Background The size of abnormal parathyroid glands in patients with primary hyperparathyroidism is highly variable, but the clinical significance of giant glands is unknown. Methods 300 consecutive patients were reviewed following parathyroidectomy for primary hyperparathyroidism. We compared patients with giant parathyroid adenomas (weight ≥95th percentile) with the remaining patients. Results Giant adenomas were defined as weight ≥95th percentile or 3.5 grams (median 0.61 g, range 0.05–29.93). Patients with giant adenomas had a higher mean preoperative calcium level, higher mean parathyroid hormone level, and were less likely to have multiglandular or symptomatic disease. Giant adenomas were successfully localized on imaging in 87% of patients, which was not significantly increased over other patients (82%). There were no differences between the groups in age, gender, gland location, or the incidence of persistent or recurrent hyperparathyroidism. Finally, giant glands had an increased incidence of symptomatic post-operative hypocalcemia including one patient who required rehospitalization following removal of a giant gland. Conclusions Giant parathyroid adenomas have a distinct presentation characterized by single gland disease and lower incidence of symptoms despite increased levels of calcium and parathyroid hormone. Additionally, following resection of a giant adenoma, patients are more likely to develop symptomatic hypocalcemia.

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Germ-line and somatic truncating mutations of the APC gene are thought to initiate colorectal tumor formation in familial adenomatous polyposis syndrome and sporadic colorectal carcinogenesis, respectively. Recently, an isoleucine-->lysine polymorphism at codon 1307 (I1307K) of the APC gene has been identified in 6%-7% of the Ashkenazi Jewish population. To assess the risk of this common APC allelic variant in colorectal carcinogenesis, we have analyzed a large cohort of unselected Ashkenazi Jewish subjects with adenomatous polyps and.or colorectal cancer, for the APC I1307K polymorphism. The APC I1307K allele was identified in 48 (10.1%) of 476 patients. Compared with the frequency in two separate population control groups, the APC I1307K allele is associated with an estimated relative risk of 1.5-1.7 for colorectal neoplasia (both P=.01). Furthermore, compared with noncarriers, APC I1307K carriers had increased numbers of adenomas and colorectal cancers per patient (P=.03), as well as a younger age at diagnosis. We conclude that the APC I1307K variant leads to increased adenoma formation and directly contributes to 3%-4% of all Ashkenazi Jewish colorectal cancer. The estimated relative risk for carriers may justify specific clinical screening for the 360,000 Americans expected to harbor this allele, and genetic testing in the setting of long-term-outcome studies may impact significantly on colorectal cancer prevention in this population.