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Journal of Medical Case Reports Nov 2019Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated... (Review)
Review
BACKGROUND
Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East.
CASE PRESENTATION
A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised.
CONCLUSIONS
Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.
Topics: Female; Humans; Hyperparathyroidism; Middle Aged; Neck; Neck Dissection; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Treatment Outcome; Ultrasonography
PubMed: 31722742
DOI: 10.1186/s13256-019-2257-7 -
Frontiers in Endocrinology 2023The malignant potential and molecular signature of atypical parathyroid adenoma (APA) remain elusive. Data from Asia are still lacking.
CONTEXT
The malignant potential and molecular signature of atypical parathyroid adenoma (APA) remain elusive. Data from Asia are still lacking.
DESIGN AND SETTING
This was a retrospective study on a large APA cohort in a single center from mainland China.
METHODS
A total of 320 patients with primary hyperparathyroidism (PHPT), containing 79 APA, 79 Parathyroid cancer (PC) and 162 benign lesions cases, were enrolled after surgery for collection of clinical data and genetic analysis.
RESULTS
APA patients showed earlier mean onset age than benign group (46.9 ± 17.1 vs. 52.0 ± 14.3 yrs). Less bone involvement and gastrointestinal symptoms were presented in APA compared to PC (35.4% vs. 62.0%, and 17.7% vs. 41.8%), while more urolithiasis was seen in APA than in benign lesions (57.0% vs. 29.6%). The APA group had moderate hypercalcemia (mean 3.02 ± 0.44mmol/L) with elevated serum PTH (median 593.0pg/ml) and proportion of hypercalcemic crisis as 22.8%, all higher than those of benign lesions but lower than those of PC group. The recurrence/no remission rate of the APA group was significantly lower than that of the PC and similar to the benign group (5.1% vs. 31.6% vs. 3.1%). Germline CDC73 mutation was the most common molecular abnormality in both PC and APA subjects. APA patients with nonsynonymous germline variants showed earlier onset age (28.5 ± 16.9 vs. 48.1 ± 17.7 yrs) and more cases developing no remission/recurrence (25.0% vs. 0.0%).
CONCLUSIONS
Patients with APA presented clinical and biochemical characteristics much less severe than PC and resembling the benign neoplasms, with a relatively good prognosis. Germline gene variations were associated with earlier onset and probably more recurrence of PHPT in APA.
Topics: Humans; Parathyroid Neoplasms; Retrospective Studies; East Asian People; Germ-Line Mutation; Adenoma; Precancerous Conditions; Hypercalcemia
PubMed: 36777354
DOI: 10.3389/fendo.2023.1027598 -
Journal of Medical Case Reports Sep 2023There is some evidence supporting the idea that double parathyroid adenomas represent a different entity from multiglandular hyperplasia; however, the distinction among...
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.
Topics: Humans; Adult; Parathyroid Neoplasms; Hyperplasia; Hypocalcemia; Bone Diseases; Parathyroid Hormone
PubMed: 37653552
DOI: 10.1186/s13256-023-04102-w -
Revista Espanola de Medicina Nuclear E... 2016Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for... (Review)
Review
Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism.
Topics: Adenoma; Humans; Multimodal Imaging; Parathyroid Neoplasms; Tomography, Emission-Computed, Single-Photon
PubMed: 27554661
DOI: 10.1016/j.remn.2016.07.004 -
Hormone and Metabolic Research =... Mar 2023Recent studies have demonstrated the close relationship between parathyroid adenoma (PA) and thyroid follicular adenoma (FTA). However, the underlying pathogenesis...
Recent studies have demonstrated the close relationship between parathyroid adenoma (PA) and thyroid follicular adenoma (FTA). However, the underlying pathogenesis remains unknown. This study focused on exploring common pathogenic genes, as well as the pathogenesis of these two diseases, through bioinformatics methods. This work obtained PA and FTA datasets from the Integrated Gene Expression Database to identify the common differentially expressed genes (DEGs) of two diseases. The functions of the genes were investigated by GO and KEGG enrichment. The program CytoHubba was used to select the hub genes, while receiver operating characteristic curves were plotted to evaluate the predictive significance of the hub genes. The DGIbd database was used to identify gene-targeted drugs. This work detected a total of 77 DEGs. Enrichment analysis demonstrated that DEGs had activities of 3',5'-cyclic AMP, and nucleotide phosphodiesterases and were associated with cell proliferation. NOS1, VWF, TGFBR2, CAV1, and MAPK1 were identified as hub genes after verification. The area under the curve of PA and FTA was>0.7, and the hub genes participated in the Relaxin Signaling Pathway, focal adhesion, and other pathways. The construction of the mRNA-miRNA interaction network yielded 11 important miRNAs, while gene-targeting drug prediction identified four targeted drugs with possible effects. This bioinformatics study demonstrated that cell proliferation and tumor suppression and the hub genes co-occurring in PA and FTA, have important effects on the occurrence and progression of two diseases, which make them potential diagnostic biomarkers and therapeutic targets.
Topics: Humans; Parathyroid Neoplasms; Thyroid Neoplasms; Cell Proliferation; Cyclic AMP; Databases, Factual; MicroRNAs; Gene Expression Profiling
PubMed: 36599456
DOI: 10.1055/a-2007-2631 -
Minerva Endocrinology Jun 2022Hyperparathyroidism is caused by parathyroid adenoma, hyperplasia or carcinoma. Parathyroid adenomas are the most common cause of parathyroid disease (85-88%) while...
BACKGROUND
Hyperparathyroidism is caused by parathyroid adenoma, hyperplasia or carcinoma. Parathyroid adenomas are the most common cause of parathyroid disease (85-88%) while atypical parathyroid adenomas and carcinomas are the least frequently seen parathyroid neoplasms which cause diagnostic difficulty. This series aims to identifiy lesions of parathyroidectomy specimens in our center and draw attention to borderline cases in between parathyroid adenoma and carcinoma.
METHODS
The study included 638 parathyroidectomy materials diagnosed in our center between the years 2005 and 2016 and examined retrospectively, and all were included in the study.
RESULTS
In all the 638 parathyroidectomy cases evaluated, 427 were diagnosed with adenoma, 117 with hyperplasia, 54 with normal parathyroid tissue, 32 with parathyroid neoplasm with uncertain malignant potential, 7 with parathyroid carcinoma and 1 with normal thyroid tissue.
CONCLUSIONS
Parathyroid neoplasm with uncertain malignant potential defines cases with suspicious histopathological features of carcinoma but doesn't meet the criteria for parathyroid carcinoma. In our series, these cases are identified as atypical parathyroid adenoma. We present clinical and morphological features of our parathyroidectomy cases in an 11-year period and aim to raise concern about borderline cases in between adenoma and carcinoma. We think that such tumors, similar to the thyroid neoplasm classification, should be defined as parathyroid neoplasms with uncertain malignant potential and should be followed closely.
Topics: Adenoma; Carcinoma; Humans; Hyperplasia; Parathyroid Neoplasms; Parathyroidectomy; Retrospective Studies
PubMed: 33103869
DOI: 10.23736/S2724-6507.20.03171-5 -
Diagnostic Pathology Jul 2023To investigate the characteristics of reticular fibre structure (RFS) in parathyroid adenoma (PTA), atypical parathyroid tumour (APT), and parathyroid carcinoma (PTC),...
BACKGROUND
To investigate the characteristics of reticular fibre structure (RFS) in parathyroid adenoma (PTA), atypical parathyroid tumour (APT), and parathyroid carcinoma (PTC), and to assess its value as a diagnostic indicator.
METHODS
Clinical data and pathological specimens of patients with PTA, APT or PTC were collected. Reticular fibre staining was performed to observe the characteristics of RFS. This study evaluated the incidence of RFS destruction in parathyroid tumours, compared RFS destruction between primary PTC and recurrent and metastatic PTC, and explored the association between RFS destruction and clinicopathological features of APT and primary PTC.
RESULTS
Reticular fibre staining was performed in 50 patients with PTA, 25 patients with APT, and 36 patients with PTC. In PTA cases, a delicate RFS was observed. In both the APT and PTC groups, incomplete RFS areas were observed. The incidence of RFS destruction was different among the PTA, APT, and PTC groups (P < 0.001, χ-test), at 0% (0/50), 44% (11/25), and 86% (31/36), respectively. When differentiating PTC from APT, the sensitivity and specificity of RFS destruction were 81% and 56%, respectively. The incidence of RFS destruction was 73% (8/11) in the primary PTC group and 92% (23/25) in the recurrent and metastatic PTC groups. In both the APT group and primary PTC group, no correlation was found between RFS destruction and clinicopathological features.
CONCLUSION
RFS destruction may indicate that parathyroid tumours have unfavourable biological behaviours.Reticular fibre staining may be a valuable tool for improving the diagnostic accuracy in parathyroid tumours.
Topics: Humans; Parathyroid Neoplasms; Thyroid Neoplasms; Reticulin; Diagnosis, Differential
PubMed: 37403167
DOI: 10.1186/s13000-023-01368-y -
Medicine Nov 2022Most patients with parathyroid adenomas are asymptomatic and rarely present with chronic pancreatitis (CP). Several studies have reported a positive association between... (Review)
Review
BACKGROUND
Most patients with parathyroid adenomas are asymptomatic and rarely present with chronic pancreatitis (CP). Several studies have reported a positive association between primary hyperparathyroidism (PHPT) and pancreatitis. Parathyroidectomy is the definitive treatment for PHPT. IV bisphosphonates can be considered the drug of choice for bridge to surgery.
METHODS
We reported a 57-year-old female patient was admitted to the emergency room with left upper quadrant abdominal pain and a diagnosis of recurrent pancreatitis. Magnetic Resonance Cholangiopancreatography confirmed the diagnosis of CP. The patient had no common etiology of pancreatitis. Persistent hypercalcemia was noted despite administering intravenous fluids, and Calcitonin. Intravenous Pamidronate, a Bisphosphonate derivative, was also administered. Although calcium levels initially decreased, they were later found to rebound to previous levels.
RESULTS
A diagnosis of parathyroid adenoma and PHPT was made based on the elevated parathyroid hormone levels and cervical ultrasonography indicated right inferior parathyroid adenoma. Technetium-99m methoxy-isobutyl-isonitrile scintigraphy revealed a focal hot spot of tracer accumulation at the right lower thyroid bed. The patient underwent right lower parathyroidectomy smoothly and successfully. After right lower parathyroidectomy, she had normal serum calcium levels (9.2 mg/dL) and parathyroid hormone (16.1 pg/mL). There was no recurrent abdominal pain after the operation.
CONCLUSION
CP is a rare manifestation of parathyroid adenoma. When patients with a history of recurrent pancreatitis, without common causes of pancreatitis, present persistent elevated serum calcium levels, PHPT could be suspected.
Topics: Humans; Female; Middle Aged; Parathyroid Neoplasms; Calcium; Pancreatitis, Chronic; Hypercalcemia; Parathyroid Hormone; Abdominal Pain
PubMed: 36401406
DOI: 10.1097/MD.0000000000031750 -
Head & Neck Dec 2015Intraneural parathyroid adenomas are rare, with only 9 cases of intravagal adenomas reported. All but one of the reported cases was found after multiple neck...
BACKGROUND
Intraneural parathyroid adenomas are rare, with only 9 cases of intravagal adenomas reported. All but one of the reported cases was found after multiple neck explorations. To the best of our knowledge, we report the first case of nonsupernumerary ectopic intravagal parathyroid identified at primary exploration.
METHODS AND RESULTS
A 17-year-old girl with primary hyperparathyroidism and nephrolithiasis was referred with a sestamibi scan reporting a left lower parathyroid adenoma. No eutopic parathyroid tissue was identified during full exploration of the left side of the neck. Exploration of the carotid sheath revealed a fusiform swelling of the vagus nerve at the level of the carotid bifurcation. Longitudinal incision of the vagal perineurium revealed a 7-mm parathyroid adenoma, which was enucleated. The patient recovered uneventfully, with normalization of serum calcium, parathyroid hormone (PTH), and normal vocal cord function.
CONCLUSION
We believe that this is the first reported case of nonsupernumerary intravagal parathyroid adenoma resected at initial exploration. The vagus nerve is a rare location for a parathyroid adenoma, but one that should be considered, even during primary exploration.
Topics: Adenoma; Adolescent; Choristoma; Female; Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Treatment Outcome; Vagus Nerve
PubMed: 25867456
DOI: 10.1002/hed.24068 -
BMJ Case Reports Jul 2021Brown tumours of bone are highly vascular osteolytic lesions that depict a reparative cellular process instead of a neoplastic process in hyperparathyroidism (HPT)...
Brown tumours of bone are highly vascular osteolytic lesions that depict a reparative cellular process instead of a neoplastic process in hyperparathyroidism (HPT) patients. These tumours have the potential to be aggressive and destructive. We report a case of a 30-year-old woman who presented with left thigh and lower back pain. The radiological evaluation showed multiple bony lesions in the pelvis and the spine, which mimicked multiple metastatic tumours. However, on biochemistry evaluation, serum calcium, alkaline phosphatase, and parathyroid hormone were all high, while serum phosphate was low, indicating primary HPT (PHPT), which was confirmed by parathyroid scintigraphy showing left parathyroid adenoma. Hence, the bony lesions were diagnosed as brown tumours secondary to PHPT. The patient underwent parathyroidectomy and developed severe hungry bone syndrome requiring parenteral calcium infusion along with oral calcium and active vitamin D supplementation. The clinical symptoms of bone pain improved after surgery.
Topics: Adult; Female; Humans; Hyperparathyroidism, Primary; Osteitis Fibrosa Cystica; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 34257125
DOI: 10.1136/bcr-2021-243478