Sporadic primary hyperparathyroidism with multiple parathyroid adenomas

E. E. Bibik; A. K. Eremkina; O. A. Knyazeva; N. G. Mokrysheva

doi:10.14341/probl12798

Sporadic primary hyperparathyroidism with multiple parathyroid adenomas

Problems of Endocrinology ◽

10.14341/probl12798 ◽

2021 ◽

Vol 67 (6) ◽

pp. 31-38

Author(s):

E. E. Bibik ◽

A. K. Eremkina ◽

O. A. Knyazeva ◽

N. G. Mokrysheva

Keyword(s):

Primary Hyperparathyroidism ◽

Life Quality ◽

Dynamic Monitoring ◽

Postoperative Hypocalcemia ◽

Target Organs ◽

Parathyroid Adenomas ◽

Active Observation ◽

Sporadic Primary Hyperparathyroidism ◽

The Right ◽

Hungry Bone

Multiple lesions of the parathyroid glands (PTG) in primary hyperparathyroidism (PHPT) can be sporadic or develop as part of hereditary syndromes, manifesting at young age. There the description of a severe sporadic PHPT with big parathyroid neoplasms in the young patient is presented. Clinical data made it possible to suspect MEN-1 syndrome or parathyroid carcinomas; however, mutations CDKN, CDC73, MEN1 were excluded. The patient underwent removal of three identified tumors: benign adenomas of the left PTG and hyperplasia of the right one. Postoperative hypocalcemia and severe hungry bone syndrome required the administration of vitamin D and calcium carbonate preparations. However, a year after the operation, a «mild» recurrent disease was confirmed. Taking into account the patient’s refusal to reoperation and a significant improvement of the target organs state, active observation was continued. The patient needs further careful dynamic monitoring by specialists in order to timely identify indications for repeated surgical treatment to improve the life quality and span.

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Rare Case of Severe Hypercalcemia Secondary to Atypical Sestamibi Negative Parathyroid Cystic Adenoma

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.540 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A266-A267

Author(s):

Timur Gusov ◽

John Chen Liu ◽

Sowjanya Naha ◽

F N U Marium ◽

Joseph Theressa Nehu Parimi ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Parathyroid Gland ◽

Severe Hypercalcemia ◽

Parathyroid Adenomas ◽

Sestamibi Scan ◽

Serum Pth ◽

The Right ◽

99Mtc Sestamibi ◽

Cystic Adenoma

Abstract Primary hyperparathyroidism (PHPT) is defined as excessive secretion of parathyroid hormone (PTH) originating from the parathyroid gland. The most common cause is a single parathyroid adenoma which is typically solid. Cystic parathyroid adenomas (CPA) are the cause of about 1–2% of cases of primary hyperparathyroidism. It is known that cystic parathyroid adenomas are a result of degeneration of an existing parathyroid adenoma. SestaMIBI is an imaging study based on uptake of radioactive technetium99 and used to localize parathyroid adenomas. We describe an unusual case of severe hypercalcemia secondary to 99mTc sestaMIBI negative atypical parathyroid cystic adenoma. A 56-year-old male presented to our facility with nausea and vomiting. His past medical history included hypertension and hepatitis C with no history of fractures or kidney disease. Physical examination was normal. Upon admission the patient was afebrile with blood pressure of 170/120 mmHg and heart rate of 62 bpm. Chemistry showed Calcium of 14.5 mg/dL (8.6–10.2mg/dL), phosphorus 2.2 (2.7–4.5) mh/dL, magnesium 1.8 (1.7–2.6)mg/dL, intact PTH of 375 (15–65) pg/mL, PTH-related peptide <2.0 pmol/L(<2 pmol/L), 25-OH vitamin D of 19 ng/ml (30–80), Creatinine 1.22 (0.7–1.2)mg/dL, alkaline phosphatase 95 (40–129) units/L. He was started on aggressive hydration, calcitonin 4 units/kg, 4 mg of IV Zolendroninc acid. Neck sonogram revealed a large, complex, predominantly anechoic lesion with solid vascular components and thick internal septations in the inferior and medial aspect of the right thyroid lobe measuring 3 x 2 x 5.5 cm. Findings were confirmed with CT of the neck. Since Sestamibi scan (planar and SPECT/CT) did not show uptake in parathyroid glands, the cyst was thought to be of thyroid origin. Fine needle aspiration was not able to detect cellular material, but PTH was >100 pg/ml on the FNA sample. Otolaryngology service was consulted for parathyroidectomy. During the surgical treatment, the right upper parathyroid gland was removed with no changes in serum PTH. Next, the cystic lesion was removed with normalization of serum PTH (from 218 pg/ml to 35.2 pg/ml respectively). Intraoperative frozen section analysis was read as a cystic parathyroid adenoma. The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia. Hypercalcemia resolved. Conclusions: Atypical cystic parathyroid adenomas are a rare cause of PHPT. 90% of parathyroid cysts are nonfunctional. Above mention is a case of a patient presenting with hypercalcemic crisis secondary to cystic parathyroid adenoma, which posed a diagnostic challenge as both neck ultrasound and 99mTc sestaMIBI scan were inconclusive. These findings should trigger suspicion for functional parathyroid lesions. Cystic components should be evaluated for PTH levels and if significantly elevated should be treated as a parathyroid adenoma.

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SAT-LB65 A Rare Existence

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1998 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jiselle Aimee Yaplito Bedia ◽

Maria Honolina S Gomez

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Clinical Presentation ◽

Renal Involvement ◽

Preoperative Imaging ◽

Biochemical Screening ◽

Central Target ◽

Target Organs ◽

Postoperative Hypoparathyroidism ◽

Parathyroid Adenomas

Abstract Primary hyperparathyroidism is a common endocrine disorder of metabolism usually due to a parathyroid adenoma. Although, the clinical presentation of primary hyperparathyroidism has changed from Albright’s description of a disease of bones and stones, the central target organs affected by this disorder continue to be the skeleton and kidneys. With the advent of routine biochemical screening, the typical diagnosis of primary hyperparathyroidism is no longer accompanied by overt skeletal and renal involvement. Majority of the cases of primary hyperparathyroidism are due to parathyroid adenomas. Giant glands were defined as greater than the 95th percentile, characterized as glands weighing > 3.5 grams. This present case in a 54-year old female is a rare case of primary hyperparathyroidism secondary to a giant parathyroid adenoma measuring 10.7 x 8.0 x 40.0 cm and weighing 145 grams, the largest giant parathyroid adenoma reported to date, with co-existent silent thymoma, multinodular goiter and osteosclerosis of the vertebral spine, metaphorically known as the “rugger-jersey spine”. The association between thymoma and parathyroid adenoma is rare, and only 3 cases have been reported in the literature. We characterized the correlation of preoperative imaging, intraoperative location, and postoperative course, including significant postoperative hypoparathyroidism, as compared to other patients with PHPT to determine whether giant adenomas represent a clinical entity with distinct clinical characteristics. Keywords: primary hyperparathyroidism, giant parathyroid adenoma, rugger-jersey spine, thymoma Abbreviation PHPT Primary hyperparathyroidism

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Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends

International Journal of Endocrinology ◽

10.1155/2011/921814 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 36

Author(s):

P. V. Pradeep ◽

B. Jayashree ◽

Anjali Mishra ◽

S. K. Mishra

Keyword(s):

Primary Hyperparathyroidism ◽

Western World ◽

Symptomatic Disease ◽

Gland Weight ◽

Vitamin D Levels ◽

Parathyroid Adenomas ◽

The Status ◽

Hungry Bone ◽

Asymptomatic Disease ◽

Related Mortality

Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.

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Escisión transcervical de un adenoma paratiroideo mediastínico gigante

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2021.64.2.06 ◽

2021 ◽

Vol 64 (2) ◽

pp. 38-45

Author(s):

Isaías Adrián Barrientos López ◽

◽

Bertha Beatriz Castillo Ventura ◽

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Thyroid Lobe ◽

Selective Treatment ◽

Case Presentation ◽

Parathyroid Adenomas ◽

History Of ◽

Thyroid Profile ◽

The Right ◽

Similar Location

Primary hyperparathyroidism (HPTP) is the third most common neuroendocrine disorder, its main cause is parathyroid adenoma. Within the classification, those adenomas that weigh more than 3.5 g are classified as giant parathyroid adenomas (APG), and are associated with a worse evolution and malignancy. The purpose of this article is to present our diagnostic and therapeutic approach of a patient with HPTP ssociated with a mediastinal APG. A search in the international literature of the last 10 years revealed that only 8 other centers ha ve reported the extraction of an APG of similardimensions to ours and in a similar location. Case presentation: A 66-year-old woman with a history of multinodular goiter, thyroid profile and parathormone (PTH) measurement were requested, with a report of 350.60 pg/mL. A thyroid/parathyroid scintigraphy was performed with 99mTc sestaMIBI which reported persistence of a focal area of the concentration located in the topography of the lower pole of the right thyroid lobe. This study was complemented with SPECT-CT, which reported an image of hyperfunctioning right inferior parathyroid compatible with adenoma and the patient was diagnosed with PTH. Finally, resection was performed, obtaining a tumor measuring 7.0 × 4.5 × 2.0 cm, with a weight of 24.5 g. Conclusions: Our case highlights the use of imaging studies to facilitate localization and achieve diagnosis together with clinical presentation and biochemical profile. Selective treatment was achieved safely through a minimally invasive transcervical technique, combined with the measurement of PTH. Keywords: Parathyroid adenoma; neoplasia; hypercalcemia; primary hyperparathyroidism; case report.

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POSTOPERATIVE HYPOCALCEMIA FOLLOWING PARATHYROIDECTOMY FOR GIANT PARATHYROID ADENOMA

AACE Clinical Case Reports ◽

10.4158/accr-2020-0474 ◽

2020 ◽

Vol 6 (6) ◽

pp. e352-e356

Author(s):

Rishi Raj ◽

Adele Amine ◽

Demetrios Herodotou

Keyword(s):

Parathyroid Adenoma ◽

Calcium Supplementation ◽

Chronic Fatigue ◽

Postoperative Hypocalcemia ◽

Rare Type ◽

Hungry Bone Syndrome ◽

Contrast Enhanced ◽

The Right ◽

Enhanced Computed Tomography ◽

Hungry Bone

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.

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Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1155 ◽

2015 ◽

Vol 7 (1) ◽

pp. 1-5

Author(s):

Mehmet Uludag ◽

Pinar Yazici ◽

Mehmet Mihmanli ◽

Emre Bozdag ◽

Nurcihan Aygun

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Minimal Invasive ◽

Parathyroid Surgery ◽

Postoperative Hypocalcemia ◽

Chi Square ◽

Parathyroid Adenomas ◽

Operative Notes ◽

Preoperative Work Up ◽

Work Up

ABSTRACT Purpose Preoperative localization studies for parathyroid adenomas are very essential to perform minimal invasive parathyroidectomy (MIP) with decreased operative time and potential complications. Although most of these studies based on radiological imaging, intraoperative assessment provides the most accurate anatomical description of the location of parathyroid adenomas. In this study, we aim to evaluate the surgical variations of locations of parathyroid adenomas in patients performed parathyroid surgery for primary hyperparathyroidism (PHPT). Materials and methods Between January 2010 and December 2013, 243 patients (201 women/42 men) who underwent parathyroid surgery due to phPT were included. A total of 254 parathyroid adenomas were detected. Demographic features, preoperative work-up, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using t-test and chi-square. continuous data are expressed as mean ± standard deviation. Results With regard to the most frequently observed, location of adenomas were as follows; right inferior (n = 89, 37.7%), left inferior (n = 78, 33%), right superior (n = 44, 18.6%), left superior (n = 25, 10.5%) and ectopic locations (n = 18). Ectopic adenomas were mostly located in the thymus (n = 9) and intrathyroidal tissue (n = 6) at a rate of 83%. Postoperative hypocalcemia (11%) was mostly seen in those with parathyroid adenoma located around the inferior lobes of the thyroid (86%) and undergoing bilateral neck exploration (75%). Conclusion The most of the parathyroid adenomas were found in orthotopic position and located around the lower pole of the thyroid gland. Ectopic adenomas were mostly located in thymus or intrathyroidal. Postoperative hypocalcemia was also higher in those with parathyroid adenoma located around the inferior lobe of the thyroid. How to cite this article Yazici P, Mihmanli M, Bozdag E, Aygun N, Uludag M. Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look? World J Endoc Surg 2015;7(1):1-5.

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