Are Biochemical Values Predictive of Adenoma’s Weight in Primary Hyperparathyroidism?

Abstract

Preoperative PTH level cannot be used as a definite guide to the parathyroid adenoma's weight. Large parathyroid adenomas seem to secrete less PTH per unit weight than small adenomas. Calcium and phosphate do not seem to be of much value in predicting adenoma's weight in primary hyperparathyroidism.

Primary hyperparathyroidism in Taiwan: clinical features and prevalence in a single-center experience

“…In the present study, although PHPT was found to be more prevalent in women (31 of 50), the female-to-male ratio (1.63) is somewhat different from that found in other large series conducted in Western [2,5,8] or Eastern countries [9,10]. However, in one series conducted in Hong Kong, the female-to-male ratio was determined to be 1.98, which is similar to our findings [11].…”

Parathyroid adenoma: a comprehensive biochemical and histological correlative study

“…reported a series of 63 patients in whom there was a significant correlation between calcium and PTH levels and PTA weight and volume. More recent studies, which evaluated cohorts of about 70 patients, found no correlation at all …”

“…More recent studies, which evaluated cohorts of about 70 patients, found no correlation at all. 11,18 A possible explanation for the discrepancy between studies could be the differences in baseline confounding factors such as calcium intake and absorption, serum albumin, renal function and vitamin D levels. It has been reported that vitamin D deficiency may be associated with heavier parathyroid adenomas probably due to secondary hyperparathyroidism 20,21 , but this association is poorly understood 22 .…”

“…[7][8][9] The value of preoperative calcium and PTH levels as a predictor of intraoperative PTA dimensions remains undetermined. Some studies reported a statistically significant correlation between preoperative calcium and PTH levels and PTA weight [11][12][13][14][15][16] whereas others failed to support these findings. 17,18 Furthermore, only two studies addressed the potential association between blood calcium and PTH levels and histological features of PTAs, with inconsistent results: one implied that predominantly, chief-cell PTAs are associated with more severe clinical manifestations than clear-cell adenomas but the other found no difference.…”

Surgery for parathyroid microadenomas: patient characteristics, localization success and operative cures

“…Management has therefore evolved to use patient pre‐operative biochemical markers such as serum calcium and parathyroid hormone (PTH) as further guides to gauge the presence of smaller adenomas. However, this biochemical relationship remains unclear with many researchers noting direct correlations and others who refute their value in predicting adenoma weight . To add to the complexity, smaller adenomas appear to be linked with non‐localizing imaging, making pre‐operative localization increasingly more technically difficult than solitary larger adenomas …”