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Romanian Journal of Internal Medicine =... Dec 2023The cortical bone is the most severely affected site in patients with primary hyperparathyroidism (PHPT) and thus, a low bone mineral density (BMD) is predominantly...
INTRODUCTION
The cortical bone is the most severely affected site in patients with primary hyperparathyroidism (PHPT) and thus, a low bone mineral density (BMD) is predominantly observed in distal forearm. Several studies have investigated potential associations between the weight of the gland and bone mineral loss. In this study, we wanted to investigate the relationship between parathyroid adenoma (PTA) volume and bone mineral loss.
METHODS
All patients with a diagnosis of PHPT who were operated at our hospital, and with a histologically proven single PTA were retrospectively analyzed. Z-scores were used as the main variable in our analysis to eliminate the effects of age, sex and gonadal status on BMD.
RESULTS
Total of 153 patients who met the inclusion criteria were eligible for the study. A significant negative correlation between the PTA volume and z-score for distal third of the radius (DR) ( = 0.006, r = -0.297) was shown. The cut-off value of gland volume for predicting cortical bone mineral loss was 9043.2 mm. There was also a significant negative correlation between the 24-hour urine calcium and z-scores for lumbar vertebrae and total hip. A significant negative correlation was found between preoperative 25-hydroxy vitamin D levels and the PTA weight.
CONCLUSIONS
As the first study that evaluated any possible association between the volume of a parathyroid adenoma and bone mineral loss in patients with PHPT, we found a significant negative correlation between DR z-scores and resected gland volume. Since the volume of a PTA can also be determined by a preoperative US, our findings may be helpful during the preoperative evaluation of a patient with a preliminary diagnosis of PHPT.
Topics: Humans; Bone Density; Forearm; Parathyroid Neoplasms; Retrospective Studies; Bone Diseases, Metabolic; Minerals; Absorptiometry, Photon
PubMed: 37493634
DOI: 10.2478/rjim-2023-0018 -
Endocrine Practice : Official Journal... Jun 2024In contrast to adults, primary hyperparathyroidism (PHPT) in children and adolescents is a rare endocrine disorder.
OBJECTIVE
In contrast to adults, primary hyperparathyroidism (PHPT) in children and adolescents is a rare endocrine disorder.
METHODS
A retrospective review of PHPT cases between 2005 and 2022 from a single tertiary university medical center, including clinical signs and symptoms, laboratory findings, radiological evaluation, treatment, and postoperative complications.
RESULTS
Ten children (mean age at diagnosis 16.3 ± 1.3 years) were diagnosed with PHPT. All patients were in late pubertal stages without sex predominance and 8 were symptomatic. Mean calcium level was 13.6 ± 2.5 mg/dL, and mean parathyroid hormone levels were 204.8 ± 163.1 pg/mL. Parathyroid adenoma was confirmed by the postsurgical pathology results.
CONCLUSIONS
PHPT in children and adolescents is often symptomatic and more severe than adults. The main cause is single parathyroid adenoma. Associated hypercalcemic syndromes were not found. Patients were cured after surgical removal of the adenoma without significant postoperative complications and no recurrence during 10.4 ± 5.9 years follow-up.
Topics: Humans; Adolescent; Parathyroid Neoplasms; Female; Male; Hyperparathyroidism, Primary; Retrospective Studies; Adenoma; Child; Parathyroid Hormone
PubMed: 38556080
DOI: 10.1016/j.eprac.2024.03.390 -
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 Endocrinological... Feb 2001Parathyroid tumors can be divided in adenomas and carcinomas, usually detected by hypercalcemia. We report a case of parathyroid adenoma in a young man, who complained...
Parathyroid tumors can be divided in adenomas and carcinomas, usually detected by hypercalcemia. We report a case of parathyroid adenoma in a young man, who complained of a pressure in the left neck region. Physical examination revealed a firm mass in the neck, without lymphnodes. Although Ca (9.7 mg/dl), phosphorus (3.3 mg/dl) and intact-PTH (49 pg/ml) were normal, imaging techniques (computed tomography scan and sestamibi substraction scan) suggested that the mass could arise from the parathyroid gland. Histology and immune staining for chromogranin and parathyroid hormone confirmed the parathyroid nature of the mass. Histological criteria defined the lesion as an atypical parathyroid adenoma. We review the pathology, diagnosis and treatment of parathyroid adenomas in its non-secreting atypical form.
Topics: Adenoma; Adult; Chromogranin A; Chromogranins; Humans; Immunoenzyme Techniques; Male; Parathyroid Hormone; Parathyroid Neoplasms; Synaptophysin; Tomography, X-Ray Computed
PubMed: 11263467
DOI: 10.1007/BF03343823 -
European Annals of Otorhinolaryngology,... May 2021
Topics: Adenoma; Humans; Hypercalcemia; Paraneoplastic Syndromes; Parathyroid Glands; Parathyroid Neoplasms
PubMed: 33867248
DOI: 10.1016/j.anorl.2021.04.001 -
European Journal of Radiology Sep 2016This study prospectively determines the shear wave elastography characteristics of parathyroid adenomas using virtual touch imaging quantification, a non-invasive...
OBJECTIVES
This study prospectively determines the shear wave elastography characteristics of parathyroid adenomas using virtual touch imaging quantification, a non-invasive ultrasound based shear wave elastography method.
METHODS
This prospective study examined 57 consecutive patients with biochemically proven primary hyperparathyroidism and solitary parathyroid adenoma identified by ultrasound and confirmed by at least one of the following: surgical resection, positive Technetium-99m Sestamibi Scintigraphy (MIBI) scan, or fine needle aspiration biopsy with positive PTH washout (performed only in MIBI negative patients). Vascularity and shear wave elastography were performed for all patients. Parathyroid adenoma stiffness was measured as shear wave velocity in meters per second.
RESULTS
The median (range) pre-surgical value for PTH and calcium were 58pg/mL (19, 427) and 10.8mg/dL (9.5, 12.1), respectively. 37 patients had positive MIBI scan. 20 patients had negative MIBI scan but diagnosis was confirmed with positive PTH washout. 42 patients underwent parathyroidectomy, and an adenoma was confirmed in all. The median (range) shear wave velocity for all parathyroid adenomas enrolled in this study was 2.02m/s (1.53, 2.50). The median (range) shear wave velocity for thyroid tissue was 2.77m/s (1.89, 3.70). The shear wave velocity of the adenomas was independent of adenoma size, serum parathyroid hormone concentration, or plasma parathyroid hormone concentration.
CONCLUSIONS
Tissue elasticity of parathyroid adenoma is significantly lower than thyroid tissue. B-mode features and distinct vascularity pattern are helpful tools in diagnosing parathyroid adenoma with ultrasound. Shear wave elastography may provide valuable information in diagnosing parathyroid adenoma.
Topics: Adult; Aged; Aged, 80 and over; Elasticity Imaging Techniques; Female; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Prospective Studies; Reproducibility of Results; Young Adult
PubMed: 27501893
DOI: 10.1016/j.ejrad.2016.06.009 -
BMJ Case Reports Sep 2019Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A...
Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.
Topics: Adenoma, Oxyphilic; Aged; Biopsy, Fine-Needle; Carcinoma; Diagnosis, Differential; Humans; Hyperparathyroidism, Primary; Lung Neoplasms; Male; Multiple Pulmonary Nodules; Neck Dissection; Neoplasm Metastasis; Parathyroid Neoplasms; Parathyroidectomy; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Thyroidectomy; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31492732
DOI: 10.1136/bcr-2019-231373 -
Endocrine Practice : Official Journal... 2012
Topics: Adenoma; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Magnetic Resonance Imaging; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed
PubMed: 22442838
DOI: No ID Found -
Surgery Today 1999We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised... (Review)
Review
We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised intrathyroid nodule was diagnosed to be parathyroid adenoma postoperatively. In the second patient, preoperative localization studies suggested the possibility of an intrathyroid adenoma. When a pathological gland is not found during surgery for primary hyperparathyroidism, an ectopic parathyroid gland including an intrathyroid adenoma should thus be considered.
Topics: Adenoma; Adult; Choristoma; Female; Humans; Hyperparathyroidism; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms
PubMed: 10483753
DOI: 10.1007/BF02482323 -
Endocrine Pathology Sep 2012
Review
Topics: Adenoma; Aged, 80 and over; Chromogranins; Cytoplasm; Humans; Hyperparathyroidism; Immunohistochemistry; Male; Middle Aged; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 22638654
DOI: 10.1007/s12022-012-9211-1