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

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.

scholarly journals Concomitant case of thyroid nodule with parathyroid adenoma - a case report

2021 ◽  
Vol 8 (2) ◽  
pp. 743
Author(s):  
Ramesh Mahadev Tambat ◽  
R. Rajashekhar Rao ◽  
A. V. Kulkarni ◽  
Rekha V. S. ◽  
Anchita Bhattacharya
Keyword(s):  
Thyroid Nodule ◽  
Parathyroid Adenoma ◽  
Thyroid Nodules ◽  
Symptomatic Treatment ◽  
Thyroid Disorder ◽  
Parathyroid Adenomas ◽  
History Of ◽  
Almost All ◽  
Preoperative Work Up ◽  
Work Up

Coexistence of PHPT in patients with thyroid nodules can complicate patient management if associated with undetected hypercalcemia or unrecognized thyroid cancer. It is an uncommonly diagnosed condition, due to overlapping symptoms in developing countries like India and almost all patient get symptomatic treatment. A 47-year-old female patient presented a history of progressively increasing swelling in the thyroid region associated with continuous dull ache and whose was diagnosed as thyroid nodule with parathyroid adenoma. Thyroidectomy with parathyroidectomy is the preferred modality of treatment for thyroid disorder with additional parathyroid adenoma. The thyroid nodules should be carefully evaluated during the preoperative work-up of a patient with primary hyperparathyroidism. Both MIBI and neck USG should be done in the evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously to locate the parathyroid adenomas.  

scholarly journals Night Sweats as the Presenting Symptom of Primary Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A207-A207
Author(s):  
Vanessa Williams ◽  
Hadoun Jabri ◽  
Michael G Jakoby
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Vasomotor Symptoms ◽  
Temperature Threshold ◽  
Hot Flushes ◽  
Parathyroid Surgery ◽  
Intact Pth ◽  
Patient Reported ◽  
Night Sweats

Abstract Background: Approximately 25–40% of patients report night sweats in the previous month during appointments with their primary care clinicians. The differential diagnosis for night sweats is broad, with hyperthyroidism, carcinoid syndrome, pheochromocytoma, medullary thyroid carcinoma, insulinoma, and acromegaly as established endocrine causes. We present a case of primary hyperparathyroidism (PHPT) in which the patient’s chief complaint was night sweats and resolution occurred after parathyroidectomy. Case. A 39-year-old female reported one-year of daily night sweats that required changes of clothes and bedding. She denied excessive daytime sweating, frequent palpitations, tremors, nightmares, rashes, fevers, chills, cough, headaches, dizziness, abdominal pain, diarrhea, disrupted menses, or unintentional weight loss. Vital signs and examination were unremarkable. Hypercalcemia (11.0 mg/dL, 8.6–10.3) was noted and confirmed by additional serum calcium measurements. Intact PTH ranged from 27–33 pg/mL (12–88), and 24 h urine calcium (258 mg) excluded familial hypocalciuric hypercalcemia (FHH). Parathyroid scintigraphy and neck ultrasound identified a left neck mass, and the patient underwent successful resection of a left inferior parathyroid adenoma. Hypercalcemia and night sweats initially resolved after surgery, but the patient returned six weeks later with recurrence of night sweats. Reevaluation was notable for serum calcium 10.4 mg/dL, phosphorus 2.4 mg/dL (2.5–5.0), and intact PTH 104 pg/mL. A right superior parathyroid adenoma was identified on repeat parathyroidectomy, and the patient experienced durable resolution of night sweats and hypercalcemia following her second parathyroid surgery. She was screened for multiple endocrine neoplasia type 1 (MEN1) due to multiple parathyroid tumors, though no known pathogenic menin gene variants were identified. Conclusions: A title/abstract search in PubMed linking “hyperparathyroidism” and “hypercalcemia” to “night sweats,” “sleep hyperhidrosis,” “sweating,” “hot flashes,” “hot flushes,” “diaphoresis” and “vasomotor symptoms” yielded only one relevant case of a postmenopausal woman with hot flushes unresponsive to hormone replacement that resolved after parathyroidectomy for PHPT. Hypercalcemia is known to affect central nervous system function. It is possible that in rare cases hypercalcemia alters function of the medial preoptic area, lowering the temperature threshold above which peripheral vasodilatation and perspiration occur to dissipate heat. The patient’s predisposition to only night sweats is unclear, though unlike the first patient reported with PHPT and sweating, our patient is premenopausal. This case indicates that vasomotor symptoms may occur with PHPT and resolve after successful parathyroid surgery.

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

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.

scholarly journals SAT-LB65 A Rare Existence

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

scholarly journals Sporadic primary hyperparathyroidism with multiple parathyroid adenomas

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.

scholarly journals Undescended retropharyngeal parathyroid adenoma with adjacent thymic tissue in a 13-year-old boy with primary hyperparathyroidism

2019 ◽  
Vol 2019 (12) ◽  
pp. 519-523 ◽  
Author(s):  
Anthony M Kordahi ◽  
Ron S Newfield ◽  
Stephen W Bickler ◽  
Jun Q Mo ◽  
Paritosh C Khanna ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
Parathyroid Adenoma ◽  
Pharyngeal Pouch ◽  
Rare Presentation ◽  
Thymic Tissue ◽  
The Third ◽  
Parathyroid Adenomas ◽  
Preoperative Ct ◽  
Third Pharyngeal Pouch

ABSTRACT We describe a rare presentation of a symptomatic parathyroid adenoma located in an ectopic retropharyngeal position in a 13-year-old boy. Preoperative CT scan and MRI demonstrated the ectopic location of the parathyroid adenoma. The patient underwent successful parathyroidectomy with cure of his hyperparathyroidism. On pathologic exam, the specimen was made up of a parathyroid adenoma and adjacent thymic tissue, indicating that it was likely an undescended lower parathyroid gland arising from the third pharyngeal pouch. Ectopic retropharyngeal parathyroid adenomas are very rare and to our knowledge, none have been previously described in adolescents.

scholarly journals RE-OPERATIVE SURGERY FOR RECURRENT PRIMARY HYPERPARATHYROIDISM ASSOCIATED WITH OLIGOMENORRHEA

2015 ◽  
Vol 2 (3) ◽  
pp. 140-143
Author(s):  
Ana Valea ◽  
V. Muntean ◽  
Andra Morar ◽  
Mara Carsote ◽  
Cristina Căpățînă ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Female Patient ◽  
Clinical Symptoms ◽  
Major Incident ◽  
Operative Surgery ◽  
Parathyroid Adenomas ◽  
History Of ◽  
Normal Calcium

Recurrent primary hyperparathyroidism is characterized by typical symptoms and biochemical recurrence of hypercalcemia after more than 6 months of normal calcium levels after surgery. We report the case of a 39-year-old female patient presenting with menses disturbances who was diagnosed with primary hyperparathyroidism caused by a left inferior parathyroid adenoma at the age of 35. Postoperative 6-month follow-up showed normalization of biochemical and hormonal profiles, with significant improvement of clinical symptoms, dominated by muscle weakness, weight loss and oligomenorrhea. The 18-month follow-up showed elevated PTH and serum calcium levels. Imaging confirmed recurrence of primary hyperparathyroidism by highlighting a right upper parathyroid adenoma. Surgery was performed again and no major incident was seen. The particularity of this case consists in the recurrence of primary hyperparathyroidism in a young patient with no family history of the disease due to asynchronous parathyroid adenomas that were successfully removed in a female patient who in addition to classic complications such as calyceal microlithiasis and osteoporosis presented oligomenorrhea which was resolved spontaneously after the correction of hypercalcemia.

Escisión transcervical de un adenoma paratiroideo mediastínico gigante

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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