Surgical treatment of double parathyroid adenomas in primary hyperparathyroidism: A clinical case

Ильичева, Е. А.; Bersenev, Gleb A.

doi:10.1016/j.ijscr.2020.08.063

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Solitary parathyroid adenoma is the most common cause of primary hyperparathyroidism; accounting for 85-90% of all cases [1]. However, multiple parathyroid adenomas are reported to occur in 2-11% of all primary hyperparathyroidism cases making it a rare entity [2]. Other causes of primary hyperparathyroidism include parathyroid hyperplasia (15% prevalence) and parathyroid carcinoma (1% prevalence) [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…However, multiple parathyroid adenomas are reported to occur in 2-11% of all primary hyperparathyroidism cases making it a rare entity [2]. Other causes of primary hyperparathyroidism include parathyroid hyperplasia (15% prevalence) and parathyroid carcinoma (1% prevalence) [1][2][3]. Primary hyperparathyroidism is defined as abnormally high serum parathyroid hormone (PTH) levels due to overactivity of the parathyroid gland.…”

Section: Introductionmentioning

confidence: 99%

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The Co-occurrence of Multiple Parathyroid Adenomas: A Case Report

Alani¹,

Awai²,

Yetukuri³

et al. 2022

Cureus

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Solitary parathyroid adenoma is the most common cause of primary hyperparathyroidism; however, multiple parathyroid adenomas are an uncommon phenomenon. In this case report, we discuss a patient presenting with two concurrent ipsilateral parathyroid adenomas, and we review the literature. A 61-year-old African American female with a history of hypertension and kidney stones presented for the evaluation of hypercalcemia. Elevated serum calcium of 11 mg/dL was found on routine laboratory tests and low25 hydroxyvitamin-D level. Parathyroid hormone (PTH) was elevated at 172.5 pg/mL and increased to 443 pg/mL after correction of vitamin D deficiency. Renal function tests and thyroid function tests revealed normal findings. Imaging studies with 99mTc-Sestamibi scintigraphy raised concern for the possibility of either a parathyroid adenoma or hyperplasia. Minimally invasive parathyroidectomy with intraoperative PTH monitoring was planned. During surgery, the right superior parathyroid gland was found to be enlarged and was excised. However, intraoperative PTH monitoring showed an initial decrease to 203 pg/mL from a baseline of 443 pg/mL and a subsequent increase to 293 pg/mL suggesting the persistence of hyperparathyroidism. Further exploration of the neck revealed an enlarged right inferior parathyroid gland and two normal left parathyroid glands. Intraoperative PTH monitoring then revealed an appropriate decrease in PTH level to 56 pg/mL 10 minutes after excision of the right inferior parathyroid gland. More than a 50% decrease in PTH was achieved, and further exploration of the opposite side revealed no evidence of four-gland hyperplasia. Pathology reported two concurrent right superior and inferior parathyroid adenomas. Successful and curative parathyroidectomy for primary hyperparathyroidism was achieved. Although rare, multiple parathyroid adenomas occur in a significant minority of cases. Intraoperative PTH monitoring along with preoperative imaging provides guidance for curative parathyroidectomy. Additionally, more sensitive imaging such as four-dimensional computed tomography scans could lead to better localization, visualization, and identification of the second parathyroid adenoma.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Co-occurrence of Multiple Parathyroid Adenomas: A Case Report

Alani¹,

Awai²,

Yetukuri³

et al. 2022

Cureus

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“…PHPT was first described approximately 90 years ago and has evolved from a severe disease characterized by the expression "stones, bones, and groans" (which refers to clinical manifestations of urolithiasis, osteopenia, and gastrointestinal disturbances, respectively) to a generally asymptomatic entity that is discovered fortuitously [2]. In most cases (80%), PHPT is caused by a single adenoma of one of the parathyroid glands; 10 to 11% of patients have more than one adenoma; another 10% have four-glands hyperplasia, and less than 1% of PHPT cases are caused by parathyroid carcinoma [3]. In recent years, it has been proposed that double adenomas represent a different clinical entity, and they should not be confused with an asynchronous form of multiglandular hyperplasia [4].…”

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confidence: 99%

Bilateral giant parathyroid adenoma and hungry bone syndrome: a case report

Martínez-Loya,

Granados-Gutiérrez,

Torrens-Chacón

et al. 2023

J Med Case Reports

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Background There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among them is not straightforward. Case presentation We described a case of primary hyperparathyroidism (PHPT) with pronounced clinical manifestations, caused by a bilateral giant parathyroid adenoma. A 34-year-old Hispanic/Latino male was diagnosed with PHPT caused by two giant parathyroid adenomas. The preoperative tests were neck ultrasound and computed tomography scan (CT-scan), showing two masses in the territory of parathyroid glands, bilaterally distributed (right was 31 × 18 × 19 mm and the left was 38 × 15 × 14 mm); sestamibi scan was not available. Parathyroid hormone (PTH) was highly elevated. Multiple complications of PHPT were present, such as bone lytic lesions, renal and pancreatic calcifications, and cardiovascular disease, the latter of which is an overlooked complication of PHPT. Multiple endocrine neoplasia 1 and 2 (MEN 1/2) were ruled out by the absence of clinical, biochemical, and radiological findings in other endocrine glands. The patient underwent subtotal parathyroidectomy with an intraoperative histopathological study; both intraoperative and definitive histopathology results were consistent with parathyroid adenomas; afterward, adequate suppression of PTH was assured, and later on, the patient presented hungry bone syndrome (HBS). Conclusions The diagnosis of double parathyroid adenomas is difficult. Regarding the similarities between multiglandular hyperplasia and parathyroid adenomas, this case report contributes to the further distinction between these two clinical entities. This case report also represents, in particular, the challenge of difficult diagnosis in places with limited resources, such as developing countries.

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Sonography of Dual and Multiple Parathyroid Adenomas in Sporadic Primary Hyperparathyroidism

Singhal

2023

Atlas of Sonography of Parathyroid

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Surgical treatment of double parathyroid adenomas in primary hyperparathyroidism: A clinical case

Cited by 3 publications

References 13 publications

The Co-occurrence of Multiple Parathyroid Adenomas: A Case Report

The Co-occurrence of Multiple Parathyroid Adenomas: A Case Report

Bilateral giant parathyroid adenoma and hungry bone syndrome: a case report

Sonography of Dual and Multiple Parathyroid Adenomas in Sporadic Primary Hyperparathyroidism

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