotic activity, but they do not invade the capsule, what is a hallmark of malignancy [12,13,26].…”

An Executive Summary of The Philippine Interim Clinical Practice Guidelines for the Diagnosis and Management of Well Differentiated Thyroid Cancer 2021

“… 60 Clearance of Levels II–V is associated with a lower risk of recurrence. 61 The role of therapeutic lymph node dissection for treatment of thyroid cancer nodal metastases is well-accepted for the clinically positive or cN1 disease, but the value of routine prophylactic Level VI (central) neck dissection and lateral neck dissection for cN0 disease remains unclear. 10 , 11 , 42 , 53 - 55 There are limited data to prove that prophylactic dissection of microscopic PTC LNM improves disease-specific outcomes.…”