Distribution of the solitary adenoma over the parathyroid glands

1997 ◽  
Vol 111 (5) ◽  
pp. 459-460 ◽  
Author(s):  
F. Debruyne ◽  
F. Ostyn ◽  
P. Delaere
Keyword(s):  
Statistical Analysis ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Histological Examination ◽  
Surgical Procedure ◽  
Random Distribution ◽  
Parathyroid Glands ◽  
Solitary Adenoma

AbstractOne hundred and ten patients with primary hyperparathyroidism were studied, in which a normal parathyroid gland was found on the same side as an adenoma (both confirmed by histological examination), and the upper or lower location could clearly be defined during surgery. The distribution of the adenomas over the upper and lower glands was unequal: 61.8 per cent in the superior versus 38.2 per cent in the inferior position. Statistical analysis revealed that this is not a random distribution (p = 0.013). The explanation of this relative predilection is unknown. The finding should not influence the surgical procedure for primary hyperparathyroidism

scholarly journals Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Fernando Mendoza-Moreno ◽  
Ángel Rodriguez-Pascual ◽  
María Rocío Díez-Gago ◽  
Marina Pérez-González ◽  
Laura Jiménez‐Alvárez ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Imaging Techniques ◽  
High Sensitivity ◽  
Parathyroid Glands ◽  
Parathyroid Surgery ◽  
Thyroid Lobe ◽  
The Impact ◽  
Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

scholarly journals Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review

2012 ◽  
Vol 56 (6) ◽  
pp. 393-403 ◽  
Author(s):  
Sofia Gouveia ◽  
Dírcea Rodrigues ◽  
Luísa Barros ◽  
Cristina Ribeiro ◽  
Anabela Albuquerque ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Median Sternotomy ◽  
Parathyroid Glands ◽  
Aortopulmonary Window ◽  
Genetic Syndromes ◽  
Subtotal Parathyroidectomy ◽  
Common Causes ◽  
Ectopic Parathyroid ◽  
99Mtc Sestamibi

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99mTc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window.

scholarly journals Parathyroid gland adenoma: Case report

2003 ◽  
Vol 56 (7-8) ◽  
pp. 377-380
Author(s):  
Gradimir Bojkovic ◽  
Zorica Caparevic ◽  
Dragos Stojanovic ◽  
Djordje Lalosevic ◽  
Mirjana Stojanovic
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Parathyroid Glands ◽  
Simultaneous Occurrence ◽  
Thyroid Adenoma ◽  
Treatment Efficiency ◽  
Laboratory Screening ◽  
Partial Thyroidectomy ◽  
Excessive Secretion

Introduction Primary hyperparathyroidism is a generalized disorder resulting from excessive secretion of parathyroid hormone involving one or more parathyroid glands. Both familial and sporadic forms exist. Histologic examination reveals parathyroid adenoma in about 90% of patients, although it is sometimes difficult to distinguish an adenoma from a normal gland. Primary hyperparathyroidism is commonly characterized by hypercalcaemia, hypophosphatemia and excessive bone resorption. Case report This is a case report of a 52-year old female patient with toxic thyroid adenoma and a parathyroid gland adenoma. The patient underwent partial thyroidectomy as a method of choice in treatment of toxic thyroid adenoma. Two years later, clinical hyperparathyroidism caused by an adenoma of parathyroid gland has manifested and was surgically removed. Discussion and conclusion In mild hypercalcaemia, many patients are asymptomatic and this condition is frequently discovered accidentally during routine laboratory screening. In order to provide operative treatment efficiency in thyroid nodule cases, besides thyroid gland morphological diagnostics, it is necessary to perform a preoperative verification of parathyroid glands as well. This diagnostic approach is essential in identifying possible simultaneous occurrence of multiple diseases, such as: thyroid and adenoma of parathyroid gland, in order to diminish incorrect diagnostic estimates.

scholarly journals Parathyroid Adenoma - From Surgical to Biochemical Cure

2021 ◽  
Vol 10 (23) ◽  
pp. 1809-1814
Author(s):  
Rupa Mehta ◽  
Nitin M. Nagarkar ◽  
Satish S.S. ◽  
Ripu Daman Arora ◽  
Jyoti Ranjan Das
Keyword(s):  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Neck Mass ◽  
The Body ◽  
Parathyroid Glands ◽  
Posterior Aspect ◽  
Biochemical Cure ◽  
High Index Of Suspicion

Parathyroid glands, minute endocrine glands, located in posterior aspect of thyroid glands secrete parathormone which plays an important role in maintaining calcium homeostasis in the body. The superior and inferior parathyroid glands originate from the 4th and 3rd branchial pouches respectively and migrate to occupy their normal positions in relation to the thyroid gland.1 Hyperparathyroidism is defined as hyper functioning of parathyroid gland and can be primary, secondary or tertiary. Primary hyperparathyroidism is due to parathyroid gland proliferative disorders which include parathyroid adenoma, parathyroid hyperplasia, parathyroid carcinoma or in association with other conditions in MEN syndrome. In more than 90 % patients, primary hyperparathyroidism is caused by a single parathyroid adenoma. Very rarely double parathyroid adenomas are seen. Secondary Hyperparathyroidism is caused in response to any chronic hypocalcaemic conditions like renal failure, gastrointestinal malabsorption, dietary rickets & drugs, like phenytoin, phenobarbital & laxative. Prolonged secondary hyperparathyroidism leads to tertiary hyperparathyroidism due to autonomous secretion. The clinical presentation of hyperparathyroidism is classically described as kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. In the initial course of the disease, the patients present with vague symptoms of fatigue, muscle and joint pain, frequent urination, nausea, constipation, and decreased appetite. If high index of suspicion is maintained, they can be conveniently diagnosed by routine blood tests which show increased calcium levels. However, in India still majority of people are diagnosed when they present with palpable neck mass, skeletal manifestations or deranged renal function. We hereby present 5 cases of parathyroid adenoma managed at our centre over a period of 2 years. P

scholarly journals Preventing blind thyroid lobectomy in patients with intrathyroidal hyperfunctioning parathyroid glands with radioguided enucleation

2020 ◽  
Vol 7 (1) ◽  
pp. IJE28
Author(s):  
Sophie Dream ◽  
Brenessa Lindeman ◽  
Herbert Chen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Gamma Probe ◽  
Parathyroid Glands ◽  
Radioguided Surgery ◽  
Thyroid Lobectomy ◽  
Abnormal Parathyroid Gland ◽  
Thyroid Parenchyma

Aim: Hyperfunctioning intrathyroidal parathyroid glands are rare and often result in thyroid lobectomy. This study examines the utility of radioguided surgery to guide enucleation of intrathyroidal parathyroids. Methods: Between December 2002 and March 2018, 2291 patients underwent parathyroidectomy by one surgeon for primary hyperparathyroidism. A total of 74 (3%) patients had an ectopic intrathyroidal parathyroid gland and underwent radioguided. Results: All of intrathyroidal parathyroid glands were localized with the gamma probe. In vivo radionuclide counts were above 120% of the background in all but three patients. All intrathyroidal parathyroids were enucleated with the guidance of the gamma probe. Conclusion: Radioguided surgery is useful for intraoperative identification of hyperfunctioning, intrathyroidal parathyroid glands. This technique allows for enucleation of the abnormal parathyroid gland, avoiding thyroid lobectomy and preserving healthy thyroid parenchyma.

scholarly journals The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

Biomedicines ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 123
Author(s):  
Łukasz Obołończyk ◽  
Izabela Karwacka ◽  
Piotr Wiśniewski ◽  
Krzysztof Sworczak ◽  
Tomasz Osęka
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Clinical Symptoms ◽  
Imaging Techniques ◽  
Preoperative Assessment ◽  
Threshold Level ◽  
Shape Index ◽  
Fine Needle Biopsy ◽  
Parathyroid Glands ◽  
Safe Procedure

Introduction. Primary hyperparathyroidism (PHPT) is a condition characterized by disorders of calcium–phosphate metabolism and bone metabolism caused by pathological overproduction of parathyroid hormone (PTH). The diagnosis of overt PHPT is based on the presence of clinical symptoms and laboratory abnormalities typical of this condition: hypercalcemia, hypercalciuria and elevated iPTH levels. Imaging studies are not used for diagnostic purposes; they are performed to localize the parathyroid glands prior to potential surgical treatment. Technetium 99 m sestamibi scintigraphy (Tc99 m-MIBI) is the gold standard in the assessment of pathologically altered parathyroid glands. Other diagnostic options include cervical ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Parathyroid biopsy (P-FNAB) with iPTH washout concentration (iPTH-WC) assessment is still an underestimated method of preoperative parathyroid gland localization. Few studies have reported the utility of US-guided P-FNAB in preoperative assessment of parathyroid lesions. The aim of the study was to present our experience with 143 P-FNAB with iPTH-WC assessment. Material and methods. Laboratory results, US findings, P-FNAB complications and comparison with other imaging techniques were described and analyzed. Results. In 133 (93.0) patients, iPTH washout-to-serum ratio exceeded threshold level 0.5 and were classified as positive results. Median iPTH-WC in this group was 16,856 pg/mL, and the iPTH-WC to serum iPTH ratio was 158. There was no correlation between iPTH-WC and serum PTH, serum calcium, parathyroid gland volume and shape index. In the group of 46 operated patients, 44 demonstrated positive iPTH-WC results, which corresponds to a sensitivity of 95.6%. In Tc99-MIBI, radiotracer retention was found in 17 cases (in 24 MIBI performed), which corresponds to a sensitivity of 52.2%. P-FNAB did not cause any major side effects −92.5% of all patients had no or mild adverse events after this procedure. Conclusions. P-FNAB with iPTH-WC is a reliable method in parathyroid adenoma localization during PHPT. Its sensitivity for diagnosis of PHPT is much higher than that of Tc99-MIBI, and in some situations, P-FNAB with iPTH-WC may even replace that method. Furthermore, cost-effectiveness of iPTH-WC is at least similar to that of Tc99-MIBI. Complications of P-FNAB are mild and we can describe this method as a safe procedure.

Primary hyperparathyroidism after thyroid surgery and autotransplantion of parathyroid gland

2018 ◽  
Author(s):  
Bernardo Marques ◽  
Raquel Martins ◽  
Joana Couto ◽  
Jacinta Santos ◽  
Teresa Martins ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Thyroid Surgery

Parathyroid glands in primary hyperparathyroidism: An ultrastructural study of 50 cases

1986 ◽  
Vol 17 (10) ◽  
pp. 1036-1046 ◽  
Author(s):  
Saverio Cinti ◽  
Giacomo Colussi ◽  
Ernesto Minola ◽  
G. Richard Dickersin
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ultrastructural Study ◽  
Parathyroid Glands

scholarly journals Advances in the diagnosis and the management of primary hyperparathyroidism

2021 ◽  
Vol 12 ◽  
pp. 204062232110159
Author(s):  
Ana Kashfia Islam
Keyword(s):  
Renal Function ◽  
Parathyroid Hormone ◽  
Bone Loss ◽  
Primary Hyperparathyroidism ◽  
Kidney Stones ◽  
Parathyroid Glands ◽  
Definitive Treatment ◽  
Indications For Surgery ◽  
Musculoskeletal Complaints ◽  
Parathyroid Cancer

The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

Sign in / Sign up

Export Citation Format

Share Document